WorldWideScience
 
 
1

Achieving quality oncology practice initiative certification through quality improvement.  

UK PubMed Central (United Kingdom)

The public and healthcare payers are increasingly looking to specialty designations and certifications to determine the quality of cancer centers. The Quality Oncology Practice Initiative (QOPI®) Certification Program is one way for cancer centers to demonstrate commitment to high-quality patient care. Achieving QOPI certification for the author's cancer center was driven by a nurse-led quality improvement initiative. The result was an official designation that reflects the mission, vision, and philosophy of the organization.

Johnson L

2013-04-01

2

Toyota production system quality improvement initiative improves perioperative antibiotic therapy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. STUDY DESIGN: Pre-post quasi-experimental study using local and national retrospective cohorts. METHODS: We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. RESULTS: Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. CONCLUSION: The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

Burkitt KH; Mor MK; Jain R; Kruszewski MS; McCray EE; Moreland ME; Muder RR; Obrosky DS; Sevick MA; Wilson MA; Fine MJ

2009-09-01

3

Water quality improvement plan: Public consultation, initial documents  

Energy Technology Data Exchange (ETDEWEB)

The objectives of the Water Quality Improvement Plan (WQIP) are to provide water to residents of the GVRD that meet all of the requirements of the Guidelines for Canadian Drinking Water Quality and will meet the recent British Columbia Ministry of Health's new Safe Drinking Water Regulation, which took effect October 1, 1992. Included in this report are reports on the current status of the WQIP, the executive summary and final summary report from 1990, the report to the Water and Environment Committe Drinking Water Quality Improvement Plan and their implementation report.

1992-01-01

4

Improving the quality of telephone-delivered health care: a national quality improvement transformation initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Many Veterans Affairs (VA) primary care (PC) patients prefer telephone-delivered care to other health care delivery modalities. OBJECTIVE: To evaluate PC patients' telephone experiences and outcomes before and after a national telephone transformation quality improvement (QI) collaborative. METHODS: Cross-sectional surveys were conducted pre- and post-collaborative. We used bivariate analyses to assess differences in pre/post outcomes and multivariate regression to identify variables associated with patients' perceptions of poor quality care. RESULTS: Patients from 13 VA facilities participated (n = 730; pre-intervention = 314, post-intervention = 416); most of them were males (90%) with a mean age of 62 years. After the collaborative (versus pre-collaborative), few experienced transfers (52% versus 62%, P = 0.0006) and most reported timely call answer (88% versus 80%, P = 0.003). Improvements in staff understanding why patients were calling and providing needed medical information were also found. There were measurable improvements in patient satisfaction (87% versus 82% very/mostly satisfied, P = 0.04) and perceived quality of telephone care (85% versus 78% excellent/good quality, P = 0.01) post- collaborative. The proportion of veterans who reported delayed care due to telephone access issues decreased from 41% to 15% after the collaborative, P < 0.0001. Perceptions of poor quality care were higher when calls were for urgent care needs did not result in receipt of needed information and included a transfer or untimely answer. CONCLUSIONS: The QI collaborative led to improvements in timeliness of answering calls, patient satisfaction and perceptions of high-quality telephone care and fewer reports of health care delays. Barriers to optimal telephone care 'quality' include untimely answer, transfers, non-receipt of needed information and urgent care needs.

Lavela SL; Gering J; Schectman G; Locatelli SM; Weaver FM; Davies M

2013-10-01

5

A multidisciplinary quality improvement educational initiative to improve the rate of deep-vein thrombosis prophylaxis.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe a quality improvement initiative to improve deep-vein thrombosis (DVT) prophylaxis rates among hospitalized medicine patients. METHODS: A standardized admission order-set with an embedded risk-assessment tool and DVT prophylaxis orders was developed. RESULTS: An audit 2 months after the intervention showed the use of optimal DVT prophylaxis was 91%, an increase from 75%. Chart review 1 year after the implementation of the order-set revealed that the increase in DVT prophylaxis was sustained at 95%. CONCLUSION: The use of formalized quality improvement methods to implement an intervention is effective in changing physician behaviour.

Vyas D; Bearelly D; Boshard B

2013-03-01

6

Improved clinical outcome after acute myocardial infarction in hospitals participating in a Swedish quality improvement initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Swedish quality improvement initiative Quality Improvement in Coronary Care previously demonstrated significant improvements in caregiver adherence to national guidelines for acute myocardial infarction. The associated impact on 1-year clinical outcome is presented here. METHODS AND RESULTS: During the baseline period July 2001 to June 2002, 6878 consecutive acute myocardial infarction patients <80 years were included at the 19 intervention and 19 control hospitals and followed for a mean of 12 months. During the postintervention period of May 2003 to April 2004, 6484 patients were included and followed in the same way. From baseline to postintervention, improvements in mortality and cardiovascular readmission rates (events per 100 patient-years) were significant in the intervention group (-2.82, 95% CI -5.26 to -0.39; -9.31, 95% CI -15.48 to -3.14, respectively). However, in the control hospitals, there were no significant improvements (0.04, 95% CI -2.40 to 2.47; -4.93, 95% CI -11.10 to 1.24, respectively). Bleedings in the control group increased in incidence (0.92, 95% CI 0.41 to 1.43), whereas the incidence remained unchanged in the intervention group (0.07, 95% CI -0.44 to 0.58). When the difference of changes between the study groups were evaluated, the results still were in favor of the intervention group, albeit significant only for bleeding complications (mortality: -2.70, 95% CI -6.37 to 0.97; cardiovascular readmissions: -6.85, 95% CI -16.62 to 2.93; bleeding complications: -0.82, 95% CI -1.66 to 0.01). CONCLUSIONS: With a systematic quality improvement initiative aiming to increase the adherence to acute myocardial infarction guidelines, it is possible to achieve long-term positive effects on clinical outcome.

Carlhed R; Bojestig M; Peterson A; Aberg C; Garmo H; Lindahl B

2009-09-01

7

A perinatal care quality and safety initiative: are there financial rewards for improved quality?  

UK PubMed Central (United Kingdom)

BACKGROUND: Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. METHODS: In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. RESULTS: For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. CONCLUSIONS: Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

Kozhimannil KB; Sommerness SA; Rauk P; Gams R; Hirt C; Davis S; Miller KK; Landers DV

2013-08-01

8

Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.  

Science.gov (United States)

Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes. PMID:20067999

Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

2010-01-12

9

Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.  

UK PubMed Central (United Kingdom)

Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

Aakre KT; Valley TB; O'Connor MK

2010-03-01

10

Award winner involves entire staff in quality improvement initiatives.  

UK PubMed Central (United Kingdom)

Have non-clinical departments identify activities that can contribute to improved outcomes. Create standing interdisciplinary teams to continually monitor best practices. Engender transparency and excellence with individualized scorecards for your staff and leaders.

2007-10-01

11

Award winner involves entire staff in quality improvement initiatives.  

Science.gov (United States)

Have non-clinical departments identify activities that can contribute to improved outcomes. Create standing interdisciplinary teams to continually monitor best practices. Engender transparency and excellence with individualized scorecards for your staff and leaders. PMID:17966198

2007-10-01

12

Cardiac care quality indicators: a new hospital-level quality improvement initiative for cardiac care in Canada.  

UK PubMed Central (United Kingdom)

Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.

Gorzkiewicz V; Lacroix J; Kingsbury K

2012-01-01

13

House Staff Quality Council: One Institution's Experience to Integrate Resident Involvement in Patient Care Improvement Initiatives.  

UK PubMed Central (United Kingdom)

BACKGROUND: Residents and fellows perform a large portion of the hands-on patient care in tertiary referral centers. As frontline providers, they are well suited to identify quality and patient safety issues. As payment reform shifts hospitals to a fee-for-value-type system with reimbursement contingent on quality outcomes, preventive health, and patient satisfaction, house staff must be intimately involved in identifying and solving care delivery problems related to quality, outcomes, and patient safety. Many challenges exist in integrating house staff into the quality improvement infrastructure; these challenges may ideally be managed by the development of a house staff quality council (HSQC). METHODS: Residents and fellows at Scott & White Memorial Hospital interested in participating in a quality council submitted an application, curriculum vitae, and letter of support from their program director. Twelve residents and fellows were selected based on their prior quality improvement experience and/or their interest in quality and safety initiatives. RESULTS: In only 1 year, our HSQC, an Alliance of Independent Academic Medical Centers National Initiative III project, initiated 3 quality projects and began development of a fourth project. CONCLUSION: Academic medical centers should consider establishing HSQCs to align institutional quality goals with residency training and medical education.

Dixon JL; Papaconstantinou HT; Erwin JP 3rd; McAllister RK; Berry T; Wehbe-Janek H

2013-01-01

14

Development and participant assessment of a practical quality improvement educational initiative for surgical residents.  

UK PubMed Central (United Kingdom)

BACKGROUND: As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. METHODS: Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. RESULTS: During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. CONCLUSIONS: Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs.

Sellers MM; Hanson K; Schuller M; Sherman K; Kelz RR; Fryer J; DaRosa D; Bilimoria KY

2013-06-01

15

Crew resource management and VTE prophylaxis in surgery: a quality improvement initiative.  

UK PubMed Central (United Kingdom)

Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)--a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and guideline-recommended prophylaxis regimens. Reviews of patient charts preinitiative and postinitiative demonstrated performance improvement in meeting guideline recommendations for the timing, inpatient duration, and use of VTE prophylaxis beyond discharge. This new model joins continuing medical education with CRM to improve the appropriate use of VTE prophylaxis in surgery.

Tapson VF; Karcher RB; Weeks R

2011-11-01

16

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.  

UK PubMed Central (United Kingdom)

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Jeffs LP; Lo J; Beswick S; Campbell H

2013-07-01

17

Gynecologic Oncology Group quality assurance audits: analysis and initiatives for improvement.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Gynecologic Oncology Group (GOG) is a multi-institution, multi-discipline Cooperative Group funded by the National Cancer Institute (NCI) to conduct clinical trials which investigate the treatment, prevention, control, quality of survivorship, and translational science of gynecologic malignancies. In 1982, the NCI initiated a program of on-site quality assurance audits of participating institutions. Each is required to be audited at least once every 3 years. In GOG, the audit mandate is the responsibility of the GOG Quality Assurance Audit Committee and it is centralized in the Statistical and Data Center (SDC). Each component (Regulatory, Investigational Drug Pharmacy, Patient Case Review) is classified as Acceptable, Acceptable, follow-up required, or Unacceptable. PURPOSE: To determine frequently occurring deviations and develop focused innovative solutions to address them. METHODS: A database was created to examine the deviations noted at the most recent audit conducted at 57 GOG parent institutions during 2004-2007. Cumulatively, this involved 687 patients and 306 protocols. RESULTS: The results documented commendable performance: Regulatory (39 Acceptable, 17 Acceptable, follow-up, 1 Unacceptable); Pharmacy (41 Acceptable, 3 Acceptable, follow-up, 1 Unacceptable, 12 N/A): Patient Case Review (31 Acceptable, 22 Acceptable, follow-up, 4 Unacceptable). The nature of major and lesser deviations was analyzed to create and enhance initiatives for improvement of the quality of clinical research. As a result, Group-wide proactive initiatives were undertaken, audit training sessions have emphasized recurring issues, and GOG Data Management Subcommittee agendas have provided targeted instruction and training. LIMITATIONS: The analysis was based upon parent institutions only; affiliate institutions and Community Clinical Oncology Program participants were not included, although it is assumed their areas of difficulty are similar. CONCLUSIONS: The coordination of the GOG Quality Assurance Audit program in the SDC has improved data quality by enhancing our ability to identify frequently occurring deviations and develop innovative solutions to avoid or minimize their occurrence in the future.

Blessing JA; Bialy SA; Whitney CW; Stonebraker BL; Stehman FB

2010-08-01

18

Evaluating a community-based program to improve healthcare quality: research design for the Aligning Forces for Quality initiative.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to increase the overall quality of healthcare in targeted communities throughout the country. In addition to sponsoring this 16-site, complex program, the RWJF funds an independent scientific evaluation to support objective research on the initiative's effectiveness and contributions to basic knowledge in 5 core programmatic areas. The research design, data, and challenges faced in the evaluation of this 10-year initiative are discussed. STUDY DESIGN: A descriptive overview of the evaluation research design for a multi-site, community based, healthcare quality improvement initiative is provided. METHODS: The multiphase research design employed by the evaluation team is discussed. RESULTS: Evaluation provides formative feedback to the RWJF, participants, and other interested audiences in real time; develops approaches to assess innovative and under-studied interventions; furthers the analysis and understanding of effective community-based collaborative work in healthcare; and helps to differentiate the various facilitators, barriers, and contextual dimensions that affect the implementation and outcomes of community-based health interventions. CONCLUSIONS: The AF4Q initiative is arguably the largest community-level healthcare improvement demonstration in the United States to date; it is being implemented at a time of rapid change in national healthcare policy. The implementation of large-scale, multi-site initiatives is becoming an increasingly common approach for addressing problems in healthcare. The evaluation research design for the AF4Q initiative, and the lessons learned from its approach, may be valuable to others tasked with evaluating similar community-based initiatives.

Scanlon DP; Alexander JA; Beich J; Christianson JB; Hasnain-Wynia R; McHugh MC; Mittler JN; Shi Y; Bodenschatz LJ

2012-09-01

19

Quality initiatives: statistical control charts: simplifying the analysis of data for quality improvement.  

UK PubMed Central (United Kingdom)

Quality improvement (QI) projects are an integral part of today's radiology practice, helping identify opportunities for improving outcomes by refining work processes. QI projects are typically driven by outcome measures, but the data can be difficult to interpret: The numbers tend to fluctuate even before a process is altered, and after a QI intervention takes place, it may be even more difficult to determine the cause of such vacillations. Control chart analysis helps the QI project team identify variations that should be targeted for intervention and avoid tampering in processes in which variation is random or harmless. Statistical control charts make it possible to distinguish among random variation or noise in the data, outlying tendencies that should be targeted for future intervention, and changes that signify the success of previous intervention. The data on control charts are plotted over time and integrated with various graphic devices that represent statistical reasoning (eg, control limits) to allow visualization of the intensity and overall effect-negative or positive-of variability. Even when variability has no substantial negative effect, appropriate intervention based on the results of control chart analysis can help increase the efficiency of a process by optimizing the central tendency of the outcome measure. Different types of control charts may be used to analyze the same outcome dataset: For example, paired charts of individual values (x) and the moving range (mR) allow robust and reliable analyses of most types of data from radiology QI projects. Many spreadsheet programs and templates are available for use in creating x-mR charts and other types of control charts.

Cheung YY; Jung B; Sohn JH; Ogrinc G

2012-11-01

20

Initial results from the Auto/Oil Air Quality Improvement Research Program  

International Nuclear Information System (INIS)

[en] The Auto/Air Quality Improvement Research Program (AQIRP), a cooperative effort by the three major US auto companies and fourteen oil companies, is the most comprehensive research effort ever undertaken to develop data on the air quality effects of the use of various motor fuels in various automotive systems and the relative cost-effectiveness of various fuel/vehicle combinations. Phase 1 of the Program, at a cost of about $15 million, is examining emissions and air quality impacts from current and older vehicles using reformulated gasolines with widely different values of aromatics content, olefin content, oxygenate content and type, sulfur content, vapor pressure (RVP) and 90% distillation temperature. Emissions from Flexible and Variable Fuel vehicles using methanol/gasoline mixtures are also being examined. A second phase with a $25 million budget over three years has also been approved. Initial findings for the Phase 1 study and Phase 2 plans are presented

1991-12-11

 
 
 
 
21

Improving access to palliative care through an innovative quality improvement initiative: an opportunity for pay-for-performance.  

UK PubMed Central (United Kingdom)

BACKGROUND: Improving access to palliative care is an important priority for hospitals as they strive to provide the best care and quality of life for their patients. Even in hospitals with longstanding palliative care programs, only a small proportion of patients with life-threatening illnesses receive palliative care services. Our two well-established palliative care programs in large academic hospitals used an innovative quality improvement initiative to broaden access to palliative care services, particularly to noncancer patients. METHODS: The initiative utilized a combination of electronic and manual screening of medical records as well as intensive outreach efforts to identify two cohorts of patients with life-threatening illnesses who, according to University HealthSystems Consortium (UHC) benchmarking criteria, would likely benefit from palliative care consultation. Given the differing cultures and structure of the two institutions, each service developed a unique protocol for identifying and consulting on suitable patients. RESULTS: Consultation rates in the target populations tripled following the initiative: from 16% to 46% at one hospital and from 15% to 48% at the other. Although two different screening and identification processes were developed, both successfully increased palliative care consultations in the target cohorts. CONCLUSION: Quality improvement strategies that incorporate pay-for-performance incentives can be used effectively to expand palliative care services to underserved populations.

Bernacki RE; Ko DN; Higgins P; Whitlock SN; Cullinan A; Wilson R; Jackson V; Dahlin C; Abrahm J; Mort E; Scheer KN; Block S; Billings JA

2012-02-01

22

Promoting preventive health screening through the use of a clinical reminder tool: an accountable care organization quality improvement initiative.  

UK PubMed Central (United Kingdom)

This quality improvement initiative was designed to increase clinical prevention performance rates in 11 Austin Regional Clinic primary care facilities as part of an accountable care initiative. The initiative was conducted between January 2011 and December 2011. The principal interventions included implementation of a care coordinator and care gap summary tool. The care gap summary includes recommended preventive healthcare services and serves as a prompt for healthcare providers. These interventions led to improvement in clinical prevention performance rates as demonstrated by aggregate organizational data. This initiative demonstrates that quality improvement initiatives including care gap summaries, workflow changes, and provider feedback can increase performance rates for clinical preventive services.

Wilkinson C; Champion JD; Sabharwal K

2013-09-01

23

[Improvement in the quality of life for patients with adjustable gastric banding: initial results].  

UK PubMed Central (United Kingdom)

UNLABELLED: The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires. METHODS: We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the body-mass index of 42.36. The average age was 29.25 years. The pars flaccida technique was used in 18, and the perigastric approach in 2 cases. RESULTS: No complications or intraoperative accidents occurred. The mean operation time was 115.5 minutes. Elective conversion was needed in one case with a BMI of 55. The average hospital stay was of 3.2 days. The follow-up was conducted at least through phone in 95% of cases, and its average duration was of 10 months. The only postoperative complications were infections of the subcutaneous port (5 cases - 25%) which needed removal of the port, but not of the banding. The average loss of excess weight was 48.23%. Using the BAROS score to determine the overall improvement of quality of life, 30% of the patients scored as "Very Good", 50% as "Good", 20% as "Fair". Using the Moorehead-Ardelt QLQ II score, 65% scored as "Very Good", 30% as "Good" and 5% as "Fair". CONCLUSION: The laparoscopic adjustable gastric banding significantly improves the quality of life for most patients with this procedure.

Puia IC; Cristea PG; Puia VR; Mocan L; Mitre C; Zdrehus C; Ionescu D

2011-05-01

24

Connecting the dots: grounding quality improvement and cost cutting initiatives in strategic planning.  

UK PubMed Central (United Kingdom)

Discuss cost management and performance improvement with any manager at an acute care hospital and you will hear several consistent themes: Quality improvement (QI) has not produced the anticipated results on a timely basis; Focused cost reduction efforts have at best provided short-term benefits; and The organization needs to be more nimble, more responsive to the marketplace. If your hospital is wrestling with these issues, take some comfort in knowing that you are not alone. In general, the same problems are being experienced by long-term care facilities, group practices, practice plans, and most other provider organizations. However, all is not doom and gloom. A common-sense, easy-to-understand solution to the cost control problem can be implemented if an organization is disciplined and can exercise patience and diligence in implementation. Business Process Redesign (BPR), a performance improvement strategy and tactic that has been successfully deployed throughout private industry, can solve the problem. If undertaken correctly, BPR links the best concepts and principles of quality improvement, operations analysis, and focused cost reduction with an organization's strategic planning efforts. BPR results in the establishment of cost management initiatives that are consistent with the organization's long term goals. This article takes a closer look at the merits of BPR in a changing healthcare environment.

Seymour DW; Guillett WV

1997-09-01

25

Cost reductions associated with a quality improvement initiative for patients with ST-elevation myocardial infarction.  

UK PubMed Central (United Kingdom)

BACKGROUND: Efforts to reduce door-to-balloon (DTB) times for patients presenting with an ST-elevation myocardial infarction (STEMI) are widespread. Reductions in DTB times have been shown to reduce short-term mortality and decrease inpatient length of stay (LOS) in these high-risk patients. However, there is a limited literature examining the effect that these quality improvement (QI) initiatives have on patient care costs. METHODS: A STEMI QI program (Cardiac Alert Team [CAT]) initiative was instituted in July 2006 at a single tertiary care medical center located in central Massachusetts. Information was collected on cost data and selected clinical outcomes for consecutively admitted patients with a STEMI. Differences in adjusted hospital costs were compared in three cohorts of patients hospitalized with a STEMI: one before the CAT initiative began (January 2005-June 2006) and two after (October 1, 2007-September 30, 2009, and October 1, 2009-September 30, 2011). RESULTS: Before the CAT initiative, the average direct inpatient costs related to the care of these patients was $14,634, which decreased to $13,308 (-9.1%) and $13,567 (-7.3%) in the two sequential periods of the study after the CAT initiative was well established. Mean DTB times were 91 minutes before the CAT initiative and were reduced to 55 and 61 minutes in the follow-up periods (p < .001). There was a nonsignificant reduction in LOS from 4.4 days pre-CAT to 3.6 days in both of the post-CAT periods (p = .11). CONCLUSIONS: A QI program aimed at reducing DTB times for patients with a STEMI also led to a significant reduction in inpatient care costs. The greatest reduction in costs was related to cardiac catheterization, which was not expected and was likely a result of standardization of care and identification of practice inefficiencies.

Darling CE; Smith CS; Sun JE; Klaucke CG; Lerner J; Cyr J; Paige PG; Paige P; Bird SB

2013-01-01

26

Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.

Kissam Stephanie; Gifford David; Parks Peggy; Patry Gail; Palmer Laura; Wilkes Linda; Fitzgerald Matthew; Petrulis Alice; Barnette Leslie

2003-01-01

27

Occlusive bags to prevent hypothermia in premature infants: a quality improvement initiative.  

UK PubMed Central (United Kingdom)

The aim of this quality improvement initiative was to improve the neonatal intensive care unit (NICU) admission rectal temperatures of premature infants less than 28 weeks' gestation by placing them in an occlusive bag from the neck down immediately after birth. The historical control group consisted of a convenience sample of 46 very low-birth-weight infants from March 1, 2010, to August 31, 2010. A convenience sample of 35 very low-birth-weight infants from October 1, 2010, to April 30, 2011, was recruited during the prospective phase. A quasi-experimental design was used. A retrospective medical record review was performed to collect data on NICU admission rectal temperatures for the historical control group. During the prospective phase, infants were placed in a bag from the neck down immediately after birth and NICU admission rectal temperatures were recorded. In both groups, NICU rectal temperatures were measured immediately upon admission. Application of the bag resulted in a higher mean NICU admission rectal temperature in the intervention group compared with the historical control group. Occlusive bags applied at delivery decreased heat loss in premature infants. The results support previous findings and resulted in a change in clinical practice.

Godfrey K; Nativio DG; Bender CV; Schlenk EA

2013-10-01

28

Occlusive bags to prevent hypothermia in premature infants: a quality improvement initiative.  

Science.gov (United States)

The aim of this quality improvement initiative was to improve the neonatal intensive care unit (NICU) admission rectal temperatures of premature infants less than 28 weeks' gestation by placing them in an occlusive bag from the neck down immediately after birth. The historical control group consisted of a convenience sample of 46 very low-birth-weight infants from March 1, 2010, to August 31, 2010. A convenience sample of 35 very low-birth-weight infants from October 1, 2010, to April 30, 2011, was recruited during the prospective phase. A quasi-experimental design was used. A retrospective medical record review was performed to collect data on NICU admission rectal temperatures for the historical control group. During the prospective phase, infants were placed in a bag from the neck down immediately after birth and NICU admission rectal temperatures were recorded. In both groups, NICU rectal temperatures were measured immediately upon admission. Application of the bag resulted in a higher mean NICU admission rectal temperature in the intervention group compared with the historical control group. Occlusive bags applied at delivery decreased heat loss in premature infants. The results support previous findings and resulted in a change in clinical practice. PMID:24042134

Godfrey, Kathleen; Nativio, Donna G; Bender, Charles V; Schlenk, Elizabeth A

2013-10-01

29

Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).  

UK PubMed Central (United Kingdom)

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

Schleyer AM; Best JA; McIntyre LK; Ehrmantraut R; Calver P; Goss JR

2013-05-01

30

A quality improvement initiative using a novel travel survey to promote patient-centered counseling.  

UK PubMed Central (United Kingdom)

BACKGROUND: We sought to evaluate and provide better itinerary-specific care to precounseled travelers and to assess diseases occurring while traveling abroad by surveying a community population. An additional quality improvement initiative was to expand our post-travel survey to be a more valuable tool in gathering high-quality quantitative data. METHODS: From de-identified data collected via post-travel surveys, we identified a cohort of 525 patients for a retrospective observational analysis. We analyzed illness encountered while abroad, medication use, and whether a physician was consulted. We also examined itinerary variables, including continents and countries visited. RESULTS: The 525 post-travel surveys collected showed that the majority of respondents traveled to Asia (31%) or Africa (30%). The mean number of travel days was 21.3 (median, 14). Univariate analysis demonstrated a statistically significant increase of risk for general illness when comparing travel duration of less than 14 days to greater than 14 days (11.3% vs 27.7%, p?improve the return rate, we plan to implement supplemental modalities including email and a web-based database.

Mackaness CA; Osborne A; Verma D; Templer S; Weiss MJ; Knouse MC

2013-07-01

31

Safety of a DVT chemoprophylaxis protocol following traumatic brain injury: a single center quality improvement initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Venous thromboembolism (VTE) is a complication that affects approximately 30 % of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU). METHODS: Between January 1st and December 31st, 2009, consecutive patients discharged from the University of Wisconsin NSICU after >a 48 h minimum stay were evaluated as part of a QI project. A protocol for the initiation of PTP was designed and implemented for NSICU patients. The protocol did not vary based on type of intracranial injury. The rate of VTE was reported as was heparin-induced thrombocytopenia and PTP-related expansion of intracranial hemorrhage (IH) requiring reoperation. The number of patients receiving PTP and the timing of therapy were tracked. Patients were excluded for persistent coagulopathy, other organ system bleeding (such as the gastrointestinal tract), or pregnancy. Faculty could opt out of the protocol without reason. Using the same criteria, patients discharged during the preceding 6 months, from July 1st to December 31st, 2008, were evaluated as controls as the PTP protocol was not in effect during this time. RESULTS: During the control period, there were 48 head trauma admissions who met the inclusion criteria. In 22 patients (45.8 %), PTP was initiated at an average of 4.9 ± 5.4 days after admission. During the protocol period, there were 87 head trauma admissions taken from 1,143 total NSICU stays who met criteria. In 63 patients (72.4 %), the care team in the NSICU successfully initiated PTP, at an average of 3.4 ± 2.8 days after admission. All 87 trauma patients were analyzed, and the rate of clinically significant deep venous thrombosis (DVT) was 6.9 % (6 of 87). Three protocol patients (3.45 %) went to the operating room for surgery after the initiation of PTP; none of these patients had a measurable change in hemorrhage size on head CT. The change in percentage of patients receiving PTP was significantly increased by the protocol (p < 0.0001); while the average days to first PTP dose trended down with institution of the protocol, this change was not statistically significant. CONCLUSION: A PTP protocol in the NSICU is useful in controlling the number of complications from DVT and pulmonary embolism while avoiding additional IH. This protocol, based on a published body of literature, allowed for VTE rates similar to published rates, while having no PTP-related hemorrhage expansion. The protocol significantly changed physician behavior, increasing the percentage of patients receiving PTP during their hospitalization; whether long-term patient outcomes are affected is a potential goal for future study.

Nickele CM; Kamps TK; Medow JE

2013-04-01

32

Hospital-based trauma quality improvement initiatives: first step toward improving trauma outcomes in the developing world.  

UK PubMed Central (United Kingdom)

BACKGROUND: Injuries remain a leading cause of death in the developing world. Whereas new investments are welcome, quality improvement (QI) at the currently available trauma care facilities is essential. The objective of this study was to determine the effect and long-term sustainability of trauma QI initiatives on in-hospital mortality and complications at a large tertiary hospital in a developing country. METHODS: In 2002, a specialized trauma team was formed (members trained using advanced trauma life support), and a western style trauma program established including a registry and quality assurance program. Patients from 1998 onward were entered in to this registry, enabling a preimplementation and postimplementation study. Adults (>15 years) with blunt or penetrating trauma were analyzed. The main outcomes of interest were (1) in-hospital mortality and (2) occurrence of any complication. Multiple logistic regression was performed to assess the impact of formalized trauma care on outcomes, controlling for covariates reaching significance in the bivariate analyses. RESULTS: A total of 1,227 patient records were analyzed. Patient demographics and injury characteristics are described in Table 1. Overall in-hospital mortality rate was 6.4%, and the complication rate was 11.1%. On multivariate analysis, patients admitted during the trauma service years were 4.9 times less likely to die (95% confidence interval, 1.77-13.57) and 2.60 times (odds ratio; 95% confidence interval, 1.29-5.21) less likely to have a complication compared with those treated in the pretrauma service years. CONCLUSION: Despite significant delays in hospital transit and lack of prehospital trauma care, hospital level implementation of trauma QI program greatly decreases mortality and complication rates in the developing world. LEVEL OF EVIDENCE: Care management study, level IV.

Hashmi ZG; Haider AH; Zafar SN; Kisat M; Moosa A; Siddiqui F; Pardhan A; Latif A; Zafar H

2013-07-01

33

Money matters: exploiting the data from outcomes research for quality improvement initiatives.  

UK PubMed Central (United Kingdom)

In recent years, there has been an increase in studies that have sought to identify predictors of treatment outcome and to examine the efficacy of surgical and non-surgical treatments. In addition to the scientific advancement associated with these studies per se, the hospitals and clinics where the studies are conducted may gain indirect financial benefit from participating in such projects as a result of the prestige derived from corporate social responsibility, a reputational lever used to reward such institutions. It is known that there is a positive association between corporate social performance and corporate financial performance. However, in addition to this, the research findings and the research staff can constitute resources from which the provider can reap a more direct benefit, by means of their contribution to quality control and improvement. Poor quality is costly. Patient satisfaction increases the chances that the patient will be a promoter of the provider to friends and colleagues. As such, involvement of the research staff in the improvement of the quality of care can ultimately result in economic revenue for the provider. The most advanced methodologies for continuous quality improvement (e.g., six-sigma) are data-driven and use statistical tools similar to those utilized in the traditional research setting. Given that these methods rely on the application of the scientific process to quality improvement, researchers have the adequate skills and mind-set to embrace them and thereby contribute effectively to the quality team. The aim of this article is to demonstrate by means of real-life examples how to utilize the findings of outcome studies for quality management in a manner similar to that used in the business community. It also aims to stimulate research groups to better understand that, by adopting a different perspective, their studies can be an additional resource for the healthcare provider. The change in perspective should stimulate researchers to go beyond the traditional studies examining predictors of treatment outcome and to see things instead in terms of the "bigger picture", i.e., the improvement of the process outcome, the quality of the service.

Impellizzeri FM; Bizzini M; Leunig M; Maffiuletti NA; Mannion AF

2009-08-01

34

Money matters: exploiting the data from outcomes research for quality improvement initiatives.  

Science.gov (United States)

In recent years, there has been an increase in studies that have sought to identify predictors of treatment outcome and to examine the efficacy of surgical and non-surgical treatments. In addition to the scientific advancement associated with these studies per se, the hospitals and clinics where the studies are conducted may gain indirect financial benefit from participating in such projects as a result of the prestige derived from corporate social responsibility, a reputational lever used to reward such institutions. It is known that there is a positive association between corporate social performance and corporate financial performance. However, in addition to this, the research findings and the research staff can constitute resources from which the provider can reap a more direct benefit, by means of their contribution to quality control and improvement. Poor quality is costly. Patient satisfaction increases the chances that the patient will be a promoter of the provider to friends and colleagues. As such, involvement of the research staff in the improvement of the quality of care can ultimately result in economic revenue for the provider. The most advanced methodologies for continuous quality improvement (e.g., six-sigma) are data-driven and use statistical tools similar to those utilized in the traditional research setting. Given that these methods rely on the application of the scientific process to quality improvement, researchers have the adequate skills and mind-set to embrace them and thereby contribute effectively to the quality team. The aim of this article is to demonstrate by means of real-life examples how to utilize the findings of outcome studies for quality management in a manner similar to that used in the business community. It also aims to stimulate research groups to better understand that, by adopting a different perspective, their studies can be an additional resource for the healthcare provider. The change in perspective should stimulate researchers to go beyond the traditional studies examining predictors of treatment outcome and to see things instead in terms of the "bigger picture", i.e., the improvement of the process outcome, the quality of the service. PMID:19294433

Impellizzeri, Franco M; Bizzini, Mario; Leunig, Michael; Maffiuletti, Nicola A; Mannion, Anne F

2009-03-18

35

Practice policy and quality initiatives: using lean principles to improve screening mammography workflow.  

UK PubMed Central (United Kingdom)

The "lean" approach is a quality improvement method that focuses on maximizing activities that are valued by the customer and eliminating waste that impedes efficiency in the workplace. The unique philosophy of the lean approach encourages all members of the team to be directly involved in identifying areas of waste and generating solutions to eliminate them. When the breast imaging section at the authors' institution became part of a multispecialty breast care center, the result was escalating examination volumes, more complex cases, and overall increased demand on radiologists' time. After several unsuccessful attempts to improve the efficiency of the section, including evaluation by outside consultants, the decision was made to embark on a comprehensive quality improvement program using the lean approach. A team of radiologists, technologists, file room personnel, information technology (IT) representatives, and administrators from the breast imaging section met twice a month to learn about lean principles and how to apply them to screening mammography workflows. Sources of inefficiency (waste) were identified, and potential solutions were generated. Multiple trials were performed to test these solutions. Throughout the process, all team members were engaged in identifying the problems, suggesting solutions, and implementing change. Most of the tested solutions were successful and resulted in decreased patient wait times, improved efficiency for the technologists and radiologists, faster report turnaround, and advances in IT. In addition, staff members were introduced to the lean philosophy and became actively involved in improving their workplace, resulting in a more cohesive section. © RSNA, 2013.

Shah CJ; Sullivan JR; Gonyo MB; Wadhwa A; Dubois MS

2013-09-01

36

Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.  

UK PubMed Central (United Kingdom)

For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

2002-11-01

37

Improving water quality through California's Clean Beach Initiative: an assessment of 17 projects.  

UK PubMed Central (United Kingdom)

California's Clean Beach Initiative (CBI) funds projects to reduce loads of fecal indicator bacteria (FIB) impacting beaches, thus providing an opportunity to judge the effectiveness of various CBI water pollution control strategies. Seventeen initial projects were selected for assessment to determine their effectiveness on reducing FIB in the receiving waters along beaches nearest to the projects. Control strategies included low-flow diversions, sterilization facilities, sewer improvements, pier best management practices (BMPs), vegetative swales, and enclosed beach BMPs. Assessments were based on statistical changes in pre- and postproject mean densities of FIB at shoreline monitoring stations targeted by the projects. Most low-flow diversions and the wetland swale project were effective in removing all contaminated runoff from beaches. UV sterilization was effective when coupled with pretreatment filtration and where effluent was released within a few hundred meters of the beach to avoid FIB regrowth. Other BMPs were less effective because they treated only a portion of contaminant sources impacting their target beach. These findings should be useful to other coastal states and agencies faced with similar pollution control problems.

Dorsey JH

2010-07-01

38

Improving the content and face validity of OSCE assessment marking criteria on an undergraduate midwifery programme: a quality initiative.  

UK PubMed Central (United Kingdom)

Objective Structured Clinical Examinations (OSCE's) have been adopted as a means of assessing midwifery students' clinical skills. The purpose of the OSCE is to provide a standardised method for the evaluation of clinical skill performance in a simulated environment. This paper describes how a quality improvement initiative using both internal and external expert review was utilised to improve OSCE assessment marking criteria. The purpose of the quality initiative was to review the content and face validity of the marking criteria for assessing performance. The design and choice of tools used to score students' performance is central to reliability and validity. 20 videos of students from year one of a midwifery preregistration programme undertaking an OSCE assessment on abdominal examination and 18 videos of students response to obstetric emergencies e.g. PPH, and shoulder dystocia were available for review. The quality initiative aimed to strengthen the reliability and validity of the OSCE in assessing student performance. Conclusion: the use of global rating scales allows for the capturing of elements of professional competency that do not appear on specific criteria for skills performance checklists.

Barry M; Bradshaw C; Noonan M

2013-09-01

39

Improving the content and face validity of OSCE assessment marking criteria on an undergraduate midwifery programme: a quality initiative.  

Science.gov (United States)

Objective Structured Clinical Examinations (OSCE's) have been adopted as a means of assessing midwifery students' clinical skills. The purpose of the OSCE is to provide a standardised method for the evaluation of clinical skill performance in a simulated environment. This paper describes how a quality improvement initiative using both internal and external expert review was utilised to improve OSCE assessment marking criteria. The purpose of the quality initiative was to review the content and face validity of the marking criteria for assessing performance. The design and choice of tools used to score students' performance is central to reliability and validity. 20 videos of students from year one of a midwifery preregistration programme undertaking an OSCE assessment on abdominal examination and 18 videos of students response to obstetric emergencies e.g. PPH, and shoulder dystocia were available for review. The quality initiative aimed to strengthen the reliability and validity of the OSCE in assessing student performance. Conclusion: the use of global rating scales allows for the capturing of elements of professional competency that do not appear on specific criteria for skills performance checklists. PMID:23348056

Barry, Maebh; Bradshaw, Carmel; Noonan, Maria

2013-01-21

40

Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We conducted semi-structured interviews with 23 primary care physicians across the US regarding their experience treating patients with depression, barriers to care, and commonly promoted CCM-based interventions. Themes were identified from interview transcripts using a grounded theory approach. Results Six barriers emerged from the interviews: difficulty diagnosing depression, patient resistance, fragmented mental health system, insurance coverage, lack of expertise, and competing demands and other responsibilities as a primary care provider. A number of interventions were seen as helpful in addressing these barriers – including care managers, mental health integration, and education – while others received mixed reviews. Mental health consultation models received the least endorsement. Two systems-related barriers, the fragmented mental health system and insurance coverage limitations, appeared incompletely addressed by the interventions. Conclusion CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is needed to overcome all barriers to care.

Henke Rachel; Chou Ann F; Chanin Johann C; Zides Amanda B; Scholle Sarah

2008-01-01

 
 
 
 
41

Quality initiatives: planning, setting up, and carrying out radiology process improvement projects.  

UK PubMed Central (United Kingdom)

In the coming decades, those who provide radiologic imaging services will be increasingly challenged by the economic, demographic, and political forces affecting healthcare to improve their efficiency, enhance the value of their services, and achieve greater customer satisfaction. It is essential that radiologists master and consistently apply basic process improvement skills that have allowed professionals in many other fields to thrive in a competitive environment. The authors provide a step-by-step overview of process improvement from the perspective of a radiologic imaging practice by describing their experience in conducting a process improvement project: to increase the daily volume of body magnetic resonance imaging examinations performed at their institution. The first step in any process improvement project is to identify and prioritize opportunities for improvement in the work process. Next, an effective project team must be formed that includes representatives of all participants in the process. An achievable aim must be formulated, appropriate measures selected, and baseline data collected to determine the effects of subsequent efforts to achieve the aim. Each aspect of the process in question is then analyzed by using appropriate tools (eg, flowcharts, fishbone diagrams, Pareto diagrams) to identify opportunities for beneficial change. Plans for change are then established and implemented with regular measurements and review followed by necessary adjustments in course. These so-called PDSA (planning, doing, studying, and acting) cycles are repeated until the aim is achieved or modified and the project closed.

Tamm EP; Szklaruk J; Puthooran L; Stone D; Stevens BL; Modaro C

2012-09-01

42

Quality initiatives: lean approach to improving performance and efficiency in a radiology department.  

Science.gov (United States)

Many hospital radiology departments are adopting "lean" methods developed in automobile manufacturing to improve operational efficiency, eliminate waste, and optimize the value of their services. The lean approach, which emphasizes process analysis, has particular relevance to radiology departments, which depend on a smooth flow of patients and uninterrupted equipment function for efficient operation. However, the application of lean methods to isolated problems is not likely to improve overall efficiency or to produce a sustained improvement. Instead, the authors recommend a gradual but continuous and comprehensive "lean transformation" of work philosophy and workplace culture. Fundamental principles that must consistently be put into action to achieve such a transformation include equal involvement of and equal respect for all staff members, elimination of waste, standardization of work processes, improvement of flow in all processes, use of visual cues to communicate and inform, and use of specific tools to perform targeted data collection and analysis and to implement and guide change. Many categories of lean tools are available to facilitate these tasks: value stream mapping for visualizing the current state of a process and identifying activities that add no value; root cause analysis for determining the fundamental cause of a problem; team charters for planning, guiding, and communicating about change in a specific process; management dashboards for monitoring real-time developments; and a balanced scorecard for strategic oversight and planning in the areas of finance, customer service, internal operations, and staff development. PMID:22323617

Kruskal, Jonathan B; Reedy, Allen; Pascal, Laurie; Rosen, Max P; Boiselle, Phillip M

2012-02-08

43

Quality initiatives: lean approach to improving performance and efficiency in a radiology department.  

UK PubMed Central (United Kingdom)

Many hospital radiology departments are adopting "lean" methods developed in automobile manufacturing to improve operational efficiency, eliminate waste, and optimize the value of their services. The lean approach, which emphasizes process analysis, has particular relevance to radiology departments, which depend on a smooth flow of patients and uninterrupted equipment function for efficient operation. However, the application of lean methods to isolated problems is not likely to improve overall efficiency or to produce a sustained improvement. Instead, the authors recommend a gradual but continuous and comprehensive "lean transformation" of work philosophy and workplace culture. Fundamental principles that must consistently be put into action to achieve such a transformation include equal involvement of and equal respect for all staff members, elimination of waste, standardization of work processes, improvement of flow in all processes, use of visual cues to communicate and inform, and use of specific tools to perform targeted data collection and analysis and to implement and guide change. Many categories of lean tools are available to facilitate these tasks: value stream mapping for visualizing the current state of a process and identifying activities that add no value; root cause analysis for determining the fundamental cause of a problem; team charters for planning, guiding, and communicating about change in a specific process; management dashboards for monitoring real-time developments; and a balanced scorecard for strategic oversight and planning in the areas of finance, customer service, internal operations, and staff development.

Kruskal JB; Reedy A; Pascal L; Rosen MP; Boiselle PM

2012-03-01

44

Risk Factors for Superficial vs Deep/Organ-Space Surgical Site Infections: Implications for Quality Improvement Initiatives.  

Science.gov (United States)

IMPORTANCE Surgical site infections (SSIs) are the focus of numerous quality improvement initiatives because they are a common and costly cause of potentially preventable patient morbidity. Superficial and deep/organ-space SSIs differ in terms of anatomical location and clinical severity. OBJECTIVE To identify risk factors that are uniquely predictive of superficial vs deep/organ-space SSIs occurring after colectomy procedures. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program. PARTICIPANTS Patients undergoing colectomy procedures in 2011 were identified by Current Procedural Terminology codes. INTERVENTION Colectomy procedures. MAIN OUTCOMES AND MEASURES We compared rates of superficial SSI and deep/organ-space SSI associated with perioperative variables of interest: demographics; preoperative clinical severity, risk factors, and comorbidities and variables related to the hospitalization or procedure. Hierarchical multivariable logistic regression models were developed to identify risk-adjusted predictors of each SSI type. RESULTS Among 27?011 patients identified from 305 hospitals, 6.2% developed a superficial SSI and 4.7% developed a deep/organ-space SSI. Risk factors common to the occurrence of both SSI types were identified: open surgery (vs laparoscopic) and current smoker. Risk factors with differential effects on each SSI type included specific postoperative diagnoses, disseminated cancer, and irradiation therapy, which were all associated with increased odds of deep/organ-space SSI only. The graded relationship between increasing body mass index and SSI occurrence appeared to be stronger for superficial SSI. CONCLUSIONS AND RELEVANCE Risk factors for superficial SSI and deep/organ-space SSI vary in terms of magnitude and significance, suggesting that these SSI types are somewhat different disease processes. Groups interested in preventing SSIs might improve success by considering these SSI types independently for root-cause analyses and development of best practices and interventions. PMID:23864108

Lawson, Elise H; Hall, Bruce Lee; Ko, Clifford Y

2013-09-01

45

Risk Factors for Superficial vs Deep/Organ-Space Surgical Site Infections: Implications for Quality Improvement Initiatives.  

UK PubMed Central (United Kingdom)

IMPORTANCE Surgical site infections (SSIs) are the focus of numerous quality improvement initiatives because they are a common and costly cause of potentially preventable patient morbidity. Superficial and deep/organ-space SSIs differ in terms of anatomical location and clinical severity. OBJECTIVE To identify risk factors that are uniquely predictive of superficial vs deep/organ-space SSIs occurring after colectomy procedures. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program. PARTICIPANTS Patients undergoing colectomy procedures in 2011 were identified by Current Procedural Terminology codes. INTERVENTION Colectomy procedures. MAIN OUTCOMES AND MEASURES We compared rates of superficial SSI and deep/organ-space SSI associated with perioperative variables of interest: demographics; preoperative clinical severity, risk factors, and comorbidities and variables related to the hospitalization or procedure. Hierarchical multivariable logistic regression models were developed to identify risk-adjusted predictors of each SSI type. RESULTS Among 27?011 patients identified from 305 hospitals, 6.2% developed a superficial SSI and 4.7% developed a deep/organ-space SSI. Risk factors common to the occurrence of both SSI types were identified: open surgery (vs laparoscopic) and current smoker. Risk factors with differential effects on each SSI type included specific postoperative diagnoses, disseminated cancer, and irradiation therapy, which were all associated with increased odds of deep/organ-space SSI only. The graded relationship between increasing body mass index and SSI occurrence appeared to be stronger for superficial SSI. CONCLUSIONS AND RELEVANCE Risk factors for superficial SSI and deep/organ-space SSI vary in terms of magnitude and significance, suggesting that these SSI types are somewhat different disease processes. Groups interested in preventing SSIs might improve success by considering these SSI types independently for root-cause analyses and development of best practices and interventions.

Lawson EH; Hall BL; Ko CY

2013-09-01

46

An empirical investigation of quality improvement initiatives in for-profit and not-for-profit hospitals: environmental, competitive and outcome concerns.  

UK PubMed Central (United Kingdom)

PURPOSE: The objective of this study is to shed some light on quality improvement practices of for-profit and not-for-profit hospitals DESIGN/METHODOLOGY/APPROACH: The scope and effectiveness of several quality improvement efforts are studied for a sample of 110 hospitals. Factor analysis was utilized to analyze the data collected. FINDINGS: The results of this study tended to suggest that for-profit and not-for-profit hospitals were more similar than different with the regard to the effective utilization of quality improvement initiatives, thus underscoring the utility of quality improvement efforts despite differences in operating characteristics, strategies and operating constraints. RESEARCH LIMITATIONS/IMPLICATIONS: The sample used in this study is limited. Thus, the results should be interpreted accordingly. PRACTICAL IMPLICATIONS: This study offers decision-makers in healthcare operational settings empirical evidence of the operational and strategic effectiveness of different quality improvement efforts, thus justifying investments related to the initiation and implementation of such quality improvement efforts. ORIGINALITY/VALUE: This study represents an important step toward understanding the effective implementation of quality improvement initiatives in different operational settings.

Miller P; Yasin MM; Zimmerer TW

2006-01-01

47

A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices.  

UK PubMed Central (United Kingdom)

BACKGROUND: There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE: To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN: US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS: Teaching-practice teams-faculty, residents and staff-participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS: Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS: These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable.

Stevens DP; Bowen JL; Johnson JK; Woods DM; Provost LP; Holman HR; Sixta CS; Wagner EH

2010-09-01

48

Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse car...

Hilarion Pilar; Groene Oliver; Colom Joan; Lopez Rosa M; Suñol Rosa

49

Improving asthma care in emergency departments: results of a multihospital collaborative quality initiative in rural western North Carolina.  

UK PubMed Central (United Kingdom)

BACKGROUND: In North Carolina, nearly one-fourth of persons with asthma visit an emergency department (ED) or urgent care center at least once a year because of an exacerbation of asthma symptoms. The Emergency Department Asthma Program was a quality-improvement initiative designed to better understand the population of patients who use the ED for asthma care in rural western North Carolina and to demonstrate whether EDs at small hospitals could, by implementing National Asthma Education and Prevention Program treatment guidelines, improve asthma care and reduce subsequent asthma-related ED visits. METHODS: Eight hospitals in western North Carolina participated in the project, which lasted from November 2003 through December 2007. The intervention consisted of a series of individual and structured continuing medical education events directed at ED physicians and staff. Additionally, patients presenting to EDs for asthma-related problems were selected to receive a short patient questionnaire, to determine their basic understanding of asthma and barriers to asthma care; to undergo asthma staging by the treating physician; to receive focused bedside asthma education by a respiratory therapist; and, finally, at the treating physician's discretion, to receive a free packet of asthma medications, including rescue therapy with a beta-agonist and corticosteroid therapy delivered via a metered-dose inhaler, before discharge. RESULTS: During the 37-month project, a total of 1,739 patients presented to the participating EDs for 2,481 asthma-related episodes of care; at 11% of these visits, patients received the intervention, with nearly 100 ED physicians referring patients to the program. Most of the patients using the ED for asthma treatment were judged to have the mildest stages, and nearly half were uninsured or were covered by Medicaid. For only 20% of the visits was a primary care physician or practice identified. The patient intervention did not appear to lessen the rate of return visits for asthma-related symptoms at 30 and 60 days. LIMITATIONS: Selection bias is likely, as patients enrolled in the study were more likely than patients in the target sample to be adults and insured. Because we did not measure ED staff attendance at educational sessions or their knowledge of and attitudes about asthma care before and after the educational program, we cannot draw conclusions about the effectiveness of the program to change their knowledge, attitudes, or behavior. CONCLUSIONS: Many patients who use the ED for care appear to have mild, intermittent asthma and do not identify a regular source of primary care. Efforts to improve asthma care on a communitywide basis and to reduce preventable exacerbations should include care provided in EDs, as this may be the only source of asthma care for many asthma patients. The project demonstrated that regional, collaborative performance improvement efforts in EDs are possible but that many barriers exist to this approach.

Crane S; Sailer D; Patch SC

2011-03-01

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Translating best care practices to improve nursing documentation regarding pediatric patients dependent on home mechanical ventilation and tracheostomy tube support: a quality improvement initiative.  

UK PubMed Central (United Kingdom)

An increasing number of children are dependent on tracheostomies or mechanical ventilation at home. Documentation of the care provided at home is important in evaluating care quality. The purpose of this project was to apply evidence to improve nursing documentation and ultimately quality of care for children who are dependent on tracheostomies and/or mechanical ventilation at home.

Peacock J; Stanik-Hutt J

2013-01-01

51

Continuous quality improvement  

Energy Technology Data Exchange (ETDEWEB)

This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated.

Bourne, P.B.

1985-01-01

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Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.  

UK PubMed Central (United Kingdom)

Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

Steele JR; Schomer DF

2009-07-01

53

Improving flameproof electric initiators  

Energy Technology Data Exchange (ETDEWEB)

Reviews the work of Mallard and Le Chatelier. The effect of the component parts of conventional instantaneous initiators on the ignition of mixtures of air and firedamp. Discusses the effect of the stocking conditions on the flameproof characteristics of these initiators. Deals with the effect of the salts content (KCl, KBr, etc.) of the secondary charge of the detonator on the ignition of the air-firedamp mixtures; study and table; detailed discussion; concluding remarks also cover high-explosives. (3 refs.) (In German)

Szeniawski, W.

1980-04-01

54

A Quality Improvement Initiative to Increase HPV Vaccine Rates Using an Educational and Reminder Strategy With Parents of Preteen Girls.  

UK PubMed Central (United Kingdom)

INTRODUCTION: A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. METHOD: Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. RESULTS: A significant difference in HPV vaccine uptake (?(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (?(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. DISCUSSION: Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice.

Cassidy B; Braxter B; Charron-Prochownik D; Schlenk EA

2013-03-01

55

A Quality Improvement Initiative to Increase HPV Vaccine Rates Using an Educational and Reminder Strategy With Parents of Preteen Girls.  

Science.gov (United States)

INTRODUCTION: A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. METHOD: Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. RESULTS: A significant difference in HPV vaccine uptake (?(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (?(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. DISCUSSION: Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice. PMID:23522561

Cassidy, Brenda; Braxter, Betty; Charron-Prochownik, Denise; Schlenk, Elizabeth A

2013-03-19

56

Image quality improvement using an image-based noise reduction algorithm: initial experience in a phantom model for urinary stones.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine signal-to-noise (SNR), contrast-to-noise ratio, and segmentation error measurements in various low-dose computed tomographic (CT) acquisitions of an anthropomorphic phantom containing urinary stones before and after implementation of a structure-preserving diffusion (SPD) denoising algorithm, and to compare the measurements with those of standard-dose CT acquisitions. METHODS: After institutional review board approval, written informed consent was waived and 36 calcium oxalate stones were evaluated after CT acquisitions in an anthropomorphic phantom at variable tube currents (33-137 mA s). The SPD denoising algorithm was applied to all images. Signal-to-noise ratio, contrast-to-noise ratio, and expected segmentation error were determined using manually drawn regions of interest to quantify the effect of the noise reduction on the image quality. RESULTS: The value of segmentation error measurements using the SPD denoising algorithm obtained at tube currents as low as 33 mA s (up to 75% dose reduction level) were similar to standard imaging at 137 mA s. The denoised images at reduced doses up to 75% dose reduction have higher SNR than the standard-dose images without denoising (P < 0.005). Stepwise regression showed significant (P < 0.001) effect of dose length product on SNR, and segmentation error measurements. CONCLUSIONS: Based on objective noise-related image quality metrics, the SPD denoising algorithm may be useful as a robust and fast tool, and it has the potential to improve image quality in low-dose CT ureter protocols.

Demehri S; Salazar P; Steigner ML; Atev S; Masoud O; Raffy P; Jacobs SA; Rybicki FJ

2012-09-01

57

Acute Dialysis Quality Initiative (ADQI).  

UK PubMed Central (United Kingdom)

ADQI0--Acute Dialysis Quality Initiative--is a process that was created seeking consensus and evidence-based recommendations in the field of acute kidney injury. This organization gave birth to important classifications such as the RIFLE and the cardiorenal syndrome. Several conferences were organized in the last 10 years. Today, ADQI is a well-known initiative and it provides useful information to the physicians and nurses interested in acute kidney injury.

Ronco C; Kellum JA; Bellomo R; Mehta RL

2013-01-01

58

Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. Methods The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. Results We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. Conclusion The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector-wide performance and the support of evidence-based guidance wherever possible. Further research should address how contextual issues shape the uptake and effectiveness of quality improvement actions and how such quality improvements can be sustained.

Hilarion Pilar; Groene Oliver; Colom Joan; Lopez Rosa M; Suñol Rosa

2010-01-01

59

Quality improvement in nursing homes.  

UK PubMed Central (United Kingdom)

Regulation, competition, and cost containment have focused attention on quality improvement in nursing homes. Definition, measurement, and monitoring of quality are essential components of any program designed for quality assurance or continuous quality improvement.

Castle NG; Zinn JS; Brannon D; Mor V

1997-06-01

60

GAIN Premix Facility: an innovative approach for improving access to quality vitamin and mineral premix in fortification initiatives.  

UK PubMed Central (United Kingdom)

BACKGROUND: Vitamin and mineral premix is one of the most significant recurring input costs for large-scale food fortification programs. A number of barriers exist to procuring adequate quality premix, including accessing suppliers, volatile prices for premix, lack of quality assurance and monitoring of delivered products, and lack of funds to purchase premix. OBJECTIVE: To develop and test a model to procure premix through a transparent and efficient process in which an adequate level of quality is guaranteed and a financial mechanism is in place to support countries or specific target groups when there are insufficient resources to cover the cost of premix. METHODS: Efforts focused on premixes used to fortify flour, such as wheat or maize (iron, zinc, B vitamins, and vitamin A), edible oils (vitamins A and D), and other food vehicles, such as fortified complementary foods, complementary food supplements, and condiments. A premix procurement model was set up with three distinct components: a certification process that establishes industry-wide standards and guidelines for premix, a procurement facility that makes premix more accessible to countries and private industry engaged in fortification, and a credit facility mechanism that helps projects finance premix purchases. RESULTS: After three years of operation, 15 premix suppliers and 29 micronutrient manufacturers have been certified, and more than US$23 million worth of premix that met quality standards has been supplied in 34 countries in Africa, Central and Southern Asia, and Eastern Europe, reaching an estimated 242 million consumers. CONCLUSIONS: The Premix Facility demonstrated its effectiveness in ensuring access to high-quality premixes, therefore enabling the success of various fortification programs.

Guinot P; Jallier V; Blasi A; Guyondet C; Van Ameringen M

2012-12-01

 
 
 
 
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The HIV/AIDS women of color initiative improving access to and quality of care for women of color.  

UK PubMed Central (United Kingdom)

In September 2009, the Health Resources and Services Administration, (HRSA) HIV-AIDS Bureau funded 11 programs to engage and retain women of color (WoC) living with HIV in care. This field report describes the rationale for this Special Project of National Significance (SPNS) initiative, the 11 programs in terms of their theoretical frameworks as well as the contexts and mechanism of care, and outlines some factors that may influence engaging and retaining WoC in care.

Blank AE; Ryerson Espino SL; Eastwood B; Matoff-Stepp S; Xavier J

2013-02-01

62

Screening for inter-hospital differences in cesarean section rates in low-risk deliveries using administrative data: An initiative to improve the quality of care  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Rising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high CSRs, and (4) possible under-use of CS. Methods We defined a population of low risk deliveries (singleton, vertex, full-term, live born, 2499 g). Using multivariable logistic regression techniques, we provided degrees of evidence regarding the observed departure ([relative risk-1]*100) of each hospital (N = 107) from the national CSR and its trend. To determine a benchmark, we defined three CSR groups (high, average and low) and compared them regarding 1 minute Apgar scores and other neonatal endpoints. An anonymous feedback is provided to the hospitals, the College of Physicians (with voluntary disclosure of the outlying hospitals for quality improvement purposes) and to the policy makers. Results Compared with available information, the completeness and accuracy of the data, regarding the variables selected to determine our study population, showed adequate. Important inter-hospital differences were found. Departures ranged from -65% up to +75%, and 9 "high CSR" and 13 "low CSR" outlying hospitals were identified. We observed a national increasing trend of 1.019 (95%CI [1.015; 1.022]) per semester, adjusted for age groups. In the "high CSR" group 1 minute Apgar scores Conclusion Rather than firm statements about quality of care, our results are to be considered a useful screening. The inter-hospital differences in CSR, the national CS upward trend, the indications of over-use and under-use, the geographically different obstetric patterns and the admission day-related concentration of deliveries, whether or not by CS, may trigger initiatives aiming at improving quality of care.

Aelvoet Willem; Windey Francis; Molenberghs Geert; Verstraelen Hans; Van Reempts Patrick; Foidart Jean-Michel

2008-01-01

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SQIMSO: Quality Improvement for Small Software Organizations  

Directory of Open Access Journals (Sweden)

Full Text Available Software quality improvement process remains incomplete if it is not initiated and conducted through a wide improvement program that considers process quality improvement, product quality improvement and evolution of human resources. But, small software organizations are not capable of bearing the cost of establishing software process improvement programs. In this work, we propose a new software quality improvement model for small organizations, SQIMSO, based on three major issues. The first issue is that every improvement program should be wide enough to include the three main trends. The second issue is that any process quality model should answer the question ?How to do? things. The third issue is that any suggested quality model should be cost-effective and practical enough to be implemented by small software organizations. SQIMSO also draws upon international quality standards, models, experiences and on a local field survey.

Rabih Zeineddine; Nashat Mansour

2005-01-01

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Comprehensive assessment of chronic pain management in primary care: a first phase of a quality improvement initiative at a multisite Community Health Center.  

UK PubMed Central (United Kingdom)

BACKGROUND: The objective of this study was to conduct a comprehensive formative assessment of chronic pain management in a large, multisite community health centre and use the results to design a quality improvement initiative based on an evidence-based practice model developed by the Veterans Health Administration. Improving quality and safety by incorporating evidence-based practices (EBP) is challenging, particularly in busy clinical practices such as Federally Qualified Health Centers (FQHCs). FQHCs grapple with financial constraints, lack of resources and complex patient populations. METHODS: The Promoting Action on Research Implementation in Health Services (PARIHS) Framework served as a basis for the comprehensive assessment. We used a range of measures and tools to examine pain care from a variety of perspectives. Patients with chronic pain were identified using self-reported pain scores and opioid prescription records. We employed multiple data collection strategies, including querying our electronic health records system, manual chart reviews and staff surveys. RESULTS: We found that patients with chronic pain had extremely high primary care utilisation rates while referral rates to pain-related specialties were low for these patients. Large gaps existed in primary care provider adherence to standards for pain care documentation and practice. There was wide provider variability in the prescription of opioids to treat pain. Staff surveys found substantial variation in both pain care knowledge and readiness to change, as well as low confidence in providers' ability to manage pain, and dissatisfaction with the resources available to support chronic pain care. CONCLUSIONS: Improving chronic pain management at this Community Health Center requires a multifaceted intervention aimed at addressing many of the problems identified during the assessment phase. During the intervention we will put a greater emphasis on increasing options for behavioural health and complementary medicine support, increasing access to specialty consultation, providing pain-specific CME for providers, and improving documentation of pain care in the electronic health records.

Anderson D; Wang S; Zlateva I

2012-01-01

65

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare.  

UK PubMed Central (United Kingdom)

BACKGROUND: Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. METHODS: A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. RESULTS: The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach's alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach's alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. CONCLUSIONS: The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

Andersson AC; Elg M; Perseius KI; Idvall E

2013-01-01

66

Introduction: the Interdisciplinary Nursing Quality Research Initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative. METHODS: INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing. RESULTS: A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing. DISCUSSION: This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.

Naylor MD; Lustig A; Kelley HJ; Volpe EM; Melichar L; Pauly MV

2013-04-01

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Quality Improvement by Qualified Managers  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of the study was to study about the impact of quality improvement strategy on creating a sustainable competitive advantage in the qualified managers. The current study was based on empirical approach. A random sample of quality improvement was drawn from seven organizations. A self administrated questionnaire was employed to collect the required data. A number of hypotheses were formulated for this purpose. This article attempts to explain the quality improvement by qualified managers by patterns of thinking. The importance of strategic, long-term policy and quality improvement is very clear to planners. Quality managers like to follow a similar and routine quality behavioral pattern. This paper reviews organizational quality improvement and quality measurement literature. For organizations to be quality improvement strategy, they had to improve their working environment and delegate their employees more authorities by qualified managers. However, this study concluded that the performance of the organization is highly affected by its quality improvement strategy and qualified manager's creativity.

Dr. Nasser Fegh-hi Farahmand

2013-01-01

68

Use of warfarin for venous thromboembolism prophylaxis following knee and hip arthroplasty: results of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2).  

UK PubMed Central (United Kingdom)

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with high rates of venous thromboembolism (VTE). Anticoagulants, such as warfarin, are commonly used to prevent VTE in such patients. The practice and effectiveness of warfarin in real world populations is not well documented. 595 TKA and THA patients treated with warfarin were followed by two anticoagulation clinics in the Michigan Anticoagulation Quality Improvement Initiative. Length of prescribed anticoagulation, percent time in therapeutic range (%TTR) and time to first therapeutic INR were calculated for each surgical group. For THA, all 300 patients received at least ten days with a 28-day median length of anticoagulation therapy. For TKA, all 295 patients received at least 10 days with a 28-day median length of anticoagulation therapy. For THA patients, time to first therapeutic INR was on average 12.0 ± 8.0 days with a mean %TTR of 36.6 ± 26.8% for goal INR 2.0-3.0. For THA patients, 39 (13%) never reached target INR. For TKA patients, time to first therapeutic INR was on average 12.8 ± 10.3 days with a mean %TTR of 36.0 ± 28.3% for goal INR 2.0-3.0. For TKA patients, 44 (14.9%) never reached target INR. Many orthopaedic surgeons who use warfarin for post-arthroplasty VTE prophylaxis do so in accordance with national guidelines. The time to first therapeutic INR is strikingly long and %TTR markedly low for these patients, raising questions about the efficacy of warfarin therapy in the first 1-2 post-operative weeks. Further studies to investigate the best target INR for warfarin prophylaxis, as well as the composite rates of VTE and clinically relevant bleeding from treatment with warfarin, LMWH and newer anticoagulants are needed.

Barnes GD; Kaatz S; Golgotiu V; Gu X; Leidal A; Kobeissy A; Haymart B; Kline-Rogers E; Kozlowski J; Almany S; Leyden T; Froehlich JB

2013-01-01

69

Warfarin use in atrial fibrillation patients at low risk for stroke: analysis of the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)).  

Science.gov (United States)

To more accurately quantify the proportion of anticoagulated patients with atrial fibrillation (AF) that may be inappropriately treated with warfarin for stroke prevention. Patients with AF have an increased risk of stroke, which is lowered by the use of warfarin. However there is likely more potential harm than benefit in patients that do not have additional stroke risk factors. Studies have described overuse of warfarin for stroke prophylaxis in lowest risk patients. However, many of those studies did not assess for electrical cardioversion (ECV) or radiofrequency ablation (RFA) as indications for warfarin therapy. Data from 1852 non-valvular AF patients treated with warfarin between October 2009 and October 2011 at seven anticoagulation centers participating in the Michigan Anticoagulation Quality Improvement Initiative registry were analyzed. Low risk AF patients were risk stratified using the CHADS2 scoring systems, with a score of zero representing lowest risk. 193 (10.4 %) of AF patients receiving warfarin were identified as having the lowest risk of stroke by the CHADS2 score. Of the patients with CHADS2 = 0, 130 (67.4 %) had undergone a recent ECV and/or RFA. Of all AF patients, only 63 (3.4 %) had a CHADS2 score of 0 and no recent ECV or RFA. The vast majority of AF patients receiving anticoagulation in this multi-center registry are doing so in accordance with national and international guidelines. In contrast to prior population-based studies, very few low risk patients are receiving inappropriate warfarin therapy for stroke prophylaxis in AF, when procedure-based indications are also considered. PMID:23653172

Barnes, Geoffrey D; Kaatz, Scott; Winfield, Julia; Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Kozlowski, Jay; Beasley, Dennis; Almany, Steve; Leyden, Tom; Froehlich, James B

2013-05-01

70

Warfarin use in atrial fibrillation patients at low risk for stroke: analysis of the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)).  

UK PubMed Central (United Kingdom)

To more accurately quantify the proportion of anticoagulated patients with atrial fibrillation (AF) that may be inappropriately treated with warfarin for stroke prevention. Patients with AF have an increased risk of stroke, which is lowered by the use of warfarin. However there is likely more potential harm than benefit in patients that do not have additional stroke risk factors. Studies have described overuse of warfarin for stroke prophylaxis in lowest risk patients. However, many of those studies did not assess for electrical cardioversion (ECV) or radiofrequency ablation (RFA) as indications for warfarin therapy. Data from 1852 non-valvular AF patients treated with warfarin between October 2009 and October 2011 at seven anticoagulation centers participating in the Michigan Anticoagulation Quality Improvement Initiative registry were analyzed. Low risk AF patients were risk stratified using the CHADS2 scoring systems, with a score of zero representing lowest risk. 193 (10.4 %) of AF patients receiving warfarin were identified as having the lowest risk of stroke by the CHADS2 score. Of the patients with CHADS2 = 0, 130 (67.4 %) had undergone a recent ECV and/or RFA. Of all AF patients, only 63 (3.4 %) had a CHADS2 score of 0 and no recent ECV or RFA. The vast majority of AF patients receiving anticoagulation in this multi-center registry are doing so in accordance with national and international guidelines. In contrast to prior population-based studies, very few low risk patients are receiving inappropriate warfarin therapy for stroke prophylaxis in AF, when procedure-based indications are also considered.

Barnes GD; Kaatz S; Winfield J; Gu X; Haymart B; Kline-Rogers E; Kozlowski J; Beasley D; Almany S; Leyden T; Froehlich JB

2013-05-01

71

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. Methods A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. Results The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. Conclusions The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

Andersson Ann-Christine; Elg Mattias; Perseius Kent-Inge; Idvall Ewa

2013-01-01

72

Validity and usefulness of members reports of implementation progress in a quality improvement initiative: findings from the Team Check-up Tool (TCT)  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Team-based interventions are effective for improving safety and quality of healthcare. However, contextual factors, such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. Yet, the science for measuring context is immature. The goal of this study is to validate measures from a short instrument tailored to track dynamic context and progress for a team-based quality improvement (QI) intervention. Methods Design: Secondary cross-sectional and longitudinal analysis of data from a clustered randomized controlled trial (RCT) of a team-based quality improvement intervention to reduce central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs). Setting: Forty-six ICUs located within 35 faith-based, not-for-profit community hospitals across 12 states in the U.S. Population: Team members participating in an ICU-based QI intervention. Measures: The primary measure is the Team Check-up Tool (TCT), an original instrument that assesses context and progress of a team-based QI intervention. The TCT is administered monthly. Validation measures include CLABSI rate, Team Functioning Survey (TFS) and Practice Environment Scale (PES) from the Nursing Work Index. Analysis: Temporal stability, responsiveness and validity of the TCT. Results We found evidence supporting the temporal stability, construct validity, and responsiveness of TCT measures of intervention activities, perceived group-level behaviors, and barriers to team progress. Conclusions The TCT demonstrates good measurement reliability, validity, and responsiveness. By having more validated measures on implementation context, researchers can more readily conduct rigorous studies to identify contextual variables linked to key intervention and patient outcomes and strengthen the evidence base on successful spread of efficacious team-based interventions. QI teams participating in an intervention should also find data from a validated tool useful for identifying opportunities to improve their own implementation.

Chan Kitty S; Hsu Yea-Jen; Lubomski Lisa H; Marsteller Jill A

2011-01-01

73

Improving soybean seed quality  

International Nuclear Information System (INIS)

[en] Both the meal and oil fractions of soybeans may be genetically improved, either by mutagenesis or by genetic engineering. There are a number of mutant lines of soybeans containing a low raffinosaccharide meal, which can be used for animal feed, with an improved total metabolizable energy content. Mutant lines with an improved fatty acid profile of the oil include high oleic and high stearic soybeans. Cloning of the mutant genes facilitates the integration of these traits into high yielding elite lines by providing molecular markers. Cloned genes may also be reintroduced into soybeans to create transgenic lines with improved meal and oil traits, such as seeds with an increased lysine content and stable soybean oils with a very low content of polyunsaturated fatty acids. The design of transgene constructs has been assisted by using soybean somatic embryos in suspension culture as a model system for soybean seed transformation. This system has allowed selection of those genes and promoters that are the most effective way of achieving the desired phenotypes in soybeans. Experiments with constructs containing fatty acid biosynthesis genes in somatic embryos have also led to the conclusion that, in soybeans, gene-transgene sense suppression is a more effective way of silencing endogenous genes than antisense. Sense suppression of genes encoding microsomal, fatty acid omega-6 desaturates has resulted in soybean lines with over 80% oleic acid in their seed oil, and this trait is stable over at least three generations. (author). 12 refs, 2 figs

1995-01-01

74

Regional quality groups in the Society for Vascular Surgery® Vascular Quality Initiative.  

UK PubMed Central (United Kingdom)

The Society for Vascular Surgery Vascular Quality Initiative (SVS VQI) is designed to improve the quality, safety, effectiveness, and cost of vascular health care. The SVS VQI is uniquely organized as a distributed network of regional quality improvement groups across the United States. The regional approach allows for the involvement of a variety of health care professionals, the pooling of available resources and expertise, and serves as a motivating factor for each participating institution. Regional quality group sizes, administrative structure, and meeting logistics vary according to geography and regional needs. This review describes the process of forming, growing, and maintaining a regional quality improvement group of the SVS VQI.

Woo K; Eldrup-Jorgensen J; Hallett JW; Davies MG; Beck A; Upchurch GR Jr; Weaver FA; Cronenwett JL

2013-03-01

75

Board quality scorecards: measuring improvement.  

UK PubMed Central (United Kingdom)

Board accountability for quality and patient safety is widely accepted but the science for how to measure it is immature, and differences between measuring performance, identifying hazards, and monitoring progress are often misunderstood. Hospital leaders often provide scorecards to assist boards with their oversight role yet, in the absence of national standards, little evidence exists regarding which measures are valid and useful to boards to assess quality improvement. The authors describe results of a cross-sectional board study, identifying the measures used to monitor quality. The measures varied widely and many were of uncertain validity, generally identifying hazards rather than measuring rates. This article identifies some important policy implications regarding boards' oversight of quality and acknowledges existing limits to how we can measure quality and safety progress on the national or hospital level. If boards and their hospitals are to monitor progress in improving quality, they need more valid outcome measures.

Goeschel CA; Berenholtz SM; Culbertson RA; Jin L; Pronovost PJ

2011-07-01

76

Board quality scorecards: measuring improvement.  

Science.gov (United States)

Board accountability for quality and patient safety is widely accepted but the science for how to measure it is immature, and differences between measuring performance, identifying hazards, and monitoring progress are often misunderstood. Hospital leaders often provide scorecards to assist boards with their oversight role yet, in the absence of national standards, little evidence exists regarding which measures are valid and useful to boards to assess quality improvement. The authors describe results of a cross-sectional board study, identifying the measures used to monitor quality. The measures varied widely and many were of uncertain validity, generally identifying hazards rather than measuring rates. This article identifies some important policy implications regarding boards' oversight of quality and acknowledges existing limits to how we can measure quality and safety progress on the national or hospital level. If boards and their hospitals are to monitor progress in improving quality, they need more valid outcome measures. PMID:21498775

Goeschel, Christine A; Berenholtz, Sean M; Culbertson, Richard A; Jin, Linda; Pronovost, Peter J

2011-04-15

77

Preanalytical quality improvement: in quality we trust.  

UK PubMed Central (United Kingdom)

Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and quality assurance methods have also assured a valuable contribution for reducing diagnostic errors. Nevertheless, several lines of evidence still suggest that most errors in laboratory diagnostics fall outside the analytical phase, and the pre- and postanalytical steps have been found to be much more vulnerable. This collective paper, which is the logical continuum of the former already published in this journal 2 years ago, provides additional contribution to risk management in the preanalytical phase and is a synopsis of the lectures of the 2nd European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled "Preanalytical quality improvement: in quality we trust" (Zagreb, Croatia, 1-2 March 2013). The leading topics that will be discussed include quality indicators for preanalytical phase, phlebotomy practices for collection of blood gas analysis and pediatric samples, lipemia and blood collection tube interferences, preanalytical requirements of urinalysis, molecular biology hemostasis and platelet testing, as well as indications on best practices for safe blood collection. Auditing of the preanalytical phase by ISO assessors and external quality assessment for preanalytical phase are also discussed.

Lippi G; Becan-McBride K; Behúlová D; Bowen RA; Church S; Delanghe J; Grankvist K; Kitchen S; Nybo M; Nauck M; Nikolac N; Palicka V; Plebani M; Sandberg S; Simundic AM

2013-01-01

78

Hanford Tanks Initiative quality assurance implementation plan  

Energy Technology Data Exchange (ETDEWEB)

Hanford Tanks Initiative (HTI) Quality Assurance Implementation Plan for Nuclear Facilities defines the controls for the products and activities developed by HTI. Project Hanford Management Contract (PHMC) Quality Assurance Program Description (QAPD)(HNF-PRO599) is the document that defines the quality requirements for Nuclear Facilities. The QAPD provides direction for compliance to 10 CFR 830.120 Nuclear Safety Management, Quality Assurance Requirements. Hanford Tanks Initiative (HTI) is a five-year activity resulting from the technical and financial partnership of the US Department of Energy`s Office of Waste Management (EM-30), and Office of Science and Technology Development (EM-50). HTI will develop and demonstrate technologies and processes for characterization and retrieval of single shell tank waste. Activities and products associated with HTI consist of engineering, construction, procurement, closure, retrieval, characterization, and safety and licensing.

Huston, J.J.

1998-06-23

79

Hanford Tanks Initiative quality assurance implementation plan  

International Nuclear Information System (INIS)

Hanford Tanks Initiative (HTI) Quality Assurance Implementation Plan for Nuclear Facilities defines the controls for the products and activities developed by HTI. Project Hanford Management Contract (PHMC) Quality Assurance Program Description (QAPD)(HNF-PRO599) is the document that defines the quality requirements for Nuclear Facilities. The QAPD provides direction for compliance to 10 CFR 830.120 Nuclear Safety Management, Quality Assurance Requirements. Hanford Tanks Initiative (HTI) is a five-year activity resulting from the technical and financial partnership of the US Department of Energy's Office of Waste Management (EM-30), and Office of Science and Technology Development (EM-50). HTI will develop and demonstrate technologies and processes for characterization and retrieval of single shell tank waste. Activities and products associated with HTI consist of engineering, construction, procurement, closure, retrieval, characterization, and safety and licensing

1998-01-01

80

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

DEFF Research Database (Denmark)

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.

TØttenborg, Sandra SØgaard; Thomsen, Reimar Wernich

2013-01-01

 
 
 
 
81

Weekly dose reports: the effects of a continuous quality improvement initiative on coronary computed tomography angiography radiation doses at a tertiary medical center.  

UK PubMed Central (United Kingdom)

RATIONALE AND OBJECTIVES: Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service. MATERIALS AND METHODS: This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April-September 2011) and 150 patients after the initiation (postintervention period: September 2011-February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012-January 2013). Patient characteristics and effective radiation were recorded and compared. RESULTS: Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7-5.7] and in the late control group (3.3 mSv [2.0-5.3] versus the preintervention period (4.1 mSv [2.1-6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control). CONCLUSION: Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.

Engel LC; Lee AM; Seifarth H; Sidhu MS; Brady TJ; Hoffmann U; Ghoshhajra BB

2013-08-01

82

[Financial incentives for quality improvement].  

UK PubMed Central (United Kingdom)

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

Belicza E; Evetovits T

2010-05-01

83

Insightful Quality Beyond Continuous Improvement  

CERN Multimedia

Continuous improvement is essential but not sufficient to assure an organizations continued success. In order to be a market leader or indeed even to survive in many cases, resources must be devoted to longer-term strategic quality activities to address radical--possibly paradigm-shifting-- improvements that might affect the organization and its competitive position. These radical improvements might result from R&D efforts within the organization (proactive) that propel the organization and its products and services to the cutting edge of the markets in which they operate. Or these radical

Sower, Victor

2012-01-01

84

Thermal analysis for improved quality  

Energy Technology Data Exchange (ETDEWEB)

From the brick plant to the advanced ceramic manufacturer, classical thermal analysis equipment such as DTA, TGA, and dilatometers is invaluable for R and D and quality control. An overview of these instruments and some examples of how they are used to improve product quality are discussed. These time-tested instruments have been providing quick, accurate, data with minimum cost investment for the ceramic segment for decades. For example, the first differential dilatometer was developed in 1963 to control expansion mismatch between ceramic components being considered for gas turbine heat exchangers.

Geiger, G.

1993-11-01

85

HSTART: An improved initial step size routine for ODE codes  

Energy Technology Data Exchange (ETDEWEB)

For the solution of initial value ordinary differential equations by library quality solvers, such as the DEPAC collection in the SLATEC library, it is important to start off with a good initial step size in order for the procedure to produce a reliable and efficient solution numerically. A substantial improvement has been made in the starting step size algorithm which corrects a long standing deficiency. Specifically, initial step sizes many orders from optimal (arising from stiff problems with mixed zero and nonzero initial values of disparate sizes) are brought under control.

Watts, H.A.

1986-11-01

86

Culture shock: Improving software quality  

Energy Technology Data Exchange (ETDEWEB)

The concept of software quality can represent a significant shock to an individual who has been developing software for many years and who believes he or she has been doing a high quality job. The very idea that software includes lines of code and associated documentation is foreign and difficult to grasp, at best. Implementation of a software quality program hinges on the concept that software is a product whose quality needs improving. When this idea is introduced into a technical community that is largely ''self-taught'' and has been producing ''good'' software for some time, a fundamental understanding of the concepts associated with software is often weak. Software developers can react as if to say, ''What are you talking about. What do you mean I'm not doing a good job. I haven't gotten any complaints about my code yetexclamation'' Coupling such surprise and resentment with the shock that software really is a product and software quality concepts do exist, can fuel the volatility of these emotions. In this paper, we demonstrate that the concept of software quality can indeed pose a culture shock to developers. We also show that a ''typical'' quality assurance approach, that of imposing a standard and providing inspectors and auditors to assure its adherence, contributes to this shock and detracts from the very goal the approach should achieve. We offer an alternative, adopted through experience, to implement a software quality program: cooperative assistance. We show how cooperation, education, consultation and friendly assistance can overcome this culture shock. 3 refs.

de Jong, K.; Trauth, S.L.

1988-01-01

87

The Improvement of Services Quality  

Directory of Open Access Journals (Sweden)

Full Text Available In the last decades, there was a strong national and international tendency to increase the services role in the economic social life. The technical progress, the enhancing social division of labor and the increase of demand both from the population and entrepreneurs led to the services development and diversification. Due to the recent radical changes in all economic, political and social fields, the economic agents’ goal to gain a rapid and substantial profit was gradually replaced by the fierce struggle for quality domination among competitors. Therefore, there is an increasing need to find more effective ways to improve the services quality, such as training and motivating the staff and implementing a quality management system.

Cristian-?tefan Craciun

2013-01-01

88

Chemotherapy medication errors in a pediatric cancer treatment center: prospective characterization of error types and frequency and development of a quality improvement initiative to lower the error rate.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chemotherapy medication errors occur in all cancer treatment programs. Such errors have potential severe consequences: either enhanced toxicity or impaired disease control. Understanding and limiting chemotherapy errors are imperative. PROCEDURE: A multi-disciplinary team developed and implemented a prospective pharmacy surveillance system of chemotherapy prescribing and administration errors from 2008 to 2011 at a Children's Oncology Group-affiliated, pediatric cancer treatment program. Every chemotherapy order was prospectively reviewed for errors at the time of order submission. All chemotherapy errors were graded using standard error severity codes. Error rates were calculated by number of patient encounters and chemotherapy doses dispensed. Process improvement was utilized to develop techniques to minimize errors with a goal of zero errors reaching the patient. RESULTS: Over the duration of the study, more than 20,000 chemotherapy orders were reviewed. Error rates were low (6/1,000 patient encounters and 3.9/1,000 medications dispensed) at the start of the project and reduced by 50% to 3/1,000 patient encounters and 1.8/1,000 medications dispensed during the initiative. Error types included chemotherapy dosing or prescribing errors (42% of errors), treatment roadmap errors (26%), supportive care errors (15%), timing errors (12%), and pharmacy dispensing errors (4%). Ninety-two percent of errors were intercepted before reaching the patient. No error caused identified patient harm. Efforts to lower rates were successful but have not succeeded in preventing all errors. CONCLUSIONS: Chemotherapy medication errors are possibly unavoidable, but can be minimized by thoughtful, multispecialty review of current policies and procedures. Pediatr Blood Cancer 2013;601320-1324. © 2013 Wiley Periodicals, Inc.

Watts RG; Parsons K

2013-08-01

89

Using Quality Function Deployment to Improve Reference Services Quality  

Directory of Open Access Journals (Sweden)

Full Text Available Much research has been conducted regarding how reference librarians can evaluate and improve the quality of the answers they provide to users' inquiries. There has been considerably less discussion, however, concerning how to improve the quality of the delivery of those answers, and to upgrade the overall quality of reference services as a whole. Suggestions for improving the quality of service contained within the business literature may be applied to improve library services as well. In this paper the use of Quality Function Deployment (QFD) as a tool for improving reference services quality is explored and an adapted framework referred to as service quality function deployment is proposed.

Pao-Long Chang; Pao-Nuan Hsieh

1996-01-01

90

Quality Improvement Practices and Trends  

DEFF Research Database (Denmark)

The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family will be visiting various countries in Europe and he will be reporting to us with respect to each country in which they stay for any period of time. His reports will take the form of co-authored paperswith the other authors including distinguished faculty from the universities with which he works as a visiting professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ).

Dahlgaard, Jens J.; Hartz, Ove

1998-01-01

91

Data quality improvements for FAA  

Energy Technology Data Exchange (ETDEWEB)

Effective communication among air safety professionals is only as good as the information being communicated. Data sharing cannot be effective unless the data are relevant to aviation safety problems, and decisions based on faulty data are likely to be invalid. The validity of aviation safety data depends on satisfying two primary characteristics. Data must accurately represent or conform to the real world (conformance), and it must be relevant or useful to addressing the problems at hand (utility). The FAA, in efforts to implement the Safety Performance Analysis System (SPAS), identified significant problems in the quality of the data which SPAS and FAA air safety professionals would use in defining the state of aviation safety in the US. These finding were reinforced by Department of Transportation Inspector General and General Accounting Office investigations into FAA surveillance of air transport operations. Many recent efforts to improve data quality have been centered on technological solutions to the problems. They concentrate on reducing errors in the data (conformance), but they cannot adequately address the relationship of data to need (utility). Sandia National Laboratories, working with the FAA`s Airport and Aircraft Safety Research and Development Division and the Flight Standards Service, has been involved in four programs to assist FAA in addressing their data quality problems. The Sandia approach has been data-driven rather than technology-driven. In other words, the focus has been on first establishing the data requirements by analyzing the FAA`s surveillance and decision-making processes. This process analysis looked at both the data requirements and the methods used to gather the data in order to address both the conformance and utility problems inherent in existing FAA data systems. This paper discusses Sandia`s data quality programs and their potential improvements to the safety analysis processes and surveillance programs of the FAA.

Perry, R.; Marlman, K.; Olson, D.; Werner, P.

1997-09-01

92

Method of improving beef quality  

UK PubMed Central (United Kingdom)

The present invention is made for the purpose of improving beef quality and upgrading its fat marbling standard (which is called beef marbling standard, or BMS). The fat marbling state is generally called "Shimofuri" in Japanese. This purpose is achieved by vitamin C administration (L-ascorbic acid) to the cattle. The vitamin C can be administered by injection etc., but the easiest way is by oral administration. When only the vitamin C is administered orally, however, it is decomposed by microorganisms in the rumen and the desired effect cannot be obtained. For that reason, the vitamin C needs to be coated with something so that it can be absorbed by the intestinal tract after passing through the stomach. Soybean-hydrogenated oil and fat is desirable for such covering material. An appropriate daily dose of the vitamin C is approximately 20 mg to 60 mg/kg of weight.; According to the result of tests conducted on the Japanese Black Cattle, in terms of the yield, there is no significant difference between the cattle given the vitamin C and those not given it. In terms of the quality of the meat, however, there are significant differences in the fat marbling (Shimofuri), luster, firmness and texture of the meat.

YANO HIDEO

93

Early EEG improvement after ketogenic diet initiation.  

UK PubMed Central (United Kingdom)

PURPOSE: This study examines electroencephalographic (EEG) changes in children with medication resistant epilepsy treated with the ketogenic diet (KD). METHODS: Routine EEGs were obtained prior to KD initiation, then one month and three months later. Changes in EEG background slowing and frequency of interictal epileptiform discharges (IEDs) were evaluated using power spectrum analysis and manual determination of spike index. KD responders were compared to non-responders to determine if baseline or early EEG characteristics predicted treatment response (>50% seizure reduction) at three months. RESULTS: Thirty-seven patients were evaluated. No differences in baseline EEG features were found between responder groups. Frequency of IEDs declined in 65% of patients as early as one month, by a median of 13.6% (IQR 2-33). Those with a ten percent or greater improvement in IED frequency at one month were greater than six times more likely to be KD responders (OR 6.5 95% CI 0.85-75 p=0.03). Qualitative and quantitative measures of EEG background slowing improved in the whole cohort, but did not predict responder status. CONCLUSION: Baseline predictors of KD response remain elusive. Most patients experienced a reduction in IEDs and improvement in EEG background slowing after KD initiation. Reduction of IEDs at one month strongly predicted KD responder status at three months.

Kessler SK; Gallagher PR; Shellhaas RA; Clancy RR; Bergqvist AG

2011-03-01

94

Assessment of on-road emissions of four Euro V diesel and CNG waste collection trucks for supporting air-quality improvement initiatives in the city of Milan.  

UK PubMed Central (United Kingdom)

This paper summarizes the results of an extensive experimental study aiming to evaluate the performance and pollutant emissions of diesel and CNG waste collection trucks under realistic and controlled operating conditions in order to support a fleet renewal initiative in the city of Milan. Four vehicles (1 diesel and 3 CNG) were tested in two phases using a portable emission measurement system. The first phase included real world operation in the city of Milan while the second involved controlled conditions in a closed track. Emissions recorded from the diesel truck were on average 2.4 kg/km for CO(2), 0.21 g/km for HC, 7.4 g/km for CO, 32.3 g/km for NO(x) and 46.4 mg/km for PM. For the CNG the values were 3.6 kg/km for CO(2), 2.19 g/km for HC, 15.8 g/km for CO, 4.38 g/km for NO(x) and 11.4 mg/km for PM. CNG vehicles presented an important advantage with regards to NO(x) and PM emissions but lack the efficiency of their diesel counterparts when it comes to CO, HC and particularly greenhouse gas emissions. This tradeoff needs to be carefully analyzed prior to deciding if a fleet should be shifted towards either technology. In addition it was shown that existing emission factors, used in Europe for environmental assessment studies, reflect well the operation for CNG but were not so accurate when it came to the diesel engine truck particularly for CO(2) and NO(x). With regard to NO(x), it was also shown that the limits imposed by current emission standards are not necessarily reflected in real world operation, under which the diesel vehicle presented almost 4 times higher emissions. Regarding CO(2), appropriate use of PEMS data and vehicle information allows for accurate emission monitoring through computer simulation.

Fontaras G; Martini G; Manfredi U; Marotta A; Krasenbrink A; Maffioletti F; Terenghi R; Colombo M

2012-06-01

95

A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis.  

UK PubMed Central (United Kingdom)

BACKGROUND: At our hospital the current model of care for children with moderate-severe CF is focused on intensive inpatient intervention, regular outpatient clinic review and specialist outreach care as required. An alternative model providing more regular physiotherapy and dietetic outreach support, in addition to these specialist services, may be more effective. METHODS: 16 children (4 male; 12 female; mean age 10.9±2.93; range 4-15years) who required >40days of IV antibiotics in the 12-months pre-intervention were enrolled. Physiotherapy included weekly-supervised exercise sessions, alongside regular review of home physiotherapy regimens. Dietetic management included 1-2 monthly monitoring of growth, appetite, intake and absorption, and nutrition education sessions. RESULTS: There was a 23% reduction in inpatient IV antibiotic requirement and 20% reduction in home IV antibiotic requirement during the intervention year. Cost-benefit analyses showed savings of £113,570. VO(2Peak) increased by 4.9ml·kg·min(-1) (95%CI 1.01 to 8.71; p=0.02), and 10m-MSWT distance and increment achieved increased by 229m (95%CI 109 to 350; p<0.001) and 2 levels (95%CI 1 to 3; p<0.002) respectively. No significant differences in physiological and patient reported outcomes were demonstrated, although there was a possible trend towards improvement in outcomes when compared to the pre-intervention year. CONCLUSION: This pilot programme demonstrated a reduction in IV and admission requirements with a cost benefit in a small group of children with moderate-severe CF. A fully powered clinical trial is now warranted.

Ledger SJ; Owen E; Prasad SA; Goldman A; Willams J; Aurora P

2013-02-01

96

Fundamentals of Quality Control and Improvement  

CERN Document Server

A statistical approach to the principles of quality control and management Incorporating modern ideas, methods, and philosophies of quality management, Fundamentals of Quality Control and Improvement, Third Edition presents a quantitative approach to management-oriented techniques and enforces the integration of statistical concepts into quality assurance methods. Utilizing a sound theoretical foundation and illustrating procedural techniques through real-world examples, this timely new edition bridges the gap between statistical quality control and quality management. The book promotes a uniq

Mitra, Amitava

2012-01-01

97

Quality of School Life: Foundations for Improvement.  

Science.gov (United States)

|Argues that the quality of work life literature is both appropriate and useful for understanding and improving the effectiveness and quality of school life. Suggests that both quality and effectiveness of learning and school operations can be improved by adopting participative management models and innovations. (CJM)|

Pratzner, Frank C.

1984-01-01

98

A framework for integrated quality improvement.  

UK PubMed Central (United Kingdom)

The importance of maintaining and improving quality is well understood in most health care organizations. This work becomes more challenging as internal and external conditions rapidly change. A quality improvement framework was developed to help clinicians and administrators organize intergrated, multifaceted quality programs that have the flexibility necessary for success in today's fast-paced health care environment.

Willoughby C; Budreau G; Livingston D

1997-02-01

99

Health Care Quality Improvement Publication Trends.  

UK PubMed Central (United Kingdom)

To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

Sun GH; Maceachern MP; Perla RJ; Gaines JM; Davis MM; Shrank WH

2013-10-01

100

Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.  

UK PubMed Central (United Kingdom)

Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

Deans R; Wade S

2011-10-01

 
 
 
 
101

Strategy to Support Improvement of Healthcare Quality.  

Directory of Open Access Journals (Sweden)

Full Text Available One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States). Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors) or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.

Ing. Andrea Zejdlova

2013-01-01

102

Towards improvement in quality assurance  

International Nuclear Information System (INIS)

This first document in the series of the International Nuclear Safety Advisory Group (INSAG) Technical Notes is a general guideline for the establishment of effective quality assurance procedures at nuclear facilities. It sets out primary requirements such as quality objectives, methods for measuring the effectiveness of the quality assurance programme, priority of activities in relation to importance of safety of items, motivation of personnel

1987-01-01

103

Acupressure improves sleep quality of psychogeriatric inpatients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Acupressure, a noninvasive form of acupuncture, may be used as a low-cost and noninvasive means of improving sleep quality. Although it has been evaluated to improve self-reported sleep quality, it has not been assessed with regard to effectiveness in improving perceived and objective measures of sleep quality outcomes. OBJECTIVES: The aim of this study was to investigate the effectiveness of acupressure in improving sleep quality of psychogeriatric inpatients. METHODS: Using a convenience sample, 60 psychogeriatric inpatients with affective disorders from southern Taiwan were recruited. They were assigned randomly to an experimental or control group. Although both groups received standard medical care, those in the experimental group received 9-minute acupressure treatment daily for 4 consecutive weeks. Acupressure was applied to three acupoints: shenmen, yangchuan, and neiguan. Outcomes were measured using the Pittsburgh Sleep Quality Index and actigraphy. Data were collected at baseline and after 4 weeks of intervention. RESULTS: Participants in the experimental group improved significantly in subjective sleep quality as measured by the Pittsburgh Sleep Quality Index and in objective sleep quality as measured by actigraphy (p < .001 for all) after 4 weeks of intervention. Although the control participants also had some improvement in sleep quality, those in the experimental group had significantly greater improvements (p < .05) in all domains of subjective and objective sleep quality than the control group. DISCUSSION: Acupressure may be an effective means of improving sleep quality of psychogeriatric inpatients.

Lu MJ; Lin ST; Chen KM; Tsang HY; Su SF

2013-03-01

104

MEASURES TO IMPROVE WATER QUALITY  

Directory of Open Access Journals (Sweden)

Full Text Available The main measures to prevent pollution of surface water -rivers, streams, lakes - consist of domestic and industrial wastewaterwhich, if untreated reach the emissary, it could degrade water quality, making it even unusable.

L. SÂMBOTIN; S. MOISA; DANA SÂMBOTIN; ANA MARIANA DINCU; C. ILIE

2010-01-01

105

Quality-of-care initiative in patients treated surgically for perforated peptic ulcer  

DEFF Research Database (Denmark)

Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present study reports the results of this initiative.

MØller, M H; Larsson, Heidi Jeanet

2013-01-01

106

Process, cost, and clinical quality: the initial oral contraceptive visit.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. STUDY DESIGN: Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. METHODS: Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. RESULTS: Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. CONCLUSIONS: Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

McMullen MJ; Woolford SW; Moore CL; Berger BM

2013-01-01

107

GREAT LAKES WATER QUALITY IMPROVEMENT  

Science.gov (United States)

This paper outlines and evaluates phosphorus loadings in the Great Lakes and suggests a strategy for its control. he municipal industrial and commercial and agricultural contribution use to the Great Lakes waters has led to a concomitant deterioration of the water quality. e must...

108

Prerequisites for quality improvement in nursing.  

UK PubMed Central (United Kingdom)

AIM: This study examines how the characteristics of nurses, working communities and leadership affect the prerequisites for quality improvement in nursing. BACKGROUND: Knowledge of the phenomena affecting nurses' action is needed, since quality of care is seen as a result of an individual carer's professional skills, work motivation and commitment to work. METHODS: Material for the study was collected using a questionnaire. The respondents were 723 nursing practitioners from two special level hospitals. The main instrument used was the Managerial Abilities instrument developed by the researchers. FINDINGS: The results of the statistical analyses showed that exhaustion experienced by the nurses is the most important obstacle to quality improvement in nursing. The education of nurses, good team work and the ward sister's managerial abilities have a positive influence on quality improvement in nursing. CONCLUSION: Nurses' exhaustion should be reduced in order to improve quality of care.

Koivula M; Paunonen M; Laippala P

1998-11-01

109

Flow charting for quality improvement.  

UK PubMed Central (United Kingdom)

This article analyzes the merits of flow charts in their relatively new application to healthcare quality management. Specific examples are given that show how a step-by-step diagram can clarify policies and procedures. Patrice Spath explains "imagineering," a technique for problem identification that compares the steps that a process actually follows with a flow chart of what steps the process should follow. In the discrepancies between the two, problems are revealed. Warnings are given that each detail in a flow chart must pertain to its actual subject and that pictorial symbols should be simple and clear. The author lists some software packages that allow flexibility and speed in flow charting. As a tool for discovering redundancies and inefficiencies, the flow chart is a valuable method for refining quality systems.

Spath PL

1991-09-01

110

Power theories for improved power quality  

CERN Document Server

Power quality describes a set of parameters of electric power and the load's ability to function properly under specific conditions. It is estimated that problems relating to power quality costs the European industry hundreds of billions of Euros annually. In contrast, financing for the prevention of these problems amount to fragments of these costs. Power Theories for Improved Power Quality addresses this imbalance by presenting and assessing a range of methods and problems related to improving the quality of electric power supply. Focusing particularly on active compensators and the DSP base

Benysek, Grzegorz

2012-01-01

111

Timing control improves seabed survey data quality  

Energy Technology Data Exchange (ETDEWEB)

Seateam has completed development of and field-proven the Dolphin data acquisition and timing system for high-density surveys offshore. The Dolphin project was initiated to improve quality control of survey sensor data and ensure time synchronization, thus leading to faster turnaround of seabed terrain information. Data received from survey sensors is asynchronous, so the system must provide for data correlation. This includes establishment of data latency, i.e., the time difference between data creation and timing of the message at first-byte arrival at the recording system. Until recently, asynchronous data from multiple sensors was collected by a single computer, regardless of whether it had additional intelligent or non-intelligent serial cards. This computer was fully responsible for time stamping all incoming data, plus associated storage and distribution. Though this initially sufficed and is still applicable to low-density data, increasingly larger data volumes required an associated boost in the capability to time stamp data prior to eventual correction.

Green, R. [Seateam, Den Helder (Netherlands)

1996-04-01

112

Physical Activity Improves Quality of Life  

Science.gov (United States)

Physical activity improves quality of life Updated:Jul 24,2013 Do you want to add years to your ... as one 30-minute session. This is achievable! Physical activity may also help encourage you to spend some ...

113

Improving the quality of existing quadrupoles  

Energy Technology Data Exchange (ETDEWEB)

A cost-effective method is shown for improving the quality of existing quadrupole magnets. In this case, the LAMPF side-coupled-linac (SCL) quadrupole doublets are being upgraded so that improved harmonics and increased integrated gradient strength can be achieved. Data are shown for the old and new states that verify these improvements. The use of investment casting technology to achieve these improvements is documented.

Hunter, W.T.; Bush, E.D. Jr.; Perez, E.M.; Archuletta, S.F.; Mays, M.G.

1988-03-01

114

Improving the quality of existing quadrupoles  

International Nuclear Information System (INIS)

[en] A cost-effective method is shown for improving the quality of existing quadrupole magnets. In this case, the LAMPF side-coupled-linac (SCL) quadrupole doublets are being upgraded so that improved harmonics and increased integrated gradient strength can be achieved. Data are shown for the old and new states that verify these improvements. The use of investment casting technology to achieve these improvements is documented

1988-01-01

115

Quality and Profitability improvement by Technical Audit  

Directory of Open Access Journals (Sweden)

Full Text Available This paper is aimed for finding the Quality and Profitability Improvement by Technical Audit, through a case study and further establishing the relationship between the product quality, profitability and technical audit. Quality audit generates the report of non conformance which basically represents the deviation from committed quality of products, or in short, it may be called as postmortem of product quality. By virtue of quality audit, the commitment, implementation and follow up for product quality are aligned. This delivers a good quality of product to the customers and thus the customer is benefited. In industries, Quality Inspectors are giving their decision for quality of product in two categories, "ACCEPTED" or "REJECTED". The accepted products are coming to the customers and the rejected products become the burden / problem to the manufacturers.If accepted product quantity is within the “NORMS”, no one cares regarding the rejected product quantities, what so ever. When the rejected product quantity increases beyond the “NORMS”, the analysis process starts to find out the reasons of rejections. Sometimes, it becomes too late to search out the reasons of rejections and survival of the industry becomes a problem. By technical audit and audit report implementation such type of conditions can be avoided and controlled.Basically, Quality is the function of Man, Machine, Materials, Methods, Movement, Manufacturing Processes, Monitoring and Management (8 M’s). If the technicality of 8 M’s is corrected by Technical Audit, the product quality will improve automatically and the profitability of the organization will improve. In short it can be solicited that if 8 M’s are all right, the product quality and profitability will automatically be set right. This may become an important aspect in the scenario of Indian Industries. The findings are supported by a case study of a Process Plant (Slag Dryer) of a reputed Indian Industry.

Dr. Mishra R. C.; Prof. Srivastava S. B.

2009-01-01

116

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?  

UK PubMed Central (United Kingdom)

BACKGROUND: Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. METHODS: The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. RESULTS: Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. CONCLUSIONS: We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.

Groene O; Mora N; Thompson A; Saez M; Casas M; Suñol R

2011-01-01

117

Quality improvement: the pursuit of excellence.  

UK PubMed Central (United Kingdom)

Sherbrooke Community Centre, a registered Eden Alternative home, has implemented structures and processes to support ongoing quality improvement (QI). A comprehensive QI program supports Sherbrooke's commitment to excellence. The organization's QI program is based on the Board of Directors' strategic plan and the core directions of the strategic plan are reflected in the QI standards. Sherbrooke's organizational principles (continuous improvement, communication/feedback, accountability, respect, empowerment/participation) are woven through the program. The result is an effective system that enhances quality of care and quality of life for residents.

Schmidt K; Beatty S

2005-07-01

118

The Neurology Quality of Life Measurement Initiative  

Science.gov (United States)

Objective The National Institute of Neurological Disorders and Stroke (NINDS) commissioned the Neurology Quality of Life (Neuro-QOL) project to develop a bilingual (English/Spanish), clinically relevant and psychometrically robust HRQL assessment tool. This paper describes the development and calibration of these banks and scales. Design Classical and modern test construction methodologies were used, including input from essential stakeholder groups. Setting An online patient panel testing service and eleven academic medical centers and clinics from across the United States and Puerto Rico that treat major neurological disorders. Participants Adult and pediatric patients representing different neurological disorders specified in this study, proxy respondents for select conditions (stroke and pediatric conditions), and English and Spanish speaking participants from the general population. Main Outcome Measures Multiple generic and condition specific measures used to provide construct validity evidence to new Neuro-QOL tool. Results Neuro-QOL has developed 14 generic item banks and 8 targeted scales to assess HRQL in five adult (stroke, multiple sclerosis, Parkinson’s disease, epilepsy, and amyotrophic lateral sclerosis) and two pediatric conditions (epilepsy and muscular dystrophies). Conclusions The Neuro-QOL system will continue to evolve, with validation efforts in clinical populations, and new bank development in health domains not currently included. The potential for Neuro-QOL measures in rehabilitation research and clinical settings is discussed.

Cella, David; Nowinski, Cindy; Peterman, Amy; Victorson, David; Miller, Deborah; Lai, Jin-Shei; Moy, Claudia

2011-01-01

119

The Continuous Improvement and Optimisation of Quality  

Directory of Open Access Journals (Sweden)

Full Text Available Accomplishing not only corporate goals, but also those of the economy as a whole, requires a continuously growing interest towards quality. This interest has evolved constantly from inspection, to control, insurance and, presently, total quality management. The management that is oriented towards total quality requires a shift from the interest of optimising quality to one that concerns continuous improvement. The link between the two and the manner in which they might contribute to an increase in the organisations’ performance are aspects that shall be addressed in the following article.

EMIL MAXIM

2006-01-01

120

Afghanistan's national strategy for improving quality in health care.  

UK PubMed Central (United Kingdom)

UNLABELLED: QUALITY PROBLEM OR ISSUE: When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. INITIAL ASSESSMENT: A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. PLAN OF ACTION: In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. IMPLEMENTATION: The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. LESSONS LEARNED: Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

Rahimzai M; Amiri M; Burhani NH; Leatherman S; Hiltebeitel S; Rahmanzai AJ

2013-07-01

 
 
 
 
121

Intergroup relationships and quality improvement in healthcare.  

UK PubMed Central (United Kingdom)

BACKGROUND: Intergroup problems among physicians, nurses and administrators in healthcare settings sometimes retard such settings' ability to foster enhanced quality of care. Without knowledge of the social dynamics that generate the difficulties, it is impossible to address some crucial issues that may affect quality initiatives. METHODS: This paper reviews three types of dynamics, social identity, communities of practice and socialisation into particular professional identities that affect relationships among professional groups in healthcare settings. RECOMMENDATIONS: A suggestion is made for the creation of cross-boundary communities of practice, socialisation into them and dual, superordinate identities as a means to foster more effective intergroup dynamics and, thus, contribute to a greater quality of care.

Bartunek JM

2011-04-01

122

Advancing Performance Measurement in Oncology: Quality Oncology Practice Initiative Participation and Quality Outcomes  

Digital Repository Infrastructure Vision for European Research (DRIVER)

American Society of Clinical Oncology Quality Oncology Practice Initiative has grown to include 973 practices as of 2010. Practices demonstrated rates of end-of-life care and other measures of quality.

Campion, Francis X.; Larson, Leanne R.; Kadlubek, Pamela J.; Earle, Craig C.; Neuss, Michael N.

123

Improving PSA quality of KSNP PSA model  

Energy Technology Data Exchange (ETDEWEB)

In the RIR (Risk-informed Regulation), PSA (Probabilistic Safety Assessment) plays a major role because it provides overall risk insights for the regulatory body and utility. Therefore, the scope, the level of details and the technical adequacy of PSA, i.e. the quality of PSA is to be ensured for the successful RIR. To improve the quality of Korean PSA, we evaluate the quality of the KSNP (Korean Standard Nuclear Power Plant) internal full-power PSA model based on the 'ASME PRA Standard' and the 'NEI PRA Peer Review Process Guidance.' As a working group, PSA experts of the regulatory body and industry also participated in the evaluation process. It is finally judged that the overall quality of the KSNP PSA is between the ASME Standard Capability Category I and II. We also derive some items to be improved for upgrading the quality of the PSA up to the ASME Standard Capability Category II. In this paper, we show the result of quality evaluation, and the activities to improve the quality of the KSNP PSA model.

Yang, Joon Eon; Ha, Jae Joo [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

2004-07-01

124

Improving PSA quality of KSNP PSA model  

International Nuclear Information System (INIS)

In the RIR (Risk-informed Regulation), PSA (Probabilistic Safety Assessment) plays a major role because it provides overall risk insights for the regulatory body and utility. Therefore, the scope, the level of details and the technical adequacy of PSA, i.e. the quality of PSA is to be ensured for the successful RIR. To improve the quality of Korean PSA, we evaluate the quality of the KSNP (Korean Standard Nuclear Power Plant) internal full-power PSA model based on the 'ASME PRA Standard' and the 'NEI PRA Peer Review Process Guidance.' As a working group, PSA experts of the regulatory body and industry also participated in the evaluation process. It is finally judged that the overall quality of the KSNP PSA is between the ASME Standard Capability Category I and II. We also derive some items to be improved for upgrading the quality of the PSA up to the ASME Standard Capability Category II. In this paper, we show the result of quality evaluation, and the activities to improve the quality of the KSNP PSA model

2004-01-01

125

Laboratory quality improvement in Thailand's northernmost provinces.  

UK PubMed Central (United Kingdom)

PURPOSE: In Thailand nearly 1000 public health laboratories serve 65 million people. A qualified indicator of a good quality laboratory is Thailand Medical Technology Council certification. Consequently, Chiang Rai Regional Medical Sciences Center established a development program for laboratory certification for 29 laboratories in the province. This paper seeks to examine this issue. DESIGN/METHODOLOGY/APPROACH: The goal was to improve laboratory service quality by voluntary participation, peer review, training and compliance with standards. The program consisted of specific activities. Training and workshops to update laboratory staffs' quality management knowledge were organized. Staff in each laboratory performed a self-assessment using a standard check-list to evaluate ten laboratory management areas. Chiang Rai Regional Medical Sciences Center staff supported the distribution of quality materials and documents. They provided calibration services for laboratory equipment. Peer groups performed an internal audit and successful laboratories received Thailand Medical Technology Council certification. FINDINGS: By December 2007, eight of the 29 laboratories had improved quality sufficiently to be certified. Factors that influenced laboratories' readiness for quality improvement included the number of staff, their knowledge, budget and staff commitment to the process. Moreover, the support of each hospital's laboratory working group or network was essential for success. RESEARCH LIMITATIONS/IMPLICATIONS: There was no clear policy for supporting the program. Laboratories voluntarily conducted quality management using existing resources. PRACTICAL IMPLICATIONS: A bottom-up approach to this kind of project can be difficult to accomplish. Laboratory professionals can work together to illustrate and highlight outcomes for top-level health officials. A top-down, practical approach would be much less difficult to implement. ORIGINALITY/VALUE: Quality certification is a critical step for laboratory staff, which also encourages them to aspire to international quality standards like ISO. The certification program is an important mechanism for addressing inadequate knowledge, budget, planning, policy and staff required to improve laboratory services.

Kanitvittaya S; Suksai U; Suksripanich O; Pobkeeree V

2010-01-01

126

Quality Improvement and Confirmation Projects: Facilitating Rapid, Measurable Performance Improvement.  

UK PubMed Central (United Kingdom)

As radiology departments continue to increase in size and complexity, the process of improving and maintaining excellent performance is becoming increasingly challenging. In response, a systematic process for efficiently implementing and sustaining measurable improvement in our radiology department has been developed, which targets focused aspects of individual performance that contribute to overall departmental quality. Projects designed to achieve such improvements have been called quality improvement and confirmation (QuIC) projects. The QuIC project process involves a project champion, medical expert, technical expert, quality improvement technologist specialist, and appropriate leaders, managers, and support personnel. The project champion conducts a preliminary investigation and organizes team members, who define the desired performance through consensus, establish data collection and analysis procedures, and prepare to launch the project. Once launched, the QuIC project process follows an execution period that is divided into four phases: (a) project launch phase, (b) support phase, (c) transition phase, and (d) maintenance phase. The first three phases focus on education, group-level feedback, and individual feedback, respectively. Weekly audits are performed to track performance improvement. Data collection, analysis, and dissemination processes are automated to the extent possible. To date, four such projects have been successfully conducted. The QuIC project concept is an attempt to apply the principles of process improvement to the process of process improvement by enabling any member of a radiology department to efficiently and reliably spearhead a quality improvement project. We consider this to be a work in progress and continue to refine the process with the goal of eventually being able to conduct many projects simultaneously.© RSNA, 2013.

Hawkins CM; Alsip CN; Pryor RM; Leach AD; Larson DB

2013-08-01

127

State public health laboratory system quality improvement activities.  

UK PubMed Central (United Kingdom)

The Association of Public Health Laboratories (APHL) and the APHL Laboratory Systems and Standards Committee manage the Laboratory System Improvement Program (L-SIP). One component of L-SIP is an assessment that allows the members and stakeholders of a laboratory system to have an open and honest discussion about the laboratory system's strengths and weaknesses. From these facilitated discussions, gaps and opportunities for improvement are identified. In some cases, ideas for how to best address these gaps emerge, and workgroups are formed. Depending on resources, both monetary and personnel, laboratory staff will then prioritize the next component of L-SIP: which quality improvement activities to undertake. This article describes a sample of quality improvement activities initiated by several public health laboratories after they conducted L-SIP assessments. These projects can result in more robust linkages between system entities, which can translate into improvements in the way the system addresses the needs of stakeholders.

Su B; Vagnone PS

2013-09-01

128

Minnesota's Provider-Initiated Approach Yields Care Quality Gains At Participating Nursing Homes.  

UK PubMed Central (United Kingdom)

Minnesota's Performance-Based Incentive Payment Program uses a collaborative, provider-initiated approach to nursing home quality improvement: up-front funding of evidence-based projects selected and designed by participating facilities, with accountable performance targets. During the first 4 rounds of funding (2007-10), 66 projects were launched at 174 facilities. Using a composite quality measure representing multiple dimensions of clinical care, we found that facilities participating during this period exhibited significantly greater gains than did nonparticipating facilities, in both targeted areas and overall quality, and maintained their quality advantage after project completion. Participating and nonparticipating facilities were similar at baseline with respect to quality scores and improvement trends, as well as acuity-adjusted payment, operating costs, and nurse staffing. Although self-selection precludes firm conclusions regarding the program's impacts, early findings indicate that the program shows promise for incentivizing nursing home quality improvement, both in facility-identified areas of concern and overall.

Arling G; Cooke V; Lewis T; Perkins A; Grabowski DC; Abrahamson K

2013-09-01

129

Minnesota's Provider-Initiated Approach Yields Care Quality Gains At Participating Nursing Homes.  

Science.gov (United States)

Minnesota's Performance-Based Incentive Payment Program uses a collaborative, provider-initiated approach to nursing home quality improvement: up-front funding of evidence-based projects selected and designed by participating facilities, with accountable performance targets. During the first 4 rounds of funding (2007-10), 66 projects were launched at 174 facilities. Using a composite quality measure representing multiple dimensions of clinical care, we found that facilities participating during this period exhibited significantly greater gains than did nonparticipating facilities, in both targeted areas and overall quality, and maintained their quality advantage after project completion. Participating and nonparticipating facilities were similar at baseline with respect to quality scores and improvement trends, as well as acuity-adjusted payment, operating costs, and nurse staffing. Although self-selection precludes firm conclusions regarding the program's impacts, early findings indicate that the program shows promise for incentivizing nursing home quality improvement, both in facility-identified areas of concern and overall. PMID:24019369

Arling, Greg; Cooke, Valerie; Lewis, Teresa; Perkins, Anthony; Grabowski, David C; Abrahamson, Kathleen

2013-09-01

130

Does Audit Improve the Quality of Care?  

Directory of Open Access Journals (Sweden)

Full Text Available BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searched up to May 2009.DISCUSSION: Audit is used as a tool to assure and assess the quality of patient health care. It is also an educational tool as it creates a lot of opportunities for professionals to think about practice and to learn from the experience of others.CONCLUSIONS: Although that audit is a powerfull and useful tool to improve and evaluate the quality of health care, on the other hand there are many barriers that make its use difficult in everyday practice.

Areti Tsaloglidou

2009-01-01

131

The DSN Asset Management/Maintenance Improvement Initiative  

Science.gov (United States)

This article describes the Asset Management/Maintenance Improvement (AMMI) initiative: the first focused Deep Space Network (DSN) initiative intended to improve the efficiency and efficacy of maintenance, support improvement in equipment reliability, and provide metrics for use in understanding equipment reliability and the use of maintenance resources. The initiative has resulted in the introduction of many new processes and procedures including the global use of a computerized maintenance management system (CMMS) and Reliability-Centered Maintenance (RCM) concepts. The work performed as part of the AMMI initiative represents significant changes to the DSN maintenance culture that has been in place for over 40 years.

Wackley, J.; Dundics, D.

2011-11-01

132

Improvement of initial growth layer in CoCr-alloy thin film media  

International Nuclear Information System (INIS)

[en] Introduction of nonmagnetic HCP-CoCrRu layer between HCP-CoCr-alloy recording layer and a HCP- or a BCC-underlayer improves the crystallographic quality of initial growth region. Magnetic properties are improved by realizing good hetero-epitaxy between the nonmagnetic and the magnetic HCP-layers

2001-01-01

133

Project Hanford management contract quality improvement project management plan  

Energy Technology Data Exchange (ETDEWEB)

On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process.

ADAMS, D.E.

1999-03-25

134

Quality-improving alliances in differentiated oligopoly  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We study rival firms' incentives in quality-improving Research and Development (R&D) networks. The analysis stresses the role of free riding associated to collaboration and three major consequences emerge: R&D efforts decrease with the number of partners, networks of alliances are over-connected as ...

Deroian, Frédéric; Gannon, Frédéric

135

Organizationwide quality improvement in health care.  

UK PubMed Central (United Kingdom)

Organizationwide quality improvement has offered many organizations in many different industries a new approach to work and leadership. The lessons learned can be applied to the health care setting. QA professionals can play an important role in this change by leading through example--first in their own departments and the work they currently perform and then throughout the entire organization.

Batalden PB

1991-03-01

136

Virginia Star Quality Initiative: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Virginia's Star Quality Initiative prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators…

Child Trends, 2010

2010-01-01

137

MULTIFOCAL CORRECTION PROVIDING IMPROVED QUALITY OF VISION  

UK PubMed Central (United Kingdom)

This invention describes strategies and devices for improving the visual experience while expanding the depth of field of presbyopic and pseudophakic patients. The invention describes strategies and devices for providing improved image quality and improved visual quality of patients employing simultaneous vision bifocal, trifocal or multifocal corrections or monovision. The invention describes strategies and devices for reducing the visibility of the defocused part of the retinal image generated by simultaneous vision bifocal and multifocal ophthalmic corrections and monovision. The invention describes strategies and devices that employ control of spherical aberration or other similar asphericities to reduce the visibility of defocused ghost images. The invention describes strategies and devices that ensure that negative defocus is always coupled with negative spherical aberration (or similar asphericity), and that positive defocus is always coupled with positive SA (or similar asphericity) as a means to reduce the visibility of defocused ghostimages.

BRADLEY ARTHUR; KOLLBAUM PETE S; THIBOS LARRY N

138

Quality in quality improvement research--a new benchmark.  

UK PubMed Central (United Kingdom)

CITATION: Scales DC, Dainty K, Hales B, Pinto R, Fowler RA, Adhikari NK, Zwarenstein M: A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. JAMA 2011, 305:363-72. CONTEXT: Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources to devote to quality improvement. OBJECTIVE: To determine the effectiveness of a multicenter quality improvement program to increase delivery of 6 evidence-based ICU practices. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, cluster-randomized trial among 15 community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred during the trial (November 2005 to October 2006) and 7141 admissions during a decay-monitoring period (December 2006 to August 2007). INTERVENTION: The authors implemented a videoconference-based forum including audit and feedback, expert-led educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. The ICUs were randomized into 2 groups. Each group received this intervention, targeting a new practice every 4 months, while acting as control for the other group, in which a different practice was targeted in the same period. MAIN OUTCOMES: The primary outcome was the summary ratio of odds ratios (ORs) for improvement in adoption (determined by daily data collection) of all 6 practices during the trial in intervention vs control ICUs. RESULTS: Overall, adoption of the targeted practices was greater in intervention ICUs than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-7.74). Improved delivery in intervention ICUs was greatest for semi recumbent positioning to prevent ventilator-associated pneumonia (90.0% of patient-days in last month vs. 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent catheter-related bloodstream infection (70.0% of patients receiving central lines vs. 10.6%; OR, 30.06; 95% CI, 11.00-82.17). Adoption of other practices, many with high baseline adherence, changed little. CONCLUSION: In a collaborative network of community ICUs, a multi-faceted quality improvement intervention improved adoption of care practices.

Asher NR; White DB

2011-01-01

139

Using qualitative measures to improve quality in radiation oncology.  

UK PubMed Central (United Kingdom)

This article introduces the use of qualitative research techniques in the field of radiation oncology with respect to quality improvement initiatives. The qualitative techniques used in this research include field observations and in-depth, one-on-one interviews with radiation therapy technologists. The observations were conducted in a fast-paced academic institution. This high-pressure, high-throughput environment provided an interesting location for observation of behaviors, workflows, and areas of improvement. Qualitative research is a useful platform for formulating questions and addressing the environment on a larger scale. The information resulting from this research led to immediate changes that improved the efficiency and effectiveness of care provided to patients and identified future initiatives to improve patient safety and the timeliness of care provided. Overall, qualitative research proved to be an exceptional resource for identifying and evaluating a clinical department and demonstrated the usefulness of this method of research for future work.

Harrison AS; Yu Y; Dicker AP; Doyle LA

2013-07-01

140

40 CFR Appendix F to Part 132 - Great Lakes Water Quality Initiative Implementation Procedures  

Science.gov (United States)

...2010-07-01 false Great Lakes Water Quality Initiative Implementation Procedures...Appendix F to Part 132âGreat Lakes Water Quality Initiative Implementation Procedures...methodology may be found in the Great Lakes Water Quality Initiative Technical...

2010-07-01

 
 
 
 
141

Diabetes Care Quality Improvement: A Workbook for State Action.  

Science.gov (United States)

Diabetes Care Quality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...

B. Kass

2004-01-01

142

Diabetes Care Quality Improvement: A Resource Guide for State Action.  

Science.gov (United States)

Diabetes Care Quality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...

R. M. Coffey T. L. Matthews K. McDermott

2004-01-01

143

Quantitative data management in quality improvement collaboratives  

Science.gov (United States)

Background Collaborative approaches in quality improvement have been promoted since the introduction of the Breakthrough method. The effectiveness of this method is inconclusive and further independent evaluation of the method has been called for. For any evaluation to succeed, data collection on interventions performed within the collaborative and outcomes of those interventions is crucial. Getting enough data from Quality Improvement Collaboratives (QICs) for evaluation purposes, however, has proved to be difficult. This paper provides a retrospective analysis on the process of data management in a Dutch Quality Improvement Collaborative. From this analysis general failure and success factors are identified. Discussion This paper discusses complications and dilemma's observed in the set-up of data management for QICs. An overview is presented of signals that were picked up by the data management team. These signals were used to improve the strategies for data management during the program and have, as far as possible, been translated into practical solutions that have been successfully implemented. The recommendations coming from this study are: From our experience it is clear that quality improvement programs deviate from experimental research in many ways. It is not only impossible, but also undesirable to control processes and standardize data streams. QIC's need to be clear of data protocols that do not allow for change. It is therefore minimally important that when quantitative results are gathered, these results are accompanied by qualitative results that can be used to correctly interpret them. Monitoring and data acquisition interfere with routine. This makes a database collecting data in a QIC an intervention in itself. It is very important to be aware of this in reporting the results. Using existing databases when possible can overcome some of these problems but is often not possible given the change objective of QICs. Introducing a standardized spreadsheet to the teams is a very practical and helpful tool in collecting standardized data within a QIC. It is vital that the spreadsheets are handed out before baseline measurements start.

van den Berg, Mireille; Frenken, Rianne; Bal, Roland

2009-01-01

144

Quantitative data management in quality improvement collaboratives  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Collaborative approaches in quality improvement have been promoted since the introduction of the Breakthrough method. The effectiveness of this method is inconclusive and further independent evaluation of the method has been called for. For any evaluation to succeed, data collection on interventions performed within the collaborative and outcomes of those interventions is crucial. Getting enough data from Quality Improvement Collaboratives (QICs) for evaluation purposes, however, has proved to be difficult. This paper provides a retrospective analysis on the process of data management in a Dutch Quality Improvement Collaborative. From this analysis general failure and success factors are identified. Discussion This paper discusses complications and dilemma's observed in the set-up of data management for QICs. An overview is presented of signals that were picked up by the data management team. These signals were used to improve the strategies for data management during the program and have, as far as possible, been translated into practical solutions that have been successfully implemented. The recommendations coming from this study are: From our experience it is clear that quality improvement programs deviate from experimental research in many ways. It is not only impossible, but also undesirable to control processes and standardize data streams. QIC's need to be clear of data protocols that do not allow for change. It is therefore minimally important that when quantitative results are gathered, these results are accompanied by qualitative results that can be used to correctly interpret them. Monitoring and data acquisition interfere with routine. This makes a database collecting data in a QIC an intervention in itself. It is very important to be aware of this in reporting the results. Using existing databases when possible can overcome some of these problems but is often not possible given the change objective of QICs. Introducing a standardized spreadsheet to the teams is a very practical and helpful tool in collecting standardized data within a QIC. It is vital that the spreadsheets are handed out before baseline measurements start.

van den Berg Mireille; Frenken Rianne; Bal Roland

2009-01-01

145

Quantitative data management in quality improvement collaboratives.  

UK PubMed Central (United Kingdom)

BACKGROUND: Collaborative approaches in quality improvement have been promoted since the introduction of the Breakthrough method. The effectiveness of this method is inconclusive and further independent evaluation of the method has been called for. For any evaluation to succeed, data collection on interventions performed within the collaborative and outcomes of those interventions is crucial. Getting enough data from Quality Improvement Collaboratives (QICs) for evaluation purposes, however, has proved to be difficult. This paper provides a retrospective analysis on the process of data management in a Dutch Quality Improvement Collaborative. From this analysis general failure and success factors are identified. DISCUSSION: This paper discusses complications and dilemma's observed in the set-up of data management for QICs. An overview is presented of signals that were picked up by the data management team. These signals were used to improve the strategies for data management during the program and have, as far as possible, been translated into practical solutions that have been successfully implemented.The recommendations coming from this study are: From our experience it is clear that quality improvement programs deviate from experimental research in many ways. It is not only impossible, but also undesirable to control processes and standardize data streams. QIC's need to be clear of data protocols that do not allow for change. It is therefore minimally important that when quantitative results are gathered, these results are accompanied by qualitative results that can be used to correctly interpret them.Monitoring and data acquisition interfere with routine. This makes a database collecting data in a QIC an intervention in itself. It is very important to be aware of this in reporting the results. Using existing databases when possible can overcome some of these problems but is often not possible given the change objective of QICs. Introducing a standardized spreadsheet to the teams is a very practical and helpful tool in collecting standardized data within a QIC. It is vital that the spreadsheets are handed out before baseline measurements start.

van den Berg M; Frenken R; Bal R

2009-01-01

146

Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always integrated and delivered by multidisciplinary teams. Aim: To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving the uptake of clinical depression guidelines in daily practice as well as the collaboration between different mental health professionals. Method: A Depression Breakthrough Collaborative was initiated from December 2006 until March 2008. The activities included the development and implementation of a stepped care depression model, a care pathway with two levels of treatment intensity: a first step treatment level for patients with non-severe depression (brief or mild depressive symptoms) and a second step level for patients with severe depression. Twelve months data were measured by the teams in terms of one outcome and several process indicators. Qualitative data were gathered by the national project team with a semi-structured questionnaire amongst the local team coordinators. Results: Thirteen multidisciplinary teams participated in the project. In total 101 health professionals were involved, and 536 patients were diagnosed. Overall 356 patients (66%) were considered non-severely depressed and 180 (34%) patients showed severe symptoms. The mean percentage of non-severe patients treated according to the stepped care model was 78%, and 57% for the severely depressed patient group. The proportion of non-severely depressed patients receiving a first step treatment according to the stepped care model, improved during the project, this was not the case for the severely depressed patients. The teams were able to monitor depression symptoms to a reasonable extent during a period of 6 months. Within 3 months, 28% of monitored patients had recovered, meaning a Beck Depression Inventory (BDI) score of 10 and lower, and another 27% recovered between 3 and 6 months. Conclusions and discussion: A stepped care approach seems acceptable and feasible in primary care, introducing different levels of care for different patient groups. Future implementation projects should pay special attention to the quality of care for severely depressed patients. Although the Depression Breakthrough Collaborative introduced new treatment concepts in primary and specialty care, the change capacity of the method remains unclear. Thorough data gathering is needed to judge the real value of these intensive improvement projects.

Gerdien Franx; Jolanda A.C. Meeuwissen; Henny Sinnema; Jan Spijker; Jochanan Huyser; Michel Wensing; Jacomine de Lange

2009-01-01

147

Investigating Service Quality Initiatives of Pakistani Commercial Banks  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The study investigated the service quality initiatives taken by Pakistani commercial banks in Lahore based on the perceptions of 447 respondents, selected by using multistage random sampling technique, through SERVQUAL scale which was found reliable at 0.866 Cronbach’s alpha. Mean scores, alphas, an...

Shaukat Ali Raza; Shahid A. Zia; Syed Abir Hassan Naqvi; Asghar Ali

148

Reporting tools for clinical quality improvement.  

UK PubMed Central (United Kingdom)

To support clinical quality improvement (QI), effective quality analysis tools are essential. New strategies that we have incorporated into our routine assessment activities include comparative screening, clinical process benchmarking tables, and run charts for key quality indicators. To target areas for improvement, we use comparative screening. We have access to clinical data for 11 comparable medical centers. Currently, these data are used to identify our ranking relative to the others for mortality, readmission, and length of stay. Diagnosis-related groups and ICD-9-CM clusters serve as clinical groupings with defined minimal case volume requirements to ensure meaningful comparisons. These comparative reports permit our clinical leaders and hospital administrators to focus QI activities. Clinical process benchmarking involves peer-to-peer interfacility communication to identify those factors that create outstanding clinical performance. We successfully have used this tool to support process improvement in cardiac-surgery, administration of patient controlled analgesia, and respiratory therapy. Interdisciplinary QI teams identify the key investigative questions. Team members then contact their counterparts at similar facilities, which differ from our hospital in quality, based on empirical evidence or through comparative screening. The information that is obtained is collated in a tabular format, along with our own information, to permit easy identification of key clinical processes associated with better outcomes. Key quality and utilization goals at our hospital include reducing unplanned readmissions by 10%, achieving a 5% lower average length of stay, and not exceeding Health Care Financing Administration expected mortality rates in any clinical area.(ABSTRACT TRUNCATED AT 250 WORDS)

Albright JM; Panzer RJ; Black ER; Mays RA; Lush-Ehmann CM

1993-10-01

149

Improving quality of service in the internet  

CERN Multimedia

The Internet transport technology was designed to be robust, resilient to link or node outages, and with no single point of failure. The resulting connectionless system supports what is called a "best effort datagram delivery service", the perfo rmance of which is often greatly unpredictable. To improve the predictability of IP-based networks, several Quality of Service technologies have been designed over the past decade. The first one, RSVP, based on reservation of resources, is operational but has several major deficiencies, such as scalability difficulties. However, associated to other more recent technologies -RSVP aggregation, Diffserv and MPLS- the combination may result into an appropriate solution for improving Quality of Service guarant ees in a scalable way. This article presents the state of the art on the field in an accurate, yet pedagogical style.

Flückiger, François

2000-01-01

150

Improvements in geomagnetic observatory data quality  

DEFF Research Database (Denmark)

Geomagnetic observatory practice and instrumentation has evolved significantly over the past 150 years. Evolution continues to be driven by advances in technology and by the need of the data user community for higher-resolution, lower noise data in near-real time. Additionally, collaboration between observatories and the establishment of observatory networks has harmonized standards and practices across the world; improving the quality of the data product available to the user. Nonetheless, operating a highquality geomagnetic observatory is non-trivial. This article gives a record of the current state of observatory instrumentation and methods, citing some of the general problems in the complex operation of geomagnetic observatories. It further gives an overview of recent improvements of observatory data quality based on presentation during 11th IAGA Assembly at Sopron and INTERMAGNET issues.

Reda, Jan; Fouassier, Danielle

2011-01-01

151

Melatonin improves sleep quality in hemodialysis patients.  

UK PubMed Central (United Kingdom)

Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment.

Edalat-Nejad M; Haqhverdi F; Hossein-Tabar T; Ahmadian M

2013-07-01

152

Goal hierarchy: Improving asset data quality by improving motivation  

International Nuclear Information System (INIS)

Many have recognized the need for high quality data on assets and the problems in obtaining them, particularly when there is a need for human observation and manual recording. Yet very few have looked at the role of the data collectors themselves in the data quality process. This paper argues that there are benefits to more fully understanding the psychological factors that lay behind data collection and we use goal hierarchy theory to understand these factors. Given the myriad of potential reasons for poor-quality data it has previously proven difficult to identify and successfully deploy employee-driven interventions; however, the goal hierarchy approach looks at all of the goals that an individual has in their life and the connections between them. For instance, does collecting data relate to whether or not they get a promotion? Stay safe? Get a new job? and so on. By eliciting these goals and their connections we can identify commonalities across different groups, sites or organizations that can influence the quality of data collection. Thus, rather than assuming what the data collectors want, a goal hierarchy approach determines that empirically. Practically, this supports the development of customized interventions that will be much more effective and sustainable than previous efforts. - Highlights: ? We need to consider psychological aspects of data collectors to improve data quality. ? We show how goal hierarchy theory furthers understanding. ? Looks at the multiple goals of each individual to determine their behavior.

2011-01-01

153

Goal hierarchy: Improving asset data quality by improving motivation  

Energy Technology Data Exchange (ETDEWEB)

Many have recognized the need for high quality data on assets and the problems in obtaining them, particularly when there is a need for human observation and manual recording. Yet very few have looked at the role of the data collectors themselves in the data quality process. This paper argues that there are benefits to more fully understanding the psychological factors that lay behind data collection and we use goal hierarchy theory to understand these factors. Given the myriad of potential reasons for poor-quality data it has previously proven difficult to identify and successfully deploy employee-driven interventions; however, the goal hierarchy approach looks at all of the goals that an individual has in their life and the connections between them. For instance, does collecting data relate to whether or not they get a promotion? Stay safe? Get a new job? and so on. By eliciting these goals and their connections we can identify commonalities across different groups, sites or organizations that can influence the quality of data collection. Thus, rather than assuming what the data collectors want, a goal hierarchy approach determines that empirically. Practically, this supports the development of customized interventions that will be much more effective and sustainable than previous efforts. - Highlights: > We need to consider psychological aspects of data collectors to improve data quality. > We show how goal hierarchy theory furthers understanding. > Looks at the multiple goals of each individual to determine their behavior.

Unsworth, Kerrie, E-mail: Kerrie.unsworth@uwa.edu.au [UWA Business School, University of Western Australia, Crawley, WA 6009 (Australia); Adriasola, Elisa; Johnston-Billings, Amber; Dmitrieva, Alina [UWA Business School, University of Western Australia, Crawley, WA 6009 (Australia); Hodkiewicz, Melinda [School of Mechanical Engineering, University of Western Australia, Crawley, WA 6009 (Australia)

2011-11-15

154

Improving quality of life through pain control.  

UK PubMed Central (United Kingdom)

The pancreas is an externally excreting gland located in the abdominal cavity behind other organs. Difficulty palpating and viewing the pancreas often contributes to late diagnoses of tumors. In advanced disease, episodes of unmanaged pain have a negative impact on patients and family members and may affect many areas of well-being. Palliative care assists oncologists as well as patients and families with legitimate options for treating advanced disease, relieving symptom burdens and improving quality of life.

Burger V; D'Olimpio JT

2013-04-01

155

Assessing goal attainment for quality improvement.  

UK PubMed Central (United Kingdom)

Organizations that support persons with intellectual disabilities will likely experience increasing pressure to provide evidence of the benefits of services to participants in programs. In this article we propose a model for assessing goal attainment modified from scales used with other populations that both develops from the person-centered planning process and informs on program and organizational efficacy. Implications for assessing goal attainment and considerations for applying information to improve individual, program and organization quality are presented.

Lawlor D; York M

2007-09-01

156

Assessing goal attainment for quality improvement.  

Science.gov (United States)

Organizations that support persons with intellectual disabilities will likely experience increasing pressure to provide evidence of the benefits of services to participants in programs. In this article we propose a model for assessing goal attainment modified from scales used with other populations that both develops from the person-centered planning process and informs on program and organizational efficacy. Implications for assessing goal attainment and considerations for applying information to improve individual, program and organization quality are presented. PMID:17846047

Lawlor, David; York, Michaela

2007-09-01

157

Striving for excellence through quality improvement.  

UK PubMed Central (United Kingdom)

Numerous factors are affecting health care services today, including increased consumer awareness; growth of medical technology; rising costs and an unpredictable financial market; a continued shortage of health care professionals, especially nurses; and a shift of many services from inpatient to outpatient settings. As a result, American health care is undergoing rapid change. This article explores how one management concept--quality improvement--can help foster innovative, effective, and efficient change in today's health care organizations.

Johnson T

1992-03-01

158

Quality improvement on the acute inpatient psychiatry unit using the model for improvement.  

UK PubMed Central (United Kingdom)

BACKGROUND: A need exists for constant evaluation and modification of processes within healthcare systems to achieve quality improvement. One common approach is the Model for Improvement that can be used to clearly define aims, measures, and changes that are then implemented through a plan-do-study-act (PDSA) cycle. This approach is a commonly used method for improving quality in a wide range of fields. The Model for Improvement allows for a systematic process that can be revised at set time intervals to achieve a desired result. METHODS: We used the Model for Improvement in an acute psychiatry unit (APU) to improve the screening incidence of abnormal involuntary movements in eligible patients-those starting or continuing on standing neuroleptics-with the Abnormal Involuntary Movement Scale (AIMS). RESULTS: After 8 weeks of using the Model for Improvement, both of the participating inpatient services in the APU showed substantial overall improvement in screening for abnormal involuntary movements using the AIMS. CONCLUSION: Crucial aspects of a successful quality improvement initiative based on the Model for Improvement are well-defined goals, process measures, and structured PDSA cycles. Success also requires communication, organization, and participation of the entire team.

Singh K; Sanderson J; Galarneau D; Keister T; Hickman D

2013-01-01

159

Measuring quality in health care and its implications for pay-for-performance initiatives.  

Science.gov (United States)

The quality of health care is important to American consumers, and discussion on quality will be a driving force toward improving the delivery of health care in America. Funding agencies are proposing a variety of quality measures, such as centers of excellence, pay-for-participation, and pay-for-performance initiatives, to overhaul the health care delivery system in this country. It is quite uncertain, however, whether these quality initiatives will succeed in curbing the unchecked growth in health care spending in this country, and physicians understandably are concerned about more intrusion into the practice of medicine. This article outlines the genesis of the quality movement and discusses its effect on the surgical community. PMID:19232918

Chung, Kevin C; Shauver, Melissa J

2009-02-01

160

Measuring quality in health care and its implications for pay-for-performance initiatives.  

UK PubMed Central (United Kingdom)

The quality of health care is important to American consumers, and discussion on quality will be a driving force toward improving the delivery of health care in America. Funding agencies are proposing a variety of quality measures, such as centers of excellence, pay-for-participation, and pay-for-performance initiatives, to overhaul the health care delivery system in this country. It is quite uncertain, however, whether these quality initiatives will succeed in curbing the unchecked growth in health care spending in this country, and physicians understandably are concerned about more intrusion into the practice of medicine. This article outlines the genesis of the quality movement and discusses its effect on the surgical community.

Chung KC; Shauver MJ

2009-02-01

 
 
 
 
161

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.

Groene Oliver; Mora Nuria; Thompson Andrew; Saez Mercedes; Casas Mercè; Suñol Rosa

2011-01-01

162

Investigating Service Quality Initiatives of Pakistani Commercial Banks  

Directory of Open Access Journals (Sweden)

Full Text Available The study investigated the service quality initiatives taken by Pakistani commercial banks in Lahore based on the perceptions of 447 respondents, selected by using multistage random sampling technique, through SERVQUAL scale which was found reliable at 0.866 Cronbach’s alpha. Mean scores, alphas, and correlations were calculated. One-Sample t-test, Independent Samples t-test, and One-way ANOVA were employed for significance and variance analysis. The study concluded that customers, employees, and managers respectively were not satisfied with the overall service quality provided by the Pakistani banks in terms of five sub-scales of service quality. However, tangibles were relatively at top whereas assurance was at the lowest position. Reliability and empathy were at almost similar level and banks failed in their responsiveness. Pakistani banks need to revisit their quality initiatives and focus on responsiveness, assurance, reliability, empathy, and tangibles in order of priority to ensure the set standards of service quality.

Shaukat Ali Raza; Shahid A. Zia; Syed Abir Hassan Naqvi; Asghar Ali

2012-01-01

163

New applicator improves waterjet dissection quality.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Waterjet dissection is accomplished with Helix Hydro-Jet, but a new device with improved operative handling and potentially superior dissection qualities has been developed. MATERIALS AND METHODS: Eighty-four fresh cadaveric pig brains were simultaneously cut with Helix Hydro-Jet and Erbejet 2. A commonly used applicator and a new applicator for the Helix Hydro-Jet were directly compared to the new Erbejet 2. Under standardised conditions, different pressure levels were applied to the brain surface without arachnoids. Technical features, cutting depth, tissue damage and differences of applicators were examined. RESULTS: Microscopic analysis of cutting depth revealed different dissection characteristics of both the devices. With the standard applicators, waterjet cutting depth was shown to be deeper and with more foaming using the Helix Hydro-Jet compared to that of the Erbejet 2. With the new applicators, less foaming and a lower and more linear increased cutting depth were observed with the Helix Hydro-Jet, very similar to the superior qualities shown by the Erbejet 2. CONCLUSIONS: The new developed applicator of the Erbejet 2 also improves the intraoperative results of the so far applied Helix Hydro-Jet. The new Erbejet 2 provides some advantages for practicability; but in combination with the new applicator, the Helix Hydro-Jet accomplished almost identical superior dissection qualities of the Erbejet 2.

Tschan CA; Tschan K; Krauss JK; Oertel J

2010-12-01

164

Improving breast cancer care through a regional quality collaborative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Regional collaborative organizations provide an effective structure for improving the quality of surgical care. With low complication rates and a long latency between surgical care and outcomes such as survival and local recurrence, quality measurement in breast cancer surgery is ideally suited to process measures. Diagnostic biopsy technique for breast cancer diagnosis is measurable and amenable to change at the provider level. We present initial results from our analysis of institutional variation in surgical and core needle biopsy use within a regional breast cancer quality collaborative. METHODS: Established in 2006, the Michigan Breast Oncology Quality Initiative (MiBOQI) consists of 18 hospitals collecting data on breast cancer care using the National Comprehensive Cancer Centers Network (NCCN) Oncology Outcomes Database Project platform to analyze and compare breast cancer practices and outcomes amongst member institutions. Institutional review board approval is obtained at each site. Data are submitted electronically to the NCCN and analyzed for concordance with practice guidelines. Aggregate and blinded data are shared with project directors and institutions at collaborative meetings, and ongoing practice patterns are observed for change. We analyzed variation in breast biopsy technique for initial cancer diagnosis over time and between institutions. Diagnostic biopsies were categorized as core needle, surgical excisional, surgical incisional, and other surgical biopsy. RESULTS: Procedural data for 8,066 patients treated for breast cancer between November 1, 2006 and December 31, 2009 were analyzed. The mean patient age was 59.5 years (range, 25.4-90.0 years). Within MiBOQI, 21% of patients underwent surgical biopsy for initial diagnosis. The percentage of patients undergoing surgical biopsy ranged from 8% to 37%, and the majority of surgical biopsies were classified as excisional biopsies. Patients with ductal carcinoma in situ were more likely to undergo surgical biopsy compared to those with invasive cancer (30.4% vs 17.8%; P < .001). There was no association between biopsy type and patient age, race, or comorbidity. Data on biopsy technique were shared with site project directors and a target surgical biopsy rate of <15% was chosen by consensus. Site project directors disseminated the data to their institutions and developed action plans for provider and patient education. Over the study period, the percentage of cases undergoing surgical biopsy for the entire MiBOQI collaborative decreased from 21% to 15% (P < .001). CONCLUSION: The regional quality collaborative model can be used to collect, analyze, and disseminate surgical breast care quality data to organizations and treating physicians. These data can be used to describe patterns of care and make comparisons over time and between organizations. These data can also be used to set regional quality standards and provide an avenue for physician-led quality improvement.

Breslin TM; Caughran J; Pettinga J; Wesen C; Mehringer A; Yin H; Share D; Silver SM

2011-10-01

165

Quality improvement in chronic illness care: a collaborative approach.  

UK PubMed Central (United Kingdom)

BACKGROUND: Despite rapid advances in the clinical and psycho-educational management of diabetes, the quality of care received by the average patient with diabetes remains lackluster. The "collaborative" approach--the Breakthrough Series (BTS; Institute for Healthcare Improvement [IHI]; Boston)--coupled with a Chronic Care Model was used in an effort to improve clinical care of diabetes in 26 health care organizations. METHODS: Descriptive and pre-post data are presented from 23 health care organizations participating in the 13-month (August 1998-September 1999) BTS to improve diabetes care. The BTS combined the system changes suggested by the chronic care model, rapid cycle improvement, and evidence-based clinical content to assist teams with change efforts. The characteristics of organizations participating in the diabetes BTS, the collaborative process and content, and results of system-level changes are described. RESULTS: Twenty-three of 26 teams completed participation. Both chart review and self-report data on care processes and clinical outcomes suggested improvement based on changes teams made in the collaborative. Many of the organizations evidencing the largest improvements were community health centers, which had the fewest resources and the most challenged populations. DISCUSSION: The initial Chronic Illness BTS was sufficiently encouraging that replication and evaluation of the BTS collaborative model is being conducted in more than 50 health care systems for diabetes, congestive heart failure, depression, and asthma. This model represents a feasible method of improving the quality of care across different health care organizations and across multiple chronic illnesses.

Wagner EH; Glasgow RE; Davis C; Bonomi AE; Provost L; McCulloch D; Carver P; Sixta C

2001-02-01

166

Introduction: Medicare quality improvement organizations--activities and partnerships.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Medicare Modernization Act (MMA) has provided an opportunity for quality improvement organizations (QIOs) to partner with Medicare Part D plan sponsors. These new relationships have developed into a set of diverse projects, each approved by the Centers for Medicare & Medicaid Services. OBJECTIVE: To provide information about the scope of the projects being conducted by the QIOs and their partners. SUMMARY: The document describes a variety of quality improvement projects addressing medication use by beneficiaries enrolled in Medicare Part D. Private Medicare QIO contractors are implementing these projects in each state. Descriptions of each project were developed by individual QIOs with the assistance of lead staff for the Physician Practice/Pharmacy QIO Support Center for all QIOs nationwide. These projects vary in their complexity, in the quality measures used, and in the clinical processes and economic impact they seek to improve. The summaries in this supplement were prepared 6 months into the current 3-year contract period, which began August 2006. Accordingly, the summaries reflect varying stages of development, funding reductions could occur that necessitate project redesign, and projects have not yet been evaluated. With few exceptions, these projects are not designed as research but as quality improvement projects following the "Plan, Do, Study, Act" model for speeding acceptance of evidence-based practice. CONCLUSIONS: This survey describes the promise of partnerships whose value will be fully realized in future years. The results of these early QIO initiatives will not be available until projects are evaluated, but QIOs and many Medicare Part D plans have established promising partnerships and have begun to share data for the purpose of assessing and improving plan and practitioner performance as well as patient engagement. Most projects are focused on ambulatory care, but some QIOs are addressing nursing home care and continuity of care between settings. Most ambulatory care projects are limited to prescription drug claims data, but a few plans are providing medical and lab data to QIOs in addition to drug claims. QIOs have historically worked almost exclusively with physicians and nurses but in many states are now engaged with colleges of pharmacy as well as with managed care and community pharmacists. QIO partnerships will provide managed care organizations and pharmacists with the opportunity for innovative quality improvement initiatives that might not otherwise be possible because of limitations of available data or resources. Pharmacists can use this document to review a wide array of options for working with QIOs and other partners in their market to design or strengthen their organization's medication therapy management and quality improvement programs. Managed care pharmacists may be particularly interested in the ability of QIOs to assist them in comparing their plans' performance with other national and regional plans.

Schulke DG; Krantzberg E; Grant J

2007-07-01

167

An endoscopic quality improvement program improves detection of colorectal adenomas.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Adenoma detection rate (ADR) is a key measure of quality in colonoscopy. Low ADRs are associated with development of interval cancer after "negative" colonoscopy. Uncontrolled studies mandating longer withdrawal time, and other incentives, have not significantly improved ADR. We hypothesized that an endoscopist training program would increase ADRs. METHODS: Our Endoscopic Quality Improvement Program (EQUIP) was an educational intervention for staff endoscopists. We measured ADRs for a baseline period, then randomly assigned half of the 15 endoscopists to undergo EQUIP training. We then examined baseline and post-training study ADRs for all endoscopists (trained and un-trained) to evaluate the impact of training. A total of 1,200 procedures were completed in each of the two study phases. RESULTS: Patient characteristics were similar between randomization groups and between study phases. The overall ADR in baseline phase was 36% for both groups of endoscopists. In the post-training phase, the group of endoscopists randomized to EQUIP training had an increase in ADR to 47%, whereas the ADR for the group of endoscopists who were not trained remained unchanged at 35%. The effect of training on the endoscopist-specific ADRs was estimated with an odds ratio of 1.73 (95% confidence interval 1.24-2.41, P=0.0013). CONCLUSIONS: Our results indicate that ADRs can be improved considerably through simple educational efforts. Ultimately, a trial involving a larger number of endoscopists is needed to validate the utility of our training methods and determine whether improvements in ADRs lead to reduced colorectal cancer.

Coe SG; Crook JE; Diehl NN; Wallace MB

2013-02-01

168

40 CFR Appendix B to Part 132 - Great Lakes Water Quality Initiative  

Science.gov (United States)

...2009-07-01 false Great Lakes Water Quality Initiative B Appendix B...Appendix B to Part 132âGreat Lakes Water Quality Initiative Methodology for...in the calculation of Great Lakes Water Quality Guidance (Guidance)...

2009-07-01

169

Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?  

UK PubMed Central (United Kingdom)

BACKGROUND: Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. MATERIALS AND METHODS: After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. RESULTS: Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). CONCLUSIONS: A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest.

Rössler B; Ziegler M; Hüpfl M; Fleischhackl R; Krychtiuk KA; Schebesta K

2013-07-01

170

Evaluation, the Path to the Quality Improvement  

Directory of Open Access Journals (Sweden)

Full Text Available To obtain educational goals, teachers should have sufficient knowledge and skills. On the other hand procen is not usually apparent. Educational authorities believe that one of the most important steps that could improve quality is documenting teaching progress so that evaluation comes as a documenting device. We think, the existing evaluation methods are not as efficient as they should be and could not gain the goals of evaluation. So we conducted a descriptive, retrospective study? Which was held in all faculties of IUMS which had been evaluated by students, educational department heads and the teachers themselves during 1998-2000. The findings show that although the results of 1999 evaluation were presented to the faculty members there were no significant changes in the 2000s' evaluation. This means that the existing assessment methods have little value in teaching improvement.

H Salmanzadeh; M Ghadamiyan; M Maleki

2001-01-01

171

Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the National Pediatric Cardiology-Quality Improvement Collaborative.  

UK PubMed Central (United Kingdom)

Introduction Despite improvements in care following Stage 1 palliation, interstage mortality remains substantial. The National Pediatric Cardiology-Quality Improvement Collaborative captures clinical process and outcome data on infants discharged into the interstage period after Stage 1. We sought to identify risk factors for interstage mortality using these data. Materials and methods Patients who reached Stage 2 palliation or died in the interstage were included. The analysis was considered exploratory and hypothesis generating. Kaplan-Meier survival analysis was used to screen for univariate predictors, and Cox multiple regression modelling was used to identify potential independent risk factors. RESULTS: Data on 247 patients who met the criteria between June, 2008 and June, 2011 were collected from 33 surgical centres. There were 23 interstage mortalities (9%). The identified independent risk factors of interstage mortality with associated relative risk were: hypoplastic left heart syndrome with aortic stenosis and mitral atresia (relative risk = 13), anti-seizure medications at discharge (relative risk = 12.5), earlier gestational age (relative risk = 11.1), nasogastric or nasojejunal feeding (relative risk = 5.5), unscheduled readmissions (relative risk = 5.3), hypoplastic left heart syndrome with aortic atresia and mitral stenosis (relative risk = 5.2), fewer clinic visits with primary cardiologist identified (relative risk = 3.1), and fewer post-operative vasoactive medications (relative risk = 2.2). Conclusion Interstage mortality remains substantial, and there are multiple potential risk factors. Future efforts should focus on further exploration of each risk factor, with potential integration of the factors into surveillance schemes and clinical practice strategies.

Cross RR; Harahsheh AS; McCarter R; Martin GR

2013-02-01

172

Quality improvement principles boost SCADA system reliability  

Energy Technology Data Exchange (ETDEWEB)

A major section of Chevron Pipe Line Co.'s SCADA system was recently brought up to the industry-standard 99.5% data-reporting reliability by an intercompany team applying quality improvement (QI) principles. To make the study manageable, the scope was limited to only half the CPL SCADA system, southeast Texas. The study concentrated on 20% of these remote sites which all happened to operate below 90% reliability. The team surveyed 21 sites and recorded data on reliability problem root causes. The data were categorized and formed into a Pareto chart. This chart indicated the root cause of 80% of problems was related to lack of maintenance on both radio equipment and RTU/PLCs. These results were presented to management along with recommendations for forming a quality improvement team to work on developing a preventative maintenance system, a task to be performed jointly between the radio technicians and the pipe line technicians. Goal was to allow the technicians to develop a working relationship with one another and to facilitate a better knowledge of the physical interfaces involved.

Boling, J.E. (Chevron Information Technology Co., New Orleans, LA (United States))

1994-08-01

173

Biospecimen Reporting for Improved Study Quality  

Energy Technology Data Exchange (ETDEWEB)

Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

2010-12-27

174

Biospecimen Reporting for Improved Study Quality (BRISQ)  

Energy Technology Data Exchange (ETDEWEB)

Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

2011-04-26

175

Biospecimen Reporting for Improved Study Quality (BRISQ)  

Energy Technology Data Exchange (ETDEWEB)

Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

2010-09-02

176

Applying PPM to ERP Maintenance and Continuous Improvement Initiatives  

DEFF Research Database (Denmark)

Enterprise Resource Planning Systems (ERP) has been implemented in many companies during the last decade and has gained an increasing significance. For many companies it means that the focus is no longer on how to implement the ERP system, but rather on how to maintain and improve the system to gain business benefits from the systems. However the ERP literature on how to do this is limited. The purpose of this article is to explore how Project Portfolio Management (PPM) from the Research and Development (R&D) literature can be applied to an ERP second wave context, when companies are to prioritize and select maintenance and continuous improvement initiatives. This is done by reviewing the existing literature in the fields of PPM from R&D literature and then by reviewing the existing literature about maintenance and improvement initiatives in the ERP literature, after which the two are compared and discussed using three case-studies. The paper contributes with a discussion on how PPM from R&D can be applied tomaintenance and continuous improvement initiatives in the second wave of ERP. The paper ends with arguing that emphasis needs to be given to this field, since a conscious and systematic prioritization of maintenance and improvement initiatives is believed to be able to increase business performance.

El-Tal, Nada Maria; Fonnesbæk, Majbrit

2006-01-01

177

Quality improvement capacity: a survey of hospital quality managers.  

UK PubMed Central (United Kingdom)

Background Skilled managers are an important component of quality improvement (QI) infrastructure, but there has been little evaluation of QI infrastructure, which is needed to guide enhancement of this capacity. Methods Quality managers at 97 acute care hospitals in Ontario, Canada, were surveyed by mail to describe how their roles were integrated with QI performance objectives. Binary and scaled responses were analysed quantitatively, and open-ended responses were analysed thematically. Results The response rate was 79.4%. Many QI managers were new to their role and had no support staff despite responsibility for multiple portfolios. Respondents thought that QI objectives should be less reactive to hospital executives or boards, adverse events or demands from government and accreditation bodies, and recommended that dedicated QI managers proactively apply explicit strategic plans and engage executives and clinicians. Findings were consistent regardless of rank, staffing or hospital type. Those with master's training and greater experience were more involved in strategic planning, data analysis and communication. Conclusions QI is not well resourced in most acute care hospitals in Ontario. To develop QI capacity, investment and QI training may be required. Research should empirically establish objective performance measures of QI capacity to guide investment and evaluation.

Gagliardi AR; Majewski C; Victor JC; Baker GR

2010-02-01

178

Improving the quality of oral surgery referrals.  

UK PubMed Central (United Kingdom)

INTRODUCTION: General referral letters to any hospital specialty are universally poor. These letters are the main source of information regarding the clinical problem and shortfalls can compromise the management of the patient. METHOD: One hundred retrospective randomly selected oral surgery referral letters in the form of proformae, made to oral and maxillofacial departments were examined against a set standard. Following the audit, a redesigned proforma, guidance and feedback questionnaires were distributed, followed by re-audit of 100 redesigned referral proformae. RESULTS: The main improvements seen were increases of: 52% in stating type of anaesthesia, 48% medical history, 38% referral date, 35% duration of symptoms, 32% use of the 'clinical details section', 31% stating treatment provided, 23% symptoms, 21% in clarity, 18% general medical practioner's (GMP's) address, 18% reason for referral, 15% social history, 14% diagnosis, 13% in using diagrams to aid explanation and 10% inclusion of a radiograph. DISCUSSION: Improvements in the quality of referral communications from local dentists were successfully made. CONCLUSION: Designing a pro-forma in close accordance with gold standards can achieve notable improvements to allow us to provide the best possible service and management for all our patients.

Shaffie N; Cheng L

2012-10-01

179

Coaching for Quality Improvement: Lessons Learned from Quality Rating and Improvement Systems (QRIS). Research Brief  

Science.gov (United States)

|Coaching and other on-site, individualized professional development strategies (consultation, mentoring, and technical assistance) are promising approaches to support the application of new teaching practices and overall quality improvement among practitioners in early care and education settings. This Research Brief summarizes a recent report…

Tout, Kathryn; Isner, Tabitha; Zaslow, Martha

2011-01-01

180

Air quality management in Canada: The smog control initiative  

International Nuclear Information System (INIS)

[en] This paper focuses on a Canadian program called the open-quotes Management Plan for Nitrogen Oxides (NOX) and Volatile Organic Compounds (VOCs).close quotes This program was developed by the Canadian Council of Ministers of the Environment (CCME), a forum composed of the 10 provincial ministers of the environment and their federal counterpart. Other air pollution control initiatives that have taken place in Canada are also reviewed in this paper to give a broader perspective of air quality management in Canada

1993-01-01

 
 
 
 
181

Improving quality and value of future hardwoods  

Science.gov (United States)

Global Forest Information Service. Science.gov - We Participate ... area is highly regarded both in this country and abroad for the high quality timber grown on ... As worldwide supplies of quality timber continue to shrink, the demand for quality  ...

182

Device for improving air quality device  

UK PubMed Central (United Kingdom)

The invention relates to a device for the improvement of the air quality. The device suits for a cabin with surrounding walls, which can reduce the carbon dioxide concentration in the air of the cabin and maintain the oxygen concentration. The device comprises a compressor which is provided with an air inlet and an air outlet, a heat exchanger and an air separation module which is provided with an inlet and a first outlet. The heat exchanger is communicated with the compressor the inlet of the air separation module is communicated with the heat exchanger wherein the air separation module is used to separate a reformed gas which is produced by the carbon dioxide and the nitrogen in the air from the compressor and the heat exchanger the reformed gas is discharged from the first outlet of the air separation module.

SHENGPING YANG; JIAMING CHEN; GUOLONG YANG

183

Continuous quality improvement of colorectal cancer screening.  

UK PubMed Central (United Kingdom)

Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms: how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient's involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

Madalinski M

2013-02-01

184

Teaching quality essentials: the effectiveness of a team-based quality improvement curriculum in a tertiary health care institution.  

UK PubMed Central (United Kingdom)

A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants' pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects.

Majka AJ; Cook KE; Lynch SL; Garovic VD; Ghosh AK; West CP; Feyereisn WL; Paat JJ; Williams BJ; Hale CW; Botz CT; Phul AE; Mueller PS

2013-05-01

185

Using continuous quality improvement tools to improve pediatric immunization rates.  

UK PubMed Central (United Kingdom)

BACKGROUND: In August 1992 the medical director of the 19 Group Health medical clinics (now part of HealthPartners) in Minnesota chartered a continuous quality improvement (CQI) team to improve the pediatric (two-year-old) immunization rates. THE TEAM'S WORK: The team created a process flow for the current immunization process, collected data on the process, determined the causes of late or missed immunizations, collected data on children not up-to-date with immunization, analyzed the data, acted on recommendations, and obtained buy-in. The chief reasons for the child's not being up-to-date on immunizations included missed opportunities (when the child is in the clinic receiving care, perhaps for an acute illness, and could have safely received the immunization but did not), no previous visits or chart, and parents instructed to have their child return at two years. INTERVENTION: Recommendations pertained to missed opportunities, record keeping, and enhanced patient and provider responsibility. For example, providers were given algorithms for catch-up of patients not on schedule or with incomplete immunizations. Another CQI team was launched to address and simplify the myriad locations in a medical record for recording information on immunizations. An automated vaccine administration record is now being piloted at two clinics. RESULTS: Immunizations have increased from a mean of 53.5% before the team started to meet to a mean of 86.5% for the most recent four quarters for which data are available. CONCLUSIONS: A problem is best addressed by the very people who will have to bring about the necessary changes for the desired improvements.

Carlin E; Carlson R; Nordin J

1996-04-01

186

Improved quality assurance testing of respirator filters  

Energy Technology Data Exchange (ETDEWEB)

The overall objective of this project was to evaluate alternative materials, devices, and procedures that could improve performance test methods for high-efficiency particulate air (HEPA) filters and media and could lead to a new generation of quality assurance (QA) test equipment. Shortcomings of the current QA test equipment and procedures include the use of di-(2-ethylhexyl)phthalate (DEHP), a suspect carcinogen, and ambiguities in particle sizing and penetration measurement. Evaluation of a prototype replacement penetrometer system built for the US Army by A. D. Little, Inc., revealed serious deficiencies in aerosol generation and particle sizing. Studies of chemical degradation in circumstances approximating use conditions and of particle size stability in high-humidity conditions suggested that tetraethylene glycol and oleic acid might be appropriate DEHP substitutes in a new generation of flash vaporization generators of QA test aerosols. The successful completion of this project provided a solid foundation for proceeding in the assembly and testing of improved penetrometers for QA testing of HEPA respirator filters. 109 refs., 20 figs., 13 tabs.

Soderholm, S.C.; Strandberg, S.W.; Ortiz, L.W.; Nielsen, S.D.; Tillery, M.I.; Gerber, B.V.; Ettinger, H.J.

1985-05-01

187

Improving quality of cancer care through surgical audit  

DEFF Research Database (Denmark)

Quality of healthcare is a hot topic and this is especially true for cancer care. New surgical techniques and effective neoadjuvant treatment regimens have significantly improved colorectal cancer outcome. Nevertheless, there seem to be substantial differences in quality of care between European countries, hospitals and doctors. To reduce hospital variation, most initiatives aim on selective referral, encouraging patients to seek care in high-volume hospitals, where cancer care is concentrated to site-specialist multidisciplinary teams. As an alternative to volume-based referral, hospitals and surgeons can also improve their results by learning from their own outcome statistics and those from colleagues treating a similar patient group. European national audit registries in surgical oncology have led to improvements with a greater impact on survival than any of the adjuvant therapies currently under study. Moreover, they offer the possibility to perform research on patient groups that are usually excluded from clinical trials. Nevertheless, between European countries remain differences in outcome and treatment schedules that cannot be easily explained. The European CanCer Organisation (ECCO) has recognised these importances and created the 'European Registration of Cancer Care' (EURECCA) framework to develop a European colorectal audit structure. EURECCA will advance future treatment improvements and spread these to all European cancer patients. It provides opportunities to treat elderly and comorbid patients evidence based while it offers an unique insight in social-economical healthcare matters such as the consequences of commercialisation, treatment availability and screening initiatives. As such, ECCO has established the basis for a strong, multidisciplinary audit structure with the commitment to improve cancer care for every European cancer patient.

van Gijn, W; van de Velde, C J H

2010-01-01

188

Driving perioperative nutrition quality improvement processes forward!  

UK PubMed Central (United Kingdom)

Evidence supporting the important role of nutrition therapy in surgical patients has evolved, with several randomized trials and meta-analyses of randomized trials clearly demonstrating benefits. Despite this evidence, surgeons and anesthesiologists have been slow to adopt recommended practices, and the traditional dogma of delaying the initiation of and restricting the amount of nutrition during the postoperative period persists. Consequently, the nutrition therapy received by surgical patients remains suboptimal; thus, patients suffer worse clinical outcomes. Knowledge translation (KT) describes the process of moving evidence learned from clinical research, and summarized in clinical practice guidelines, to its incorporation into clinical and policy decision making. In this paper, we apply Graham et al's knowledge-to-action model to illuminate our understanding of the issues pertinent to KT in surgical nutrition. We illustrate various components of this model using empirically derived research, commentaries, and published studies from both critical care and surgical nutrition. Barriers to improving surgical nutrition practice may be related to (1) the nature of the underlying evidence and clinical practice guidelines; (2) guideline implementation factors; (3) characteristics of the health system, hospital, and surgical team; (4) provider attitudes and beliefs; and (5) patient factors (eg, type of surgery, underlying disease, and nutrition status). Interventions tailored to overcoming these barriers must be developed, evaluated, and implemented. A system of audit and feedback must guide this process and evaluate improvements over time so that every patient undergoing major surgery will have the opportunity to be optimally assessed and managed according to best nutrition practices.

Heyland DK; Dhaliwal R; Cahill NE; Carli F; Flum D; Ko C; Kozar R; Drover JW; McClave SA

2013-09-01

189

Continuous quality improvement of colorectal cancer screening  

Directory of Open Access Journals (Sweden)

Full Text Available Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms: how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient’s involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

Mariusz Madalinski

2013-01-01

190

Institutionalization of quality improvement programs in Korean hospitals.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the institutionalization of quality improvement (QI) programs in Korean hospitals, in which organizational efforts to improve the quality of care have been made only recently. DESIGN: A cross-sectional study based upon an initial telephone contact and follow-up mail survey. STUDY PARTICIPANTS: All hospitals with 400 beds or more, 100 as of 1997, were contacted in the initial telephone survey. The survey questionnaire was then sent to all of 28 hospitals found to have a QI department; 26 hospitals returned the completed questionnaire. RESULTS: Hospitals that had larger bed capacities, that provided tertiary levels of care or that were in urban areas were found to have a higher tendency to establish QI departments. These QI departments most frequently cited improvement of patient satisfaction as one of their overall missions. They also reported that their most important responsibilities were monitoring performance and preparing for the two national Korean hospital assessment programs. Participating in these hospital assessment programs helped them to initiate and develop their QI activities. The main difficulties they had in performing their QI programs stemmed from lack of knowledge and resources. These survey findings indicate that hospital assessment programs significantly aided Korean hospitals to institutionalize their QI programs. At the same time, the survey data indicate that the hospital assessment programs may emphasize short-term benefits from QI activities at the expense of long-term QI institutionalization. CONCLUSION: QI programs have not as yet been fully institutionalized in Korean hospitals. More support for QI structure and organizational preparation at both the national and organizational levels will be needed.

Kim CY; Cho SH

2000-10-01

191

Measures for Improving the Quality of Health Care  

Directory of Open Access Journals (Sweden)

Full Text Available Quality and safety in the health sector go “hand in hand”, which means that both components are inseparably linked - quality improvement will often affect more security. Good quality services will be successfully implemented in organizations that already have a "quality culture", i.e., where the value system of employees is consistent with their commitment to providing high quality health services. The organization must have a clear strategic commitment to providing quality services at all levels of an organization. Quality and safety are not "an extra element in providing services, but make its ground. As such, the quality and safety must be built into the organization. Patient satisfaction, quality service and efficient management of resources become “holy trinity” of modern health care, strictly oriented towards the patient, aimed at reducing costs while increasing quality. Healthcare system worldwide try to develop new strategies, the implementation of which would lead to the end result -improvement of health care quality.

Aleksandar Višnji?; Vladica Veli?kovi?; Sla?ana Jovi?

2012-01-01

192

40 CFR Appendix E to Part 132 - Great Lakes Water Quality Initiative Antidegradation Policy  

Science.gov (United States)

... 2010-07-01 2010-07-01 false Great Lakes Water Quality Initiative Antidegradation Policy E Appendix...132, App. E Appendix E to Part 132âGreat Lakes Water Quality Initiative Antidegradation Policy Great...

2010-07-01

193

Associations between organizational characteristics and quality improvement activities of clinics participating in a quality improvement collaborative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Few studies have rigorously evaluated the associations between organizational characteristics and intervention activities of health care organizations participating in quality improvement collaboratives (QICs). OBJECTIVE: To examine the relationship between clinic characteristics and intervention activities by primary care clinics that provide HIV care and that participated in a QIC. DESIGN: Cross-sectional study of Ryan White CARE Act (now called Ryan White HIV/AIDS Treatment Modernization Act) funded clinics that participated in a QIC over 16 months in 2000 and 2001. The QIC was originally planned to be a more typical 12 months long, but was extended to increase the likelihood of success. Data were collected using surveys of clinicians and administrators in participating clinics and monthly reports of clinic improvement activities. MEASURES: Number of interventions attempted, percent of interventions repeated, percent of interventions evaluated, and organizational characteristics. RESULTS: Clinics varied significantly in their intervention choices. Organizations with a more open culture and a greater emphasis on quality improvement attempted more interventions (P < 0.01, P < 0.05) and interventions that were more comprehensive (P < 0.01, P < 0.10). Presence of multidisciplinary teams and measurement of progress toward quantifiable goals also were associated with comprehensiveness of interventions (P < 0.01, P < 0.05). CONCLUSION: Clinic characteristics predicted intervention activities during a QIC. Further research is needed on how these organizational characteristics affect quality of care through their influence on intervention activities.

Deo S; McInnes K; Corbett CJ; Landon BE; Shapiro MF; Wilson IB; Cleary PD

2009-09-01

194

Southern Appalachian Mountains initiative: Regional partnership for air quality management  

Energy Technology Data Exchange (ETDEWEB)

The Southern Appalachian Mountains Initiative (SAMI) is a voluntary partnership of state and federal agencies, industry, environmental groups, academia, and interested public. SAMI was established to identify and recommend air emissions management strategies to remedy existing and prevent future adverse air quality impacts to natural resources in Southern Appalachia, with particular focus on Class I national park and wilderness areas. SAMI's integrated assessment is focusing simultaneously on ozone, visibility impairment, and acid deposition. Computer models are linking emissions, atmospheric transport, exposures, and environmental and socioeconomic effects. The assessment is considering the impacts of existing and newly enacted federal air regulatory requirements and alternative emissions management strategies that SAMI might recommend for regional, state, or community-based actions.

Brewer, P.F.

1999-07-01

195

DEVELOPING WEED SUPPRESSIVE SOILS THROUGH IMPROVED SOIL QUALITY MANAGEMENT  

Science.gov (United States)

Sustainable agriculture is based in part on efficient management of soil microorganisms for improving soil quality. However, identification of biological indicators of soil quality for predicting weed suppression in soils has received little attention. We investigated differences in soil microbial ...

196

Improving UAV Handling Qualities Using Time Delay Compensation.  

Science.gov (United States)

This research investigated control loop time delay and its effect on UAV handling qualities. Compensation techniques to improve handling qualities in the presence of varying amounts of time delay were developed and analyzed. One technique was selected and...

A. J. Thurling

2000-01-01

197

Some questions of improving quality control of well construction  

Energy Technology Data Exchange (ETDEWEB)

Main avenues for improving quality control of drilling operations are covered. Measures are suggested which are the basis for the system of quality control of well construction which have been developed in the Nizhnevartovskneftegaz association.

Syromyatinkov, Ye.S.; Fumberg, V.A.; Isangulov, K.I.; Zaripov, R.I.

1984-01-01

198

Improvement of quality service based on common benchmarks and indicators  

Directory of Open Access Journals (Sweden)

Full Text Available Consider ways to improve the quality management system based on common criteria and indicators for evaluating the quality of products, works and services in housing and domestic service.

Pohaydak, Olha Bohdanivna

2011-01-01

199

Satisfaction After Hysterectomy Linked to Quality of Life Improvements  

Science.gov (United States)

... Email. Research Activities Online Newsletter Archive, 1995-2009 Satisfaction after hysterectomy linked to quality of life improvements ... Quality (HS11657). See "Predictors of hysterectomy use and satisfaction," by Dr. Kuppermann, Lee A. Learman, M.D. ...

200

Improving laboratory data entry quality using Six Sigma.  

UK PubMed Central (United Kingdom)

PURPOSE: The Uganda Makerere University provides clinical laboratory support to over 70 clients in Uganda. With increased volume, manual data entry errors have steadily increased, prompting laboratory managers to employ the Six Sigma method to evaluate and reduce their problems. The purpose of this paper is to describe how laboratory data entry quality was improved by using Six Sigma. DESIGN/METHODOLOGY/APPROACH: The Six Sigma Quality Improvement (QI) project team followed a sequence of steps, starting with defining project goals, measuring data entry errors to assess current performance, analyzing data and determining data-entry error root causes. Finally the team implemented changes and control measures to address the root causes and to maintain improvements. Establishing the Six Sigma project required considerable resources and maintaining the gains requires additional personnel time and dedicated resources. FINDINGS: After initiating the Six Sigma project, there was a 60.5 percent reduction in data entry errors from 423 errors a month (i.e. 4.34 Six Sigma) in the first month, down to an average 166 errors/month (i.e. 4.65 Six Sigma) over 12 months. The team estimated the average cost of identifying and fixing a data entry error to be $16.25 per error. Thus, reducing errors by an average of 257 errors per month over one year has saved the laboratory an estimated $50,115 a year. PRACTICAL IMPLICATIONS: The Six Sigma QI project provides a replicable framework for Ugandan laboratory staff and other resource-limited organizations to promote quality environment. Laboratory staff can deliver excellent care at a lower cost, by applying QI principles. ORIGINALITY/VALUE: This innovative QI method of reducing data entry errors in medical laboratories may improve the clinical workflow processes and make cost savings across the health care continuum.

Elbireer A; Le Chasseur J; Jackson B

2013-01-01

 
 
 
 
201

The importance of improving the quality of emergency surgery for a regional quality collaborative.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. METHODS: We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. RESULTS: Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). CONCLUSIONS: Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

Smith M; Hussain A; Xiao J; Scheidler W; Reddy H; Olugbade K Jr; Cummings D; Terjimanian M; Krapohl G; Waits SA; Campbell D Jr; Englesbe MJ

2013-04-01

202

Quality improvement through consumer sorting and disposal  

UK PubMed Central (United Kingdom)

Sorting allows consumers to capture the value of quality differences. As higher quality goods are removed, the value of the seller's remaining stock falls, lowering the price and profits. Bundling and other marketing mechanisms can discourage sorting and prevent the depreciation of the seller's stock. With comparative statics and simulations, the author shows that sellers can increase expected quality and profits by committing to discard a proportion of their resale stock after sorting occurs. In this manner, sorting acts similarly to agricultural grading.

Ferrier Peyton

2009-01-01

203

Initiation from hemodialysis treatment: quality of life, feelings and difficulties  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: to know the perception of the chronic renal patient on quality of life. Methods: qualitative study, with patients that started the hemodialysis’ treatment from September 2007 to February 2008, in a hospital from Vale do Paraiba, São Paulo state. It were participated all patients with Chronic Renal Failure and excluding children under 18 and those with difficulty of communication. Data was organized and analyzed based on hermeneutics methodology. Results: 37 patients were studied, most males (23/62%), predominantly in the age of 51 to 60 years. In the subjects examined, 57% reported having received information about the hemodialysis, the first professional guidance through the medical and day-to-day treatment by the nursing staff. The information of the need for dialysis was received with mixed feelings as many, acceptance, concern, sadness, among others. It was observed that patients identify the food as the primary care related to their health. Conclusion: the upheld and reciprocity of health professionals as well as family support are factors that contribute to better adherence to treatment, helping them to live with the conflicting feelings, thus improving their quality of life.

Maria Leopoldino da Rocha, Sheila dos Santos Vieira, Sheyla de Oliveira Braga, Vanessa de Brito Poveda, Elizabeth Hoffman Sanchez

2009-01-01

204

O processo da avaliação institucional como multiplicador de iniciativas para o aperfeiçoamento docente: 2ª parte The institutional evaluation process as a multiplier of initiatives for quality improvement of the teaching staff: part 2  

Directory of Open Access Journals (Sweden)

Full Text Available O presente trabalho propõe uma reflexão a respeito do processo de avaliação institucional, especialmente da avaliação docente, como possibilidade de aperfeiçoamento didático-pedagógico de professores.This paper proposes an alternative reflection regarding the institutional evaluation process, in particular the evaluation of the teaching staff, as a possibility of didactic and pedagogic improvement of the professors.

Antonio Reges Brasil; Clara Irene Veiga Barbosa; Francisco de Paula Marques Rodrigues; Maria Dias Blois; Myriam Siqueira da Cunha; Regina Trilho Otero Xavier

2007-01-01

205

Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' – an emergent approach  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues.

Soper Bryony; Buxton Martin; Hanney Stephen; Oortwijn Wija; Scoggins Amanda; Steel Nick; Ling Tom

2008-01-01

206

Improvement in onychomycosis after initiation of combined antiretroviral therapy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Onychomycosis is frequent in patients with late and advanced HIV disease; immunocompromised patients may develop atypical clinical presentations that can be difficult to control. Current treatment for onychomycosis is based on the prolonged administration of antifungal therapies that may have significant interactions with combined antiretroviral therapy (cART). An improvement in certain HIV-associated opportunistic infections has been associated with initiation of cART. OBJECTIVES: The aim of this study was to analyze the influence of cART on the outcome of onychomycosis in HIV-infected patients. METHODS: HIV-infected patients with dermatologic lesions attending the National Institute of Respiratory Diseases were asked to undergo physical examination. Detailed clinical histories were recorded. Routine laboratory tests, CD4 T cell count, and HIV viral load were performed. Onychomycosis was diagnosed on the basis of clinical appearance. Nail scrapings were collected from toenails and fingernails. Specimens were analyzed using direct microscopy. Nail changes after cART initiation were assessed by clinical examination. RESULTS: Improvement in onychomycosis was observed in six patients with late and advanced HIV disease after initiation of cART. Complete resolution of onychomycosis was observed in one patient without the use of antifungal therapy; one patient required topical antifungal treatment, and two patients required systemic antifungal treatment to achieve complete resolution. CONCLUSIONS: Onychomycosis should be included in the group of pathologies that improve with cART-induced immune reconstitution. The pathogenesis of onychomycosis in HIV disease warrants investigation in the context of cell-mediated immunity restoration.

Moreno-Coutiño G; Arenas R; Reyes-Terán G

2013-03-01

207

Integrating quality improvement into pre-registration education.  

UK PubMed Central (United Kingdom)

Healthcare organisations around the world are adopting new strategies to improve the quality of patient care in response to reports of negative patient outcomes and cuts to public service expenditure. However, many nurses lack the knowledge, skills and attitude to improve the systems within which they work, calling for a radical redesign of nursing education to integrate quality improvement science. This article describes the integration of quality improvement education within undergraduate nursing education programmes in Wales through collaboration between higher education institutions, NHS Wales and the UK Institute for Healthcare Improvement Open School.

Jones A; Williams A; Carson-Stevens A

2013-03-01

208

Quality assurance and performance improvement in nursing homes: using evidence-based protocols to observe nursing care processes in real time.  

UK PubMed Central (United Kingdom)

The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.

Dellefield ME; Kelly A; Schnelle JF

2013-01-01

209

Total quality improvement: an example of an effective team.  

UK PubMed Central (United Kingdom)

Total quality improvement (TQI) advocates that all staff members in an organization develop their own ideas on job improvement about their own specific jobs. This process helps to improve staff performance and to build continually on those improvements. This article will describe how the TQI process was used successfully by quality management staff members at a federal medical center to investigate a problem with linen.

Miller D; Smith DJ; Brophy M; Mollman M; Owen J; Smith G; More C

1996-01-01

210

The role of the hospitalist in quality improvement: systems for improving the care of patients with acute coronary syndrome.  

UK PubMed Central (United Kingdom)

Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies.

Whelan CT

2010-09-01

211

Applying control charts to quality improvement.  

UK PubMed Central (United Kingdom)

This article reviews the definitions and principles that should guide the use of control charts in healthcare quality. Several examples from the literature are used to illustrate significant problems and issues in control chart construction.

Finison LJ; Finison KS

1996-11-01

212

IMPROVED AODV BASED ON LINK QUALITY METRICS  

Directory of Open Access Journals (Sweden)

Full Text Available The wireless interfaces in mobile ad-hoc networks (MANET) have limited transmission range; communication traffic is relayed over several intermediate nodes to ensure a communication link between two nodes. Since the destination is reached using multiple hops from the source, routing plays an important role in Ad hoc network reliability. Since the network is dynamic in nature, conventional routing protocol may not perform well during adverse conditions like poor link quality, high mobility. In this paper, a new MANET routing method based on Ad hoc On demand Distance Vector (AODV) and Ant Colony Optimization (ACO) is proposed for networks with varying levels of link quality. ACO is inspired from the biological behaviour of ants. Achievement of complex solutions with limited intelligence and individual capacity within these communities can be emulated in ad hoc networks. A new link quality metric is defined to enhance AODV routing algorithm so that it can handle link quality between nodes to evaluate routes.

Balaji V; V. Duraisamy

2012-01-01

213

Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care  

Science.gov (United States)

Over the past decade, there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases, including inflammatory bowel disease. Inflammatory bowel disease is a complex, chronic condition with associated morbidity, health care costs, and reductions in quality of life. The condition is managed primarily in the outpatient setting. The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity, the use of steroid-sparing agents, screening prior to anti-tumor necrosis factor therapy, and monitoring thiopurine therapy. This review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs, quality improvement frameworks, collaborative efforts in quality improvement, and the use of healthcare information technology.

Weizman, Adam V; Nguyen, Geoffrey C

2013-01-01

214

Improvement in the textural qualities of irradiated legumes  

International Nuclear Information System (INIS)

The potential for use of gamma radiation processing to improve texture, hydration and cooking quality of pulses, particularly red gram, has been examined. The textural changes in irradiated pulses in terms of softening is measured by a texturometer, Radiation (1 Mrad) processing of pulses resulted in reduction of cooking time varying from 8 to 39%, red gram showing the maximum reduction. Initial higher hydration rate on soaking and cooking, stabilized on prolonged cooking and resulted in better and uniform texture of irradiated red gram. In the uncooked, irradiated (1 Mrad) sample, destruction of riboflavin was negligible, whereas thiamine and niacin showed about 7% loss. However, the vitamins were retained better in the samples irradiated and then cooked, compared to the corresponding control ones. (F.J.)

1975-01-01

215

Global oximetry: an international anaesthesia quality improvement project.  

UK PubMed Central (United Kingdom)

Pulse oximetry is mandatory during anaesthesia in many countries, a standard endorsed by the World Health Organization 'Safe Surgery Saves Lives' initiative. The Association of Anaesthetists of Great Britain and Ireland, the World Federation of Societies of Anaesthesiologists and GE Healthcare collaborated in a quality improvement project over a 15-month period to investigate pulse oximetry in four pilot sites in Uganda, Vietnam, India and the Philippines, using 84 donated pulse oximeters. A substantial gap in oximeter provision was demonstrated at the start of the project. Formal training was essential for oximeter-naïve practitioners. After introduction of oximeters, logbook data were collected from over 8000 anaesthetics, and responses to desaturation were judged appropriate. Anaesthesia providers believed pulse oximeters were essential for patient safety and defined characteristics of the ideal oximeter for their setting. Robust systems for supply and maintenance of low-cost oximeters are required for sustained uptake of pulse oximetry in low- and middle-income countries.

Walker IA; Merry AF; Wilson IH; McHugh GA; O'Sullivan E; Thoms GM; Nuevo F; Whitaker DK

2009-10-01

216

Recent improvements in quality control at Quintette Operating Corporation  

Energy Technology Data Exchange (ETDEWEB)

Historical ash control at Quintette, recent process changes in the plant, improvement of coal recovery of blends, and bias tracking and quality control are described. An ash control chart was developed for use in the plant. Quality control was improved at the Quintette clean coal stockpiles at Ridley Terminals. The processing plant at Quintette Coal Limited was modified in 1992-93 to improve the efficiency of recovery of clean coal. Since the ash content of the seams are uneven, new problems with ash quality control resulted. The ash quality control problems and their solutions are discussed. 8 figs., 2 tabs.

Leeder, W.R.; Smith, R.J.; Blocka, R.L. [Quintette Operating Corporation, Tumbler Ridge, BC (Canada)

1994-12-31

217

How do we improve quality in primary dental care?  

UK PubMed Central (United Kingdom)

Quality improvement differs from quality assurance (which is retrospective in nature) in that it attempts to use a quality assessment cycle and focuses on the organisation or system of production as a whole. In this paper, the third in a series of three published in this Journal, we discuss the concept and evidence base of quality improvement, the main approaches that have been used in other healthcare settings and the importance of a multi-faceted strategy to address this issue. These topics are then related to the context of primary dental care and the way dentistry currently addresses quality improvement. Finally, we set out an agenda and provide recommendations for a system-based quality improvement strategy for primary dental care and identify the likely barriers and facilitators for this approach.

Campbell S; Tickle M

2013-09-01

218

A quality assurance initiative for commercial-scale production in high-throughput cryopreservation of blue catfish sperm.  

Science.gov (United States)

Cryopreservation of fish sperm has been studied for decades at a laboratory (research) scale. However, high-throughput cryopreservation of fish sperm has recently been developed to enable industrial-scale production. This study treated blue catfish (Ictalurus furcatus) sperm high-throughput cryopreservation as a manufacturing production line and initiated quality assurance plan development. The main objectives were to identify: (1) the main production quality characteristics; (2) the process features for quality assurance; (3) the internal quality characteristics and their specification designs; (4) the quality control and process capability evaluation methods, and (5) the directions for further improvements and applications. The essential product quality characteristics were identified as fertility-related characteristics. Specification design which established the tolerance levels according to demand and process constraints was performed based on these quality characteristics. Meanwhile, to ensure integrity throughout the process, internal quality characteristics (characteristics at each quality control point within process) that could affect fertility-related quality characteristics were defined with specifications. Due to the process feature of 100% inspection (quality inspection of every fish), a specific calculation method, use of cumulative sum (CUSUM) control charts, was applied to monitor each quality characteristic. An index of overall process evaluation, process capacity, was analyzed based on in-control process and the designed specifications, which further integrates the quality assurance plan. With the established quality assurance plan, the process could operate stably and quality of products would be reliable. PMID:23872356

Hu, E; Liao, T W; Tiersch, T R

2013-07-18

219

Improvement of image quality on image processing for radiography  

Energy Technology Data Exchange (ETDEWEB)

The contrast and the quality of images given by image processing on minimal defects of thickness metal have generally been low insufficient. To improve the contrast and the quality, we applied the X-ray TV-system which made it possible to reconstruct images by processing density histgrams using the integral calculus manner of input images. The result showed that the quality of images and perceptibility were improved. (author).

Handa, Madoka; Watanabe, Yoshihiko; Koike, Yuji [Tokyo Metropolitan Isotope Research Center (Japan)

1993-02-01

220

Evaluating and improving nurses' health and quality of work life.  

UK PubMed Central (United Kingdom)

This article discusses evaluating and improving the health and quality of work life (QOWL) of nurses. Nurses are reported to have higher illness, disability, and absenteeism rates than all other health care workers. Research suggests that QOWL impacts nurses' health and the provision of quality health care, particularly patient safety. Occupational health nurses have a pivotal role in evaluating and improving nurses' QOWL and health. This will ensure quality health outcomes for nurses and patients and reduce costs for the health care system.

Horrigan JM; Lightfoot NE; Larivière MA; Jacklin K

2013-04-01

 
 
 
 
221

EQUIPping ourselves for future quality improvements in colonoscopy.  

UK PubMed Central (United Kingdom)

Although colonoscopy is estimated to reduce colorectal cancer (CRC) mortality by about 50%, there is room for improvement. Quality improvement efforts to date have largely focused on adenoma detection rate (ADR). A few studies have now been successful in improving this measure. However, the question remains whether continued quality improvement should focus so heavily on this metric. Given the likely importance of the serrated pathway to the problem of post colonoscopy (or interval) cancer, future quality work should consider both the detection and resection of these lesions.

Robertson DJ

2013-02-01

222

Improving Quality in Education: Dynamic Approaches to School Improvement  

Science.gov (United States)

This book explores an approach to school improvement that merges the traditions of educational effectiveness research and school improvement efforts. It displays how the dynamic model, which is theoretical and empirically validated, can be used in both traditions. Each chapter integrates evidence from international and national studies, showing…

Creemers, Bert P. M.; Kyriakides, Leonidas

2011-01-01

223

Quality-of-care initiative in patients treated surgically for perforated peptic ulcer.  

UK PubMed Central (United Kingdom)

BACKGROUND: Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present study reports the results of this initiative. METHODS: This was a nationwide cohort study based on prospectively collected data, involving all hospitals caring for patients with PPU in Denmark. Details of patients treated surgically for PPU between September 2004 and August 2011 were reported to the Danish Clinical Register of Emergency Surgery. Changes in baseline patient characteristics and in seven QOC indicators are presented, including relative risks (RRs) for achievement of the indicators. RESULTS: The study included 2989 patients. An increasing number fulfilled the following four QOC indicators in 2010-2011 compared with the first 2 years of monitoring: preoperative delay no more than 6 h (59·0 versus 54·0 per cent; P = 0·030), daily monitoring of bodyweight (48·0 versus 29·0 per cent; P < 0·001), daily monitoring of fluid balance (79·0 versus 74·0 per cent; P = 0·010) and daily monitoring of vital signs (80·0 versus 68·0 per cent; P < 0·001). A lower proportion of patients had discontinuation of routine prophylactic antibiotics (82·0 versus 90·0 per cent; P < 0·001). Adjusted 30-day mortality decreased non-significantly from 2005-2006 to 2010-2011 (adjusted RR 0·87, 95 per cent confidence interval 0·76 to 1·00), whereas the rate of reoperative surgery remained unchanged (adjusted RR 0·98, 0·78 to 1·23). CONCLUSION: This nationwide quality improvement initiative was associated with reduced preoperative delay and improved perioperative monitoring in patients with PPU. A non-significant improvement was seen in 30-day mortality.

Møller MH; Larsson HJ; Rosenstock S; Jørgensen H; Johnsen SP; Madsen AH; Adamsen S; Jensen AG; Zimmermann-Nielsen E; Thomsen RW

2013-03-01

224

Quality improvement in pediatric inflammatory bowel disease: Moving forward to improve outcomes  

Science.gov (United States)

In recent years, pediatric health care has embraced the concept of quality improvement to improve patient outcomes. As quality improvement efforts are implemented, network collaboration (where multiple centers and practices implement standardized programs) is a popular option. In a collaborative network, improvement in the conduct of structural, process and outcome quality measures can lead to improvements in overall health, and benchmarks can be used to assess and compare progress. In this review article, we provided an overview of the quality improvement movement and the role of quality indicators in this movement. We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD), as well as other pediatric chronic illnesses. We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care, and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance. We aimed to assess current quality improvement efforts in pediatric IBD and other diseases, such as childhood asthma, childhood arthritis, and neonatal health. By doing so, we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.

Quach, Pauline; Nguyen, Geoffrey C; Benchimol, Eric I

2013-01-01

225

Improving housing quality as a marketing strategy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Prospective housing clients in Portugal face up a marked lack of information on the characteristics of housing products, which most often turn out to be very different to their expectations. This lack of information does not allow them to relate quality and cost adequately. Furthermore, housing prod...

Fernandes, Sílvia; Teixeira, José M. Cardoso; Lopes, Jorge

226

Active filters for power quality improvement  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This paper deals with problems related with harmonics in power system networks. Several international standards issued to control power quality problems are briefly described and some important methods to analyse electrical circuits with non-sinusoidal waveforms are introduced and evaluated. One of ...

Afonso, João L.; Silva, Henrique Jorge de Jesus Ribeiro da; Martins, Júlio S.

227

[Improving the quality of glass ocular prostheses  

UK PubMed Central (United Kingdom)

A critical analysis has been attempted of the current state-of-the-art in studying seleno-cadmium ruby glasses applicable for glass ocular prosthesis production. Better quality of these prostheses can be achieved by both the refinement of the ruby glass composition and by its strengthening (hardening) through proper methods.

Nadare?shvili TB; Pakhomova TS; Labutina LV; Kachko AL

1979-11-01

228

Nursing Homes: Federal Actions Needed to Improve Targeting and Evaluation of Assistance by Quality Improvement Organizations.  

Science.gov (United States)

In 2002, CMS contracted with Quality Improvement Organizations (QIO) to help nursing homes address quality problems such as pressure ulcers, a deficiency frequently identified during routine inspections conducted by state survey agencies. CMS awarded $117...

2007-01-01

229

Improving the Improved Modified Euler Method for Better Performance on Autonomous Initial Value Problems  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this paper was to propose a modification that would lead to a much improved approximation technique for the computation of the numerical solutions of initial value problems, particularly the autonomous type. The method that has been improved upon is our Improved Modified Euler method. By the simple modification effected, a much better performance was achieved, not just for the autonomous problem, but for the non-autonomous problem as well. The new method was also shown to be of order 2.

Abraham OCHOCHE

2008-01-01

230

Zero tolerance for failure. An AREVA initiative to improve reliability  

International Nuclear Information System (INIS)

[en] Significant improvements in fuel reliability have been realized over the past 2 decades, but total elimination of failures has remained elusive. Driving reliability to higher levels requires a philosophy that does not accept that even infrequent and isolated failures are inevitable - it was on this foundation that Areva's Zero Tolerance for Failure (ZTF) initiative was established. This is not in itself either a program or project, but a fundamental shift in the way of thinking about work according to the following four principles: - Failures are avoidable, - Zero failures are our goal, - We will respond rapidly to any failure, - We succeed when we fix failures in a way that precludes recurrence. The shift to a ZTF philosophy is a broad change in corporate culture that expands the concept of failure far beyond cases where fuel rod cladding integrity is breached. While this paper specifically illustrates the ways in which ZTF has shaped the company's response to enhancing fuel rod reliability, ZTF extends to any failures of fuel products to deliver expected levels of performance, manufacturing processes to meet specifications and high first-pass acceptance criteria, and beyond to error-free performance of engineering analyses and cycle design and licensing services. Application of ZTF to enhancing fuel reliability deploys efforts in the areas of manufacturing, human factors, design, R and D, processes and product strategy. In order to achieve the necessary improvements, a number of important actions have been initiated across regions and facilities. In addition to these global scale projects and measures, each region contributes by adopting measures which are relevant to its particular activities and market needs. (orig.)

2010-01-01

231

A quality improvement program in pathology  

Directory of Open Access Journals (Sweden)

Full Text Available Quality becomes an important measure for pathology reporting. Accreditation is one of the principal ways for quality assurance. In this study, Anatomic Pathology Checklist defined by College of American Pathologists is used as a guide by Quality Control Committee formed as a prerequisite for laboratory accreditation of our department to evaluate 1 year period, compare the results with previous periods and test the reliability of this reference. The committee choose 94 relevant criteria out of 104. Unmet criteria and causes for these are searched for. A Physician Satisfaction Survey was applied. A problem record notebook was put on desk to ascertain the problems throughout the process. Last results are compared with the first data; problems and solutions are discussed.At the end of the study, 87.2% of criteria were met. Priority was given to some of the problems according to the results of survey and evaluation of parameters. Average turnaround time decreased to 3.5 days when the pathologists were informed about this measurement. Frozen section turnaround time decreased to less than 20 minutes in 63% of cases after frozen section unit was transferred to the operating theatre. Notebook served for the quick catch up of problems and work-ups of solutions or prevention. Controls were formed for histochemistry and immunohistochemistry. Unmet 8 criteria were about turnaround time, intra- and interdepartmental consultation which requires extra work and concensus among people and, technical issues.Quality control and quality assurance methods should be used for reports bearing accurate diagnosis and data concerning treatment and, preparation for accreditation. By this way, working procedures are formed, problems are easily seen, favourable results as compared to pre-evaluation period could be obtained by discussion of suggested solutions.

Alp USUBÜTÜN; Özay GÖKÖZ; P?nar FIRAT; Arzu SUNGUR

2007-01-01

232

Improved initial osteoblast functions on amino-functionalized titanium surfaces.  

UK PubMed Central (United Kingdom)

Adhesion and spreading of cells on biomaterials are integrin-mediated processes. But recent findings indicate a key role of the cell membrane associated matrix substance hyaluronan (HA) in interface interactions. Because HA is a negatively charged molecule we assume that a biomaterial surface with an opposed charge could boost the first contact of the cell to the surface. Polished cp titanium (R(a)=0.19 microm) was coated with an amino-group containing plasma polymer (Ti PPA). For this purpose, a microwave excited, pulsed, low-pressure plasma was used. Additionally, collagen was immobilized on Ti PPA with polyethylene glycol diacid (PEG-DA), catalyzed by carbodiimide (CDI). The physico-chemical surface analytical techniques like XPS, FT-IR, water contact angle and zeta-potential verified the retention of the allylamine precursor structure. Human osteoblasts were cultured in serum-free Dulbecco's modified Eagle medium (DMEM). Adhesion and cell cycle phases were calculated by flow cytometry. Spreading and actin cytoskeleton were visualized by confocal microscopy. Gene expression of osteogenic markers was detected by real-time RT-PCR. Ti PPA is significantly advantageous concerning initial adhesion and spreading during the first hours of the cell contact to the surface. The proliferation of osteoblasts is positively influenced. Gene expression of the differentiation marker bone sialoprotein was upregulated after 24h. Our results demonstrate that functionalization of titanium with positively charged amino-groups is sufficiently enough to significantly improve initial steps of the cellular contact to the material surface.

Nebe B; Finke B; Lüthen F; Bergemann C; Schröder K; Rychly J; Liefeith K; Ohl A

2007-11-01

233

Care pathways to improve care co-ordination and quality between primary and hospital care for patients with radical prostatectomy: a quality improvement project.  

UK PubMed Central (United Kingdom)

BACKGROUND: Care pathways are widely used in hospitals to improve quality. There is a growing interest in extending care pathways into primary care. There is little evidence on the relationship between care pathways across the primary-hospital care continuum and improvement in quality of care. Members of primary and hospital care services in the region of Bruges (Belgium) developed a care pathway for radical prostatectomy patients. An evaluation of this care pathway encountered some problems. AIM: To assess if a revision of the care pathway would improve quality of care enhancing patient outcomes. METHODS: An exploratory trial was performed to test the feasibility of quality measurement, the possible intervention effect and recruitment. A pre-post-intervention postal survey was used. Quality of care was translated into process and outcome indicators. These indicators were measured in two groups receiving a postal questionnaire: one group before (pre-intervention) and another group after implementation (post-intervention). A Fisher's exact test was used to compare differences for dichotomous variables, and a Mann-Whitney U-test to compare ordinal and continuous variables. RESULTS: Observed improvements in process and outcome indicators were not statistically significant after correcting for multiple testing: 95.1% of patients received the information pack during the pre-operative consultation (versus 81.0% in the pre-intervention), 86.0% of the patients consulted a physiotherapist who specialised in pelvic floor muscle exercise treatment (versus 56.0% in the pre-intervention) and no patients experienced pain (versus 13.6% in the pre-intervention). No changes were observed for communication and co-ordination between caregivers. CONCLUSION: Given the background of scarce evidence on the quality improvement effect of care pathways between primary and hospital care, this exploratory trial provides information about the quality measurement, the possible intervention effect and recruitment. The quality improvement process is continuing as the hospital takes further initiatives to improve well-being.

Van Houdt S; Heyrman J; Vanhaecht K; Sermeus W; De Lepeleire J

2013-01-01

234

Improvement of supply quality in distribution systems  

Energy Technology Data Exchange (ETDEWEB)

The growing number of low-pulse power electronic loads in distribution networks causes an increasing line voltage distortion. At the same time a large portion of consumers are sensitive to deviations of the line voltage from its ideal sinusoidal waveform, which can also result from network faults or unbalanced loading. This paper describes the main power quality problems in distribution systems and ways of solving them by utilizing state of the art power electronic equipment, the so called Power Conditioner. (Author)

Povh, D.; Pregizer, K.; Weinhold, M.; Zurowski, R. [Siemans AG (Germany)

1997-12-31

235

Quality of Instruction Improved by Evaluation and Consultation of Instructors  

Science.gov (United States)

One aim of student evaluation of instruction is the improvement of teaching quality, but there is little evidence that student assessment of instruction alone improves teaching. This study tried to improve the effects of evaluation by combining evaluation with individual counselling in an institutional development approach. Evaluation was…

Rindermann, Heiner; Kohler, Jurgen; Meisenberg, Gerhard

2007-01-01

236

Beam quality improvement by joint compensation of amplitude and phase.  

UK PubMed Central (United Kingdom)

The M² factor could be decomposed as amplitude term and phase term. A method to improve the beam quality of laser beams is proposed. In our method, the amplitude and phase of a laser beam are both compensated in order to improve the beam quality completely. In experiment, a laser amplifier is set to modulate the amplitude to Gaussian type, and a deformable mirror is used to compensate the phase aberration. The laser beam is well compensated by our method; the beam quality factor of the laser is improved from 1.7 to 1.1.

Gong ML; Qiu Y; Huang L; Liu Q; Yan P; Zhang HT

2013-04-01

237

Progress in BGO quality improvement at Hitachi  

International Nuclear Information System (INIS)

[en] Hitachi BGO scintillators have been produced from crystal boules of typically 3 in. dia by 9 in. long. The typical BGO scintillator used for Positron Emission Tomography has a working energy resolution of about 10%. The energy resolutions of 2 in. dia by 2 in. long and 3 in. dia by 3 in. long scintillators are 13% and 20%, for 137Cs, respectively. For crystal growth of BGO, further research will be made for development of larger and higher quality scintillators to be utilized in every field such as nuclear physics and high energy physics

1982-01-01

238

Treatment: improvement or deterioration of water quality  

Energy Technology Data Exchange (ETDEWEB)

The formation of trihalomethanes through chlorination has shown very clearly that water treatment processes may adversely affect water quality. There are many more examples of such effects, including the following which are discussed in detail: 1. Formation of organohalogen compounds in addition to trihalomethanes by chlorination and other oxidation processes. 2. Formation of more polar, more biodegradable organics by ozonation for example, and the consequent increase in bacterial growth in the distribution system. 3. Formation and removal of organic and inorganic corrosion inhibitors by treatment, and the consequent higher heavy metal concentrations in tap water.

Kuehn, W.; Sontheimer, H.

1981-04-01

239

Quality Improvement of Business Critical Systems  

Directory of Open Access Journals (Sweden)

Full Text Available Today’s society is crucially dependent on software systems. The number of areas where functioning software is at the core of operation is growing steadily. Both financial systems and e-business systems relies on increasingly larger and more complex computer and software systems. To increase e.g. the reliability and performance of such systems we rely on a plethora of methods, techniques and processes specifically aimed at improving the development, operation and maintenance of such software. The Business Critical Systems generally seek to develop and evaluate methods to improve the support for development, operation and maintenance of Business Critical System and systems. Improving software processes relies on the ability to analyze previous projects and derive concrete improvement proposals.This paper is a part of the work done on the BCS basic research and development project (Business Critical System). The BCS project was funded by two small software companies, based at Hyderabad, Andhra Pradesh, India, as a basic R&D project in IT in the year 2004.

Mr. P. Jitendra Srinivas Kumar

2011-01-01

240

Improved initial osteoblast functions on amino-functionalized titanium surfaces.  

Science.gov (United States)

Adhesion and spreading of cells on biomaterials are integrin-mediated processes. But recent findings indicate a key role of the cell membrane associated matrix substance hyaluronan (HA) in interface interactions. Because HA is a negatively charged molecule we assume that a biomaterial surface with an opposed charge could boost the first contact of the cell to the surface. Polished cp titanium (R(a)=0.19 microm) was coated with an amino-group containing plasma polymer (Ti PPA). For this purpose, a microwave excited, pulsed, low-pressure plasma was used. Additionally, collagen was immobilized on Ti PPA with polyethylene glycol diacid (PEG-DA), catalyzed by carbodiimide (CDI). The physico-chemical surface analytical techniques like XPS, FT-IR, water contact angle and zeta-potential verified the retention of the allylamine precursor structure. Human osteoblasts were cultured in serum-free Dulbecco's modified Eagle medium (DMEM). Adhesion and cell cycle phases were calculated by flow cytometry. Spreading and actin cytoskeleton were visualized by confocal microscopy. Gene expression of osteogenic markers was detected by real-time RT-PCR. Ti PPA is significantly advantageous concerning initial adhesion and spreading during the first hours of the cell contact to the surface. The proliferation of osteoblasts is positively influenced. Gene expression of the differentiation marker bone sialoprotein was upregulated after 24h. Our results demonstrate that functionalization of titanium with positively charged amino-groups is sufficiently enough to significantly improve initial steps of the cellular contact to the material surface. PMID:17825608

Nebe, Barbara; Finke, Birgit; Lüthen, Frank; Bergemann, Claudia; Schröder, Karsten; Rychly, Joachim; Liefeith, Klaus; Ohl, Andreas

2007-08-01

 
 
 
 
241

Quality Improvement of an Acid Treated Fuel Oil  

Directory of Open Access Journals (Sweden)

Full Text Available The work on the quality improvement of fuel oil using acid treatment was carried out. The improvement of the fuel oil was done using sulphuric acid to remove contaminants. Sulphuric acid at different concentrations were mixed with the oil and kept at 45°C for four hours in the agitator vessel to allow reaction to take place. Acidic sludge was then drained off from the agitator and the oil was neutralized with sodium hydroxide. Centrifugation operation was used to extract the sulphonate dispersed in the oil. The treated and untreated oils were characterized for various properties and the results showed that the viscosity, total sulphur of fuel oil decreased from 6.0 to before 5.0 cst after acid treatment and 2.57 to 1.2225% w/w respectively while the flash point increased from 248 to 264°F. The water and sediment content increased from trace before to 0.6 after treatment. In addition, the calorific value increased from initial value of 44,368 to 44,805 and 44,715 kJ/kg at 50% and 75% conc. H2SO4 while decreasing with 85% and 90% conc. H2SO4. However, both carbon residue and ash content decreases with an increase in acid concentration.

Elizabeth Jumoke ETERIGHO; Moses Aderemi OLUTOYE

2008-01-01

242

Process safety improvement-Quality and target zero  

International Nuclear Information System (INIS)

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

2008-11-15

243

Process safety improvement--quality and target zero.  

Science.gov (United States)

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given. PMID:18374483

Van Scyoc, Karl

2008-02-17

244

The 1999 ICSI/IHI colloquium on clinical quality improvement--"quality: settling the frontier".  

UK PubMed Central (United Kingdom)

BACKGROUND: A Colloquium on Clinical Quality Improvement, "Quality: Setting the Frontier," held in May 1999, covered methods and programs in clinical quality improvement. Leadership and organizational behavior were the main themes of the breakout sessions; specific topics included implementing guidelines, applying continuous quality improvement (CQI) methods in preventive services and primary care, and using systems thinking to improve clinical outcomes. Three keynote addresses were presented. LEADERSHIP FOR QUALITY: James L. Reinertsen, MD (CareGroup, Boston), characterized the financial challenges faced by many health care organizations as a "clarion call" for leadership on quality. "The leadership imperative is to establish an environment in which quality can thrive, despite unprecedented, severe economic pressures on our health systems." LINKING GROUP AND ORGANIZATIONAL KNOWLEDGE TO IMPROVEMENT STRATEGIES: How do we make improvement more effective? G. Ross Baker, PhD (University of Toronto), reviewed what organizational literature says about making teams more effective, understanding the organizational context to enable improvement work, and augmenting existing methods for creating sustainable improvement. For example, he noted the increasing interest among may organizations in rapid-cycle improvement but cautioned that such efforts may work best where problems can be addressed by existing clinical teams (not cross-functional work groups) and where there are available solutions that have worked in other settings. IMPROVING THE ENVIRONMENT FOR QUALITY: Mark Chassin, MD (Mount Sinai School of Medicine, New York), stated that critical tasks for improving quality include increasing public awareness, engaging clinicians in improvement, increasing the investment in producing measures and improvement tools, and reinventing health care delivery, clinical education and training, and QI.

Palmersheim TM

1999-12-01

245

CONTRIBUTIONS OF WATER FILTRATION TO IMPROVING WATER QUALITY  

Science.gov (United States)

A variety of water quality improvements can be accomplished by properly operated filtration plants. These include reduction of turbidity, micro-organisms, asbestos fibers, color, trihalomethane precursors, and organics adsorbed to particulate matter. The focus of the paper is on ...

246

Controller Design of Power Quality-Improving Appliances  

Energy Technology Data Exchange (ETDEWEB)

This paper presents an innovative solution to power quality problems using power quality-improving (PQI) appliances. PQI appliances conduct currents that supplement and correct the sum of the other load currents within a premise. From the utility side, the premise housing a PQI appliance thus becomes an improved, if not ideal, utility customer. The PQI appliance improves both harmonic power quality and power factor while performing its normal function, such as heating water. In this paper, the water heater PQI appliance is used as an example to demonstrate the control circuit design and function. Both computer simulation results and laboratory experiment results are presented to demonstrate the effectiveness of the approach. The estimated costs of the PQI controller and of harmonic compensating filters are compared to show that the PQI appliance may be an economic way to provide power quality improvement at the building level.

Hammerstrom, Donald J.; Zhou, Ning; Lu, Ning

2007-05-01

247

METHOD FOR IMPROVING THE BUD QUALITY OF A PLANT  

UK PubMed Central (United Kingdom)

The present invention relates to the use of a compound, in particular of a derivative of phosphorous acid, especially of fosetyl-Al, for treating plants for the purpose of improving the bud quality thereof.

ROSATI DOMINIQUE; DE MAEYER LUK; CREEMERS PIET; SCHOOFS HILDE; DECKERS TOM

248

METHOD FOR IMPROVING THE BUD QUALITY OF A PLANT.  

UK PubMed Central (United Kingdom)

The present invention relates to the use of a compound, in particular of a derivative of phosphorous acid, especially of fosetyl-AI, for treating plants for the purpose of improving the bud quality thereof.

ROSATI DOMINIQUE; MAEYER LUK DE; CREEMERS PIET; SCHOOFS HILDE; DECKERS TOM

249

Patient safety and quality improvement education: a cross-sectional study of medical students’ preferences and attitudes  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Recent educational initiatives by both the World Health Organization and the American Association of Medical Colleges have endorsed integrating teaching of patient safety and quality improvement (QI) to medical students. Curriculum development should take into ac...

Teigland Claire L; Blasiak Rachel C; Wilson Lindsay A; Hines Rachel E; Meyerhoff Karen L; Viera Anthony J

250

Leadership – The Key Element in Improving Quality Management  

Directory of Open Access Journals (Sweden)

Full Text Available The present contribution is processed partial results of the survey application of leadership as one of the fundamental principles of quality management in organizations in the Slovak Republic. This survey was conducted in the research project VEGA No. 1/0229/08 Perspectives of quality management development in coherence with requirements of Slovak republic market. Results from the survey were the basis for proposals to improve the quality management in Slovak industrial organizations

Iveta Paulová; Miroslava M?kva

2011-01-01

251

The business case for health-care quality improvement.  

UK PubMed Central (United Kingdom)

The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

Swensen SJ; Dilling JA; Mc Carty PM; Bolton JW; Harper CM Jr

2013-03-01

252

Integrating quality improvement into continuing medical education activities within a community hospital system.  

UK PubMed Central (United Kingdom)

The integration of the Mercy Health System's quality improvement (QI) and continuing medical educational (CME) activities is described. With the implementation of computerized medical data, the opportunities for QI-focused CME are growing. The authors reviewed their regularly scheduled series and special CME programs to assess their impact on quality care processes. Clinical improvements were affected by combining national guidelines and advancements with local clinical data and interactions with physicians within interdisciplinary as well as specialty conferences. Case-based, multidisciplinary conferences lent themselves to this process to a greater extent than didactic conferences. The latter also could lead to QI when the topics were focused on specific quality initiatives that often are part of a national QI initiative. Although the authors consider these efforts to be at an intermediate stage of development, they have observed several QI/patient safety process improvements.

Eiser AR; McNamee WB Jr; Miller JY

2013-05-01

253

Towards Improving the Quality of Work Life in Education.  

Science.gov (United States)

|Addressing the need to consider ways in which the quality of educator work life can be improved, the author uses J. Walton's eight-point definition of the quality of work life as a framework for discussion. The eight points include (1) adequate and fair compensation, in which financial incentives are provided for advanced coursework; (2) safe and…

Wood, J. M.

254

Using Deming To Improve Quality in Colleges and Universities.  

Science.gov (United States)

|Of all the people known for stressing quality in industry, W. Edwards Deming is the pioneer. He stresses statistical process control (SPC) and a 14-point process for managers to improve quality and productivity. His approach is humanistic and treats people as intelligent human beings who want to do a good job. Twelve administrators in a…

Cornesky, Robert A.; And Others

255

The role of health plans in improving quality of care.  

UK PubMed Central (United Kingdom)

Regulations and accrediting bodies have charged health plans with assuring and improving the quality of care delivered to plan members. Now, health plans also have an opportunity to promote payment reform designed to align incentives so that plans, providers, employers, and patients can all focus on achieving high-quality care.

Barco D; Chauncey P

2013-03-01

256

Continuous quality improvement in dialysis units: basic tools.  

UK PubMed Central (United Kingdom)

Physicians and allied health professionals are expected to understand and participate in the assessment and improvement of the quality of care delivered to patients in end-stage renal disease (ESRD) treatment centers. Participating in the quality improvement process will bring clinicians into contact with special knowledge and skills drawn from the areas of statistical process control and industrial engineering. Some of the more frequently encountered of these concepts and tools are described.

McClellan WM; Goldman RS

2001-04-01

257

Physician-initiated follow-up contact improves patient satisfaction, provides opportunities to improve care.  

UK PubMed Central (United Kingdom)

Numerous studies have shown that follow-up contact with patients after they have received care in the ED can move the needle upward on patient satisfaction surveys. Many organizations give this responsibility to ancillary staff, but an initiative involving all 22 EDs within Kaiser Permanente's northern California region is challenging the treating providers to initiate this follow-up. Three years into the initiative, ED directors indicate that while obtaining physician buy-in of the practice was initially challenging, most now view the approach as an opportunity to improve care. A pilot of the approach found that there is little difference between phone contact and e-mail communications, although e-mail contact is much more efficient. Most providers take advantage of a web-based tool to make follow-up contact with patients via e-mail. The approach is a HIPAA-complaint process that enables providers to include confidential medical information within the e-mail communications. Providers say the follow-up contact gives them an opportunity to reinforce important medical instructions and to answer any questions the patient may have neglected to ask during the medical emergency. Administrators recommend that ED managers interested in implementing postED-visit contacts establish attainable goals for their providers and publish performance figures as means to improve adoption of the practice.

2013-06-01

258

Inside the health disparities collaboratives: a detailed exploration of quality improvement at community health centers.  

UK PubMed Central (United Kingdom)

BACKGROUND: Quality improvement collaboratives (QICs) based on the Chronic Care Model (CCM) are widely used models for improving medical care, but there has been little information to date about the specific projects undertaken by participants in these collaboratives and their outcomes. OBJECTIVES: To describe initiatives undertaken by community health centers (CHCs) participating in QICs (the Health Disparities Collaboratives) for asthma, cardiovascular disease, or diabetes, and to determine whether particular features of these initiatives were associated with improvement in health care processes or outcomes. RESEARCH DESIGN: Observational cohort study. DATA SOURCES/STUDY SETTING: Reports of quality improvement (QI) activities and clinical data from 40 CHCs participating in Health Disparities Collaboratives, 2000-2002. MEASURES: Clinical quality scores based on indicators of chronic disease care. RESULTS: Participating CHCs undertook an average of 44 QI activities per center (range, 8-84). These interventions were distributed broadly throughout the elements of the CCM, with particular emphasis on patient registry development and linkages to the surrounding community. Fifty-three percent of the interventions were fully institutionalized and 28% were evaluated by the centers. We found no relationships between improvement in quality and markers of QI activity quantity, intensity, or CCM category. CONCLUSIONS: Organizations participating in QICs fully integrate the CCM components into their QI activities. However, it remains unclear how specific activities pursued under the guidance of the CCM and QICs contribute to quality improvement.

Grossman E; Keegan T; Lessler AL; Ly MH; Huynh L; O'Malley AJ; Guadagnoli E; Landon BE

2008-05-01

259

Improvement of image quality in holographic microscopy.  

UK PubMed Central (United Kingdom)

A novel technique of noise reduction in holographic microscopy has been experimentally studied. It has been shown that significant improvement in the holomicroscopic images of actual low-contrast continuous tone biological objects can be achieved without trade off in image resolution. The technique makes use of holographically produced multidirectional phase gratings used as diffusers and the continuous addition of subchannel holograms. It has been shown that the self-imaging property of this type of diffuser makes the use of these diffusers ideal for microscopic objects. Experimental results have also been presented to demonstrate real-time image processing capability of this technique.

Budhiraja CJ; Som SC

1981-05-01

260

Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement.  

UK PubMed Central (United Kingdom)

Quality of care improvement has become a priority for decision-makers. Important variations in the quality and cost of care are being documented often without evidence of improved outcomes. Therapeutic advances are not consistently applied to practice despite efforts from professional organisations to create guidelines. The quality movement emerged following increasing evidence that the creation and measurement of quality indicators can improve quality of care and health outcomes. Quality indicators can measure healthcare system performance across providers, system levels and regions. In rheumatology, early efforts to develop quality measures have focused on examining all aspects of care while more recent efforts have focused on disease course monitoring. The American College Rheumatology has recently endorsed seven quality indicators for rheumatoid arthritis (RA) that are evidence based and measurable for use in routine rheumatology practices. This review provides an overview on quality indicators in rheumatology with a focus on RA, and discusses the application of quality measures into routine rheumatology practices to improve quality of care for RA.

Bombardier C; Mian S

2013-04-01

 
 
 
 
261

Evaluating and improving nurses' health and quality of work life.  

Science.gov (United States)

This article discusses evaluating and improving the health and quality of work life (QOWL) of nurses. Nurses are reported to have higher illness, disability, and absenteeism rates than all other health care workers. Research suggests that QOWL impacts nurses' health and the provision of quality health care, particularly patient safety. Occupational health nurses have a pivotal role in evaluating and improving nurses' QOWL and health. This will ensure quality health outcomes for nurses and patients and reduce costs for the health care system. PMID:23557346

Horrigan, Judith M; Lightfoot, Nancy E; Larivière, Michel A S; Jacklin, Kristen

2013-04-01

262

Creating effective quality-improvement collaboratives: a multiple case study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness. STUDY SETTING: 182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy. STUDY DESIGN: Multiple case before-after study. DATA COLLECTION: 75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers). PRINCIPAL FINDINGS: The degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets. CONCLUSIONS: The effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs.

Strating MM; Nieboer AP; Zuiderent-Jerak T; Bal RA

2011-04-01

263

Radiation technology of improved quality materials production  

International Nuclear Information System (INIS)

The technology of materials production from metals and alloys with high operational properties is developed. The technology is based on use of radiation methods in powder metallurgy. Use of radiation processing allows to improve technological conditions of sintering. It is established, that in certain regimes the sintering temperature is decreasing from 1200 deg C up to 950 deg C in the result of radiation processing of stainless steel powders . According to the processing regimes it is possible load reduction by powder pressing on 15-20 % and sintering time in to 1,5 - 2 times . The radiation methods give possibility to produce high qualitative goods from cheap powder materials without use energy-intensive processes and prolonged processing of finished products

1997-01-01

264

40 CFR Appendix D to Part 132 - Great Lakes Water Quality Initiative Methodology for the Development of Wildlife Criteria  

Science.gov (United States)

...2009-07-01 false Great Lakes Water Quality Initiative Methodology for...Appendix D to Part 132âGreat Lakes Water Quality Initiative Methodology for...Introduction A. A Great Lakes Water Quality Wildlife Criterion...

2009-07-01

265

Power quality improvement with an extended custom power park  

Energy Technology Data Exchange (ETDEWEB)

This paper describes the operation principles of an extended custom power park (CPP). The proposed park is more effective when it is compared to the conventional power parks regarding the yield of improving both current and voltage quality of linear and nonlinear loads using dynamic voltage restorer (DVR), active power filter (APF), static transfer switch (STS) and diesel generator (DG). Moreover, a supervisory power quality control centre is presented to coordinate these custom power (CP) devices by providing pre-specified quality of power. A fast sag/swell detection unit is also presented to improve the system response. The ability of the extended CPP for power quality improvements is further analyzed using PSCAD/EMTDC through a set of simulation tests. (author)

Meral, M. Emin; Teke, Ahmet; Bayindir, K. Cagatay; Tumay, Mehmet [Cukurova University, Department of Electrical and Electronics Engineering, Balcali, 01330, Adana (Turkey)

2009-11-15

266

Sources of Indoor Air Pollution- Improving Indoor Air Quality  

Science.gov (United States)

There are three basic strategies to improve indoor air quality: source control, improved ventilation, and air cleaners. This site offers the reader some insights to improving air quality through increased ventilation, air cleaners for particle removal, and other common sense methods that may be employed. Many times the quality of the air in our homes and public or office buildings is marginal at best. The sources of indoor pollution may be outside of our ability to rectify or it may be as simple as adjusting the flame on our furnace or kitchen stove or maybe something as simple as opening a door or window. However, in many instances we have no control over the air quality because of the materials used in the construction of the building.

2007-01-21

267

Improving the quality of bed separation  

Energy Technology Data Exchange (ETDEWEB)

The problem of preventing water influx during operation of oil beds at certain fields of the association ''Udmurtneft''' is the most acute. Of the drillable fields, the El'nikovskiy field has the most flooded wells in the initial period of operation (1-4 months). In 1977 every second well here produced oil with water. The productive beds in this field are represented by sandstones and aleurolites of the Yasnopolyanskiy substage and limestones of Tournaisian stage. The water beds located below the oil are characterized by high permeability, and the thickness of their stripped part is less than 10 m. In certain cases, in drilling in intervals of occurrence of these beds, absorption of the drilling fluid is observed. This article presents wells which indicated that into the well from the lower water-bearing beds on channels into the transpipe space through perforated openings made in the interval of occurrence of the oil beds water penetrates. In many wells, the results of geophysical studies indicate the poor fusion of the cement stone with the rock in the near-face well zone. In order to reveal the reasons and to prevent flooding of wells, an analysis was also made of the condition of the equipment and the technology of well reinforcement. Processing of the field material indicated that at the Yel'nikovskiy field, of the 26 studied factors, especial attention should be drawn to the thickness of the argillaceous crust, permeability and intake capacity of the lower lying water beds. Therefore measures were taken to reduce permeability of the water-bearing bed in the near-face zone before lowering of the casing. Experiments are now being conducted at other fields of the association.

Bikbulatov, I.Kh.; Makhumetsafina, G.R.

1982-01-01

268

Lean management systems: creating a culture of continuous quality improvement.  

Science.gov (United States)

This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management. PMID:23757036

Clark, David M; Silvester, Kate; Knowles, Simon

2013-06-11

269

Lean management systems: creating a culture of continuous quality improvement.  

UK PubMed Central (United Kingdom)

This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

Clark DM; Silvester K; Knowles S

2013-08-01

270

Improving fracture initiation predictions on arbitrarily oriented wells in anisotropic shales  

Energy Technology Data Exchange (ETDEWEB)

Hydraulic fracturing stimulation of unconventional organic shale reservoirs is usually implemented in horizontal wells. This requires the identification of sections along the well with good reservoir and completion quality. Shales are known to exhibit anisotropic elastic properties. This paper presents the process of improving fracture initiation predictions on arbitrarily oriented wells in anisotropic shales. The elastic anisotropic properties of shales are of the first order as four key geomechanical steps affect them. These are: stress concentration around the borehole, failure properties in tension and compression, hydraulic fracture geometry, and in-situ stress field. A thorough sensitivity analysis of in-situ stress, material anisotropy and well orientation conditions for three different scenarios was performed. The study shows that the scenario 3, or the full anisotropic scenario, is the most appropriate for predicting initiation pressures. It was also clear that the observed effects are amplified by the degree of anisotropy of the rock.

Prioul, Romain; Karpfinger, Florian; Deenadayalu, Chaitanya; Suarez-Rivera, Roberto [Schlumberger (United States)

2011-07-01

271

What really went wrong? Root cause determination study and improvement initiative results.  

Science.gov (United States)

Many incident investigations stop before identifying the real root cause or all root causes. In 2004 with the implementation of a new corporate-wide incident reporting electronic database, an evaluation was made possible as to the quality of incident investigations and reports at all sites within the case study organization. After reviewing almost 1,000 incident reports, the Occupational and Process Safety expertise teams in this organization determined a need for improvement in the determination of the real Root Causes of the incidents and development of appropriate Corrective Actions. A communication and training initiative across multiple functional groups ensued to enable all sites within the organization to better understand why incidents were happening and to develop Corrective Actions to successfully prevent recurrence of the same or related incidents. This paper will give a brief background of the initiative, demonstrate what activities were undertaken and illustrate the success of this approach. PMID:18374484

Kiihne, Gregg M

2008-03-10

272

Early-career registered nurses' participation in hospital quality improvement activities.  

UK PubMed Central (United Kingdom)

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

Djukic M; Kovner CT; Brewer CS; Fatehi FK; Bernstein I

2013-07-01

273

Design and Simulation of STATCOM to Improve Power Quality  

Directory of Open Access Journals (Sweden)

Full Text Available The performance of power systems decreases with the size, the loading and the complexity of the networks. This is related to problems with load flow, power oscillations and voltage quality. Such problems are even deepened by the changing situations resulting from deregulation of the electrical power markets, where contractual power flows do no more follow the initial design criteria of the existing network configuration. Additional problems can arise in case of large system interconnections, especially when the connecting AC links are weak. FACTS devices, however, provide the necessary features to avoid technical problems in the power systems and they increase the transmission efficiency. This paper presents a study on the design of a shunt connected FACTS device (STATCOM) and investigates the application of this device to control voltage dynamics and to damp out the oscillation in electric power system. STATCOM is one of the key shunt controllers in flexible alternating current transmission system (FACTS) to control the transmission line voltage and can be used to enhance the load ability of transmission line and extend the voltage stability margin. In this paper, the proposed shunt controller based on the voltage source converter topology as it is conventionally realized by VSC that can generate controllable current directly at its output terminal. The performance and behavior of this shunt controller is tested in 3-machine 9-bus system as well as the performance is compared in the test system with and without STATCOM at three cases in MATLAB/Simulink. Simulation results prove that the modeled shunt controller is capable to improve the Power quality significantly.

Md. Nazrul Islam; Md. Arifur Kabir; Yashiro Kazushige

2013-01-01

274

The software improvement process - tools and rules to encourage quality  

International Nuclear Information System (INIS)

The Applications section of the CERN accelerator controls group has decided to apply a systematic approach to quality assurance (QA), the 'Software Improvement Process' - SIP. This process focuses on three areas: the development process itself, suitable QA tools, and how to practically encourage developers to do QA. For each stage of the development process we have agreed on the recommended activities and deliverables, and identified tools to automate and support the task. For example we do more code reviews. As peer reviews are resource intensive, we only do them for complex parts of a product. As a complement, we are using static code checking tools, like FindBugs and Checkstyle. We also encourage unit testing and have agreed on a minimum level of test coverage recommended for all products, measured using Clover. Each of these tools is well integrated with our IDE (Eclipse) and give instant feedback to the developer about the quality of their code. The major challenges of SIP have been to 1) agree on common standards and configurations, for example common code formatting and Javadoc documentation guidelines, and 2) how to encourage the developers to do QA. To address the second point, we have successfully implemented 'SIP days', i.e. one day dedicated to QA work to which the whole group of developers participates, and 'Top/Flop' lists, clearly indicating the best and worst products with regards to SIP guidelines and standards, for example test coverage. This paper presents the SIP initiative in more detail, summarizing our experience since two years and our future plans. (authors)

2012-01-01

275

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. METHODS: THE HOSPITAL INFORMATION SYSTEM IN SEOUL NATIONAL UNIVERSITY HOSPITAL CONSISTS OF COMPONENT APPLICATIONS: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. RESULTS: Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. CONCLUSIONS: Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system.

Choi J; Kim JW; Seo JW; Chung CK; Kim KH; Kim JH; Kim JH; Chie EK; Cho HJ; Goo JM; Lee HJ; Wee WR; Nam SM; Lim MS; Kim YA; Yang SH; Jo EM; Hwang MA; Kim WS; Lee EH; Choi SH

2010-12-01

276

Improvement of Initiating Events Analsis in Low-Power and Shutdown PSA for Korea Standard Nuclear Power Plant  

International Nuclear Information System (INIS)

In this study, we have improved the methodology of the initiating event identification for the KSNP LPSD PSA to complement the deficiency obtained from Review of KSNP LPSD PSA Mode based on ANS LPSD PSA Standard. To improve the quality of initiating event analysis, we integrated three systematic approachs for this purpose such as Master Logic Diagram, the empirical approach using domestic and international operating experience and the engineering approach. And we have identified 22 initiation events finally. We could got a basis and satisfied a structured, systematic process for initiating event identification demanded in ANS LPSD PSA Standard. But the sufficient completeness of initiating event analysis for LPSD PSA, the domestic low power and shutdown operating experience for overhaul and un-planed outages analysis is also needed.

2005-01-01

277

Improvement of Initiating Events Analsis in Low-Power and Shutdown PSA for Korea Standard Nuclear Power Plant  

Energy Technology Data Exchange (ETDEWEB)

In this study, we have improved the methodology of the initiating event identification for the KSNP LPSD PSA to complement the deficiency obtained from Review of KSNP LPSD PSA Mode based on ANS LPSD PSA Standard. To improve the quality of initiating event analysis, we integrated three systematic approachs for this purpose such as Master Logic Diagram, the empirical approach using domestic and international operating experience and the engineering approach. And we have identified 22 initiation events finally. We could got a basis and satisfied a structured, systematic process for initiating event identification demanded in ANS LPSD PSA Standard. But the sufficient completeness of initiating event analysis for LPSD PSA, the domestic low power and shutdown operating experience for overhaul and un-planed outages analysis is also needed.

Park, Jin Jee; Jang, Seung Chul; Lim, Ho Gon

2005-04-15

278

Improving overtriage of aeromedical transport in trauma: a regional process improvement initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Aeromedical transport (AMT) is an effective but costly means of rescuing critically injured patients. Although studies have shown that it improves survival to hospital discharge compared with ground transportation, an efficient threshold or universal criteria for this mode of transport remains to be established. Herein, we examined the effect of implementing a Trauma Advisory Committee (TAC) initiative focused on reducing AMT overtriage (OT) rates. METHODS: TAC outreach coordinators implemented a process improvement (PI) initiative and collected data prospectively from January 2007 to December 2011. OT was defined as patients who were airlifted from scene and later discharged from the emergency department. Serving as liaisons to surrounding counties, TAC outreach coordinators conducted quarterly PI meetings with local emergency medical service agencies. Patients were grouped into those who were airlifted from TAC counties versus counties outside TAC's jurisdiction (non-TAC). Standard statistical methods were used. RESULTS: From 2007 to 2011, 3,349 patients were airlifted from 30 counties, 1,427 (43%) from TAC counties and 1,922 (57%) from non-TAC counties. The OT rates from TAC counties declined compared with non-TAC counties each year and reached statistical significance in 2008 (17% vs. 23%, p < 0.05), 2009 (11% vs. 17%m p < 0.05), and 2011 (6% vs. 12%, p < 0.05). The reduction in OT continued over the study duration, with improvement in TAC counties compared with previous years. CONCLUSION: Implementation of a regional TAC PI initiative focused on OT issues led to a more efficient use of AMT. LEVEL OF EVIDENCE: Prognostic study, level III; therapeutic study, level IV.

Wormer BA; Fleming GP; Christmas AB; Sing RF; Thomason MH; Huynh T

2013-07-01

279

International Trauma Teleconference: Evaluating Trauma Care and Facilitating Quality Improvement.  

UK PubMed Central (United Kingdom)

Abstract Background: Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. Materials and Methods: In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. Results: During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage protocol on two occasions; it was determined that imaging resources were adequately used in half of the cases; the initial care was mostly provided by emergency room physicians; and a surgeon, operating room, and intensive care unit were not readily available 83% of the time. The ease of patient flow was cumbersome because of a lack of a structured system for trauma care except for one academic urban center. Adequate trauma resources are present in less than 50% of the time. Multidisciplinary resources, quality improvement programs, protocols, and guidelines were deficient. Conclusions: A well-structured international teleconference can be used as a dynamic window of observation to evaluate and identify deficiencies in trauma care in the Latin American region. These findings can be used to formulate specific recommendations based on local resources. Furthermore, by raising local awareness, leaders could be identified to become the executors of more efficient healthcare policies that can potentially affect trauma care.

Parra MW; Castillo RC; Rodas EB; Suarez-Becerra JM; Puentes-Manosalva FE; Wendt LM 3rd

2013-07-01

280

'Wading through treacle': quality improvement lessons from the frontline.  

UK PubMed Central (United Kingdom)

In a time of financial uncertainty and structural reform, the National Health Service (NHS) in England needs clinical leadership to help improve the quality of patient care. Increasingly, leadership development is being targeted at doctors in postgraduate training to help prepare them for their future leadership roles as consultants and general practitioners. However, there is a risk that we are missing an opportunity here by failing to recognise the role that doctors in training can play now, during their training. As our frontline clinicians they have a unique view of the health service and the inefficiencies therein. The London Deanery has been running an educational programme called Beyond Audit to provide doctors in training with quality improvement skills. During this programme we have been given a unique insight into NHS systems as viewed by junior doctors. They have identified a wide range of small system problems that, when combined, result in large-scale inefficiency and prevent the delivery of high quality patient care. These problems they identify have implications for cost, efficiency, patient safety, team-working and patient experience. Any attempt to improve the quality of care delivered in the NHS needs to look at the system from the point of view of those delivering the care, including our doctors in postgraduate training. By empowering them to make improvements to the systems that they see, there is the potential to make significant improvement in the quality of patient care that they deliver.

Roueche A; Hewitt J

2012-03-01

 
 
 
 
281

Quality improvement in small office settings: an examination of successful practices.  

UK PubMed Central (United Kingdom)

BACKGROUND: Physicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives. METHODS: We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities. RESULTS: Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers. CONCLUSION: These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.

Wolfson D; Bernabeo E; Leas B; Sofaer S; Pawlson G; Pillittere D

2009-01-01

282

Contributing to quality improvement at Rocky Flats Plant  

Energy Technology Data Exchange (ETDEWEB)

In the last three years the Statistical Applications group at Rocky Flats Plant (RFP) in Golden, Colorado has made significant progress towards implementing a sound quality improvement plan. The statistics group has used a combination of education, training and hands on experience to promote new thinking at the plant. The ideas have progressed over several years and go hand in hand with the new attitudes on quality now sweeping the country. In the context of immediate concerns from the manufacturing and development areas at the plant Statistical Applications at RFP developed a specific process development strategy that included basic concepts of quality improvement. This paper outlines the seemingly long road to implementation and change, documents certain specific successes and describes the plan now in progress by the statistics group for adding to the quality picture at Rocky Flats and the statisticians' role in that picture.

Halteman, E.J.; Ikle, D.N.; Lawton, B.B.

1987-01-01

283

Enzymatic treatment to improve the quality of black tea extracts  

UK PubMed Central (United Kingdom)

Enzymatic extraction was investigated to improve the quality of black tea extracts with pretreatment of pectinase and tannase independently, successively and simultaneously. Pectinase improved the extractable-solids-yield (ESY) up to 11.5%, without much of an improvement in polyphenols recovery, while tannase pre-treatment showed a significant improvement in polyphenols recovery (14.3%) along with an 11.1% improvement in ESY. Among the four treatments, tannase-alone treatment showed the maximum improvement in tea quality, with higher polyphenols-in-extracted solids. Treatments involving tannase resulted in the significant release of gallic acid, due to its hydrolytic activity, leading to greater solubility besides favourably improving TF/TR ratio. The results suggested that employing a single enzyme, tannase, for the pre-treatment of black tea is desirable. Enzymatic extraction may be preferred over enzymatic clarification as it not only displayed reduction in tea cream and turbidity but also improved the recovery of polyphenols and ESY in the extract, as well as maintaining a good balance of tea quality.

Chandini SK; Rao LJ; Gowthaman MK; Haware DJ; Subramanian R

2011-08-01

284

Improving quality, service delivery and patient experience in a musculoskeletal service.  

UK PubMed Central (United Kingdom)

The purpose of this quality improvement initiative was to enhance service delivery and patient experience in a musculoskeletal out-patient setting. A cross-sectional survey, with 6 annual stages, evaluated the musculoskeletal outpatient physiotherapy service in a large National Health Service hospital in Southern England. The population comprised 1095 patients, referred by medical staff to the service from rheumatology, orthopaedics, pain clinic and occupational health departments. The individual clinician-initiated strategies for quality improvement included: cue cards; reminders; reflections and training. The systems-changes comprised revised documentation and booking systems. The primary outcome was patient experience, measured with the Chartered Society of Physiotherapy's standardised 'Patients feedback' questionnaire. Attendance data was a secondary outcome. This initiative showed that strategies to motivate individual clinicians to change their behaviour were unsuccessful, whereas system-changes resulted in 32/37 improvements (8 statistically significant) in patient experience. Furthermore, the revised systems resulted in a 6% decrease in wasted appointments. It is essential that clinical services are evaluated through the eyes of their users. This initiative demonstrates the value of service evaluations (alongside research) and the importance of patient feedback to show how it can drive change and positively impact upon health-care experiences. Furthermore, this work has shown that active implementation strategies with systems-level changes produced greater improvements in service quality and patient experience, than simply encouraging and supporting clinicians to change their behaviour.

Roberts L

2013-02-01

285

Proposed standards for the design and conduct of a national clinical audit or quality improvement study.  

UK PubMed Central (United Kingdom)

PURPOSE: The purposes were to find and synthesize available literature on explicit or implicit standards for the design and conduct of a national activity that involves measuring and facilitating improvement of the quality of patient care, such as a national clinical audit or a quality improvement (QI) study, and to develop proposed standards for the design and conduct of the national activity. DATA SOURCES, SELECTION AND ANALYSIS: The literature was searched to identify key aspects of good practice in the conduct of national or international clinical audits, QI studies, performance or quality indicator measurements or equivalent national initiatives that have the purpose of driving improvement in the quality of care provided in a healthcare system. Key aspects of good practice in design or operation of these activities were abstracted from the literature, and organized logically into standard statements according to the stages in the design or conduct of such an activity. RESULTS: Thirty standards for the design and conduct of a national clinical audit or QI study were derived from the published literature. The standards are on structural, process and outcome aspects of any national activity that involves measuring and improving healthcare services. Most of the standards focus on measurement processes. CONCLUSION: It is hoped that these proposed standards for a national clinical audit or QI study will facilitate debate on how to assure the quality of these national activities. Activities that meet accepted standards may be more effective in influencing participating sites to achieve improvements in the quality of care.

Dixon N

2013-09-01

286

The ongoing quality improvement journey: next stop, high reliability.  

UK PubMed Central (United Kingdom)

Quality improvement in health care has a long history that includes such epic figures as Ignaz Semmelweis, the nineteenth-century obstetrician who introduced hand washing to medical care, and Florence Nightingale, the English nurse who determined that poor living conditions were a leading cause of the deaths of soldiers at army hospitals. Systematic and sustained improvement in clinical quality in particular has a more brief and less heroic trajectory. Over the past fifty years, a variety of approaches have been tried, with only limited success. More recently, some health care organizations began to adopt the lessons of high-reliability science, which studies organizations such as those in the commercial aviation industry, which manage great hazard extremely well. We review the evolution of quality improvement in US health care and propose a framework that hospitals and other organizations can use to move toward high reliability.

Chassin MR; Loeb JM

2011-04-01

287

Initial evaluation of quality indicators for psychosocial care of adults with cancer.  

UK PubMed Central (United Kingdom)

BACKGROUND: The American Psychosocial Oncology Society has developed the first indicators of the quality of psychosocial care for cancer patients. This report describes the initial evaluation of these indicators. METHODS: Medical records of 388 colorectal cancer patients first seen by a medical oncologist in 2006 at seven practice sites were reviewed by trained abstractors whose accuracy was documented by periodic checks. RESULTS: Rates of assessment of emotional well-being within 1 month of a patient's first visit with a medical oncologist ranged from 6% to 84% (mean = 60%; P < .001). Among the 45 patients identified as having a problem with emotional well-being, rates of evidence of action taken (or explanation for no action) ranged from 0% to 100% (mean = 51%; P = .85). A direct comparison showed that pain was assessed more often than emotional well-being in these patients (87% vs 60%, P < .001). CONCLUSIONS: Findings show these indicators can be measured easily and reliably, demonstrate variability across practices that suggests potential for improvement, and yield information that can be used to take actions to improve quality. Additional findings suggest that, to date, efforts to promote routine symptom assessment have been more successful for pain than for emotional well-being.

Jacobsen PB; Shibata D; Siegel EM; Lee JH; Alemany CA; Brown R; Cartwright TH; Levine RM; Smith JC; Abesada-Terk G Jr; Malafa MP

2009-10-01

288

The neurology quality-of-life measurement initiative.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe the development and calibration of the banks and scales of the Quality of Life in Neurological Disorders (Neuro-QOL) project, commissioned by the National Institute of Neurological Disorders and Stroke to develop a bilingual (English/Spanish), clinically relevant, and psychometrically robust health-related quality-of-life (HRQOL) assessment tool. DESIGN: Classic and modern test construction methods were used, including input from essential stakeholder groups. SETTING: An online patient panel testing service and 11 academic medical centers and clinics from across the United States and Puerto Rico that treat major neurologic disorders. PARTICIPANTS: Adult and pediatric patients representing different neurologic disorders specified in this study, proxy respondents for select conditions (stroke, pediatric conditions), and English- and Spanish-speaking participants from the general population. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Multiple generic and condition-specific measures used to provide construct validity evidence for the new Neuro-QOL tool. RESULTS: Neuro-QOL has developed 14 generic item banks and 8 targeted scales to assess HRQOL in 5 adult (stroke, multiple sclerosis, Parkinson's disease, epilepsy, amyotrophic lateral sclerosis) and 2 pediatric conditions (epilepsy, muscular dystrophies). CONCLUSIONS: The Neuro-QOL system will continue to evolve, with validation efforts in clinical populations and new bank development in health domains not presently included. The potential for Neuro-QOL measures in rehabilitation research and clinical settings is discussed.

Cella D; Nowinski C; Peterman A; Victorson D; Miller D; Lai JS; Moy C

2011-10-01

289

An agenda for quality improvement in forensic mental health consultation.  

UK PubMed Central (United Kingdom)

Recent developments in quality assurance in health care have embraced the total quality management approach to industrial quality control. Setting a goal of "continuous quality improvement" for medical care, this approach features special attention to the process and systems of care provision. Applying this approach to the specialty of forensic mental health consultation yields a variety of potential ways of improving care, by articulating common problems in the consultation process that might respond to the total quality management approach. These problems include the setting of appropriate goals for forensic evaluation, and selecting cases for attention on the basis of those goals; determining appropriate standards for thoroughness and validity in the use of evaluation techniques; and establishing clear expectations regarding the provision of mental health services beyond the consultation process itself. Creating interdisciplinary teams at various levels of administration of trial courts and mental health agencies can provide contexts for reviewing cases, with the aim of discovering problems in these areas, educating professionals across boundaries about sources of problems, and developing clearer and more consistent standards of practice to reduce problems and improve quality of service.

Barnum R

1993-01-01

290

A new quality assessment and improvement system for print media  

Science.gov (United States)

Print media collections of considerable size are held by cultural heritage organizations and will soon be subject to digitization activities. However, technical content quality management in digitization workflows strongly relies on human monitoring. This heavy human intervention is cost intensive and time consuming, which makes automization mandatory. In this article, a new automatic quality assessment and improvement system is proposed. The digitized source image and color reference target are extracted from the raw digitized images by an automatic segmentation process. The target is evaluated by a reference-based algorithm. No-reference quality metrics are applied to the source image. Experimental results are provided to illustrate the performance of the proposed system. We show that it features a good performance in the extraction as well as in the quality assessment step compared to the state-of-the-art. The impact of efficient and dedicated quality assessors on the optimization step is extensively documented.

Liu, Mohan; Konya, Iuliu; Nandzik, Jan; Flores-Herr, Nicolas; Eickeler, Stefan; Ndjiki-Nya, Patrick

2012-12-01

291

Software Metrics to Improve Software Quality in HEP  

UK PubMed Central (United Kingdom)

The ALEPH reconstruction program maintainability has been evaluatedwith a case tool implementing an ISO standard methodology based on softwaremetrics. It has been found that the overall quality of the program is good andhas shown improvement over the past five years. Frequently modified routinesexhibit lower quality; most bugs were located in routines with particularly lowquality. Implementing from the beginning a quality criteria could have avoidedtime losses due to bug corrections.1 Introduction1.1 What is a software metric?Software metrics refer to measurement criteria for computer software1. Theyare primarily used to define quality and productivity measurements. Twotypes of measurements exists. Direct measurements which are concerned withsize and speed and indirect measurements which evaluate complexity, maintainabilityor quality. Software metrics are generally applied in large "professional" software projects2.1.2 General frameworkLarge and long life c...

E. Lancon; C. E. Saclay

292

Ontario primary care reform and quality improvement activities: an environmental scan.  

UK PubMed Central (United Kingdom)

BACKGROUND: Quality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province. METHODS: Data were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior's approach to document analysis in an iterative process. RESULTS: The environmental scan identified many activities (n=43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked. CONCLUSIONS: Within the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

Sibbald SL; McPherson C; Kothari A

2013-01-01

293

Next generation quality, Part 2: Balanced scorecards and organizational improvement.  

UK PubMed Central (United Kingdom)

Part 1 of this two-part series defined a new quality paradigm called the next generation quality model. This model applies the principles of the Malcolm Baldrige Criteria for Performance Excellence to clinical processes. The model's components are clinical pathways, variance management systems, stream-lined patient documentation, and continuous improvement. Part 2 extends the next generation quality model, describes the principles and applications of integrated performance measurement systems, and explains how measurement systems are adapted to different levels of an organization to effect change.

Luttman RJ

1998-11-01

294

Next generation quality, Part 2: Balanced scorecards and organizational improvement.  

Science.gov (United States)

Part 1 of this two-part series defined a new quality paradigm called the next generation quality model. This model applies the principles of the Malcolm Baldrige Criteria for Performance Excellence to clinical processes. The model's components are clinical pathways, variance management systems, stream-lined patient documentation, and continuous improvement. Part 2 extends the next generation quality model, describes the principles and applications of integrated performance measurement systems, and explains how measurement systems are adapted to different levels of an organization to effect change. PMID:10338710

Luttman, R J

1998-11-01

295

Maize dryers technology improvements and grain agroindustrial quality  

Energy Technology Data Exchange (ETDEWEB)

In the early 1980, the hot air temperature increase in maize dryers gave rise to quality problems for industrial users of this production (especially starch industry). Increase of air temperature from 90 to 140{sup 0}C leads to biochemical modifications of the endosperm constituents. Corrections of heterogeneity in hot air temperature, and especially in air and grain flows show, on industrial dryers, a real quality increase without having to lower too much temperature, and consequently productivity. Improvements in drying process (rest areas, slow cooling, or two steps drying) put in evidence the possibility of having simultaneously quality, low energy consumption, productivity and drying low cost. 8 refs.; 11 figs.

Lasseran, J.C.

1990-01-01

296

The CCLM contribution to improvements in quality and patient safety.  

UK PubMed Central (United Kingdom)

Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

Plebani M

2013-01-01

297

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe].  

UK PubMed Central (United Kingdom)

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus.

Kolozsvári LR; Rurik I

2013-07-01

298

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe].  

Science.gov (United States)

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus. PMID:23835354

Kolozsvári, László Róbert; Rurik, Imre

2013-07-14

299

INTEGRATED SAFETY MANAGEMENT SYSTEM SAFETY CULTURE IMPROVEMENT INITIATIVE  

Energy Technology Data Exchange (ETDEWEB)

In 2007, the Department of Energy (DOE) identified safety culture as one of their top Integrated Safety Management System (ISMS) related priorities. A team was formed to address this issue. The team identified a consensus set of safety culture principles, along with implementation practices that could be used by DOE, NNSA, and their contractors. Documented improvement tools were identified and communicated to contractors participating in a year long pilot project. After a year, lessons learned will be collected and a path forward determined. The goal of this effort was to achieve improved safety and mission performance through ISMS continuous improvement. The focus of ISMS improvement was safety culture improvement building on operating experience from similar industries such as the domestic and international commercial nuclear and chemical industry.

MCDONALD JA JR

2009-01-16

300

INTERNATIONAL TENDENCIES OF INFOMATIZATION DEVELOPMENT AND IMPROVEMENT OF EDUCATION QUALITY ?????????? ????????? ???????? ?????????????? ?????? ?? ?????????? ?? ??????  

Directory of Open Access Journals (Sweden)

Full Text Available In the article actual tendencies of educational system informatization development in the world are analyzed. There are stated the basic advantages of information and communication technologies (ICT) use in the educational process. It is presented experience of the coordination of national standards with international ones in the different countries of the world which will give the chance to Ukraine to be guided for improvement of education quality, that means improvement of information technologies (I?) quality. As Ukraine is a part of the European and international information and educational space, therefore in this branch there should be a development responding to the level of other countries.? ?????? ???????????? ????????? ????????? ???????? ?????????????? ?????? ?????? ? ?????. ? ?????? ????????? ??????? ???????? ???????????? ????????????-?????????????? ?????????? (???) ? ??????? ????????. ?????????????? ?????? ?????????? ???????????? ?????????? ?? ???????????? ? ?????? ??????? ?????, ?????????? ????? ????? ?????????? ???????????? ?????????? ?????? ??????, ?????? ?????????? ?????? ????????????? ?????????? (??) ? ???????. ???????? ??????? ?????? ?? ????????? ? ???????????? ???????? ???????, ??????????? ??????? ?????????? ?????? ??? ???????? ?????? ?? ?????????????? ????? ??????? ??????????.

?.?. ??????????; A.?. ????; K.?. ???????

2011-01-01

 
 
 
 
301

Quality improvement in a primary care case management program.  

UK PubMed Central (United Kingdom)

In this article we describe and evaluate quality monitoring and improvement activities conducted by Massachusetts Medicaid for its primary care case management program, the primary care clinician plan (PCC). Emulating managed care organization (MCO) practices, the State uses claims to analyze and report service delivery rates on the practice level and then works directly with individual medical practices on quality improvement (QI) activities. We discuss the value and limitations of claims-based data for profiling, report provider perspectives, and identify challenges in evaluating the impact of these activities. We also provide lessons learned that may be useful to other States considering implementing similar activities.

Walsh EG; Osber DS; Nason CA; Porell MA; Asciutto AJ

2002-01-01

302

IMPROVEMENT FOR TOFU QUALITY AND MICROBIOLOGICAL STABILITY USING ULTRACOLD COOLING  

UK PubMed Central (United Kingdom)

PURPOSE: A quality improvement method for bean curd by ultra-low temperature aging the bean curd is provided to prevent the generation of microorganism, and to reduce the unique flavor of soybeans from the bean curd. CONSTITUTION: A quality improvement method for bean curd comprises the following steps: aging the bean curd after freezing at the ultra-low temperature for 24-72 hours packaging the aged bean curd and distributing the bean curd by maintaining the temperature lower than 5 deg C. The ultra-low temperature is 1-3 deg C.

RYU YUNG GI; YEO IK HYUN; KANG CHANG SOO; CHO SUNG BIN; KIM YEON O; LEE CHANG HYUN; LEE MIN GEUN

303

Translation enhancer improves the ribosome liberation from translation initiation.  

UK PubMed Central (United Kingdom)

For translation initiation in bacteria, the Shine-Dalgarno (SD) and anti-SD sequence of the 30S subunit play key roles for specific interactions between ribosomes and mRNAs to determine the exact position of the translation initiation region. However, ribosomes also must dissociate from the translation initiation region to slide toward the downstream sequence during mRNA translation. Translation enhancers upstream of the SD sequences of mRNAs, which likely contribute to a direct interaction with ribosome protein S1, enhance the yields of protein biosynthesis. Nevertheless, the mechanism of the effect of translation enhancers to initiate the translation is still unknown. In this paper, we investigated the effects of the SD and enhancer sequences on the binding kinetics of the 30S ribosomal subunits to mRNAs and their translation efficiencies. mRNAs with both the SD and translation enhancers promoted the amount of protein synthesis but destabilized the interaction between the 30S subunit and mRNA by increasing the dissociation rate constant (koff) of the 30S subunit. Based on a model for kinetic parameters, a 16-fold translation efficiency could be achieved by introducing a tandem repeat of adenine sequences (A20) between the SD and translation enhancer sequences. Considering the results of this study, translation enhancers with an SD sequence regulate ribosomal liberation from translation initiation to determine the translation efficiency of the downstream coding region.

Takahashi S; Furusawa H; Ueda T; Okahata Y

2013-09-01

304

The development of a quality assurance project plan for the USEPA dioxin exposure initiative program  

Energy Technology Data Exchange (ETDEWEB)

All projects planned and implemented under the United States Environmental Protection Agency (USEPA) Dioxin Exposure Initiative are required to have completed Quality Assurance Projects Plans (QAPPs). EPA Order 5360.1 A2 states, ''All work funded by the United States Environmental Protection Agency (EPA) that involves the acquisition of environmental data generated from direct measurement activities, collected from other sources, or compiled from computerized data bases and information systems are implemented in accordance with an approved QA Project Plan except under circumstances requiring immediate actions to protect human health and the environment or operations conducted under police powers''. This policy is based on the newly revised national consensus standard, ANSI/ASQC E-4-2004. These QAPPs have proven invaluable in the development and improvement of analytical methodology for dioxin-like compounds over the intervening years and in the verification and validation of the results of dioxin exposure studies.

Byrne, C.; Ferrario, J. [Stennis Space Center, MS (USA). USEPA Environmental Chemistry Laboratory

2004-09-15

305

A quality initiative. Reducing rates of hospitalizations by objectively monitoring volume removal.  

Science.gov (United States)

Morbidity, hospitalizations, and costs for the treatment of individuals with end-stage renal disease are simply not improving at a rate that is acceptable to many physicians and dialysis providers in the United States. Various conferences and papers have suggested what processes need to become part of the dialysis prescription to accelerate change. Controlling cardiovascular disease is a part of that change, and controlling extra-cellular volume (ECV) is necessary to accomplish this. Three dialysis providers joined in a quality initiative to objectively assess the ultrafiltration process and measure "normalized" ECV, with the outcome objective to decrease ECV-related hospitalizations. The results show a decrease in ECV-related hospitalizations by 50%. The model of dialysis prescription needs to now change to Kt/V + objective ECV control. PMID:23581174

Parker, Tom F; Hakim, Raymond; Nissenson, Allen R; Krishnan, Mahesh; Bond, T Christopher; Chan, Kevin; Maddux, Franklin W; Glassock, Richard

2013-03-01

306

A quality initiative. Reducing rates of hospitalizations by objectively monitoring volume removal.  

UK PubMed Central (United Kingdom)

Morbidity, hospitalizations, and costs for the treatment of individuals with end-stage renal disease are simply not improving at a rate that is acceptable to many physicians and dialysis providers in the United States. Various conferences and papers have suggested what processes need to become part of the dialysis prescription to accelerate change. Controlling cardiovascular disease is a part of that change, and controlling extra-cellular volume (ECV) is necessary to accomplish this. Three dialysis providers joined in a quality initiative to objectively assess the ultrafiltration process and measure "normalized" ECV, with the outcome objective to decrease ECV-related hospitalizations. The results show a decrease in ECV-related hospitalizations by 50%. The model of dialysis prescription needs to now change to Kt/V + objective ECV control.

Parker TF 3rd; Hakim R; Nissenson AR; Krishnan M; Bond TC; Chan K; Maddux FW; Glassock R

2013-03-01

307

Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. DESIGN/METHODOLOGY/APPROACH: The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. FINDINGS: Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. ORIGINALITY/VALUE: The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

Millar R

2013-01-01

308

The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement.  

UK PubMed Central (United Kingdom)

BACKGROUND: Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging. METHODS: We conducted a year-long quality improvement project involving internal medicine residents at an academic medical centre. Resident champions designed and implemented a discharge summary improvement bundle, which employed an educational curriculum, an electronic discharge summary template, regular data feedback and a financial incentive. The timeliness and quality of discharge summaries were measured before and after the intervention. Residents and faculty were surveyed about their perceptions of the project; primary care providers were surveyed about their satisfaction with hospital provider communication. RESULTS: With implementation of the bundle, the average time from patient discharge to completion of the discharge summary fell from 3.5 to 0.61 days (p<0.001). The percentage of summaries completed on the day of discharge rose from 38% to 83% (p<0.001) and this improvement was sustained for 6 months following the end of the project. The percentage of summaries that included all recommended elements increased from 5% to 88% (p<0.001). Primary care providers reported a lower likelihood of discharge summaries being unavailable at the time of outpatient follow-up (38% to 4%, p<0.001). Residents reported that the systems changes, more than the financial incentive, accounted for their behaviour change. CONCLUSIONS: Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.

Bischoff K; Goel A; Hollander H; Ranji SR; Mourad M

2013-09-01

309

Intensive-care unit lungs - possibilities to improve the quality  

International Nuclear Information System (INIS)

X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the X-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the X-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest X-ray, is emphasized. (orig.)

1984-01-01

310

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.  

UK PubMed Central (United Kingdom)

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.

Gordon DB; Pellino TA; Miaskowski C; McNeill JA; Paice JA; Laferriere D; Bookbinder M

2002-12-01

311

[Quality improvement: recommendations for risks and irregularities management].  

UK PubMed Central (United Kingdom)

This document describes the different steps to implement for the risk management system in a medical laboratory. The risk management and the treatment of non-conformities are two essential pieces in the continuous improvement of quality system. Taking into account, according to the requirements, the non-conformities leads to immediately remedial action, with corrective action to avoid recurrence is a real task for information and continuous improvement.

Pernas P

2013-06-01

312

Is this the right patient? An educational initiative to improve compliance with two patient identifiers.  

Science.gov (United States)

A rehabilitation nursing unit implemented an educational initiative to improve compliance with two patient identifiers. The education consisted of a poster presentation and then, 2 months later, a mandatory in-service education program. Compliance with two patient identifiers improved, although more improvement was demonstrated after the mandatory in-service. The results of this performance improvement project suggest that investing time and money in safety initiatives improves staff practice patterns. PMID:19489521

Mollon, Deene' L; Fields, Willa L

2009-05-01

313

Is this the right patient? An educational initiative to improve compliance with two patient identifiers.  

UK PubMed Central (United Kingdom)

A rehabilitation nursing unit implemented an educational initiative to improve compliance with two patient identifiers. The education consisted of a poster presentation and then, 2 months later, a mandatory in-service education program. Compliance with two patient identifiers improved, although more improvement was demonstrated after the mandatory in-service. The results of this performance improvement project suggest that investing time and money in safety initiatives improves staff practice patterns.

Mollon DL; Fields WL

2009-05-01

314

A resident-led institutional patient safety and quality improvement process.  

UK PubMed Central (United Kingdom)

The authors used a multipronged approach to gain resident involvement in institutional quality improvement over a 3-year period; the initiative included a survey, a retreat, workgroups, a resurvey, and another retreat. Survey results (from 2007 compared with those of 2010) demonstrated significant improvement in almost all the top issues concerning patient safety for residents-emergency department boarding and crowding, adequacy of patient flow through the institution, adequacy of nursing and technical support staffing, and laboratory specimen handling (initial overall mean concern level was 2.87, and final concern level was 2.19; P < .01). This perceived improvement in patient safety concerns for residents was associated with observable improvements in areas of high concern for hospital leaders. By surveying residents and students, prioritizing concerns, convening a hospital-wide retreat with key leaders, and implementing accountable plans, the authors have demonstrated that resident perceptions of quality and safety can help drive quality improvement and engage residents in improvement efforts at an institutional level.

Stueven J; Sklar DP; Kaloostian P; Jaco C; Kalishman S; Wayne S; Doering A; Gonzales D

2012-09-01

315

Quality management science in clinical chemistry: a dynamic framework for continuous improvement of quality.  

UK PubMed Central (United Kingdom)

Current quality assurance approaches will not be adequate to satisfy the needs for quality in the next decade. Quality management science (QMS), as evolving in industry today, provides the dynamic framework necessary to provide continuous improvement of quality. QMS emphasizes the importance of defining quality goals based on the needs and expectations (implied needs) of customers. The laboratory can develop customer-friendly goals and measures of quality by recognizing that customers' experiences are represented by a totality of results. Quality goals and measures are best communicated as "total performance" by specifying a limit and percentile of the distribution, rather than a mean and standard deviation. Application of quality goals within the laboratory will usually require partitioning the total performance goal into components and translating those components into specifications to guide the operation and management of production processes. QMS also extends beyond technical processes to people processes and provides guidance for improving the quality of worklife and caring for the laboratory's most essential resource--our people.

Westgard JO; Burnett RW; Bowers GN

1990-10-01

316

ACHIEVING IRRIGATION RETURN FLOW QUALITY CONTROL THROUGH IMPROVED LEGAL SYSTEMS  

Science.gov (United States)

The key to irrigated agricultural return flow quality control is proper utilization and management of the resource itself, and an accepted tool in out society is the law. This project is designed to develop legal alternatives that will facilitate the implementation of improved wa...

317

Evaluating an Improved Quality Preschool Program in Rural Bangladesh  

Science.gov (United States)

|An important goal of education in developing countries is to implement and improve early childhood education. A pre-post intervention-control design was used to compare a piloted-revised versus a regular preschool program offered by an organization in rural Bangladesh. After 7 months in operation, the quality of the piloted-revised program was…

Moore, Anna C.; Akhter, Sadika; Aboud, Frances E.

2008-01-01

318

Quality Improvement of Multispectral Images for Ancient Document Analysis.  

Czech Academy of Sciences Publication Activity Database

blind source deconvolutionKód oboru RIV: JD - Využití po?íta??, robotika a její aplikace http://library.utia.cas.cz/separaty/2010/ZOI/zitova-quality%20improvement%20of%20multispectral%20images%20for%20ancient%20document%20analysis.pdf

Bianco, G.; Bruno, F.; Salerno, E.; Tonazzini, A.; Zitová, BarbaraG; Šroubek, Filip

319

[Structured documentation in gastroscopy: a method for improved quality assurance?].  

Science.gov (United States)

To further improve quality assurance of gastrointestinal endoscopy, a computer assisted documentation system for gastroscopic data was assessed. In this context, for the structured written recording system, parameters "expenditure of time" and "acceptance by doctors" was evaluated. Contrary to free, unstructured data recording, the structured system employing predefined terms was able to promote doctors' acceptance of endoscopic terminology standards. PMID:7801658

Jacob, U; Foerster, E C; Stettin, J; Schübbe, H; Domschke, W

1994-09-01

320

[Structured documentation in gastroscopy: a method for improved quality assurance?  

UK PubMed Central (United Kingdom)

To further improve quality assurance of gastrointestinal endoscopy, a computer assisted documentation system for gastroscopic data was assessed. In this context, for the structured written recording system, parameters "expenditure of time" and "acceptance by doctors" was evaluated. Contrary to free, unstructured data recording, the structured system employing predefined terms was able to promote doctors' acceptance of endoscopic terminology standards.

Jacob U; Foerster EC; Stettin J; Schübbe H; Domschke W

1994-09-01

 
 
 
 
321

Software quality and process improvement in scientific simulation codes  

Energy Technology Data Exchange (ETDEWEB)

This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

Ambrosiano, J.; Webster, R. [Los Alamos National Lab., NM (United States)

1997-11-01

322

Biking improves the air quality; Fietsen schept lucht  

Energy Technology Data Exchange (ETDEWEB)

The Dutch Association for Cyclists is looking for ways to create more interest for the use of bikes in the debate on improving the air quality in the Netherlands. [Dutch] De Fietsersbond zoekt naar mogelijkheden om de fiets hoger op de agenda te krijgen in het debat over de luchtkwaliteit in Nederland.

Borgman, F. [Fietsersbond, Utrecht (Netherlands)

2007-06-15

323

Quality improvement in North Carolina's public health departments.  

UK PubMed Central (United Kingdom)

North Carolina has been a leader in the application of quality improvement (QI) to public health practice. Over the past decade, numerous developments have served to accelerate the adoption of QI in North Carolina's local health departments. The outstanding results from the widespread application of QI should help North Carolina to become a healthier state.

Randolph GD; Bruckner J; See CH

2013-03-01

324

Continuous Quality Improvement and Adult Education: Common Principles, Common Practices.  

Science.gov (United States)

|Adult education and Continuous Quality Improvement (CQI) have at least 10 areas of commonality, the most obvious being that they are both client centered. They have gone against the grain of excessive specialization by becoming advocates for interdisciplinary learning and interconnected functions. (JOW)|

Buchen, Irving H.

1995-01-01

325

Quality characteristics improvement of low-phenylalanine toast bread  

UK PubMed Central (United Kingdom)

This study was designed to prepare and evaluate low-phenylalanine toast bread made from gliadin-free wheat flour and hydrocolloids. Wheat protein fraction (gliadin) rich in phenylalanine was extracted using aqueous alcohol solution for the production of low-phenylalanine wheat flour. Pectin, gum arabic and carboxymethylcellulose (CMC) were used separately to improve the quality of bread at levels of 1, 2 and 3%. Chemical, rheological, organoleptic, baking, staling and microstructure of bread were studied. Phenylalanine content of gliadin-free bread samples reduced by 43.2% compared with control. Separation of gliadin negatively affected the rheological properties of dough and baking quality of bread, while rheological properties, baking quality and staling were improved upon hydrocolloids addition. Microscopic examination of crumb structure revealed remarkable differences in control and treated breads. It was found that acceptable bread could be produced using gliadin-free wheat flour with the addition of pectin or CMC up to 2 and 3%, respectively.

Mohsen SobhyM; Yaseen AttiaA; Ammar AbdallaM; Mohammad AymanA

2010-10-01

326

AIP: a proposed mechanism for evaluating adherence improvement initiatives.  

Science.gov (United States)

Pharmacy prescription databases are useful for determining rates of adherence to long-term medication therapy. Thus far, however, analyses based on such databases have provided only snapshots of adherence rates over discrete time intervals and have been of limited usefulness for the timely measurement of adherence trends when adherence improvement strategies change over time. The Adherence Index of Performance is new mechanism that can be used to monitor pharmacy prescription databases over time to detect changes that occur when adherence improvement strategies are changed during a therapeutic period. PMID:16020399

Day, David

327

AIP: a proposed mechanism for evaluating adherence improvement initiatives.  

UK PubMed Central (United Kingdom)

Pharmacy prescription databases are useful for determining rates of adherence to long-term medication therapy. Thus far, however, analyses based on such databases have provided only snapshots of adherence rates over discrete time intervals and have been of limited usefulness for the timely measurement of adherence trends when adherence improvement strategies change over time. The Adherence Index of Performance is new mechanism that can be used to monitor pharmacy prescription databases over time to detect changes that occur when adherence improvement strategies are changed during a therapeutic period.

Day D

2005-03-01

328

Applying PPM to ERP Maintenance and Continuous Improvement Initiatives  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Enterprise Resource Planning Systems (ERP) has been implemented in many companies during the last decade and has gained an increasing significance. For many companies it means that the focus is no longer on how to implement the ERP system, but rather on how to maintain and improve the system to gain...

El-Tal, Nada Maria; Fonnesbæk, Majbrit; Kræmmergaard, Pernille

329

Codifying Implementation Guidelines for a Collaborative Improvement Initiative  

Science.gov (United States)

The application of action learning in inter-organizational settings is largely undeveloped. This article presents a description of and reflection on an action learning approach to enabling collaborative improvement in the extended manufacturing enterprise. The article focuses in particular on implementing the action learning approach. However, the…

Coughlan, Paul; Coghlan, David

2008-01-01

330

A measurement instrument for spread of quality improvement in healthcare.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread and sustainability of changed work practices were also explored to assess convergent validity. DESIGN: We developed and tested a measurement instrument for spread in a follow-up study. The instrument consisted of 18-items with four subscales. SETTING AND PARTICIPANTS: The sample consisted of former improvement teams in a quality improvement program for long-term care (nteams = 73, nrespondents = 127). Data were collected in a questionnaire about 1 year post-pilot site improvement implementation. INTERVENTIONS: Quality improvements in long-term care practices. MAIN OUTCOME MEASURES: Four variables were construed: (i) actions for spread of work practices, (ii) actions for spread of results, (iii) effectiveness of spread of work practices and (iv) effectiveness of spread of results. RESULTS: Psychometric analysis yielded positive results on the item level. The intended four-factor model yielded satisfactory fit. The internal consistency of each scale was fine (Cronbach's ? 0.70-0.93). Bivariate correlations revealed that the spread variables were strongly related but distinct, and positively related to the sustainability variables. CONCLUSIONS: The psychometric properties are in line with methodological standards. Convergent validity was confirmed with sustainability. The measurement instrument offers a good starting point for the analysis of spread.

Slaghuis SS; Strating MM; Bal RA; Nieboer AP

2013-04-01

331

Pay for performance improves quality across demographic groups.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate quality and the effect of pay for performance among minority patient groups, during a pay-for-performance program in 22 primary care practice sites. METHODS: Data were collected on 26 standardized measures of care for 2 measurement cycles. Proportions of recommended care received across 5 composite quality domains were analyzed by demographic group. Regression models including significant covariates were constructed. Adjusted odds ratios (ORs) were derived to assess the effect of pay of performance within demographic groups. RESULTS: Improvements were observed from 2007 to 2009 for all patients in each of 5 composite quality domains of diabetes, coronary artery disease, heart failure, screening and prevention, and all care. With the exception of heart failure care for Hispanic/Latino and Spanish language-preferring patients, improvement was observed in all domains for African American/black race, Hispanic/Latino ethnicity, and Spanish language-preferred groups. Following adjustment for covariates, pay for performance was associated with significant improvement in all-patient diabetes care (adjusted OR = 1.15; [95% confidence interval [CI], 1.09-1.22), screening and prevention (adjusted OR = 1.55; 95% CI, 1.41-1.69), and all care (adjusted OR = 1.27; 95% CI, 1.20-1.35). Significant improvements were also observed within the minority demographic groups noted earlier. CONCLUSIONS: Pay-for-performance programs structured as additional incentive monies for providers improved care for all patients and among minority groups, in whom disparities have historically been observed.

Bhalla R; Schechter CB; Strelnick AH; Deb N; Meissner P; Currie BP

2013-07-01

332

The role of quality control circles in sustained improvement of medical quality.  

UK PubMed Central (United Kingdom)

We used quality control circles (QCC) followed by the PDCA Deming cycle and analyzed the application of QCC to the sustained improvement of a medical institution in Zhejiang province. Analyses of the tangible and intangible achievements of QCC revealed that the achievement indices for reductions in internal errors, reductions in costs, improvements in the degree of patient satisfaction, improvements in work quality, and improvements in economic performance were 109.84% ± 16.47%, 135.04% ± 50.33%, 126.26% ± 53.69%, 100.58% ± 22.83%, and 104.07% ± 5.45%, respectively. The improvements in these areas were 61.12% ± 13.2%, 60.47% ± 28.91%, 34.41% ± 22.96%, 49.22% ± 25.39%, and 73.70% ± 5.24%, respectively. The intangible achievements were reflected as follows: 5% of QCC members showed an activity growth value of 1-2 points, 83% 1-2 points, 12% more than 2 points. As a result, QCC activity showed prominent results in fostering long-lasting improvement in the quality of medical institutions in terms of both tangible and intangible factors. In short, QCC can be used as an effective tool to improve medical quality.

Wang LR; Wang Y; Lou Y; Li Y; Zhang XG

2013-12-01

333

An Initial Look at the Quality of Life of Malaysian Families That Include Children with Disabilities  

Science.gov (United States)

Background: While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual…

Clark, M.; Brown, R.; Karrapaya, R.

2012-01-01

334

Research on Improving Manufacturing Practice Quality in Mechanical Industrial Design  

Directory of Open Access Journals (Sweden)

Full Text Available In order to solve the problems existing in the manufacturing practice of mechanical industrial design, a series of methods and concrete measures are proposed, so as to improve the quality of manufacturing practice of mechanical industrial design. In this study, the problems existing in the manufacturing practice of mechanical industrial design are analyzed detailedly. And the methods and concrete measures including establishing the new mode of manufacturing practice of mechanical industrial design, improving the understanding to manufacturing practice and knowing the major role, establishing a professional characteristic base of manufacturing practice and strengthening the construction of instructor troops of manufacturing practice are proposed, which will certainly have a profound theoretical and practical guiding significance. On this foundation, the research conclusion on improving manufacturing practice quality in mechanical industrial design is done.

Xiaowei Jiang

2013-01-01

335

The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality.  

UK PubMed Central (United Kingdom)

Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

Song Z; Safran DG; Landon BE; Landrum MB; He Y; Mechanic RE; Day MP; Chernew ME

2012-08-01

336

The hybrid progress note: semiautomating daily progress notes to achieve high-quality documentation and improve provider efficiency.  

UK PubMed Central (United Kingdom)

Health care institutions are moving toward fully functional electronic medical records (EMRs) that promise improved documentation, safety, and quality of care. However, many hospitals do not yet use electronic documentation. Paper charting, including writing daily progress notes, is time-consuming and error prone. To improve the quality of documentation at their hospital, the authors introduced a highly formatted paper note template (hybrid note) that is prepopulated with data from the EMR. Inclusion of vital signs and active medications improved from 75.5% and 60% to 100% (P < .001), respectively. The use of unapproved abbreviations in the medication list decreased from 13.3% to 0% (P < .001). Prepopulating data enhances provider efficiency. Interviews of key clinician leaders also suggest that the initiative is well accepted and that documentation quality is enhanced. The hybrid progress note improves documentation and provider efficiency, promotes quality care, and initiates the development of the forthcoming electronic progress note.

Kargul GJ; Wright SM; Knight AM; McNichol MT; Riggio JM

2013-01-01

337

40 CFR Appendix A to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Aquatic Life Criteria and...  

Science.gov (United States)

... 2010-07-01 2010-07-01 false Great Lakes Water Quality Initiative Methodologies for Development of Aquatic...132, App. A Appendix A to Part 132âGreat Lakes Water Quality Initiative Methodologies for Development of...

2010-07-01

338

40 CFR Appendix C to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Human Health Criteria and...  

Science.gov (United States)

... 2009-07-01 2009-07-01 false Great Lakes Water Quality Initiative Methodologies for Development of Human...132, App. C Appendix C to Part 132âGreat Lakes Water Quality Initiative Methodologies for Development of...

2009-07-01

339

Improving treatment adherence in your patients with schizophrenia: the STAY initiative.  

Science.gov (United States)

Partial and non-adherence to medication is a common problem in schizophrenia, leading to an increased risk of relapse, increased likelihood of hospitalization and poorer long-term outcomes. In contrast, continuous medication in the treatment of schizophrenia is associated with positive outcomes, including improved clinical status, improved quality of life and functioning, and reduced risk of relapse and rehospitalization. Strategies aimed at improving medication adherence are therefore key for patients to achieve their treatment goals. In an attempt to address the issues of partial/non-adherence to antipsychotic medication in schizophrenia, a group of psychiatrists convened to discuss and develop a set of principles aimed at helping patients adhere to their medication. These principles were then refined and developed into the STAY (the Six principles to improve Treatment Adherence in Your patients) initiative following presentation to a wider group of psychiatrists from across Europe. This manuscript summarizes these principles and explains the rationale for their selection. These principles are: (1) recognizing that most patients with schizophrenia are at risk of partial/non-adherence at some time during the course of their illness; (2) the benefits of a good therapeutic alliance for identifying potential adherence issues; (3) tailored treatment plans to meet an individual's needs, including the most suitable route of delivery of antipsychotic medication; (4) involving family/key persons in care and psychoeducation of the patient, assuming the patient agrees to this; (5) ensuring optimal effectiveness of care; and (6) ensuring continuity in the care of patients with schizophrenia. The application of these six principles should help to raise awareness of and address poor patient adherence, as well as generally improving care of patients with schizophrenia. In turn, this should lead to improved overall clinical outcomes for patients receiving long-term treatment for schizophrenia. PMID:23288695

Cañas, Fernando; Alptekin, Koksal; Azorin, Jean Michel; Dubois, Vincent; Emsley, Robin; García, Antonio G; Gorwood, Philip; Haddad, Peter M; Naber, Dieter; Olivares, José M; Papageorgiou, Georgios; Roca, Miquel

2013-02-01

340

Improving treatment adherence in your patients with schizophrenia: the STAY initiative.  

UK PubMed Central (United Kingdom)

Partial and non-adherence to medication is a common problem in schizophrenia, leading to an increased risk of relapse, increased likelihood of hospitalization and poorer long-term outcomes. In contrast, continuous medication in the treatment of schizophrenia is associated with positive outcomes, including improved clinical status, improved quality of life and functioning, and reduced risk of relapse and rehospitalization. Strategies aimed at improving medication adherence are therefore key for patients to achieve their treatment goals. In an attempt to address the issues of partial/non-adherence to antipsychotic medication in schizophrenia, a group of psychiatrists convened to discuss and develop a set of principles aimed at helping patients adhere to their medication. These principles were then refined and developed into the STAY (the Six principles to improve Treatment Adherence in Your patients) initiative following presentation to a wider group of psychiatrists from across Europe. This manuscript summarizes these principles and explains the rationale for their selection. These principles are: (1) recognizing that most patients with schizophrenia are at risk of partial/non-adherence at some time during the course of their illness; (2) the benefits of a good therapeutic alliance for identifying potential adherence issues; (3) tailored treatment plans to meet an individual's needs, including the most suitable route of delivery of antipsychotic medication; (4) involving family/key persons in care and psychoeducation of the patient, assuming the patient agrees to this; (5) ensuring optimal effectiveness of care; and (6) ensuring continuity in the care of patients with schizophrenia. The application of these six principles should help to raise awareness of and address poor patient adherence, as well as generally improving care of patients with schizophrenia. In turn, this should lead to improved overall clinical outcomes for patients receiving long-term treatment for schizophrenia.

Cañas F; Alptekin K; Azorin JM; Dubois V; Emsley R; García AG; Gorwood P; Haddad PM; Naber D; Olivares JM; Papageorgiou G; Roca M

2013-02-01

 
 
 
 
341

Statistical process management: An essential element of quality improvement  

Energy Technology Data Exchange (ETDEWEB)

Successful quality improvement requires a balanced program involving the three elements that control quality: organization, people and technology. The focus of the SPC/SPM User`s Group is to advance the technology component of Total Quality by networking within the Group and by providing an outreach within Westinghouse to foster the appropriate use of statistic techniques to achieve Total Quality. SPM encompasses the disciplines by which a process is measured against its intrinsic design capability, in the face of measurement noise and other obscuring variability. SPM tools facilitate decisions about the process that generated the data. SPM deals typically with manufacturing processes, but with some flexibility of definition and technique it accommodates many administrative processes as well. The techniques of SPM are those of Statistical Process Control, Statistical Quality Control, Measurement Control, and Experimental Design. In addition, techniques such as job and task analysis, and concurrent engineering are important elements of systematic planning and analysis that are needed early in the design process to ensure success. The SPC/SPM User`s Group is endeavoring to achieve its objectives by sharing successes that have occurred within the member`s own Westinghouse department as well as within other US and foreign industry. In addition, failures are reviewed to establish lessons learned in order to improve future applications. In broader terms, the Group is interested in making SPM the accepted way of doing business within Westinghouse.

Buckner, M.R.

1992-09-01

342

Statistical process management: An essential element of quality improvement  

Energy Technology Data Exchange (ETDEWEB)

Successful quality improvement requires a balanced program involving the three elements that control quality: organization, people and technology. The focus of the SPC/SPM User's Group is to advance the technology component of Total Quality by networking within the Group and by providing an outreach within Westinghouse to foster the appropriate use of statistic techniques to achieve Total Quality. SPM encompasses the disciplines by which a process is measured against its intrinsic design capability, in the face of measurement noise and other obscuring variability. SPM tools facilitate decisions about the process that generated the data. SPM deals typically with manufacturing processes, but with some flexibility of definition and technique it accommodates many administrative processes as well. The techniques of SPM are those of Statistical Process Control, Statistical Quality Control, Measurement Control, and Experimental Design. In addition, techniques such as job and task analysis, and concurrent engineering are important elements of systematic planning and analysis that are needed early in the design process to ensure success. The SPC/SPM User's Group is endeavoring to achieve its objectives by sharing successes that have occurred within the member's own Westinghouse department as well as within other US and foreign industry. In addition, failures are reviewed to establish lessons learned in order to improve future applications. In broader terms, the Group is interested in making SPM the accepted way of doing business within Westinghouse.

Buckner, M.R.

1992-01-01

343

GENETICS AND MOLECULAR BIOLOGY AND PIG MEAT QUALITY IMPROVEMENT  

Directory of Open Access Journals (Sweden)

Full Text Available The main goals in pig breeding have for many years been to improve growth rate, feedconversion and carcass composition. There have been less efforts to improve meat qualityparameters (WHC, pH, tenderness, colour etc.) but the main contribution has been areduction of stress susceptibility and PSE meat. Unfortunately, the quantitative geneticapproach has yielded few clues regarding the fundamental genetic changes that accompaniedthe selection of animal for superior carcass attributes. While mapping efforts are makingsignificant major effects on carcass and his quality composition DNA test would be availableto detect some positive or negative alleles. There are clear breed effects on meat quality,which in some cases are fully related to the presence of a single gene with major effect (RYR1,MYF4, H-FABP, LEPR, IGF2). Molecular biology methods provides excellent opportunitiesto improve meat quality in selection schemes within breeds and lines. Selection on majorgenes will not only increase average levels of quality but also decrease variability (ei increaseuniformity). The aim of this paper is to discuss there genetic and non-genetic opportunities.

BULLA, J.; OMELKA, R.; JASEK, S.; ?URLEJ, J.; BENCSIK, J.; FILISTOWICZ, A.

2007-01-01

344

Quality and productivity improvement program (PPKP) from alumni perspective  

Science.gov (United States)

Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

Ruza, Nadiah; Mustafa, Zainol

2013-04-01

345

Assuring quality by continuously improving quality: new directions for health record professionals.  

UK PubMed Central (United Kingdom)

Quality improvement is catching fire in the health care community, but there is much work to be done, much to learn, and much to teach. All health care professionals must remember that there are no short cuts to improving quality. American managers are so steeped in a quick-fix mentality that they resist the systematic infrastructure rebuilding described above. They scurry about fighting the same fires over and over, thinking they are doing their jobs. The truth remains that if results are to be improved, not just manipulated, then the processes that produce those results must be improved. For this to occur managers must be given the process improvement technology that separates the world class companies from those who are still wondering what hit them during the 1970s.

Howell WT; Nickle BW

1991-03-01

346

Quality: performance improvement, teamwork, information technology and protocols.  

UK PubMed Central (United Kingdom)

Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.

Coleman NE; Pon S

2013-04-01

347

Software Defect Prediction Models for Quality Improvement: A Literature Study  

Directory of Open Access Journals (Sweden)

Full Text Available In spite of meticulous planning, well documentation and proper process control during software development, occurrences of certain defects are inevitable. These software defects may lead to degradation of the quality which might be the underlying cause of failure. In todays cutting edge competition its necessary to make conscious efforts to control and minimize defects in software engineering. However, these efforts cost money, time and resources. This paper identifies causative factors which in turn suggest the remedies to improve software quality and productivity. The paper also showcases on how the various defect prediction models are implemented resulting in reduced magnitude of defects.

Mrinal Singh Rawat; Sanjay Kumar Dubey

2012-01-01

348

Using information technology to improve quality in the OR.  

UK PubMed Central (United Kingdom)

This article summarizes the current state of technology as it pertains to quality in the operating room, ties the current state back to its evolutionary pathway to understand how the current capabilities and their limitations came to pass, and elucidates how the overlay of information technology (IT) as a wrapper around current monitoring and device technology provides a significant advance in the ability of anesthesiologists to use technology to improve quality along many axes. The authors posit that IT will enable all the information about patients, perioperative systems, system capacity, and readiness to follow a development trajectory of increasing usefulness.

Rothman B; Sandberg WS; St Jacques P

2011-03-01

349

[In-service training to improve quality of health care].  

UK PubMed Central (United Kingdom)

UNLABELLED: Argentine's neonatal mortality rate represents 60% of infant mortality; implementation of strategies that improve quality of neonatal care is a priority. Traditionally, the training of health professionals is accomplished through scientific meetings with little capacity for exchange; in-service training incorporates the identification and resolution of problems joining the daily patient care. OBJECTIVE: To describe the in-service training program (ISTP), to identify its strengths as strategies for quality of care improvement and to evaluate its impact in four different Argentine maternity services. METHOD: Design: health services research intervention study, not controlled, before and after evaluation. INTERVENTION: This program is a multidimensional strategy consisting in regular visits by a neonatologist and a nurse to health professionals in their own settings. Program stages: 1) service assessment and design of the action plan according to the priorities, 2) implementation, 3) consolidation and analysis through indicators. RESULTS: Greatest impact was found over equipment and human resources improvement; we also observed an improvement in management related aspects like organization and coordination of care. The reduction of preventable deaths varied between centers. CONCLUSIONS: The in-service training program is an effective tool with measurable quantitative and qualitative results with positive impact on the quality of care. Conjunctural factors and political will were determinant on the program's success, as it is commonly seen in the implementation of strategies that involve changing established structures.

Fariña D; Rodríguez S; Erpen N

2012-01-01

350

Learning from practice variation to improve the quality of care.  

UK PubMed Central (United Kingdom)

Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. In this paper, we describe some of these quality improvement (QI) techniques. The first section deals with the identification of practice variation as the starting point of a systematic QI endeavour. This involves collecting data in multiple centres on a set of quality indicators as well as on case-mix variables that are thought to affect those indicators. Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the 'package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI.

Tomson CR; van der Veer SN

2013-02-01

351

Improvement of image quality using interpolated projection in myocardial SPECT  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Myocardial SPECT imaging is usually performed acquiring 32 views in 180 degree with equal steps of 5.625 degrees. Acquiring more images requires spending more time or injection of more activity to the patients. An idea to improve the quality reconstructed images without acquiring extra images is producing the extra images interpolating the data between adjacent projections. The aim of present study was investigation the feasibility of this idea. Methods: Obviously such investigation cannot be performed on real patient's data. Therefore, data were simulated using NCAT digital phantom and SimSET Monte Carlo code. The imaging was performed as usual, acquiring 32 views from right anterior oblique to left posterior oblique. The data were interpolated to construct 5 images between adjacent projections convert it into 187 projections. The simulation was performed again acquiring 187 images as the reference. The conventional, interpolated and reference data set were reconstructed and compared for improvement and degradation in quality of final images. The above procedure was repeated for phantoms representing different types of heart disease, different cardiac size and different count densities. Results: The results showed that Hermit interpolation technique produces better quality images comparing to other interpolation methods tested. Results also confirmed that streak artifacts decreases, signal to noise ratio and contrast increased due to increasing the number of samples. Conclusion: These results indicate that the physical properties of reconstructed images improve significantly. This directly must improve the lesions delectability of images. However the matter is still under investigation

Mohamad-Ali Askari; Hossein Rajabi; Armaghan Fard-Esfahani

2010-01-01

352

Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement.  

UK PubMed Central (United Kingdom)

PROBLEM: In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. SETTING: A district hospital in remote western Nepal. KEY MEASURES FOR IMPROVEMENT: To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery. Strategies for change To develop a morbidity and mortality conference (M&M) quality improvement initiative that aims to facilitate structured analysis of patient care and identify barriers to providing quality care, which can subsequently be improved. DESIGN: The authors designed an M&M involving clinical and non-clinical staff in conducting root-cause analyses of healthcare delivery at their hospital. Weekly conferences focus on seven domains of causal analysis: operations, supply chain, equipment, personnel, outreach, societal, and structural. Each conference focuses on assessing the care provided, and identifying ways in which services can be improved in the future. EFFECTS OF CHANGE: Staff reception of the M&Ms was positive. In these M&Ms, staff identified problem areas in healthcare delivery and steps for improvement. Subsequently, changes were made in hospital workflow, supply procurement, and on-site training. LESSONS LEARNT: While widely practiced throughout the world, M&Ms typically do not involve both clinical and non-clinical staff members and do not take a systems-level approach. The authors' experience suggests that the adapted M&M conference is a simple, feasible tool for quality improvement in resource-limited settings. Senior managerial commitment is crucial to ensure successful implementation of M&Ms, given the challenging logistics of implementing these programmes in resource-limited health facilities.

Schwarz D; Schwarz R; Gauchan B; Andrews J; Sharma R; Karelas G; Rajbhandari R; Acharya B; Mate K; Bista A; Bista MG; Sox C; Smith-Rohrberg Maru D

2011-12-01

353

PIES free boundary stellarator equilibria with improved initial conditions  

International Nuclear Information System (INIS)

The MFBE procedure developed by Strumberger (1997 Nucl. Fusion 37 19) is used to provide an improved starting point for free boundary equilibrium computations in the case of W7-X (Nuehrenberg and Zille 1986 Phys. Lett. A 114 129) using the Princeton iterative equilibrium solver (PIES) code (Reiman and Greenside 1986 Comput. Phys. Commun. 43 157). Transferring the consistent field found by the variational moments equilibrium code (VMEC) (Hirshmann and Whitson 1983 Phys. Fluids 26 3553) to an extended coordinate system using the VMORPH code, a safe margin between plasma boundary and PIES domain is established. The new EXTENDERP code implements a generalization of the virtual casing principle, which allows field extension both for VMEC and PIES equilibria. This facilitates analysis of the 5/5 islands of the W7-X standard case without including them in the original PIES computation

2005-01-01

354

PIES free boundary stellarator equilibria with improved initial conditions  

Science.gov (United States)

The MFBE procedure developed by Strumberger (1997 Nucl. Fusion 37 19) is used to provide an improved starting point for free boundary equilibrium computations in the case of W7-X (Nührenberg and Zille 1986 Phys. Lett. A 114 129) using the Princeton iterative equilibrium solver (PIES) code (Reiman and Greenside 1986 Comput. Phys. Commun. 43 157). Transferring the consistent field found by the variational moments equilibrium code (VMEC) (Hirshmann and Whitson 1983 Phys. Fluids 26 3553) to an extended coordinate system using the VMORPH code, a safe margin between plasma boundary and PIES domain is established. The new EXTENDER_P code implements a generalization of the virtual casing principle, which allows field extension both for VMEC and PIES equilibria. This facilitates analysis of the 5/5 islands of the W7-X standard case without including them in the original PIES computation.

Drevlak, M.; Monticello, D.; Reiman, A.

2005-07-01

355

Inter-branch initiative to improve children's mental health.  

UK PubMed Central (United Kingdom)

Pre-registration nursing programmes have been criticized for not adequately preparing nurses to work with children and young people with mental health issues. This article highlights the importance of developing strategies across traditional branch boundaries to remedy this curricula deficit. In 2007, the School of Health Science at Swansea University began an interprofessional initiative between mental health and child branches and designed a 2-day child and adolescent mental health services (CAMHS) workshop in collaboration with a local specialist CAMHS nurse. The purpose of the workshop was to raise students' awareness of child and adolescent mental health issues, to provide the opportunity for students to meet local CAMHS providers and to promote interprofessional practice. This workshop has been delivered successfully for the past 2 years, has been favourably evaluated by students, and is now a regular part of the curriculum. The authors believe that the inter-branch workshop may provide a template for other higher education institutions with large undergraduate populations to promote learning around child and adolescent mental health issues in a unique way.

Terry J; Maunder EZ; Bowler N; Williams D

2009-03-01

356

Inter-branch initiative to improve children's mental health.  

Science.gov (United States)

Pre-registration nursing programmes have been criticized for not adequately preparing nurses to work with children and young people with mental health issues. This article highlights the importance of developing strategies across traditional branch boundaries to remedy this curricula deficit. In 2007, the School of Health Science at Swansea University began an interprofessional initiative between mental health and child branches and designed a 2-day child and adolescent mental health services (CAMHS) workshop in collaboration with a local specialist CAMHS nurse. The purpose of the workshop was to raise students' awareness of child and adolescent mental health issues, to provide the opportunity for students to meet local CAMHS providers and to promote interprofessional practice. This workshop has been delivered successfully for the past 2 years, has been favourably evaluated by students, and is now a regular part of the curriculum. The authors believe that the inter-branch workshop may provide a template for other higher education institutions with large undergraduate populations to promote learning around child and adolescent mental health issues in a unique way. PMID:19273988

Terry, Julia; Maunder, Eryl Zac; Bowler, Nic; Williams, Deborah

357

Quality, cost efficiency, the new quality-cost imperative: systemwide improvements can yield financial gains.  

UK PubMed Central (United Kingdom)

The need to focus internally on cost management has largely replaced the revenue growth model of the past two decades and the external pursuit of opportunities for market and service expansion, according to Stephen R Mayfield, DHA, senior vice president of quality and performance improvement for the American Hospital Association. Outside financial pressure from primarily uncontrollable forces--the potential bundling of Medicare reimbursements to hospitals and nonpayments for readmissions and adverse events, to name a few--have compelled healthcare organizations to spend more time looking inward to finetune existing capabilities. As a result, quality improvement is evolving into a strategy for fiscal stability as well as a critical priority in itself.

Birk S

2010-01-01

358

The influence of teams to sustain quality improvement in nursing homes that "need improvement".  

UK PubMed Central (United Kingdom)

OBJECTIVES: Qualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement." DESIGN/SETTING/PARTICIPANTS: A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. RESULTS: The qualitative analysis revealed a subgroup of homes ("Full Adopters") likely to continue quality improvement activities that were able to effectively use teams. "Full Adopters" had either the nursing home administrator or director of nursing who supported and were actively involved in the quality improvement work of the team. "Full Adopters" also selected care topics for the focus of their quality improvement team, instead of "communication" topics of the "Partial Adopters" or "Non-Adopters" in the study who were identified as unlikely to continue to continue quality improvement activities after the intervention. "Full Adopters" had evidence of the key elements of complexity science: information flow, cognitive diversity, and positive relationships among staff; this evidence was lacking in other subgroups. All subgroups were able to recruit interdisciplinary teams, but only those that involved leaders were likely to be effective and sustain team efforts at quality improvement of care delivery systems. CONCLUSIONS: Results of this qualitative analysis can help leaders and medical directors use the key elements and promote information flow among staff, residents, and families; be inclusive as discussions about care delivery, making sure diverse points of view are included; and help build positive relationships among all those living and working in the nursing home. Wide-spread adoption of the intervention in the randomized study is feasible and could be enabled by nursing home Medical Directors in collaborative practice with Advanced Practice Nurses.

Rantz MJ; Zwygart-Stauffacher M; Flesner M; Hicks L; Mehr D; Russell T; Minner D

2013-01-01

359

Mandibular implant supported complete dentures improved quality of life.  

UK PubMed Central (United Kingdom)

DESIGN: Randomised controlled trial. INTERVENTION: Patients from hospital waiting lists who had been edentulous for at least two years and required replacement of conventional dentures were recruited. Baseline quality of life and satisfaction measures were taken and all patients were provided with new conventional complete dentures (CCDs) that they wore for three months, at which point they were reassessed using the same measures. Patients were then randomly assigned either to continue with CCDs (control) or to have implant-retained overdentures (IODs) made (test group). The control group was assessed after a further three months (six months after receiving CCDs). The test group was assessed three months after receiving IODs. OUTCOME MEASURE: The outcome measures used were the Oral Health Impact Profile-49 (OHIP-49) Denture Satisfaction Questionnaire (DSQ) and the Schedule for the Evaluation of Individual Quality of Life (SEIQoL). RESULTS: Three months after receiving CCDs patients reported significant improvements in satisfaction and quality of life (P < 0.05). However no further improvements were seen in the control group at six months for any measure. Following placement of IODs the test groups had significant additional improvements in the functional limitation, physical pain, psychological discomfort, physical disability, social disability, psychological disability and handicap scales of the OHIP and on 10 of the 11 scales of the Denture Satisfaction Questionnaire (P < 0.05, ANOVA). CONCLUSIONS: The findings show that, controlling for expectancy bias and variability in baseline levels, IODs significantly increase patient satisfaction, dental function and quality of life over and above those achieved with good quality CCDs.

Keenan AV

2013-03-01

360

Crystal quality analysis and improvement using x-ray topography.  

Energy Technology Data Exchange (ETDEWEB)

The Topography X-ray Laboratory of the Advanced Photon Source (APS) at Argonne National Laboratory operates as a collaborative effort with APS users to produce high performance crystals for APS X-ray beamline experiments. For many years the topography laboratory has worked closely with an on-site optics shop to help ensure the production of crystals with the highest quality, most stress-free surface finish possible. It has been instrumental in evaluating and refining methods used to produce high quality crystals. Topographical analysis has shown to be an effective method to quantify and determine the distribution of stresses, to help identify methods that would mitigate the stresses and improve the Rocking curve, and to create CCD images of the crystal. This paper describes the topography process and offers methods for reducing crystal stresses in order to substantially improve the crystal optics.

Maj, J.; Goetze, K.; Macrander, A.; Zhong, Y.; Huang, X.; Maj, L.; Univ. of Chicago

2008-01-01

 
 
 
 
361

Crystal quality analysis and improvement using x-ray topography  

International Nuclear Information System (INIS)

The Topography X-ray Laboratory of the Advanced Photon Source (APS) at Argonne National Laboratory operates as a collaborative effort with APS users to produce high performance crystals for APS X-ray beamline experiments. For many years the topography laboratory has worked closely with an on-site optics shop to help ensure the production of crystals with the highest quality, most stress-free surface finish possible. It has been instrumental in evaluating and refining methods used to produce high quality crystals. Topographical analysis has shown to be an effective method to quantify and determine the distribution of stresses, to help identify methods that would mitigate the stresses and improve the Rocking curve, and to create CCD images of the crystal. This paper describes the topography process and offers methods for reducing crystal stresses in order to substantially improve the crystal optics.

2008-01-01

362

Improving Quality of Care among COPD outpatients in Denmark 2008-2011  

DEFF Research Database (Denmark)

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 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% for all indicators. Compared to 2008, a higher proportion of COPD outpatients in 2011 received annual measurements of the forced expiratory volume in one second in percent of predicted (FEV1% predicted) (RR 2.14, 95% CI, 2.09; 2.19), assessment of BMI (RR 2.24, 95% CI, 2.19; 2.29), assessment of dyspnea using the Medical Research Council (MRC) scale (RR 2.25, 95% CI, 2.20; 2.31), registration of smoking status (RR2.41, 95% CI, 2.35; 2.47), smoking cessation recommendation (RR 3.40, 95% CI, 3.18; 3.64) and offering of pulmonary rehabilitation (RR 2.78, 95% CI, 2.65; 2.90). Moderate variation in quality of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (p<0.0001). CONCLUSION: Based on increased registration practice of important processes of care, the present study indicates 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.

TØttenborg, Sandra SØgaard; Thomsen, Reimar W.

2012-01-01

363

Improvement of bacteriological quality of frozen chicken by gamma radiation  

International Nuclear Information System (INIS)

The possible use of gamma irradiation at doses of 1.6 to 4.0 kGy to improve bacteriological quality of frozen chicken was investigated. The effects of gamma irradiation on salmonella viability in frozen chicken and on sensory quality of frozen chicken were also evaluated. D10-values for different isolated strains of salmonella in frozen chicken varied from 0.41 to 0.57 kGy. A dose of 4 kGy is required for a seven log cycle reduction of salmonella contamination in frozen chicken. Approximately 21 per cent of frozen chicken examined were contaminated with salmonella. Salmonella typhimurium, salmonella virchow, and salmonella java were predominant. Irradiation of frozen chicken at a minimum dose of 3.2 kGy eliminated salmonella, coliform, Escherichia coli, and Staphylococcus aureus and, in addition, reduced baterial load by 2 log cycles. Faecal streptococci was still present in a 3.2 kGy samples but in a very small percentage and the count was not over 100 colonies per g. Discoloring of chicken meat was noted after a 2 kGy treatment. The sensory quality of frozen chicken irradiated at 3 and 4 kGy tended to decrease during frozen storage but was within the acceptable range on a nine point hedonic scale even after eight months of frozen storage. Dosage at 3.2 kGy appeared to be sufficient for improving bacteriological quality of frozen chicken

1986-01-01

364

IMPROVEMENT OF POWER QUALITY OF A DISTRIBUTED GENERATION POWER SYSTEM  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of this work is to improve the power quality for Distributed Generation (DG) with power storage system. Power quality is the combination of voltage quality and current quality. Power quality is the set of limits of electrical properties that allows electrical systems to function in their intended manner without significant loss of performance or life. The electrical power quality is more concerned issue. The main problems are stationery and transient distortions in the line voltage such as harmonics, flicker, swells, sags and voltage asymmetries. Distributed Generation (DG) also called as site generation, dispersed generation, embedded generation, decentralized generation, decentralized energy or distributed energy, generates electricity from the many small energy sources. In recent years, micro electric power systems such as photovoltaic generation systems, wind generators and micro gas turbines, etc., have increased with the deregulation and liberalization of the power market. Under such circumstances the environment surrounding the electric power industry has become ever more complicated and provides high-quality power in a stable manner which becomes an important topic. Here DG is assumed to include Wind power Generation (WG) and Fuel Cells (FC), etc. Advantages of this system are constant power supply, constant voltage magnitude, absence of harmonics in supply voltage, un-interrupted power supply. In this project the electric power qualities in two cases will be compared. Case I: With the storage battery when it is introduced. Case II: Without the storage battery. The storage battery executes the control that maintains the voltage in the power system. It will be found that the electric power quality will be improved, when storage battery is introduced. The model system used in this Project work is composed of a Wind Turbine, an Induction Generator, Fuel Cells, An Inverter and a Storage Battery. A miniature Wind Power Generator is represented by WG. A fuel cell module is represented by FC. Transmission lines will be simulated by resistors and coils. The combined length of the lines from synchronous generator to the load terminal is 1.5 km. This model will be simulated using MATLAB/SIMULINK.

Aruna Garipelly

2012-01-01

365

[Financial incentives in improving healthcare quality. SESPAS Report 2012].  

UK PubMed Central (United Kingdom)

We address the contribution of financial incentives linked to pay for performance (P4P) to improving the quality of care. The situation of P4P is analyzed internationally and in the distinct health services in Spain. The participation of P4P in wage compensation and the effects of the current economic crisis on these incentives is discussed. We review the results of recent studies to clarify the role of these incentive models and assess possible orientations and new proposals.

Eirea Eiras C; Ortún Rubio V

2012-03-01

366

Quality improvement in industrial process plants - the role of radioisotopes  

International Nuclear Information System (INIS)

Supported by appropriate case studies, this paper argues that radioisotope techniques have an important part to play in the quality improvement processes currently being undertaken by many industrial companies. Examples, which are drawn predominantly from large-scale chemical industry, include the use of sealed and unsealed sources of radiation in instruments for measurement and control, the application of radioisotope tracers to investigate a range of process problems, and an activable tracer-technique applied to a solids blending study. (author).

1990-01-01

367

Pressure sores no more: a quality improvement project.  

UK PubMed Central (United Kingdom)

Review of staff performance in the area of pressure sore prevention revealed that nursing practice was adequate. But the staff's belief that it could do a better job provided the impetus for a quality improvement project. Based on research data a planned change was implemented, and follow-up study reflected positive outcome results. This successful project integrated the concepts of research, cost effectiveness, and patient outcome.

Sideranko S; Yeston NS

1994-07-01

368

Teaching internal medicine residents quality improvement and patient safety: a lean thinking approach.  

Science.gov (United States)

Patient safety (PS) and quality improvement (QI) are among the highest priorities for all health systems. Resident physicians are often at the front lines of providing care for patients. In many instances, however, QI and PS initiatives exclude trainees. By aligning the goals of the health system with those of the residency program to engage residents in QI and PS projects, there is a unique opportunity to fulfill both a corporate and educational mission to improve patient care. Here, the authors briefly describe one residency program's educational curriculum to provide foundational knowledge in QI and PS to all its trainees and highlight a resident team-based project that applied principles of lean thinking to evaluate the process of responding to an in-hospital cardiopulmonary arrest. This approach provided residents with a practical experience but also presented an opportunity for trainees to align with the health system's approach to improving quality and safety. PMID:20357082

Kim, Christopher S; Lukela, Michael P; Parekh, Vikas I; Mangrulkar, Rajesh S; Del Valle, John; Spahlinger, David A; Billi, John E

2010-03-31

369

Quality Improvement, Quality Assurance, and Benchmarking: Comparing two frameworks for managing quality processes in open and distance learning  

Directory of Open Access Journals (Sweden)

Full Text Available Managing quality processes become critically important for higher education institutions generally, but especially for institutions involved in open and distance learning. In Australia, managers of centers responsible for open and distance learning have identified two frameworks that potentially offer ways of conceiving of the application of quality processes: the Quality Framework published in Inglis, Ling, and Joosten (1999); and the Benchmarking Framework published in McKinnon, Walker, and Davis (2000). However, managers who have been considering applying one or other framework within their institutional contexts have had to face the issue of how they should choose between, or combine the use, of these frameworks. Part of their dilemma lies in distinguishing among the related functions of quality improvement, quality assurance, and benchmarking. This article compares the frameworks in terms of their scope, institutional application, structures, and method of application, and then considers what implications the similarities and differences between the frameworks have for their use.

Alistair Inglis

2005-01-01

370

Production method for improving quality of Liupu tea  

UK PubMed Central (United Kingdom)

The invention relates to application of eurotium cristatum in the production of Liupu tea, which belongs to the crossing field of food engineering and biotechnology. The production method for the Liupu tea is an improvement on the prior Liupu tea production flow through biotechnology, namely after primary distillation, a bacterial suspension containing eurotium cristatum spores is used for spray inoculation, and after redistillation, tea strains are crushed into pieces for inoculation again. Thus, when the Liupu tea is in composting fermentation, the eurotium cristatum can quickly become predominant bacteria to inhibit the growth of other bacteria, and when the Liupu tea is in ageing, golden flowers grow out frondently and universally so as to improve the quality of the Liupu tea. The application of the eurotium cristatum improves the quality of the Liupu tea, and solves the problems that in the prior art, the quality is unstable, the ageing time is long, the growing golden flowers aredifficult to control and are easy to pollute and the like. Simultaneously, the invention discloses a method for simply and easily obtaining and expanding the cultivation of eurotium cristatum strains.

MINGGUO JIANG; SHANGGUANG CHEN; RUILE HUANG; ZHIYUN JIANG; LINGYING ZHOU

371

Helping primary care teams emerge through a quality improvement program.  

UK PubMed Central (United Kingdom)

BACKGROUND: Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. OBJECTIVE: The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. METHODS: An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. RESULTS: Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. CONCLUSION: The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.

Hilts L; Howard M; Price D; Risdon C; Agarwal G; Childs A

2013-04-01

372

The physician quality reporting initiative: what is it, will it increase health care quality, and should wide participation be encouraged?  

UK PubMed Central (United Kingdom)

The physician quality reporting initiative (PQRI) is a voluntary program for reporting certain quality measures on Medicare patients in return for receiving a small bonus payment. However, the PQRI procedures are such that a large number of those who try to participate do not receive incentive payments. Also, many indicate that the small bonus for participation is not worth the effort and costs incurred. Furthermore, it has been found that many of the quality measures are not a good indicator of a favorable outcome, and do not clearly promote significant increases in the quality of patient care. However, penalties will be given from the year 2015 for not participating in PQRI. Also, it is expected that PQRI will be a precursor to Pay for Performance legislation, which will require mandatory participation by physicians. Therefore, participation in PQRI now is recommended by many experts, so that health care professionals can learn the procedures and make necessary adjustments in their practice procedures.

Harolds JA; Merrill JK

2011-02-01

373

The clinical nurse specialist: leadership in quality improvement.  

UK PubMed Central (United Kingdom)

Healthcare delivery is in a crisis, requiring improvement. How to improve and who should assume more leadership are not clear. At the same time, the nursing profession struggles with a weak education system, graduating students who require major support for an extended time. There is also confusion related to nursing roles, particularly with nurses who have a graduate degree. The Institute of Medicine has published a series of reports about the healthcare system and need for improvement and describes a structure for improvement. The clinical nurse specialist is particularly suited to assume a major role in nursing leadership to guide staff and the healthcare system to better ensure improved care. There is great need to communicate that the clinical nurse specialist can and should assume this role. This will require a review and development of more quality improvement content and experiences in clinical nurse specialist educational programs, but much of the content is already in programs. The clinical nurse specialist works in systems, impacts systems, works with staff, and can thus reach more patients with improvement approaches.

Finkelman A

2013-01-01

374

Evaluating the State of Quality-Improvement Science through Evidence Synthesis: Insights from the Closing the Quality Gap Series.  

UK PubMed Central (United Kingdom)

CONTEXT: The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. OBJECTIVE: To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). METHODS: We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. RESULTS: Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. CONCLUSIONS: Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

McDonald KM; Schultz EM; Chang C

2013-09-01

375

Impact of mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA)  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The improvment of the quality of testing services in public laboratories is a high priority in many countries. Consequently, initiatives to train laboratory staff on quality management are being implemented, for example, the World Health Organization Regional Headquarters for Africa (WHO-AFRO) Strengthening Laboratory Management Towards Accreditation (SLMTA). Mentorship may be an effective way to augment these efforts. Methods: Mentorship was implemented at four hospital laboratories in Lesotho, three districts and one central laboratory, between June 2009 and December 2010. The mentorship model that was implemented had the mentor fully embedded within the operations of each of the laboratories. It was delivered in a series of two mentoring engagements of six and four week initial and follow-up visits respectively. In total, each laboratory received 10 weeks mentorship that was separated by 6–8 weeks. Quality improvements were measured at baseline and at intervals during the mentorship using the WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and scoring system. Results: At the beginning of the mentorship, all laboratories were at the SLIPTA zero star rating. After the initial six weeks of mentorship, two of the three district laboratories had improved from zero to one (out of five) star although the difference between their baseline (107.7) and the end of the six weeks (136.3) average scores was not statistically significant (p = 0.25). After 10 weeks of mentorship there was a significant improvement in average scores (182.3; p = 0.034) with one laboratory achieving WHO-AFRO three out of a possible five star status and the two remaining laboratories achieving a two star status. At Queen Elizabeth II (QE II) Central Laboratory, the average baseline score was 44%, measured using a section-specific checklist. There was a significant improvement by five weeks (57.2%; p = 0.021). Conclusion: The mentorship programme in this study resulted in significant measurable improvements towards preparation for the WHO-AFRO SLIPTA process in less than six months. We recommend that mentorship be incorporated into laboratory quality improvement and management training programmes such as SLMTA, in order to accelerate the progress of laboratories towards achieving accreditation.

Talkmore Maruta; David Motebang; Lebina Mathabo; Philip J. Rotz; Joseph Wanyoike; Trevor Peter

2011-01-01

376

Quantity-quality measuring method possibilities in improving operator's learning quality  

Energy Technology Data Exchange (ETDEWEB)

Possibilities of obtaining qualitative-quantitative estimations of different aspects of learning process and their application in determination of learning purposes, substantiation of the training program choice of types and forms of studies directed at quality improvement of operator learning are considered.

Zvonarev, V.P.

1984-01-01

377