Update on value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Agent-Based Framework for Personalized Service Provisioning in Converged IP Networks

NASA Astrophysics Data System (ADS)

Podobnik, Vedran; Matijasevic, Maja; Lovrek, Ignac; Skorin-Kapov, Lea; Desic, Sasa

In a global multi-service and multi-provider market, the Internet Service Providers will increasingly need to differentiate in the service quality they offer and base their operation on new, consumer-centric business models. In this paper, we propose an agent-based framework for the Business-to-Consumer (B2C) electronic market, comprising the Consumer Agents, Broker Agents and Content Agents, which enable Internet consumers to select a content provider in an automated manner. We also discuss how to dynamically allocate network resources to provide end-to-end Quality of Service (QoS) for a given consumer and content provider.

Development of a questionnaire to measure the key attributes of the community palliative care specialist nurse role.

PubMed

Cameron, Dee; Johnston, Bridget

2015-02-01

Recent worldwide economic events have forced an examination of the nurse's contribution to high-quality, effective, person-centred care. Since the role of specialist nurses is considered one of the least understood or valued developments in nursing, specialist nurses must demonstrate their contribution to quality, person-centred health care. To develop a questionnaire which aims to measure the quality of care provided by palliative care specialist nurses from the patients' perspective and to undertake initial validation. The process of questionnaire development involved six phases including systematic literature reviews, patient advisory groups and expert panel reviews, each of which contributed to the questionnaire face and content validity. Johnston's Expert Palliative Care Nurse Model (2002; 2005) provided an evidence-based framework for the development of the questionnaire, and enabled the identification of the key attributes of the palliative care specialist nurse role, thereby providing the themes on which to base the questionnaire. The Quality Measure for Palliative Nursing, a questionnaire, was developed. The themes identified in the questionnaire--personal characteristics, communication skills, knowledge, relationship with patient and providing comfort--aim to facilitate measurement of the quality of care provided by palliative care specialist nurses. Designed for use by palliative patients the Quality Measure for Palliative Nursing is a one-page questionnaire comprising of 15 questions. The Quality Measure for Palliative Nursing is unique since it aims to measure the quality of care provided by community palliative care specialist nurses, and could also be used to measure patient satisfaction with the quality of care provided. Further testing is recommended to ensure that this questionnaire can provide reliable and valid results.

Ontology Based Quality Evaluation for Spatial Data

NASA Astrophysics Data System (ADS)

Yılmaz, C.; Cömert, Ç.

2015-08-01

Many institutions will be providing data to the National Spatial Data Infrastructure (NSDI). Current technical background of the NSDI is based on syntactic web services. It is expected that this will be replaced by semantic web services. The quality of the data provided is important in terms of the decision-making process and the accuracy of transactions. Therefore, the data quality needs to be tested. This topic has been neglected in Turkey. Data quality control for NSDI may be done by private or public "data accreditation" institutions. A methodology is required for data quality evaluation. There are studies for data quality including ISO standards, academic studies and software to evaluate spatial data quality. ISO 19157 standard defines the data quality elements. Proprietary software such as, 1Spatial's 1Validate and ESRI's Data Reviewer offers quality evaluation based on their own classification of rules. Commonly, rule based approaches are used for geospatial data quality check. In this study, we look for the technical components to devise and implement a rule based approach with ontologies using free and open source software in semantic web context. Semantic web uses ontologies to deliver well-defined web resources and make them accessible to end-users and processes. We have created an ontology conforming to the geospatial data and defined some sample rules to show how to test data with respect to data quality elements including; attribute, topo-semantic and geometrical consistency using free and open source software. To test data against rules, sample GeoSPARQL queries are created, associated with specifications.

Evidence-Based Practice Point-of-Care Resources: A Quantitative Evaluation of Quality, Rigor, and Content.

PubMed

Campbell, Jared M; Umapathysivam, Kandiah; Xue, Yifan; Lockwood, Craig

2015-12-01

Clinicians and other healthcare professionals need access to summaries of evidence-based information in order to provide effective care to their patients at the point-of-care. Evidence-based practice (EBP) point-of-care resources have been developed and are available online to meet this need. This study aimed to develop a comprehensive list of available EBP point-of-care resources and evaluate their processes and policies for the development of content, in order to provide a critical analysis based upon rigor, transparency and measures of editorial quality to inform healthcare providers and promote quality improvement amongst publishers of EBP resources. A comprehensive and systematic search (Pubmed, CINAHL, and Cochrane Central) was undertaken to identify available EBP point-of-care resources, defined as "web-based medical compendia specifically designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, and evidence-based information (and possibly also guidance) to clinicians." A pair of investigators independently extracted information on general characteristics, content presentation, editorial quality, evidence-based methodology, and breadth and volume. Twenty-seven summary resources were identified, of which 22 met the predefined inclusion criteria for EBP point-of-care resources, and 20 could be accessed for description and assessment. Overall, the upper quartile of EBP point-of-care providers was assessed to be UpToDate, Nursing Reference Centre, Mosby's Nursing Consult, BMJ Best Practice, and JBI COnNECT+. The choice of which EBP point-of-care resources are suitable for an organization is a decision that depends heavily on the unique requirements of that organization and the resources it has available. However, the results presented in this study should enable healthcare providers to make that assessment in a clear, evidence-based manner, and provide a comprehensive list of the available options. © 2015 Sigma Theta Tau International.

Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

ERIC Educational Resources Information Center

Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

2012-01-01

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

PROJECT SUMMARY: DEVELOPMENT OF THE VIRTUAL BEACH MODEL, PHASE I: AN EMPIRICAL MODEL

EPA Science Inventory

Mathematical models based on water-quality and other environmental surrogates may help to provide water quality assessment within a few hours and potentially provide one to three day forecasts, providing beach managers and public-health officials a tool for developing beach-speci...

Changes in the relationship between nursing home financial performance and quality of care under public reporting.

PubMed

Park, Jeongyoung; Werner, Rachel M

2011-07-01

The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

Classification accuracy of claims-based methods for identifying providers failing to meet performance targets.

PubMed

Hubbard, Rebecca A; Benjamin-Johnson, Rhondee; Onega, Tracy; Smith-Bindman, Rebecca; Zhu, Weiwei; Fenton, Joshua J

2015-01-15

Quality assessment is critical for healthcare reform, but data sources are lacking for measurement of many important healthcare outcomes. With over 49 million people covered by Medicare as of 2010, Medicare claims data offer a potentially valuable source that could be used in targeted health care quality improvement efforts. However, little is known about the operating characteristics of provider profiling methods using claims-based outcome measures that may estimate provider performance with error. Motivated by the example of screening mammography performance, we compared approaches to identifying providers failing to meet guideline targets using Medicare claims data. We used data from the Breast Cancer Surveillance Consortium and linked Medicare claims to compare claims-based and clinical estimates of cancer detection rate. We then demonstrated the performance of claim-based estimates across a broad range of operating characteristics using simulation studies. We found that identification of poor performing providers was extremely sensitive to algorithm specificity, with no approach identifying more than 65% of poor performing providers when claims-based measures had specificity of 0.995 or less. We conclude that claims have the potential to contribute important information on healthcare outcomes to quality improvement efforts. However, to achieve this potential, development of highly accurate claims-based outcome measures should remain a priority. Copyright © 2014 John Wiley & Sons, Ltd.

Monitoring surface water quality using social media in the context of citizen science

NASA Astrophysics Data System (ADS)

Zheng, Hang; Hong, Yang; Long, Di; Jing, Hua

2017-02-01

Surface water quality monitoring (SWQM) provides essential information for water environmental protection. However, SWQM is costly and limited in terms of equipment and sites. The global popularity of social media and intelligent mobile devices with GPS and photography functions allows citizens to monitor surface water quality. This study aims to propose a method for SWQM using social media platforms. Specifically, a WeChat-based application platform is built to collect water quality reports from volunteers, which have been proven valuable for water quality monitoring. The methods for data screening and volunteer recruitment are discussed based on the collected reports. The proposed methods provide a framework for collecting water quality data from citizens and offer a primary foundation for big data analysis in future research.

Design and Testing of an Air Force Services Mystery Shopping Program.

DTIC Science & Technology

1998-11-01

Base level Air Force Services’ lodging and foodservice activities use limited service quality measurement tools to determine customer perceptions of... service quality . These tools, specifically management observation and customer comment cards, do not provide a complete picture of service quality . Other... service quality measurement methods such as mystery shopping are rarely used. Bases do not consider using mystery shopping programs because of the

British Thoracic Society quality standards for home oxygen use in adults

PubMed Central

Suntharalingam, Jay; Wilkinson, Tom; Annandale, Joseph; Davey, Claire; Fielding, Rhea; Freeman, Daryl; Gibbons, Michael; Hardinge, Maxine; Hippolyte, Sabrine; Knowles, Vikki; Lee, Cassandra; MacNee, William; Pollington, Jacqueline; Vora, Vandana; Watts, Trefor; Wijesinghe, Meme

2017-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Methods Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations. PMID:29018527

Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor.

PubMed

Zimmerman, Kathleen N; Ledford, Jennifer R; Severini, Katherine E; Pustejovsky, James E; Barton, Erin E; Lloyd, Blair P

2018-03-03

Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD. Copyright © 2018 Elsevier Ltd. All rights reserved.

Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

PubMed

Locatelli, Sara M; LaVela, Sherri L

2015-01-01

Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.

[Potential for the survey of quality indicators based on a national emergency department registry : A systematic literature search].

PubMed

Hörster, A C; Kulla, M; Brammen, D; Lefering, R

2018-06-01

Emergency department processes are often key for successful treatment. Therefore, collection of quality indicators is demanded. A basis for the collection is systematic, electronic documentation. The development of paper-based documentation into an electronic and interoperable national emergency registry is-besides the establishment of quality management for emergency departments-a target of the AKTIN project. The objective of this research is identification of internationally applied quality indicators. For the investigation of the current status of quality management in emergency departments based on quality indicators, a systematic literature search of the database PubMed, the Cochrane Library and the internet was performed. Of the 170 internationally applied quality indicators, 25 with at least two references are identified. A total of 10 quality indicators are ascertainable by the data set. An enlargement of the data set will enable the collection of seven further quality indicators. The implementation of data of care behind the emergency processes will provide eight additional quality indicators. This work was able to show that the potential of a national emergency registry for the establishment of quality indicators corresponds with the international systems taken into consideration and could provide a comparable collection of quality indicators.

Quality management in home care: models for today's practice.

PubMed

Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

Factors affecting success of an integrated community-based telehealth system.

PubMed

Hsieh, Hui-Lung; Tsai, Chung-Hung; Chih, Wen-Hai; Lin, Huei-Hsieh

2015-01-01

The rise of chronic and degenerative diseases in developed countries has become one critical epidemiologic issue. Telehealth can provide one viable way to enhance health care, public health, and health education delivery and support. The study aims to empirically examine and evaluate the success factors of community-based telehealth system adoption. The valid 336 respondents are the residents of a rural community in Taiwan. The structural equation modeling (SEM) was used to assess the proposed model applied to telehealth. The findings showed the research model had good explanatory power and fitness. Also, the findings indicated that system quality exerted the strongest overall effect on intention to use. Furthermore, service quality exerted the strongest overall effect on user satisfaction. The findings also illustrated that the joint effects of three intrinsic qualities (system quality, information quality, and service quality) on use were mediated by user satisfaction and intention to use. The study implies that community-based telehealth service providers should improve three intrinsic qualities to enhance user satisfaction and intention to use, which in turn can lead to increase the usage of the telehealth equipment. The integrated community-based telehealth system may become an innovative and suitable way to deliver better care to the residents of communities.

Peer Assessment: Judging the Quality of Students' Work by Comments Rather than Marks

ERIC Educational Resources Information Center

Davies, Phil

2006-01-01

This paper reports the results of a study into the quality of peer feedback provided by students within a computerised peer-assessment environment. The study looks at the creation of a "feedback index" that represents the quality of an essay based upon the feedback provided during a peer-marking process and identifies a significant…

Research on Air Quality Evaluation based on Principal Component Analysis

NASA Astrophysics Data System (ADS)

Wang, Xing; Wang, Zilin; Guo, Min; Chen, Wei; Zhang, Huan

2018-01-01

Economic growth has led to environmental capacity decline and the deterioration of air quality. Air quality evaluation as a fundamental of environmental monitoring and air pollution control has become increasingly important. Based on the principal component analysis (PCA), this paper evaluates the air quality of a large city in Beijing-Tianjin-Hebei Area in recent 10 years and identifies influencing factors, in order to provide reference to air quality management and air pollution control.

Ensuring quality in studies linking cancer registries and biobanks.

PubMed

Langseth, Hilde; Luostarinen, Tapio; Bray, Freddie; Dillner, Joakim

2010-04-01

The Nordic countries have a long tradition of providing comparable and high quality cancer data through the national population-based cancer registries and the capability to link the diverse large-scale biobanks currently in operation. The joining of these two infrastructural resources can provide a study base for large-scale studies of etiology, treatment and early detection of cancer. Research projects based on combined data from cancer registries and biobanks provides great opportunities, but also presents major challenges. Biorepositories have become an important resource in molecular epidemiology, and the increased interest in performing etiological, clinical and gene-environment-interaction studies, involving information from biological samples linked to population-based cancer registries, warrants a joint evaluation of the quality aspects of the two resources, as well as an assessment of whether the resources can be successfully combined into a high quality study. While the quality of biospecimen handling and analysis is commonly considered in different studies, the logistics of data handling including the linkage of the biobank with the cancer registry is an overlooked aspect of a biobank-based study. It is thus the aim of this paper to describe recommendations on data handling, in particular the linkage of biobank material to cancer registry data and the quality aspects thereof, based on the experience of Nordic collaborative projects combining data from cancer registries and biobanks. We propose a standard documentation with respect to the following topics: the quality control aspects of cancer registration, the identification of cases and controls, the identification and use of data confounders, the stability of serum components, historical storage conditions, aliquoting history, the number of freeze/thaw cycles and available volumes.

Delivery system integration and health care spending and quality for Medicare beneficiaries.

PubMed

McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Hamed, Pasha; Landon, Bruce E

2013-08-12

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care. To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers. Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.

Quality Appraisal of Single-Subject Experimental Designs: An Overview and Comparison of Different Appraisal Tools

ERIC Educational Resources Information Center

Wendt, Oliver; Miller, Bridget

2012-01-01

Critical appraisal of the research literature is an essential step in informing and implementing evidence-based practice. Quality appraisal tools that assess the methodological quality of experimental studies provide a means to identify the most rigorous research suitable for evidence-based decision-making. In single-subject experimental research,…

A Risk and Standards Based Approach to Quality Assurance in Australia's Diverse Higher Education Sector

ERIC Educational Resources Information Center

Australian Government Tertiary Education Quality and Standards Agency, 2015

2015-01-01

The Australian Government Tertiary Education Quality and Standards Agency's (TEQSA's) role is to assure that quality standards are being met by all registered higher education providers. This paper explains how TEQSA's risk-based approach to assuring higher education standards is applied in broad terms to a diverse sector. This explanation is…

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

Capacity and readiness for quality improvement among home and community-based service providers.

PubMed

Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

2016-01-01

The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

ERIC Educational Resources Information Center

Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

2010-01-01

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

Developing Information Services and Tools to Access and Evaluate Data Quality in Global Satellite-based Precipitation Products

NASA Astrophysics Data System (ADS)

Liu, Z.; Shie, C. L.; Meyer, D. J.

2017-12-01

Global satellite-based precipitation products have been widely used in research and applications around the world. Compared to ground-based observations, satellite-based measurements provide precipitation data on a global scale, especially in remote continents and over oceans. Over the years, satellite-based precipitation products have evolved from single sensor and single algorithm to multi-sensors and multi-algorithms. As a result, many satellite-based precipitation products have been enhanced such as spatial and temporal coverages. With inclusion of ground-based measurements, biases of satellite-based precipitation products have been significantly reduced. However, data quality issues still exist and can be caused by many factors such as observations, satellite platform anomaly, algorithms, production, calibration, validation, data services, etc. The NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC) is home to NASA global precipitation product archives including the Tropical Rainfall Measuring Mission (TRMM), the Global Precipitation Measurement (GPM), as well as other global and regional precipitation products. Precipitation is one of the top downloaded and accessed parameters in the GES DISC data archive. Meanwhile, users want to easily locate and obtain data quality information at regional and global scales to better understand how precipitation products perform and how reliable they are. As data service providers, it is necessary to provide an easy access to data quality information, however, such information normally is not available, and when it is available, it is not in one place and difficult to locate. In this presentation, we will present challenges and activities at the GES DISC to address precipitation data quality issues.

Measuring and improving the quality of mental health care: a global perspective

PubMed Central

Kilbourne, Amy M.; Beck, Kathryn; Spaeth‐Rublee, Brigitta; Ramanuj, Parashar; O'Brien, Robert W.; Tomoyasu, Naomi; Pincus, Harold Alan

2018-01-01

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology‐based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient‐centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement‐based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems. PMID:29352529

An evidence-based framework to measure quality of allied health care.

PubMed

Grimmer, Karen; Lizarondo, Lucylynn; Kumar, Saravana; Bell, Erica; Buist, Michael; Weinstein, Philip

2014-02-26

There is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services. A realist synthesis framework describing what AH does, how it does it, and what is achieved, was developed. This was populated by the findings of a systematic review of literature published since 1980 reporting concepts of quality relevant to AH. Articles were included on quality measurement concepts, theories, debates, and/or hypothetical frameworks. Of 139 included articles, 21 reported on descriptions of quality potentially relevant to AH. From these, 24 measures of quality were identified, with 15 potentially relating to what AH does, 17 to how AH delivers care, 8 relating to short term functional outcomes, and 9 relating to longer term functional and health system outcomes. A novel evidence-based quality framework was proposed to address the complexity of AH therapies. This should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.

Exploring the impact of word-of-mouth about Physicians' service quality on patient choice based on online health communities.

PubMed

Lu, Naiji; Wu, Hong

2016-11-26

Health care service is a high-credence service and patients may face difficulties ascertaining service quality in order to make choices about their available treatment options. Online health communities (OHCs) provide a convenient channel for patients to search for physicians' information, such as Word-of-Mouth (WOM), particularly on physicians' service quality evaluated by other patients. Existing studies from other service domains have proved that WOM impacts consumer choice. However, how patients make a choice based on physicians' WOM has not been studied, particularly with reference to different patient characteristics and by using real data. One thousand eight hundred fifty three physicians' real data were collected from a Chinese online health community. The data were analyzed using ordinary least squares (OLS) method. The study found that functional quality negatively moderated the relationship between technical quality and patient choice, and disease risk moderated the relationship between physicians' service quality and patient choice. Our study recommends that hospital managers need to consider the roles of both technical quality and functional quality seriously. Physicians should improve their medical skills and bedside manners based on the severity and type of disease to provide better service.

Making Quality Sense: A Guide to Quality, Tools and Techniques, Awards and the Thinking Behind Them.

ERIC Educational Resources Information Center

Owen, Jane

This document is intended to guide further education colleges and work-based learning providers through some of the commonly used tools, techniques, and theories of quality management. The following are among the topics discussed: (1) various ways of defining quality; methods used by organizations to achieve quality (quality control, quality…

Data from selected U.S. Geological Survey National Stream Water-Quality Networks (WQN)

USGS Publications Warehouse

Alexander, Richard B.; Slack, J.R.; Ludtke, A.S.; Fitzgerald, K.K.; Schertz, T.L.; Briel, L.I.; Buttleman, K.P.

1996-01-01

This CD-ROM set contains data from two USGS national stream water-quality networks, the Hydrologic Benchmark Network (HBN) and the National Stream Quality Accounting Network (NASQAN), operated during the past 30 years. These networks were established to provide national and regional descriptions of stream water-quality conditions and trends, based on uniform monitoring of selected watersheds throughout the United States, and to improve our understanding of the effects of the natural environment and human activities on water quality. The HBN, consisting of 63 relatively small, minimally disturbed watersheds, provides data for investigating naturally induced changes in streamflow and water quality and the effects of airborne substances on water quality. NASQAN, consisting of 618 larger, more culturally influenced watersheds, provides information for tracking water-quality conditions in major U.S. rivers and streams.

Quality Rating Systems--The Experiences of Center Directors

ERIC Educational Resources Information Center

Friedman, Dana E.

2007-01-01

Quality Rating System (QRS) initiatives define levels of quality based on research and then support providers with funding and technical assistance to increase their quality. Each program is assessed and given a number of "stars" to indicate to parents what level of quality the program has reached. In this article, the author describes…

Analysis of Open Education Service Quality with the Descriptive-Quantitative Approach

ERIC Educational Resources Information Center

Priyogi, Bilih; Santoso, Harry B.; Berliyanto; Hasibuan, Zainal A.

2017-01-01

The concept of Open Education (OE) is based on the philosophy of e-Learning which aims to provide learning environment anywhere, anytime, and for anyone. One of the main issue in the development of OE services is the availability of the quality assurance mechanism. This study proposes a metric for measuring the quality of OE service. Based on…

A case study of a team-based, quality-focused compensation model for primary care providers.

PubMed

Greene, Jessica; Hibbard, Judith H; Overton, Valerie

2014-06-01

In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

DEVELOPMENT OF MARINE WATER QUALITY CRITERIA

EPA Science Inventory

The U.S. Environmental Protectional Agency has developed guidelines for deriving numerical national water quality criteria for the protection of aquatic organisms and their uses. These guidelines provide the method for deriving water quality criteria, including minimum data base...

Citrus Quality Control: An NMR/MRI Problem-Based Experiment

ERIC Educational Resources Information Center

Erhart, Sarah E.; McCarrick, Robert M.; Lorigan, Gary A.; Yezierski, Ellen J.

2016-01-01

An experiment seated in an industrial context can provide an engaging framework and unique learning opportunity for an upper-division physical chemistry laboratory. An experiment that teaches NMR/MRI through a problem-based quality control of citrus products was developed. In this experiment, using a problem-based learning (PBL) approach, students…

Targeting Environmental Quality to Improve Population Health ...

EPA Pesticide Factsheets

Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Yet, the stakeholders are typically all within the healthcare system, e.g. the Accountable Care Organization or Patient-Centered Medical Home, leaving important contributors to the health of the population such as the public health and environmental health systems absent. And rarely is the quality of the environment regarded as a modifiable factor capable of imparting a health benefit. Underscoring this point, a PubMed search of the search terms “environmental quality” with “value-based payment”, “value-based healthcare” or “value-based reimbursement” returned no relevant articles, providing further evidence that the healthcare industry largely disregards the quality of the environment as a significant determinant of wellbeing and an actionable risk factor for clinical disease management and population health intervention. Yet, the quality of the environment is unequivocally related to indicators of population health including all-cause mortality. The EPA’s Environmental Quality Index (EQI) composed of five different domains (air, land use, water, built environment and social) has provided new estimates of the associations between environmental quality and health stat

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

Application of CCME Water Quality Index to monitor water quality: a case study of the Mackenzie River Basin, Canada.

PubMed

Lumb, Ashok; Halliwell, Doug; Sharma, Tribeni

2006-02-01

All six ecosystem initiatives evolved from many years of federal, provincial, First Nation, local government and community attention to the stresses on sensitive habitats and species, air and water quality, and the consequent threats to community livability. This paper assesses water quality aspect for the ecosystem initiatives and employs newly developed Canadian Council of Ministers of the Environment Water Quality Index (CCME WQI) which provides a convenient mean of summarizing complex water quality data that can be easily understood by the public, water distributors, planners, managers and policy makers. The CCME WQI incorporates three elements: Scope - the number of water quality parameters (variables) not meeting water quality objectives (F(1)); Frequency - the number of times the objectives are not met (F(2)); and Amplitude. the extent to which the objectives are not met (F(3)). The index produces a number between 0 (worst) to 100 (best) to reflect the water quality. This study evaluates water quality of the Mackenzie - Great Bear sub-basin by employing two modes of objective functions (threshold values): one based on the CCME water quality guidelines and the other based on site-specific values that were determined by the statistical analysis of the historical data base. Results suggest that the water quality of the Mackenzie-Great Bear sub-basin is impacted by high turbidity and total (mostly particulate) trace metals due to high suspended sediment loads during the open water season. Comments are also provided on water quality and human health issues in the Mackenzie basin based on the findings and the usefulness of CCME water quality guidelines and site specific values.

Quality Assurance in Continuing Professional Education. An Analysis.

ERIC Educational Resources Information Center

Tovey, Philip

Based on research conducted in and around universities in the United Kingdom, this book analyzes quality assurance in continuing professional education (CPE). An introduction provides a close look at the terms "quality,""quality assurance," and "CPE." Part I deals with context. Chapter 1 looks at theoretical…

Using Early Learning Standards to Provide High-Quality Education for All Children: The Early Learning Guidelines Toolkit

ERIC Educational Resources Information Center

Flores, Roseanne L.; Curby, Timothy W.; Coleman, Hardin; Melo, Kristan

2016-01-01

Today with the rise in the number of 3- to 6-year-old children enrolled in center-based early childhood programs, and a focus on program quality, it becomes imperative for educators to have a better understanding of the role research plays in establishing high-quality programs as these programs provide much of the foundation that supports early…

[Discussion on research thinking of traditional Chinese medicine standardization system based on whole process quality control].

PubMed

Dong, Ling; Sun, Yu; Pei, Wen-Xuan; Dai, Jun-Dong; Wang, Zi-Yu; Pan, Meng; Chen, Jiang-Peng; Wang, Yun

2017-12-01

The concept of "Quality by design" indicates that good design for the whole life cycle of pharmaceutical production enables the drug to meet the expected quality requirements. Aiming at the existing problems of the traditional Chinese medicine (TCM) industry, the TCM standardization system was put forward in this paper from the national strategic level, under the guidance by the idea of quality control in international manufacturing industry and with considerations of TCM industry's own characteristics and development status. The connotation of this strategy was to establish five interrelated systems: multi-indicators system based on tri-indicators system, quality standard and specification system of TCM herbal materials and decoction pieces, quality traceability system, data monitoring system based on whole-process quality control, and whole-process quality management system of TCM, and achieve the whole process systematic and scientific study in TCM industry through "top-level design-implement in steps-system integration" workflow. This article analyzed the correlation between the quality standards of all links, established standard operating procedures of each link and whole process, and constructed a high standard overall quality management system for TCM industry chains, in order to provide a demonstration for the establishment of TCM whole-process quality control system and provide systematic reference and basis for standardization strategy in TCM industry. Copyright© by the Chinese Pharmaceutical Association.

Effect of pooled comparative information on judgments of quality

PubMed Central

Baumgart, Leigh A.; Bass, Ellen J.; Voss, John D.; Lyman, Jason A.

2015-01-01

Quality assessment is the focus of many health care initiatives. Yet it is not well understood how the type of information used in decision support tools to enable judgments of quality based on data impacts the accuracy, consistency and reliability of judgments made by physicians. Comparative pooled information could allow physicians to judge the quality of their practice by making comparisons to other practices or other specific populations of patients. In this study, resident physicians were provided with varying types of information derived from pooled patient data sets: quality component measures at the individual and group level, a qualitative interpretation of the quality measures using percentile rank, and an aggregate composite quality score. 32 participants viewed thirty quality profiles consisting of information applicable to the practice of thirty de-identified resident physicians. Those provided with quality component measures and a qualitative interpretation of the quality measures (rankings) judged quality of care more similarly to experts and were more internally consistent compared to participants who were provided with quality component measures alone. Reliability between participants was significantly less for those who were provided with a composite quality score compared to those who were not. PMID:26949581

A quantitative analysis of the quality and content of the health advice in popular Australian magazines.

PubMed

Wilson, Amanda; Smith, David; Peel, Roseanne; Robertson, Jane; Kypri, Kypros

2017-06-01

To examine how health advice is provided in popular magazines and the quality of that advice. A prospective quantitative analysis of the quality of health advice provided in Australian magazines between July and December 2011 was conducted. A rating instrument was adapted from the Media Doctor Australia rating tool used to assess quality of health news reporting. Criteria included: recommends seeing a doctor; advice based on reliable evidence; advice clear and easily applied; benefits presented meaningfully; potential harms mentioned; evidence of disease mongering; availability and cost of treatments; obvious advertising; vested interest, and anecdotal evidence. 163 health advice articles were rated showing a wide variation in the quality of advice presented between magazines. Magazines with 'health' in the title, rated most poorly with only 36% (26/73) of these articles presenting clear and meaningful advice and 52% (38/73) giving advice based on reliable evidence. Australian magazines, especially those with health in the title, generally presented poor quality, unreliable health advice. Teen magazine Dolly provided the highest quality advice. Consumers need to be aware of this when making health choices. © 2016 Public Health Association of Australia.

Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

PubMed Central

2013-01-01

Introduction In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities. Methods We interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction. Results Objective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received. Conclusions CBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community. PMID:23680066

Models and Methods of Aggregating Linguistic Information in Multi-criteria Hierarchical Quality Assessment Systems

NASA Astrophysics Data System (ADS)

Azarnova, T. V.; Titova, I. A.; Barkalov, S. A.

2018-03-01

The article presents an algorithm for obtaining an integral assessment of the quality of an organization from the perspective of customers, based on the method of aggregating linguistic information on a multilevel hierarchical system of quality assessment. The algorithm is of a constructive nature, it provides not only the possibility of obtaining an integral evaluation, but also the development of a quality improvement strategy based on the method of linguistic decomposition, which forms the minimum set of areas of work with clients whose quality change will allow obtaining the required level of integrated quality assessment.

Improved protein model quality assessments by changing the target function.

PubMed

Uziela, Karolis; Menéndez Hurtado, David; Shu, Nanjiang; Wallner, Björn; Elofsson, Arne

2018-06-01

Protein modeling quality is an important part of protein structure prediction. We have for more than a decade developed a set of methods for this problem. We have used various types of description of the protein and different machine learning methodologies. However, common to all these methods has been the target function used for training. The target function in ProQ describes the local quality of a residue in a protein model. In all versions of ProQ the target function has been the S-score. However, other quality estimation functions also exist, which can be divided into superposition- and contact-based methods. The superposition-based methods, such as S-score, are based on a rigid body superposition of a protein model and the native structure, while the contact-based methods compare the local environment of each residue. Here, we examine the effects of retraining our latest predictor, ProQ3D, using identical inputs but different target functions. We find that the contact-based methods are easier to predict and that predictors trained on these measures provide some advantages when it comes to identifying the best model. One possible reason for this is that contact based methods are better at estimating the quality of multi-domain targets. However, training on the S-score gives the best correlation with the GDT_TS score, which is commonly used in CASP to score the global model quality. To take the advantage of both of these features we provide an updated version of ProQ3D that predicts local and global model quality estimates based on different quality estimates. © 2018 Wiley Periodicals, Inc.

24 CFR 983.101 - Housing quality standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Housing quality standards. 983.101... DEVELOPMENT PROJECT-BASED VOUCHER (PBV) PROGRAM Dwelling Units § 983.101 Housing quality standards. (a) HQS applicability. Except as otherwise provided in this section, 24 CFR 982.401 (housing quality standards) applies...

Campania Region's Educational Quality Facilities Project

ERIC Educational Resources Information Center

Ponti, Giorgio

2009-01-01

This article describes the Educational Quality Facilities project undertaken by Italy's Campania Region to provide quality facilities to all of its communities basing new spaces on the "Flexible Learning Module". The objectives of the five-year project are to: build and equip new educational spaces; improve the quality of existing…

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

PubMed

Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

2015-07-01

The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P < 0.01) and PMTCT services (from 58 to 73%; P = 0.003); there was no significant change at comparison sites. Providers' perceptions of the work environment generally improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

The Quality of Written Feedback by Attendings of Internal Medicine Residents.

PubMed

Jackson, Jeffrey L; Kay, Cynthia; Jackson, Wilkins C; Frank, Michael

2015-07-01

Attending evaluations are commonly used to evaluate residents. Evaluate the quality of written feedback of internal medicine residents. Retrospective. Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. From monthly evaluations of residents by attendings, a randomly selected sample of 500 written comments by attendings were qualitatively coded and rated as high-, moderate-, or low-quality feedback by two independent coders with good inter-rater reliability (kappa: 0.94). Small group exercises with residents and attendings also coded the utterances as high, moderate, or low quality and developed criteria for this categorization. In-service examination scores were correlated with written feedback. There were 228 internal medicine residents who had 6,603 evaluations by 334 attendings. Among 500 randomly selected written comments, there were 2,056 unique utterances: 29% were coded as nonspecific statements, 20% were comments about resident personality, 16% about patient care, 14% interpersonal communication, 7% medical knowledge, 6% professionalism, and 4% each on practice-based learning and systems-based practice. Based on criteria developed by group exercises, the majority of written comments were rated as moderate quality (65%); 22% were rated as high quality and 13% as low quality. Attendings who provided high-quality feedback rated residents significantly lower in all six of the Accreditation Council for Graduate Medical Education (ACGME) competencies (p <0.0005 for all), and had a greater range of scores. Negative comments on medical knowledge were associated with lower in-service examination scores. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments on medical knowledge correlated with lower in-service training scores.

Development of a cloud-based application for the Fracture Liaison Service model of care.

PubMed

Holzmueller, C G; Karp, S; Zeldow, D; Lee, D B; Thompson, D A

2016-02-01

The aims of this study are to develop a cloud-based application of the Fracture Liaison Service for practitioners to coordinate the care of osteoporotic patients after suffering primary fractures and provide a performance feedback portal for practitioners to determine quality of care. The application provides continuity of care, improved patient outcomes, and reduced medical costs. The purpose of this study is to describe the content development and functionality of a cloud-based application to broadly deploy the Fracture Liaison Service (FLS) to coordinate post-fracture care for osteoporotic patients. The Bone Health Collaborative developed the FLS application in 2013 to support practitioners' access to information and management of patients and provide a feedback portal for practitioners to track their performance in providing quality care. A five-step protocol (identify, inform, initiate, investigate, and iterate) organized osteoporotic post-fracture care-related tasks and timelines for the application. A range of descriptive data about the patient, their medical condition, therapies and care, and current providers can be collected. Seven quality of care measures from the National Quality Forum, The Joint Commission, and the Centers for Medicare and Medicaid Services can be tracked through the application. There are five functional areas including home, tasks, measures, improvement, and data. The home, tasks, and data pages are used to enter patient information and coordinate care using the five-step protocol. Measures and improvement pages are used to enter quality measures and provide practitioners with continuous performance feedback. The application resides within a portal, running on a multitenant, private cloud-based Avedis enterprise registry platform. All data are encrypted in transit and users access the application using a password from any common web browser. The application could spread the FLS model of care across the US health care system, provide continuity of care, effectively manage osteoporotic patients, improve outcomes, and reduce medical costs.

Scaling up Evidence-based Practices for Children and Families in New York State: Towards Evidence-based Policies on Implementation for State Mental Health Systems

PubMed Central

Hoagwood, Kimberly Eaton; Olin, S. Serene; Horwitz, Sarah; McKay, Mary; Cleek, Andrew; Gleacher, Alissa; Lewandowski, Eric; Nadeem, Erum; Acri, Mary; Chor, Ka Ho Brian; Kuppinger, Anne; Burton, Geraldine; Weiss, Dara; Frank, Samantha; Finnerty, Molly; Bradbury, Donna M.; Woodlock, Kristin M.; Hogan, Michael

2014-01-01

Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems. PMID:24460518

Hydrologic and Water Quality System (HAWQS)

EPA Science Inventory

The Hydrologic and Water Quality System (HAWQS) is a web-based interactive water quantity and quality modeling system that employs as its core modeling engine the Soil and Water Assessment Tool (SWAT), an internationally-recognized public domain model. HAWQS provides users with i...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

A system framework of inter-enterprise machining quality control based on fractal theory

NASA Astrophysics Data System (ADS)

Zhao, Liping; Qin, Yongtao; Yao, Yiyong; Yan, Peng

2014-03-01

In order to meet the quality control requirement of dynamic and complicated product machining processes among enterprises, a system framework of inter-enterprise machining quality control based on fractal was proposed. In this system framework, the fractal-specific characteristic of inter-enterprise machining quality control function was analysed, and the model of inter-enterprise machining quality control was constructed by the nature of fractal structures. Furthermore, the goal-driven strategy of inter-enterprise quality control and the dynamic organisation strategy of inter-enterprise quality improvement were constructed by the characteristic analysis on this model. In addition, the architecture of inter-enterprise machining quality control based on fractal was established by means of Web service. Finally, a case study for application was presented. The result showed that the proposed method was available, and could provide guidance for quality control and support for product reliability in inter-enterprise machining processes.

Considerations of Administrative Licensure, Provider Type, and Leadership Quality: Recommendations for Research, Policy, and Practice

ERIC Educational Resources Information Center

Hackmann, Donald G.

2016-01-01

This article reviews U.S. administrative licensure regulations, focusing on type of school leader licensure, provider types, and leadership quality. Licensure obtained through university-based and alternative routes is examined. Due to limited research on alternative school administrative licensure, regulations in medicine, psychology,…

The Student Experience of Community-Based Research: An Autoethnography

ERIC Educational Resources Information Center

Ingman, Benjamin C.

2016-01-01

This autoethnography provides a description and thematic illustration of the student experience of a community-based research (CBR) course and partnership. Through evaluating personal experiences with CBR, the author identified three qualities of meaningful CBR experiences: trust, indeterminacy, and emotion. These qualities are explored, and…

Evaluating Response Cards as Evidence Based

ERIC Educational Resources Information Center

Owiny, Ruby L.; Spriggs, Amy D.; Sartini, Emily C.; Mills, Jeremy R.

2018-01-01

Increased accountability for quality instruction leading to higher achievement for all students has made it essential for identification and implementation of evidence-based practices. The Council for Exceptional Children's development of quality indicators (QI) has provided measures for researchers to apply to a body of literature to determine if…

Six Sigma Quality Management System and Design of Risk-based Statistical Quality Control.

PubMed

Westgard, James O; Westgard, Sten A

2017-03-01

Six sigma concepts provide a quality management system (QMS) with many useful tools for managing quality in medical laboratories. This Six Sigma QMS is driven by the quality required for the intended use of a test. The most useful form for this quality requirement is the allowable total error. Calculation of a sigma-metric provides the best predictor of risk for an analytical examination process, as well as a design parameter for selecting the statistical quality control (SQC) procedure necessary to detect medically important errors. Simple point estimates of sigma at medical decision concentrations are sufficient for laboratory applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Needs Assessment for the Use of NASA Remote Sensing Data for Regulatory Water Quality

NASA Technical Reports Server (NTRS)

Spiering, Bruce; Underwood, Lauren

2010-01-01

This slide presentation reviews the assessment of the needs that NASA can use for the remote sensing of water quality. The goal of this project is to provide information for decision-making activities (water quality standards) using remotely sensed/satellite based water quality data from MODIS and Landsat data.

Total Quality Leadership

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity. The panel presentations and Keynote speeches revolving around the theme of total quality leadership provided a solid base of understanding of the importance, benefits, and principles of total quality management (TQM). The presentations from the conference are summarized.

Disclosure of Complementary and Alternative Medicine to Conventional Medical Providers: Variation by Race/Ethnicity and Type of CAM

PubMed Central

Chao, Maria T.; Wade, Christine; Kronenberg, Fredi

2009-01-01

Background Complementary and alternative medicine (CAM) is often used alongside conventional medical care, yet fewer than half of patients disclose CAM use to medical doctors. CAM disclosure is particularly low among racial/ethnic minorities, but reasons for differences, such as type of CAM used or quality of conventional healthcare, have not been explored. Objective We tested the hypotheses that disclosure of CAM use to medical doctors is higher for provider-based CAM and among non-Hispanic whites, and that access to and quality of conventional medical care account for racial/ethnic differences in CAM disclosure. Methods Bivariate and multiple variable analyses of the 2002 National Health Interview Survey and 2001 Health Care Quality Survey were performed. Results Disclosure of CAM use to medical providers was higher for provider-based than self-care CAM. Disclosure of any CAM was associated with access to and quality of conventional care and higher among non-Latino whites relative to minorities. Having a regular doctor and quality patient–provider relationship mitigated racial/ethnic differences in CAM disclosure. Conclusion Insufficient disclosure of CAM use to conventional providers, particularly for self-care practices and among minority populations, represents a serious challenge in medical encounter communications. Efforts to improve disclosure of CAM use should be aimed at improving consistency of care and patient–physician communication across racial/ethnic groups. PMID:19024232

A Delphi Study to Examine the Quality Measurement Standards by Online Instructors Using the Quality Matters™ Rubric as a Basis for Creating Instructional Materials

ERIC Educational Resources Information Center

Robinson, Daniel J.

2017-01-01

Quality measurement tools such as the Rubric for Online Instruction (ROI) and Quality Matters (QM) have developed guidelines by providing research based educational criteria for planning, creating, and implementing quality online education courses. This dissertation reviews QM program standards and identifies the primary characteristics of…

The relationship between motivation, monetary compensation, and data quality among US- and India-based workers on Mechanical Turk.

PubMed

Litman, Leib; Robinson, Jonathan; Rosenzweig, Cheskie

2015-06-01

In this study, we examined data quality among Amazon Mechanical Turk (MTurk) workers based in India, and the effect of monetary compensation on their data quality. Recent studies have shown that work quality is independent of compensation rates, and that compensation primarily affects the quantity but not the quality of work. However, the results of these studies were generally based on compensation rates below the minimum wage, and far below a level that was likely to play a practical role in the lives of workers. In this study, compensation rates were set around the minimum wage in India. To examine data quality, we developed the squared discrepancy procedure, which is a task-based quality assurance approach for survey tasks whose goal is to identify inattentive participants. We showed that data quality is directly affected by compensation rates for India-based participants. We also found that data were of a lesser quality among India-based than among US participants, even when optimal payment strategies were utilized. We additionally showed that the motivation of MTurk users has shifted, and that monetary compensation is now reported to be the primary reason for working on MTurk, among both US- and India-based workers. Overall, MTurk is a constantly evolving marketplace where multiple factors can contribute to data quality. High-quality survey data can be acquired on MTurk among India-based participants when an appropriate pay rate is provided and task-specific quality assurance procedures are utilized.

Automatic assessment of voice quality according to the GRBAS scale.

PubMed

Sáenz-Lechón, Nicolás; Godino-Llorente, Juan I; Osma-Ruiz, Víctor; Blanco-Velasco, Manuel; Cruz-Roldán, Fernando

2006-01-01

Nowadays, the most extended techniques to measure the voice quality are based on perceptual evaluation by well trained professionals. The GRBAS scale is a widely used method for perceptual evaluation of voice quality. The GRBAS scale is widely used in Japan and there is increasing interest in both Europe and the United States. However, this technique needs well-trained experts, and is based on the evaluator's expertise, depending a lot on his own psycho-physical state. Furthermore, a great variability in the assessments performed from one evaluator to another is observed. Therefore, an objective method to provide such measurement of voice quality would be very valuable. In this paper, the automatic assessment of voice quality is addressed by means of short-term Mel cepstral parameters (MFCC), and learning vector quantization (LVQ) in a pattern recognition stage. Results show that this approach provides acceptable results for this purpose, with accuracy around 65% at the best.

Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PubMed

Klein, Jonathan D; Handwerker, Lisa; Sesselberg, Tracy S; Sutter, Erika; Flanagan, Erinn; Gawronski, Beth

2007-08-01

To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Provider Perspectives on School-Based Mental Health for Urban Minority Youth: Access and Services

ERIC Educational Resources Information Center

Gamble, Brandon E.; Lambros, Katina M.

2014-01-01

This article provides results from a qualitative study on the efforts of school-based mental health providers (SBMHPs) who serve students in urban, suburban, and ethnically diverse settings to help families access quality mental health services. School-based mental health plays a key role in the provision of direct and indirect intervention…

Assessing healthcare quality using routine data: evaluating the performance of the national tuberculosis programme in South Africa.

PubMed

McLaren, Zoë M; Sharp, Alana R; Zhou, Jifang; Wasserman, Sean; Nanoo, Ananta

2017-02-01

To assess the performance of healthcare facilities by means of indicators based on guidelines for clinical care of TB, which is likely a good measure of overall facility quality. We assessed quality of care in all public health facilities in South Africa using graphical, correlation and locally weighted kernel regression analysis of routine TB test data. Facility performance falls short of national standards of care. Only 74% of patients with TB provided a second specimen for testing, 18% received follow-up testing and 14% received drug resistance testing. Only resistance testing rates improved over time, tripling between 2004 and 2011. National awareness campaigns and changes in clinical guidelines had only a transient impact on testing rates. The poorest performing facilities remained at the bottom of the rankings over the period of study. The optimal policy strategy requires both broad-based policies and targeted resources to poor performers. This approach to assessing facility quality of care can be adapted to other contexts and also provides a low-cost method for evaluating the effectiveness of proposed interventions. Devising targeted policies based on routine data is a cost-effective way to improve the quality of public health care provided. © 2016 John Wiley & Sons Ltd.

Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico

PubMed Central

De Castro, Filipa; Barrientos-Gutiérrez, Tonatiuh; Leyva-López, Ahideé

2017-01-01

Objective Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world’s adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. Methods This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. Results At the national level 13.9% (95%CI: 6.9–26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4–77.3) medium quality and 17.5% (95%CI: 11.9–25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. Conclusions The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care. PMID:28273129

Development of an electronic device quality aluminum antimonide (AlSb) semiconductor for solar cell applications

DOEpatents

Sherohman, John W; Yee, Jick Hong; Combs, III, Arthur W

2014-11-11

Electronic device quality Aluminum Antimonide (AlSb)-based single crystals produced by controlled atmospheric annealing are utilized in various configurations for solar cell applications. Like that of a GaAs-based solar cell devices, the AlSb-based solar cell devices as disclosed herein provides direct conversion of solar energy to electrical power.

Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial

PubMed Central

Planas, Maria-Elena; García, Patricia J.; Bustelo, Monserrat; Carcamo, Cesar P.; Martinez, Sebastian; Nopo, Hugo; Rodriguez, Julio; Merino, Maria-Fernanda; Morrison, Andrew

2015-01-01

Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0·7% (p = 0·23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima. PMID:25671664

Effects of ethnic attributes on the quality of family planning services in Lima, Peru: a randomized crossover trial.

PubMed

Planas, Maria-Elena; García, Patricia J; Bustelo, Monserrat; Carcamo, Cesar P; Martinez, Sebastian; Nopo, Hugo; Rodriguez, Julio; Merino, Maria-Fernanda; Morrison, Andrew

2015-01-01

Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0.7% (p = 0.23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima.

Comparison of case note review methods for evaluating quality and safety in health care.

PubMed

Hutchinson, A; Coster, J E; Cooper, K L; McIntosh, A; Walters, S J; Bath, P A; Pearson, M; Young, T A; Rantell, K; Campbell, M J; Ratcliffe, J

2010-02-01

To determine which of two methods of case note review--holistic (implicit) and criterion-based (explicit)--provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process-outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. Case notes of patients at randomly selected hospitals in England. In the first part of the study, retrospective multiple reviews of 684 case notes were undertaken at nine acute hospitals using both holistic and criterion-based review methods. Quality-of-care measures included evidence-based review criteria and a quality-of-care rating scale. Textual commentary on the quality of care was provided as a component of holistic review. Review teams comprised combinations of: doctors (n = 16), specialist nurses (n = 10) and clinically trained audit staff (n = 3) and non-clinical audit staff (n = 9). In the second part of the study, process (quality and safety) of care data were collected from the case notes of 1565 people with either chronic obstructive pulmonary disease (COPD) or heart failure in 20 hospitals. Doctors collected criterion-based data from case notes and used implicit review methods to derive textual comments on the quality of care provided and score the care overall. Data were analysed for intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs) and completeness of criterion data capture, and comparisons were made within and between staff groups and between review methods. To explore the process-outcome relationship, a range of publicly available health-care indicator data were used as proxy outcomes in a multilevel analysis. Overall, 1473 holistic and 1389 criterion-based reviews were undertaken in the first part of the study. When same staff-type reviewer pairs/groups reviewed the same record, holistic scale score inter-rater reliability was moderate within each of the three staff groups [intraclass correlation coefficient (ICC) 0.46-0.52], and inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61-0.88). When different staff-type pairs/groups reviewed the same record, agreement between the reviewer pairs/groups was weak to moderate for overall care (ICC 0.24-0.43). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement (p-values for difference 0.406 and 0.223, respectively), although results from all three staff types showed no overall level of agreement (p-value for difference 0.057). Detailed qualitative analysis of the textual data indicated that the three staff types tended to provide different forms of commentary on quality of care, although there was some overlap between some groups. In the process-outcome study there generally were high criterion-based scores for all hospitals, whereas there was more interhospital variation between the holistic review overall scale scores. Textual commentary on the quality of care verified the holistic scale scores. Differences among hospitals with regard to the relationship between mortality and quality of care were not statistically significant. Using the holistic approach, the three groups of staff appeared to interpret the recorded care differently when they each reviewed the same record. When the same clinical record was reviewed by doctors and non-clinical audit staff, there was no significant difference between the assessments of quality of care generated by the two groups. All three staff groups performed reasonably well when using criterion-based review, although the quality and type of information provided by doctors was of greater value. Therefore, when measuring quality of care from case notes, consideration needs to be given to the method of review, the type of staff undertaking the review, and the methods of analysis available to the review team. Review can be enhanced using a combination of both criterion-based and structured holistic methods with textual commentary, and variation in quality of care can best be identified from a combination of holistic scale scores and textual data review.

Using fuzzy gap analysis to measure service quality of medical tourism in Taiwan.

PubMed

Ho, Li-Hsing; Feng, Shu-Yun; Yen, Tieh-Min

2015-01-01

The purpose of this paper is intended to create a model to measure quality of service, using fuzzy linguistics to analyze the quality of service of medical tourism in Taiwan so as to find the direction for improvement of service quality in medical tourism. The study developed fuzzy questionnaires based on the characteristics of medical tourism quality of service in Taiwan. Questionnaires were delivered and recovered from February to April 2014, using random sampling according to the proportion of medical tourism companies in each region, and 150 effective samples were obtained. The critical quality of service level is found through the fuzzy gap analysis using questionnaires examining expectations and perceptions of customers, as the direction for continuous improvement. From the study, the primary five critical service items that improve the quality of service for medical tourism in Taiwan include, in order: the capability of the service provider to provide committed medical tourism services reliably and accurately, facility service providers in conjunction with the services provided, the cordial and polite attitude of the service provider eliciting a sense of trust from the customer, professional ability of medical (nursing) personnel in hospital and reliability of service provider. The contribution of this study is to create a fuzzy gap analysis to assess the performance of medical tourism service quality, identify key quality characteristics and provide a direction for improvement and development for medical tourism service quality in Taiwan.

Comparing Panelists' Understanding of Standard Setting across Multiple Levels of an Alternate Science Assessment

ERIC Educational Resources Information Center

Hansen, Mary A.; Lyon, Steven R.; Heh, Peter; Zigmond, Naomi

2013-01-01

Large-scale assessment programs, including alternate assessments based on alternate achievement standards (AA-AAS), must provide evidence of technical quality and validity. This study provides information about the technical quality of one AA-AAS by evaluating the standard setting for the science component. The assessment was designed to have…

Criteria for clinical audit of women friendly care and providers' perception in Malawi.

PubMed

Kongnyuy, Eugene J; van den Broek, Nynke

2008-07-22

There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

Criteria for clinical audit of women friendly care and providers' perception in Malawi

PubMed Central

Kongnyuy, Eugene J; van den Broek, Nynke

2008-01-01

Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers. PMID:18647388

The Role of Reliability, Vulnerability and Resilience in the Management of Water Quality Systems

NASA Astrophysics Data System (ADS)

Lence, B. J.; Maier, H. R.

2001-05-01

The risk based performance indicators reliability, vulnerability and resilience provide measures of the frequency, magnitude and duration of the failure of water resources systems, respectively. They have been applied primarily to water supply problems, including the assessment of the performance of reservoirs and water distribution systems. Applications to water quality case studies have been limited, although the need to consider the length and magnitude of violations of a particular water quality standard has been recognized for some time. In this research, the role of reliability, vulnerability and resilience in water quality management applications is investigated by examining their significance as performance measures for water quality systems and assessing their potential for assisting in decision making processes. The importance of each performance indicator is discussed and a framework for classifying such systems, based on the relative significance of each of these indicators, is introduced and illustrated qualitatively with various case studies. Quantitative examples drawn from both lake and river water quality modeling exercises are then provided.

Performance measurement: integrating quality management and activity-based cost management.

PubMed

McKeon, T

1996-04-01

The development of an activity-based management system provides a framework for developing performance measures integral to quality and cost management. Performance measures that cross operational boundaries and embrace core processes provide a mechanism to evaluate operational results related to strategic intention and internal and external customers. The author discusses this measurement process that allows managers to evaluate where they are and where they want to be, and to set a course of action that closes the gap between the two.

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

“Putting It All Together” to Improve Resuscitation Quality

PubMed Central

Sutton, Robert M.; Nadkarni, Vinay; Abella, Benjamin S.

2013-01-01

Cardiac arrest is a major public health problem affecting thousands of individuals each year in both the before hospital and in-hospital settings. However, although the scope of the problem is large, the quality of care provided during resuscitation attempts frequently does not meet quality of care standards, despite evidence-based cardiopulmonary resuscitation (CPR) guidelines, extensive provider training, and provider credentialing in resuscitation medicine. Although this fact may be disappointing, it should not be surprising. Resuscitation of the cardiac arrest victim is a highly complex task requiring coordination between various levels and disciplines of care providers during a stressful and relatively infrequent clinical situation. Moreover, it requires a targeted, high-quality response to improve clinical outcomes of patients. Therefore, solutions to improve care provided during resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. PMID:22107978

Quality Inspection and Analysis of Three-Dimensional Geographic Information Model Based on Oblique Photogrammetry

NASA Astrophysics Data System (ADS)

Dong, S.; Yan, Q.; Xu, Y.; Bai, J.

2018-04-01

In order to promote the construction of digital geo-spatial framework in China and accelerate the construction of informatization mapping system, three-dimensional geographic information model emerged. The three-dimensional geographic information model based on oblique photogrammetry technology has higher accuracy, shorter period and lower cost than traditional methods, and can more directly reflect the elevation, position and appearance of the features. At this stage, the technology of producing three-dimensional geographic information models based on oblique photogrammetry technology is rapidly developing. The market demand and model results have been emerged in a large amount, and the related quality inspection needs are also getting larger and larger. Through the study of relevant literature, it is found that there are a lot of researches on the basic principles and technical characteristics of this technology, and relatively few studies on quality inspection and analysis. On the basis of summarizing the basic principle and technical characteristics of oblique photogrammetry technology, this paper introduces the inspection contents and inspection methods of three-dimensional geographic information model based on oblique photogrammetry technology. Combined with the actual inspection work, this paper summarizes the quality problems of three-dimensional geographic information model based on oblique photogrammetry technology, analyzes the causes of the problems and puts forward the quality control measures. It provides technical guidance for the quality inspection of three-dimensional geographic information model data products based on oblique photogrammetry technology in China and provides technical support for the vigorous development of three-dimensional geographic information model based on oblique photogrammetry technology.

Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures.

PubMed

Tang, Paul C; Ralston, Mary; Arrigotti, Michelle Fernandez; Qureshi, Lubna; Graham, Justin

2007-01-01

New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR. The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.

Methodology of quality improvement projects for the Texas Medicare population.

PubMed

Pendergrass, P W; Abel, R L; Bing, M; Vaughn, R; McCauley, C

1998-07-01

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

[Designing and implementation of a web-based quality monitoring system for plasma glucose measurement in multicenter population study].

PubMed

Liu, Yong; Wang, Limin; Pang, Richard; Mo, Nanxun; Hu, Yan; Deng, Qian; Hu, Zhaohui

2015-05-01

The aim of this paper is to describe the designing and implementation of a web-based plasma glucose measurement quality monitoring system to assess the analytical quality of plasma glucose measurements in multicenter population study and provide evidence for the future studies. In the chronic non-communicable disease and related factor surveillance in China, a web based quality monitoring system for plasma glucose measurement was established to conduct evaluation on plasma glucose monitoring quality and effectiveness in 302 surveillance centers, including quality control data entry, transmission and feedback. The majority of the surveillance centers met the quality requirements and passed the evaluation of reproducibility and precision of plasma glucose measurement, only a few centers required intensive training and re-assessment. In order to ensure the completeness and reliability of plasma glucose measurement in the surveillance centers, the establishment of web-based plasma glucose measurement quality control system can facilitate the identification of the qualified surveillance centers and evaluation of plasma glucose measurement quality in different regions. Communication and training are important in ensuring plasma glucose measurement quality. It is necessary to further improve this web-based plasma glucose measurement quality monitoring system in the future to reduce the method specific plasma glucose measurement bias.

Development of Innovative Business Model of Modern Manager's Qualities

ERIC Educational Resources Information Center

Yashkova, Elena V.; Sineva, Nadezda L.; Shkunova, Angelika A.; Bystrova, Natalia V.; Smirnova, Zhanna V.; Kolosova, Tatyana V.

2016-01-01

The paper defines a complex of manager's qualities based on theoretical and methodological analysis and synthesis methods, available national and world literature, research papers and publications. The complex approach methodology was used, which provides an innovative view of the development of modern manager's qualities. The methodological…

Discussion on the application of high additional value of high purity and high quality direct reduced iron

NASA Astrophysics Data System (ADS)

Yue, Chongfeng; Bai, Lu; Hong, Yicheng; Xu, Lijun

2018-03-01

The high purity and high quality direct reduced iron(DRI) products which were produced by high grade and high quality iron powder, with a high grade and low impurity characteristics. This article introduced the application of high purity and high quality DRI in the fields of amorphous base material, atomized iron powder, powder superalloy, high purity and ultra-low carbon special metallurgy products, precision casting, super alloy and various iron-based alloys. It provides a reference for the high added value utilization of DRI.

Coupling online effects-based monitoring with physicochemical, optical, and spectroscopy methods to assess quality at a surface water intake

EPA Science Inventory

Effects-based monitoring of water quality is a proven approach to monitoring the status of a water source. Only biological material can integrate factors which dictate toxicity. Online Toxicity Monitors (OTMs) provide a means to digitize sentinel organism responses to dynamic wa...

Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

ERIC Educational Resources Information Center

Lawrence, Sharmila; Stephens, Samuel A.

2016-01-01

This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

A tool to determine financial impact of adverse events in health care: healthcare quality calculator.

PubMed

Yarbrough, Wendell G; Sewell, Andrew; Tickle, Erin; Rhinehardt, Eric; Harkleroad, Rod; Bennett, Marc; Johnson, Deborah; Wen, Li; Pfeiffer, Matthew; Benegas, Manny; Morath, Julie

2014-12-01

Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin. Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement. The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications. The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.

Recreational Water Quality Criteria Limits

EPA Pesticide Factsheets

This set of Frequently Asked Questions (FAQ) provides an overview of NPDES permitting applicable to continuous dischargers (such as POTWs) based on water quality standards for pathogens and pathogen indicators associated with fecal contamination.

A condition metric for Eucalyptus woodland derived from expert evaluations.

PubMed

Sinclair, Steve J; Bruce, Matthew J; Griffioen, Peter; Dodd, Amanda; White, Matthew D

2018-02-01

The evaluation of ecosystem quality is important for land-management and land-use planning. Evaluation is unavoidably subjective, and robust metrics must be based on consensus and the structured use of observations. We devised a transparent and repeatable process for building and testing ecosystem metrics based on expert data. We gathered quantitative evaluation data on the quality of hypothetical grassy woodland sites from experts. We used these data to train a model (an ensemble of 30 bagged regression trees) capable of predicting the perceived quality of similar hypothetical woodlands based on a set of 13 site variables as inputs (e.g., cover of shrubs, richness of native forbs). These variables can be measured at any site and the model implemented in a spreadsheet as a metric of woodland quality. We also investigated the number of experts required to produce an opinion data set sufficient for the construction of a metric. The model produced evaluations similar to those provided by experts, as shown by assessing the model's quality scores of expert-evaluated test sites not used to train the model. We applied the metric to 13 woodland conservation reserves and asked managers of these sites to independently evaluate their quality. To assess metric performance, we compared the model's evaluation of site quality with the managers' evaluations through multidimensional scaling. The metric performed relatively well, plotting close to the center of the space defined by the evaluators. Given the method provides data-driven consensus and repeatability, which no single human evaluator can provide, we suggest it is a valuable tool for evaluating ecosystem quality in real-world contexts. We believe our approach is applicable to any ecosystem. © 2017 State of Victoria.

Development of visibility forecasting modeling framework for the Lower Fraser Valley of British Columbia using Canada's Regional Air Quality Deterministic Prediction System.

PubMed

So, Rita; Teakles, Andrew; Baik, Jonathan; Vingarzan, Roxanne; Jones, Keith

2018-05-01

Visibility degradation, one of the most noticeable indicators of poor air quality, can occur despite relatively low levels of particulate matter when the risk to human health is low. The availability of timely and reliable visibility forecasts can provide a more comprehensive understanding of the anticipated air quality conditions to better inform local jurisdictions and the public. This paper describes the development of a visibility forecasting modeling framework, which leverages the existing air quality and meteorological forecasts from Canada's operational Regional Air Quality Deterministic Prediction System (RAQDPS) for the Lower Fraser Valley of British Columbia. A baseline model (GM-IMPROVE) was constructed using the revised IMPROVE algorithm based on unprocessed forecasts from the RAQDPS. Three additional prototypes (UMOS-HYB, GM-MLR, GM-RF) were also developed and assessed for forecast performance of up to 48 hr lead time during various air quality and meteorological conditions. Forecast performance was assessed by examining their ability to provide both numerical and categorical forecasts in the form of 1-hr total extinction and Visual Air Quality Ratings (VAQR), respectively. While GM-IMPROVE generally overestimated extinction more than twofold, it had skill in forecasting the relative species contribution to visibility impairment, including ammonium sulfate and ammonium nitrate. Both statistical prototypes, GM-MLR and GM-RF, performed well in forecasting 1-hr extinction during daylight hours, with correlation coefficients (R) ranging from 0.59 to 0.77. UMOS-HYB, a prototype based on postprocessed air quality forecasts without additional statistical modeling, provided reasonable forecasts during most daylight hours. In terms of categorical forecasts, the best prototype was approximately 75 to 87% correct, when forecasting for a condensed three-category VAQR. A case study, focusing on a poor visual air quality yet low Air Quality Health Index episode, illustrated that the statistical prototypes were able to provide timely and skillful visibility forecasts with lead time up to 48 hr. This study describes the development of a visibility forecasting modeling framework, which leverages the existing air quality and meteorological forecasts from Canada's operational Regional Air Quality Deterministic Prediction System. The main applications include tourism and recreation planning, input into air quality management programs, and educational outreach. Visibility forecasts, when supplemented with the existing air quality and health based forecasts, can assist jurisdictions to anticipate the visual air quality impacts as perceived by the public, which can potentially assist in formulating the appropriate air quality bulletins and recommendations.

Quality based prequalification of contractors

DOT National Transportation Integrated Search

2001-08-01

This report summarizes the efforts to provide the Kentucky Transportation Cabinet with a system for evaluating the quality of the performance of contractors on highway construction projects and using that evaluation in the Cabinet's annual prequalifi...

Unisys' experience in software quality and productivity management of an existing system

NASA Technical Reports Server (NTRS)

Munson, John B.

1988-01-01

A summary of Quality Improvement techniques, implementation, and results in the maintenance, management, and modification of large software systems for the Space Shuttle Program's ground-based systems is provided.

Quality of core collections for effective utilisation of genetic resources review, discussion and interpretation.

PubMed

Odong, T L; Jansen, J; van Eeuwijk, F A; van Hintum, T J L

2013-02-01

Definition of clear criteria for evaluation of the quality of core collections is a prerequisite for selecting high-quality cores. However, a critical examination of the different methods used in literature, for evaluating the quality of core collections, shows that there are no clear guidelines on the choices of quality evaluation criteria and as a result, inappropriate analyses are sometimes made leading to false conclusions being drawn regarding the quality of core collections and the methods to select such core collections. The choice of criteria for evaluating core collections appears to be based mainly on the fact that those criteria have been used in earlier publications rather than on the actual objectives of the core collection. In this study, we provide insight into different criteria used for evaluating core collections. We also discussed different types of core collections and related each type of core collection to their respective evaluation criteria. Two new criteria based on genetic distance are introduced. The consequences of the different evaluation criteria are illustrated using simulated and experimental data. We strongly recommend the use of the distance-based criteria since they not only allow the simultaneous evaluation of all variables describing the accessions, but they also provide intuitive and interpretable criteria, as compared with the univariate criteria generally used for the evaluation of core collections. Our findings will provide genebank curators and researchers with possibilities to make informed choices when creating, comparing and using core collections.

A new method based on fuzzy logic to evaluate the contract service provider performance.

PubMed

Miguel, C A; Barr, C; Moreno, M J L

2008-01-01

This paper puts forward a fuzzy inference system for evaluating the service quality performance of service contract providers. An application service provider (ASP) model for computerized maintenance management was used in establishing common performance indicators of the quality of service. This model was implemented in 10 separate hospitals. As a result, inference produced a service cost/acquisition cost (SC/AC) ratio reduction from 16.14% to 6.09%, an increase of 20.9% in availability, with a maintained repair quality (NRR) in the period of December 2001 to January 2003.

Quality Indicators for Learning Analytics

ERIC Educational Resources Information Center

Scheffel, Maren; Drachsler, Hendrik; Stoyanov, Slavi; Specht, Marcus

2014-01-01

This article proposes a framework of quality indicators for learning analytics that aims to standardise the evaluation of learning analytics tools and to provide a mean to capture evidence for the impact of learning analytics on educational practices in a standardised manner. The criteria of the framework and its quality indicators are based on…

Postacute rehabilitation quality of care: toward a shared conceptual framework.

PubMed

Jesus, Tiago Silva; Hoenig, Helen

2015-05-01

There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Quality of Web-based information on cocaine addiction.

PubMed

Khazaal, Yasser; Chatton, Anne; Cochand, Sophie; Zullino, Daniele

2008-08-01

To evaluate the quality of web-based information on cocaine use and addiction and to investigate potential content quality indicators. Three keywords: cocaine, cocaine addiction and cocaine dependence were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. Of the 120 websites identified, 61 were included. Most were commercial sites. The results of the study indicate low scores on each of the measures including content quality. A global score (the sum of accountability, interactivity, content quality and aesthetic criteria) appeared as a good content quality indicator. While cocaine education websites for patients are widespread, their global quality is poor. There is a need for better evidence-based information about cocaine use and addiction on the web. The poor and variable quality of web-based information and its possible impact on physician-patient relationship argue for a serious provider for patient talk about the health information found on Internet. Internet sites could improve their content using the global score as a quality indicator.

Competition and quality in health care markets: a differential-game approach.

PubMed

Brekke, Kurt R; Cellini, Roberto; Siciliani, Luigi; Straume, Odd Rune

2010-07-01

We investigate the effect of competition on quality in health care markets with regulated prices taking a differential game approach, in which quality is a stock variable. Using a Hotelling framework, we derive the open-loop solution (health care providers set the optimal investment plan at the initial period) and the feedback closed-loop solution (providers move investments in response to the dynamics of the states). Under the closed-loop solution competition is more intense in the sense that providers observe quality in each period and base their investment on this information. If the marginal provision cost is constant, the open-loop and closed-loop solutions coincide, and the results are similar to the ones obtained by static models. If the marginal provision cost is increasing, investment and quality are lower in the closed-loop solution (when competition is more intense). In this case, static models tend to exaggerate the positive effect of competition on quality.

Protocol for the evaluation of a quality-based pay for performance scheme in Liberia.

PubMed

Bawo, Luke; Leonard, Kenneth L; Mohammed, Rianna

2015-01-13

Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level. This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals. We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?

Quality of asthma care under different primary care models in Canada: a population-based study.

PubMed

To, Teresa; Guan, Jun; Zhu, Jingqin; Lougheed, M Diane; Kaplan, Alan; Tamari, Itamar; Stanbrook, Matthew B; Simatovic, Jacqueline; Feldman, Laura; Gershon, Andrea S

2015-02-14

Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.

Analysis of quality raw data of second generation sequencers with Quality Assessment Software.

PubMed

Ramos, Rommel Tj; Carneiro, Adriana R; Baumbach, Jan; Azevedo, Vasco; Schneider, Maria Pc; Silva, Artur

2011-04-18

Second generation technologies have advantages over Sanger; however, they have resulted in new challenges for the genome construction process, especially because of the small size of the reads, despite the high degree of coverage. Independent of the program chosen for the construction process, DNA sequences are superimposed, based on identity, to extend the reads, generating contigs; mismatches indicate a lack of homology and are not included. This process improves our confidence in the sequences that are generated. We developed Quality Assessment Software, with which one can review graphs showing the distribution of quality values from the sequencing reads. This software allow us to adopt more stringent quality standards for sequence data, based on quality-graph analysis and estimated coverage after applying the quality filter, providing acceptable sequence coverage for genome construction from short reads. Quality filtering is a fundamental step in the process of constructing genomes, as it reduces the frequency of incorrect alignments that are caused by measuring errors, which can occur during the construction process due to the size of the reads, provoking misassemblies. Application of quality filters to sequence data, using the software Quality Assessment, along with graphing analyses, provided greater precision in the definition of cutoff parameters, which increased the accuracy of genome construction.

The importance of knowledge-based technology.

PubMed

Cipriano, Pamela F

2012-01-01

Nurse executives are responsible for a workforce that can provide safer and more efficient care in a complex sociotechnical environment. National quality priorities rely on technologies to provide data collection, share information, and leverage analytic capabilities to interpret findings and inform approaches to care that will achieve better outcomes. As a key steward for quality, the nurse executive exercises leadership to provide the infrastructure to build and manage nursing knowledge and instill accountability for following evidence-based practices. These actions contribute to a learning health system where new knowledge is captured as a by-product of care delivery enabled by knowledge-based electronic systems. The learning health system also relies on rigorous scientific evidence embedded into practice at the point of care. The nurse executive optimizes use of knowledge-based technologies, integrated throughout the organization, that have the capacity to help transform health care.

Evidence based post graduate training. A systematic review of reviews based on the WFME quality framework

PubMed Central

2011-01-01

Background A framework for high quality in post graduate training has been defined by the World Federation of Medical Education (WFME). The objective of this paper is to perform a systematic review of reviews to find current evidence regarding aspects of quality of post graduate training and to organise the results following the 9 areas of the WFME framework. Methods The systematic literature review was conducted in 2009 in Medline Ovid, EMBASE, ERIC and RDRB databases from 1995 onward. The reviews were selected by two independent researchers and a quality appraisal was based on the SIGN tool. Results 31 reviews met inclusion criteria. The majority of the reviews provided information about the training process (WFME area 2), the assessment of trainees (WFME area 3) and the trainees (WFME area 4). One review covered the area 8 'governance and administration'. No review was found in relation to the mission and outcomes, the evaluation of the training process and the continuous renewal (respectively areas 1, 7 and 9 of the WFME framework). Conclusions The majority of the reviews provided information about the training process, the assessment of trainees and the trainees. Indicators used for quality assessment purposes of post graduate training should be based on this evidence but further research is needed for some areas in particular to assess the quality of the training process. PMID:21977898

Improved adjoin-list for quality-guided phase unwrapping based on red-black trees

NASA Astrophysics Data System (ADS)

Cruz-Santos, William; López-García, Lourdes; Rueda-Paz, Juvenal; Redondo-Galvan, Arturo

2016-08-01

The quality-guide phase unwrapping is an important technique that is based on quality maps which guide the unwrapping process. The efficiency of this technique depends in the adjoin-list data structure implementation. There exists several proposals that improve the adjoin-list; Ming Zhao et. al. proposed an Indexed Interwoven Linked List (I2L2) that is based on dividing the quality values into intervals of equal size and inserting in a linked list those pixels with quality values within a certain interval. Ming Zhao and Qian Kemao proposed an improved I2L2 replacing each linked list in each interval by a heap data structure, which allows efficient procedures for insertion and deletion. In this paper, we propose an improved I2L2 which uses Red-Black trees (RBT) data structures for each interval. Our proposal has as main goal to avoid the unbalanced properties of the head and thus, reducing the time complexity of insertion. In order to maintain the same efficiency of the heap when deleting an element, we provide an efficient way to remove the pixel with the highest quality value in the RBT using a pointer to the rightmost element in the tree. We also provide a new partition strategy of the phase values that is based on a density criterion. Experimental results applied to phase shifting profilometry are shown for large images.

[Discussion on Quality Evaluation Method of Medical Device During Life-Cycle in Operation Based on the Analytic Hierarchy Process].

PubMed

Zheng, Caixian; Zheng, Kun; Shen, Yunming; Wu, Yunyun

2016-01-01

The content related to the quality during life-cycle in operation of medical device includes daily use, repair volume, preventive maintenance, quality control and adverse event monitoring. In view of this, the article aims at discussion on the quality evaluation method of medical devices during their life cycle in operation based on the Analytic Hierarchy Process (AHP). The presented method is proved to be effective by evaluating patient monitors as example. The method presented in can promote and guide the device quality control work, and it can provide valuable inputs to decisions about purchase of new device.

[On-site quality control of acupuncture randomized controlled trial: design of content and checklist of quality control based on PICOST].

PubMed

Li, Hong-Jiao; He, Li-Yun; Liu, Zhi-Shun; Sun, Ya-Nan; Yan, Shi-Yan; Liu, Jia; Zhao, Ye; Liu, Bao-Yan

2014-02-01

To effectively guarantee quality of randomized controlld trial (RCT) of acupuncture and develop reasonable content and checklist of on-site quality control, influencing factors on quality of acupuncture RCT are analyzed and scientificity of quality control content and feasibility of on-site manipulation are put into overall consideration. Based on content and checklist of on-site quality control in National 11th Five-Year Plan Project Optimization of Comprehensive Treatment Plan for TCM in Prevention and Treatment of Serious Disease and Clinical Assessment on Generic Technology and Quality Control Research, it is proposed that on-site quality control of acupuncture RCT should be conducted with PICOST (patient, intervention, comparison, out come, site and time) as core, especially on quality control of interveners' skills and outcome assessment of blinding, and checklist of on-site quality control is developed to provide references for undertaking groups of the project.

Water quality of groundwater and stream base flow in the Marcellus Shale Gas Field of the Monongahela River Basin, West Virginia, 2011-12

USGS Publications Warehouse

Chambers, Douglas B.; Kozar, Mark D.; Messinger, Terence; Mulder, Michon L.; Pelak, Adam J.; White , Jeremy S.

2015-01-01

This study provides a baseline of water-quality conditions in the Monongahela River Basin in West Virginia during the early phases of development of the Marcellus Shale gas field. Although not all inclusive, the results of this study provide a set of reliable water-quality data against which future data sets can be compared and the effects of shale-gas development may be determined.

[Publication of healthcare quality data to citizens--status and perspectives].

PubMed

Utzon, Jan; Kaergaard, Johan

2009-05-11

Public quality reports are intended to stimulate active consumer participation by enabling consumers to make informed choices about their healthcare providers. Despite all efforts, public reporting has been shown not to be effective in stimulating consumers to choose their healthcare provider based on performance information in Denmark and other countries. Numerous barriers are identified. In an effort to move towards an effective public reporting system in Denmark, the present article discusses how quality information can be made accessible and meaningful to wider groups of consumers.

Quality care for persons experiencing dementia: the significance of relational ethics.

PubMed

Sellevold, Gerd S; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke

2013-05-01

The degree of success in creating quality care for people suffering from dementia is limited despite extensive research. This article describes healthcare providers' experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and its impact on quality care. The material is based on qualitative, in-depth individual narrative interviews with 12 professional healthcare providers from two different nursing homes. The transcribed interview texts were subjected to a phenomenological-hermeneutical interpretation. To provide quality care to patients with dementia, the healthcare providers emphasized the importance of sensing and understanding the patients' emotional and bodily expressions through sentient attentiveness and recognition of the patient as a person. They also described reciprocity of expressions in the relationship where the patient recognized them both as persons and healthcare providers. The analyses of the findings are, inter alia, discussed in light of Løgstrup's relational philosophy of ethics.

Quality geriatric care as perceived by nurses in long-term and acute care settings.

PubMed

Barba, Beth Ellen; Hu, Jie; Efird, Jimmy

2012-03-01

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings. Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide. Descriptive design. The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings. Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities. Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities. Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care. © 2011 Blackwell Publishing Ltd.

Healthcare Transformation and Changing Roles for Nursing

PubMed Central

Salmond, Susan W.; Echevarria, Mercedes

2017-01-01

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement. PMID:28107295

Identifying and Investigating the "Best" Schools: A Network-Based Analysis

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2018-01-01

This paper aims to provide a fresh perspective on the predominantly negative discourse on schooling quality in low-income countries by focusing on the research questions: "How can one identify great schools and what makes them special?" Using a network-based perspective, I measure peer evaluations of quality in two districts in Nepal.…

Critical loads and levels: Leveraging existing monitoring data

Treesearch

D. G. Fox; A. R. Riebau; R. Fisher

2006-01-01

A snapshot of current air quality in the National Parks and Wilderness areas of the US is presented based on data from the 165 site Interagency Monitoring of Protected Visual Environments, or IMPROVE program, and other relevant air quality monitoring programs. This snapshot is provided using the VIEWS web service, an on-line web-based data warehouse, analysis, and...

78 FR 21547 - Approval and Promulgation of Air Quality Implementation Plans; Oregon: Eugene-Springfield PM10

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... revision as a direct final rule without prior proposal because EPA views this as a noncontroversial SIP... daily multi-stage advisory issued each winter from November through the end of February. The daily advisory, which is based upon forecast meteorology and air quality, provides a color-coded stage based on...

Assessing decision quality in patient-centred care requires a preference-sensitive measure

PubMed Central

Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient’s record. PMID:24335587

Mobile phone-based clinical guidance for rural health providers in India.

PubMed

Gautham, Meenakshi; Iyengar, M Sriram; Johnson, Craig W

2015-12-01

There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance. © The Author(s) 2014.

Neural Network based Control of SG based Standalone Generating System with Energy Storage for Power Quality Enhancement

NASA Astrophysics Data System (ADS)

Nayar, Priya; Singh, Bhim; Mishra, Sukumar

2017-08-01

An artificial intelligence based control algorithm is used in solving power quality problems of a diesel engine driven synchronous generator with automatic voltage regulator and governor based standalone system. A voltage source converter integrated with a battery energy storage system is employed to mitigate the power quality problems. An adaptive neural network based signed regressor control algorithm is used for the estimation of the fundamental component of load currents for control of a standalone system with load leveling as an integral feature. The developed model of the system performs accurately under varying load conditions and provides good dynamic response to the step changes in loads. The real time performance is achieved using MATLAB along with simulink/simpower system toolboxes and results adhere to an IEEE-519 standard for power quality enhancement.

Fidelity Assessment to Improve Teacher Instruction and School Decision Making

ERIC Educational Resources Information Center

McKenna, John William; Parenti, Melissa

2017-01-01

Teachers must provide high-quality instruction based on evidence-based practices to provide students meaningful opportunities to learn and to improve school outcomes. Although teachers have access to a variety of resources on evidence-based practices, poor implementation may limit the effectiveness of teacher practices, as indicated by low levels…

Key concepts relevant to quality of complex and shared decision-making in health care: a literature review.

PubMed

Dy, Sydney M; Purnell, Tanjala S

2012-02-01

High-quality provider-patient decision-making is key to quality care for complex conditions. We performed an analysis of key elements relevant to quality and complex, shared medical decision-making. Based on a search of electronic databases, including Medline and the Cochrane Library, as well as relevant articles' reference lists, reviews of tools, and annotated bibliographies, we developed a list of key concepts and applied them to a decision-making example. Key concepts identified included provider competence, trustworthiness, and cultural competence; communication with patients and families; information quality; patient/surrogate competence; and roles and involvement. We applied this concept list to a case example, shared decision-making for live donor kidney transplantation, and identified the likely most important concepts as provider and cultural competence, information quality, and communication with patients and families. This concept list may be useful for conceptualizing the quality of complex shared decision-making and in guiding research in this area. Copyright © 2011 Elsevier Ltd. All rights reserved.

A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

PubMed Central

Xie, Anping; Carayon, Pascale

2014-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

Multi-Agent Architecture with Support to Quality of Service and Quality of Control

NASA Astrophysics Data System (ADS)

Poza-Luján, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, Jose-Enrique

Multi Agent Systems (MAS) are one of the most suitable frameworks for the implementation of intelligent distributed control system. Agents provide suitable flexibility to give support to implied heterogeneity in cyber-physical systems. Quality of Service (QoS) and Quality of Control (QoC) parameters are commonly utilized to evaluate the efficiency of the communications and the control loop. Agents can use the quality measures to take a wide range of decisions, like suitable placement on the control node or to change the workload to save energy. This article describes the architecture of a multi agent system that provides support to QoS and QoC parameters to optimize de system. The architecture uses a Publish-Subscriber model, based on Data Distribution Service (DDS) to send the control messages. Due to the nature of the Publish-Subscribe model, the architecture is suitable to implement event-based control (EBC) systems. The architecture has been called FSACtrl.

Method and apparatus for in-process sensing of manufacturing quality

DOEpatents

Hartman, Daniel A [Santa Fe, NM; Dave, Vivek R [Los Alamos, NM; Cola, Mark J [Santa Fe, NM; Carpenter, Robert W [Los Alamos, NM

2005-02-22

A method for determining the quality of an examined weld joint comprising the steps of providing acoustical data from the examined weld joint, and performing a neural network operation on the acoustical data determine the quality of the examined weld joint produced by a friction weld process. The neural network may be trained by the steps of providing acoustical data and observable data from at least one test weld joint, and training the neural network based on the acoustical data and observable data to form a trained neural network so that the trained neural network is capable of determining the quality of a examined weld joint based on acoustical data from the examined weld joint. In addition, an apparatus having a housing, acoustical sensors mounted therein, and means for mounting the housing on a friction weld device so that the acoustical sensors do not contact the weld joint. The apparatus may sample the acoustical data necessary for the neural network to determine the quality of a weld joint.

DOGMA: domain-based transcriptome and proteome quality assessment.

PubMed

Dohmen, Elias; Kremer, Lukas P M; Bornberg-Bauer, Erich; Kemena, Carsten

2016-09-01

Genome studies have become cheaper and easier than ever before, due to the decreased costs of high-throughput sequencing and the free availability of analysis software. However, the quality of genome or transcriptome assemblies can vary a lot. Therefore, quality assessment of assemblies and annotations are crucial aspects of genome analysis pipelines. We developed DOGMA, a program for fast and easy quality assessment of transcriptome and proteome data based on conserved protein domains. DOGMA measures the completeness of a given transcriptome or proteome and provides information about domain content for further analysis. DOGMA provides a very fast way to do quality assessment within seconds. DOGMA is implemented in Python and published under GNU GPL v.3 license. The source code is available on https://ebbgit.uni-muenster.de/domainWorld/DOGMA/ CONTACTS: e.dohmen@wwu.de or c.kemena@wwu.de Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Method and Apparatus for In-Process Sensing of Manufacturing Quality

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hartman, D.A.; Dave, V.R.; Cola, M.J.

2005-02-22

A method for determining the quality of an examined weld joint comprising the steps of providing acoustical data from the examined weld joint, and performing a neural network operation on the acoustical data determine the quality of the examined weld joint produced by a friction weld process. The neural network may be trained by the steps of providing acoustical data and observable data from at least one test weld joint, and training the neural network based on the acoustical data and observable data to form a trained neural network so that the trained neural network is capable of determining themore » quality of a examined weld joint based on acoustical data from the examined weld joint. In addition, an apparatus having a housing, acoustical sensors mounted therein, and means for mounting the housing on a friction weld device so that the acoustical sensors do not contact the weld joint. The apparatus may sample the acoustical data necessary for the neural network to determine the quality of a weld joint.« less

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

The endoscopy Global Rating Scale – Canada: Development and implementation of a quality improvement tool

PubMed Central

MacIntosh, Donald; Dubé, Catherine; Hollingworth, Roger; van Zanten, Sander Veldhuyzen; Daniels, Sandra; Ghattas, George

2013-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer. OBJECTIVE: To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided. METHODS: Based on feedback from 22 sites across Canada that completed the UK endoscopy GRS, and integrating results of the Canadian consensus on safety and quality indicators in endoscopy and other Canadian consensus reports, a working group of endoscopists experienced with the GRS developed the GRS-Canada (GRS-C). RESULTS: The GRS-C mirrors the two dimensions (clinical quality and quality of the patient experience) and 12 patient-centred items of the UK-GRS, but was modified to apply to Canadian health care infrastructure, language and current practice. Each item is assessed by a yes/no response to eight to 12 statements that are divided into levels graded D (basic) through A (advanced). A core team consisting of a booking clerk, charge nurse and the physician responsible for the unit is recommended to complete the GRS-C twice yearly. CONCLUSION: The GRS-C is intended to improve endoscopic services in Canada by providing endoscopy units with a straightforward process to review the quality of the service they provide. PMID:23472242

Balancing Quality Early Education and Parents' Workforce Success: Insights from the Urban Institute's Assessment of the Massachusetts Subsidized Child Care System. Research Report

ERIC Educational Resources Information Center

Adams, Gina; Katz, Michael

2015-01-01

This report examines the Massachusetts child care subsidy system's balance between providing quality early childhood education and providing workforce support for parents. It is based on qualitative and quantitative data and findings from several studies conducted as part of a legislatively mandated assessment of the Massachusetts subsidized child…

Does Web-Based Role-Play Establish a High Quality Learning Environment? Design versus Evaluation

ERIC Educational Resources Information Center

Ludewig, Alexandra; Ludewig-Rohwer, Iris

2013-01-01

Online role-plays have been celebrated for providing an environment which allows for high quality learning. Innovative approaches have been embraced in foreign language studies, especially in countries where a great distance to the target country needs to be overcome, not only to expose students to the target language but also to provide them with…

Depth image enhancement using perceptual texture priors

NASA Astrophysics Data System (ADS)

Bang, Duhyeon; Shim, Hyunjung

2015-03-01

A depth camera is widely used in various applications because it provides a depth image of the scene in real time. However, due to the limited power consumption, the depth camera presents severe noises, incapable of providing the high quality 3D data. Although the smoothness prior is often employed to subside the depth noise, it discards the geometric details so to degrade the distance resolution and hinder achieving the realism in 3D contents. In this paper, we propose a perceptual-based depth image enhancement technique that automatically recovers the depth details of various textures, using a statistical framework inspired by human mechanism of perceiving surface details by texture priors. We construct the database composed of the high quality normals. Based on the recent studies in human visual perception (HVP), we select the pattern density as a primary feature to classify textures. Upon the classification results, we match and substitute the noisy input normals with high quality normals in the database. As a result, our method provides the high quality depth image preserving the surface details. We expect that our work is effective to enhance the details of depth image from 3D sensors and to provide a high-fidelity virtual reality experience.

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

PubMed Central

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

2016-01-01

Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout sub-Saharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia. PMID:26976883

Improving Diabetes care through Examining, Advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals

PubMed Central

2014-01-01

Background New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care. Aim To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes. Design/methods We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed and examined (using anonymised computer records), and advised (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use. Discussion Consistent with UK Medical Research Council guidance and building on previous development research, this pragmatic cluster randomised trial will evaluate the effectiveness of a theory-based complex intervention focusing on changing multiple clinical behaviours to improve quality of diabetes care. Trial registration ISRCTN66498413. PMID:24886606

Linking quality and performance. Quality orientation can be a competitive strategy for health care providers.

PubMed

Rapert, M I; Babakus, E

1996-01-01

Many organizations are not convinced a quality orientation pays off and are looking for ways to link quality with performance. The authors' exploratory study found that a quality orientation is a differentiating factor between low-performing and high-performing general service hospitals. They also developed a quality scale to assess the performance implications of quality-based strategies in the health care industry. Successful health care organizations (1) develop a strategic quality orientation at the management level, (2) support the pursuit of quality at the contact level, and (3) monitor external customers' perceptions of quality.

Assessment and prediction of air quality using fuzzy logic and autoregressive models

NASA Astrophysics Data System (ADS)

Carbajal-Hernández, José Juan; Sánchez-Fernández, Luis P.; Carrasco-Ochoa, Jesús A.; Martínez-Trinidad, José Fco.

2012-12-01

In recent years, artificial intelligence methods have been used for the treatment of environmental problems. This work, presents two models for assessment and prediction of air quality. First, we develop a new computational model for air quality assessment in order to evaluate toxic compounds that can harm sensitive people in urban areas, affecting their normal activities. In this model we propose to use a Sigma operator to statistically asses air quality parameters using their historical data information and determining their negative impact in air quality based on toxicity limits, frequency average and deviations of toxicological tests. We also introduce a fuzzy inference system to perform parameter classification using a reasoning process and integrating them in an air quality index describing the pollution levels in five stages: excellent, good, regular, bad and danger, respectively. The second model proposed in this work predicts air quality concentrations using an autoregressive model, providing a predicted air quality index based on the fuzzy inference system previously developed. Using data from Mexico City Atmospheric Monitoring System, we perform a comparison among air quality indices developed for environmental agencies and similar models. Our results show that our models are an appropriate tool for assessing site pollution and for providing guidance to improve contingency actions in urban areas.

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

PubMed

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

2012-08-01

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.

A CNN based neurobiology inspired approach for retinal image quality assessment.

PubMed

Mahapatra, Dwarikanath; Roy, Pallab K; Sedai, Suman; Garnavi, Rahil

2016-08-01

Retinal image quality assessment (IQA) algorithms use different hand crafted features for training classifiers without considering the working of the human visual system (HVS) which plays an important role in IQA. We propose a convolutional neural network (CNN) based approach that determines image quality using the underlying principles behind the working of the HVS. CNNs provide a principled approach to feature learning and hence higher accuracy in decision making. Experimental results demonstrate the superior performance of our proposed algorithm over competing methods.

Trust-Based Service Composition and Binding for Tactical Networks with Multiple Objectives

DTIC Science & Technology

2013-12-01

services, then it will have a set of four-tuple records for each abstract service that it can provide. We assume that the service quality of a SP in...user (i.e., a SR) does not have knowledge of the “best” service quality , so its satisfaction level with services received is based on what has been...hand, when USRm is less than USTm, identifies the culprits with low performance (by comparing the advertised service quality profile with the

Providing leadership to a decentralized total quality process.

PubMed

Diederich, J J; Eisenberg, M

1993-01-01

Integrating total quality management into the culture of an organization and the daily work of employees requires a decentralized leadership structure that encourages all employees to become involved. This article, based upon the experience of the University of Michigan Hospitals Professional Services Divisional Lead Team, outlines a process for decentralizing the total quality management process.

Assessing the Ethical and Content Quality of Online Parenting Resources

ERIC Educational Resources Information Center

Suárez-Perdomo, Arminda; Byrne, Sonia; Rodrigo, Maria-José

2018-01-01

The quality of the online resources for parents offering access to open knowledge has hardly received attention despite their increasing number. This paper provides a framework to examine the ethical and content quality of parenting resources. The ethical criteria were based on "the Health on the Net" (HON) framework whereas the content…

Improving the Quality of Services in Residential Treatment Facilities: A Strength-Based Consultative Review Process

ERIC Educational Resources Information Center

Pavkov, Thomas W.; Lourie, Ira S.; Hug, Richard W.; Negash, Sesen

2010-01-01

This descriptive case study reports on the positive impact of a consultative review methodology used to conduct quality assurance reviews as part of the Residential Treatment Center Evaluation Project. The study details improvement in the quality of services provided to youth in unmonitored residential treatment facilities. Improvements were…

Distribution and Availability of State and Areawide Water Quality Reports in Oklahoma Libraries.

ERIC Educational Resources Information Center

McClure, Charles R.; Million, Anne

This report examines the distribution and availability of water quality reports in the state of Oklahoma. Based on legislation from the Clean Water Act and regulations from the Environmental Protection Agency's "Public Participation Handbook for Water Quality Management," depository libraries must be established to provide citizen access to…

Relational Resources of a University as a Source of Education Quality Assurance

ERIC Educational Resources Information Center

Bagdasaryan, Irina; Vasilyeva, Zoya; Almabekova, Olga

2015-01-01

This paper considers high quality educational services provided by a university being the highest priority and assumes relational resources as valuable sources that can facilitate and enhance quality assurance. Each university with a unique resource base is connected with a variety of entities--other universities, non-profit and for-profit…

Evaluating Performance Measurement Systems in Nonprofit Agencies: The Program Accountability Quality Scale (PAQS).

ERIC Educational Resources Information Center

Poole, Dennis L.; Nelson, Joan; Carnahan, Sharon; Chepenik, Nancy G.; Tubiak, Christine

2000-01-01

Developed and field tested the Performance Accountability Quality Scale (PAQS) on 191 program performance measurement systems developed by nonprofit agencies in central Florida. Preliminary findings indicate that the PAQS provides a structure for obtaining expert opinions based on a theory-driven model about the quality of proposed measurement…

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

PubMed

Xie, Anping; Carayon, Pascale

2015-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

A classification of freshwater Louisiana lakes based on water quality and user perception data.

PubMed

Burden, D G; Malone, R F

1987-09-01

An index system developed for Louisiana lakes was based on correlations between measurable water quality parameters and perceived lake quality. Support data was provided by an extensive monitoring program of 30 lakes coordinated with opinion surveys undertaken during summer 1984. Lakes included in the survey ranged from 4 to 735 km(2) in surface area with mean depths ranging from 0.5 to 8.0 m. Water quality data indicated most of these lakes are eutrophic, although many have productive fisheries and are considered recreational assets. Perception ratings of fishing quality and its associated water quality were obtained by distributing approximately 1200 surveys to Louisiana Bass Club Associaton members. The ability of Secchi disc transparency, total organic carbon, total Kjeldahl nitrogen, total phosphorus, and chlorophyll a to discriminate between perception classes was examined using probability distributions and multivariate analyses. Secchi disc and total organic carbon best reflected perceived lake conditions; however, these parameters did not provide the discrimination necessary for developing a quantitative risk assessment of lake trophic state. Consequently, an interim lakes index system was developed based on total organic carbon and perceived lake conditions. The developed index system will aid State officials in interpretating and evaluating regularly collected lake quality data, recognizing potential problem areas, and identifying proper management policies for protecting fisheries usage within the State.

Innovative and Successful Approaches to Improving Care Transitions From Hospital to Home

PubMed Central

Labson, Margherita C.

2015-01-01

Abstract Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes. PMID:25654457

Influence of raw milk quality on processed dairy products: How do raw milk quality test results relate to product quality and yield?

PubMed

Murphy, Steven C; Martin, Nicole H; Barbano, David M; Wiedmann, Martin

2016-12-01

This article provides an overview of the influence of raw milk quality on the quality of processed dairy products and offers a perspective on the merits of investing in quality. Dairy farmers are frequently offered monetary premium incentives to provide high-quality milk to processors. These incentives are most often based on raw milk somatic cell and bacteria count levels well below the regulatory public health-based limits. Justification for these incentive payments can be based on improved processed product quality and manufacturing efficiencies that provide the processor with a return on their investment for high-quality raw milk. In some cases, this return on investment is difficult to measure. Raw milks with high levels of somatic cells and bacteria are associated with increased enzyme activity that can result in product defects. Use of raw milk with somatic cell counts >100,000cells/mL has been shown to reduce cheese yields, and higher levels, generally >400,000 cells/mL, have been associated with textural and flavor defects in cheese and other products. Although most research indicates that fairly high total bacteria counts (>1,000,000 cfu/mL) in raw milk are needed to cause defects in most processed dairy products, receiving high-quality milk from the farm allows some flexibility for handling raw milk, which can increase efficiencies and reduce the risk of raw milk reaching bacterial levels of concern. Monitoring total bacterial numbers in regard to raw milk quality is imperative, but determining levels of specific types of bacteria present has gained increasing importance. For example, spores of certain spore-forming bacteria present in raw milk at very low levels (e.g., <1/mL) can survive pasteurization and grow in milk and cheese products to levels that result in defects. With the exception of meeting product specifications often required for milk powders, testing for specific spore-forming groups is currently not used in quality incentive programs in the United States but is used in other countries (e.g., the Netherlands). Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Grades evaluation of Phellodendri chinensis cortex pieces based on quality constant].

PubMed

Deng, Zhe; Jiao, Meng-Jiao; Zhang, Jun; Zhang, Qing; Cui, Wen-Jin; Shen, Li; Cheng, Jin-Tang; Liu, An

2017-09-01

Quality constant is a comprehensive grades evaluation method for traditional Chinese medicine decoction pieces, which is better but based on traditional way. In this paper, a new grading mode for Phellodendri chinensis pieces was established based on quality constant evaluation method. The results showed that the range of relative quality constant for 15 batches of different samples was from 0.41 to 0.96. As customary, if these samples were divided into three grades: the relative quality constant shall be ≥0.77 for first grade; <0.77 but ≥0.48 for the second grade; and ＜0.48 for the third grade. This research indicated that the quality constant mode can be used to effectively grade the P. chinensis pieces in a scientific, reasonable, objective and specific way. Simultaneously, it provided a beneficial reference for grading cortex herbal pieces or medicines. Copyright© by the Chinese Pharmaceutical Association.

Do water quality criteria based on nonnative species provide appropriate protection for native species?

PubMed

Jin, Xiaowei; Wang, Zijian; Wang, Yeyao; Lv, Yibing; Rao, Kaifeng; Jin, Wei; Giesy, John P; Leung, Kenneth M Y

2015-08-01

The potential use of toxicity data for nonnative species to derive water quality criteria is controversial because it is sometimes questioned whether criteria based on species from one geographical region provide appropriate protection for species in a different region. However, this is an important concept for the development of Chinese water quality criteria or standards. Data were assembled on 38 chemicals for which values were available for both native and nonnative species. Sensitivities of these organisms were compared based on the 5% hazardous concentration values and the species sensitivity distribution from a literature review. Results of the present study's analysis showed that there is approximately 74% certainty that use of nonnative species to generate water quality criteria would be sufficiently protective of aquatic ecosystems in China. Without applying any assessment factor to the water quality criteria generated from nonnative species, the uncertainty would be 26% when the native Chinese species might be under protection. Applying an assessment factor of 10 would offer adequate protection to native Chinese species for approximately 90% of tested chemicals and thus reduce the uncertainty from 26% to 10%. © 2015 SETAC.

DataFed: A Federated Data System for Visualization and Analysis of Spatio-Temporal Air Quality Data

NASA Astrophysics Data System (ADS)

Husar, R. B.; Hoijarvi, K.

2017-12-01

DataFed is a distributed web-services-based computing environment for accessing, processing, and visualizing atmospheric data in support of air quality science and management. The flexible, adaptive environment facilitates the access and flow of atmospheric data from provider to users by enabling the creation of user-driven data processing/visualization applications. DataFed `wrapper' components, non-intrusively wrap heterogeneous, distributed datasets for access by standards-based GIS web services. The mediator components (also web services) map the heterogeneous data into a spatio-temporal data model. Chained web services provide homogeneous data views (e.g., geospatial, time views) using a global multi-dimensional data model. In addition to data access and rendering, the data processing component services can be programmed for filtering, aggregation, and fusion of multidimensional data. A complete application software is written in a custom made data flow language. Currently, the federated data pool consists of over 50 datasets originating from globally distributed data providers delivering surface-based air quality measurements, satellite observations, emissions data as well as regional and global-scale air quality models. The web browser-based user interface allows point and click navigation and browsing the XYZT multi-dimensional data space. The key applications of DataFed are for exploring spatial pattern of pollutants, seasonal, weekly, diurnal cycles and frequency distributions for exploratory air quality research. Since 2008, DataFed has been used to support EPA in the implementation of the Exceptional Event Rule. The data system is also used at universities in the US, Europe and Asia.

Intercultural Internet-Based Learning: Know Your Audience and What They Value

ERIC Educational Resources Information Center

Bentley, Joanne P. H.; Tinney, Mari Vawn; Chia, Bing Howe

2004-01-01

As the internet-based learning (IBL) market becomes increasingly global, understanding differing educational values and cultural expectations could provide an important competitive edge for providers (universities, publishing houses, and corporate training entities). How each of person determines "good" or "quality" instruction…

A Practical Probabilistic Graphical Modeling Tool for Weighing Ecological Risk-Based Evidence

EPA Science Inventory

Past weight-of-evidence frameworks for adverse ecological effects have provided soft-scoring procedures for judgments based on the quality and measured attributes of evidence. Here, we provide a flexible probabilistic structure for weighing and integrating lines of evidence for e...

Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries.

PubMed

Horwood, Christiane M; Youngleson, Michele S; Moses, Edward; Stern, Amy F; Barker, Pierre M

2015-07-01

Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

The attendees' view of quality in community-based day centre services for people with psychiatric disabilities.

PubMed

Lundqvist, Lars-Olov; Ivarsson, Ann-Britt; Rask, Mikael; Brunt, David; Schröder, Agneta

2018-05-01

Community-based day centres in Sweden are well-established arenas for psychiatric rehabilitation, but little is known of the attendees' perception of the quality of the service provided. The aim of the study was thus to describe and investigate the quality of the services in community-based day centre for people with psychiatric disabilities. A sample of 218 attendees in 14 community-based day centre services in Sweden completed the Quality in Psychiatric Care - Daily Activities (QPC-DA). The results showed that people with psychiatric disabilities perceived the quality of community-based day centre services as high. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the centre, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement. From an occupational science perspective, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the centre.

Content-based management service for medical videos.

PubMed

Mendi, Engin; Bayrak, Coskun; Cecen, Songul; Ermisoglu, Emre

2013-01-01

Development of health information technology has had a dramatic impact to improve the efficiency and quality of medical care. Developing interoperable health information systems for healthcare providers has the potential to improve the quality and equitability of patient-centered healthcare. In this article, we describe an automated content-based medical video analysis and management service that provides convenience and ease in accessing the relevant medical video content without sequential scanning. The system facilitates effective temporal video segmentation and content-based visual information retrieval that enable a more reliable understanding of medical video content. The system is implemented as a Web- and mobile-based service and has the potential to offer a knowledge-sharing platform for the purpose of efficient medical video content access.

Quality Improvement in Pediatric Endoscopy: A Clinical Report From the NASPGHAN Endoscopy Committee.

PubMed

Kramer, Robert E; Walsh, Catharine M; Lerner, Diana G; Fishman, Douglas S

2017-07-01

The current era of healthcare reform emphasizes the provision of effective, safe, equitable, high-quality, and cost-effective care. Within the realm of gastrointestinal endoscopy in adults, renewed efforts are in place to accurately define and measure quality indicators across the spectrum of endoscopic care. In pediatrics, however, this movement has been less-defined and lacks much of the evidence-base that supports these initiatives in adult care. A need, therefore, exists to help define quality metrics tailored to pediatric practice and provide a toolbox for the development of robust quality improvement (QI) programs within pediatric endoscopy units. Use of uniform standards of quality reporting across centers will ensure that data can be compared and compiled on an international level to help guide QI initiatives and inform patients and their caregivers of the true risks and benefits of endoscopy. This report is intended to provide pediatric gastroenterologists with a framework for the development and implementation of endoscopy QI programs within their own centers, based on available evidence and expert opinion from the members of the NASPGHAN Endoscopy Committee. This clinical report will require expansion as further research pertaining to endoscopic quality in pediatrics is published.

Options for reducing food waste by quality-controlled logistics using intelligent packaging along the supply chain.

PubMed

Heising, Jenneke K; Claassen, G D H; Dekker, Matthijs

2017-10-01

Optimising supply chain management can help to reduce food waste. This paper describes how intelligent packaging can be used to reduce food waste when used in supply chain management based on quality-controlled logistics (QCL). Intelligent packaging senses compounds in the package that correlate with the critical quality attribute of a food product. The information on the quality of each individual packaged food item that is provided by the intelligent packaging can be used for QCL. In a conceptual approach it is explained that monitoring food quality by intelligent packaging sensors makes it possible to obtain information about the variation in the quality of foods and to use a dynamic expiration date (IP-DED) on a food package. The conceptual approach is supported by quantitative data from simulations on the effect of using the information of intelligent packaging in supply chain management with the goal to reduce food waste. This simulation shows that by using the information on the quality of products that is provided by intelligent packaging, QCL can substantially reduce food waste. When QCL is combined with dynamic pricing based on the predicted expiry dates, a further waste reduction is envisaged.

Safety considerations in providing allergen immunotherapy in the office.

PubMed

Mattos, Jose L; Lee, Stella

2016-06-01

This review highlights the risks of allergy immunotherapy, methods to improve the quality and safety of allergy treatment, the current status of allergy quality metrics, and the future of quality measurement. In the current healthcare environment, the emphasis on outcomes measurement is increasing, and providers must be better equipped in the development, measurement, and reporting of safety and quality measures. Immunotherapy offers the only potential cure for allergic disease and asthma. Although well tolerated and effective, immunotherapy can be associated with serious consequence, including anaphylaxis and death. Many predisposing factors and errors that lead to serious systemic reactions are preventable, and the evaluation and implementation of quality measures are crucial to developing a safe immunotherapy practice. Although quality metrics for immunotherapy are in their infancy, they will become increasingly sophisticated, and providers will face increased pressure to deliver safe, high-quality, patient-centered, evidence-based, and efficient allergy care. The establishment of safety in the allergy office involves recognition of potential risk factors for anaphylaxis, the development and measurement of quality metrics, and changing systems-wide practices if needed. Quality improvement is a continuous process, and although national allergy-specific quality metrics do not yet exist, they are in development.

A simple method for low-contrast detectability, image quality and dose optimisation with CT iterative reconstruction algorithms and model observers.

PubMed

Bellesi, Luca; Wyttenbach, Rolf; Gaudino, Diego; Colleoni, Paolo; Pupillo, Francesco; Carrara, Mauro; Braghetti, Antonio; Puligheddu, Carla; Presilla, Stefano

2017-01-01

The aim of this work was to evaluate detection of low-contrast objects and image quality in computed tomography (CT) phantom images acquired at different tube loadings (i.e. mAs) and reconstructed with different algorithms, in order to find appropriate settings to reduce the dose to the patient without any image detriment. Images of supraslice low-contrast objects of a CT phantom were acquired using different mAs values. Images were reconstructed using filtered back projection (FBP), hybrid and iterative model-based methods. Image quality parameters were evaluated in terms of modulation transfer function; noise, and uniformity using two software resources. For the definition of low-contrast detectability, studies based on both human (i.e. four-alternative forced-choice test) and model observers were performed across the various images. Compared to FBP, image quality parameters were improved by using iterative reconstruction (IR) algorithms. In particular, IR model-based methods provided a 60% noise reduction and a 70% dose reduction, preserving image quality and low-contrast detectability for human radiological evaluation. According to the model observer, the diameters of the minimum detectable detail were around 2 mm (up to 100 mAs). Below 100 mAs, the model observer was unable to provide a result. IR methods improve CT protocol quality, providing a potential dose reduction while maintaining a good image detectability. Model observer can in principle be useful to assist human performance in CT low-contrast detection tasks and in dose optimisation.

Projection pursuit water quality evaluation model based on chicken swam algorithm

NASA Astrophysics Data System (ADS)

Hu, Zhe

2018-03-01

In view of the uncertainty and ambiguity of each index in water quality evaluation, in order to solve the incompatibility of evaluation results of individual water quality indexes, a projection pursuit model based on chicken swam algorithm is proposed. The projection index function which can reflect the water quality condition is constructed, the chicken group algorithm (CSA) is introduced, the projection index function is optimized, the best projection direction of the projection index function is sought, and the best projection value is obtained to realize the water quality evaluation. The comparison between this method and other methods shows that it is reasonable and feasible to provide decision-making basis for water pollution control in the basin.

Providing High-Quality Support Services to Home-Based Child Care: A Conceptual Model and Literature Review

ERIC Educational Resources Information Center

Bromer, Juliet; Korfmacher, Jon

2017-01-01

Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of…

Managing Quality Improvement of eLearning in a Large, Campus-Based University

ERIC Educational Resources Information Center

Ellis, Robert A.; Jarkey, Nerida; Mahony, Mary Jane; Peat, Mary; Sheely, Stephen

2007-01-01

Purpose: This paper seeks to discuss the characteristics that shape a model to manage eLearning in a large, predominantly campus-based university. It focuses on how such a model can provide a sustainable approach to supporting eLearning for more than 40,000 students while still managing basic quality assurance for the University executive and the…

An Assessment of the Quality of Life in the European Union Based on the Social Indicators Approach

ERIC Educational Resources Information Center

Grasso, Marco; Canova, Luciano

2008-01-01

This article carries out a multidimensional analysis of welfare based on the social indicators approach aimed at assessing the quality of life in the 25 member countries of the European Union. It begins with description of the social indicators approach and provides some specifications on its most controversial points. It then specifies the…

Fusion and quality analysis for remote sensing images using contourlet transform

NASA Astrophysics Data System (ADS)

Choi, Yoonsuk; Sharifahmadian, Ershad; Latifi, Shahram

2013-05-01

Recent developments in remote sensing technologies have provided various images with high spatial and spectral resolutions. However, multispectral images have low spatial resolution and panchromatic images have low spectral resolution. Therefore, image fusion techniques are necessary to improve the spatial resolution of spectral images by injecting spatial details of high-resolution panchromatic images. The objective of image fusion is to provide useful information by improving the spatial resolution and the spectral information of the original images. The fusion results can be utilized in various applications, such as military, medical imaging, and remote sensing. This paper addresses two issues in image fusion: i) image fusion method and ii) quality analysis of fusion results. First, a new contourlet-based image fusion method is presented, which is an improvement over the wavelet-based fusion. This fusion method is then applied to a case study to demonstrate its fusion performance. Fusion framework and scheme used in the study are discussed in detail. Second, quality analysis for the fusion results is discussed. We employed various quality metrics in order to analyze the fusion results both spatially and spectrally. Our results indicate that the proposed contourlet-based fusion method performs better than the conventional wavelet-based fusion methods.

Energy efficiency in wireless communication systems

DOEpatents

Caffrey, Michael Paul; Palmer, Joseph McRae

2012-12-11

Wireless communication systems and methods utilize one or more remote terminals, one or more base terminals, and a communication channel between the remote terminal(s) and base terminal(s). The remote terminal applies a direct sequence spreading code to a data signal at a spreading factor to provide a direct sequence spread spectrum (DSSS) signal. The DSSS signal is transmitted over the communication channel to the base terminal which can be configured to despread the received DSSS signal by a spreading factor matching the spreading factor utilized to spread the data signal. The remote terminal and base terminal can dynamically vary the matching spreading factors to adjust the data rate based on an estimation of operating quality over time between the remote terminal and base terminal such that the amount of data being transmitted is substantially maximized while providing a specified quality of service.

The effect of foot orthoses and in-shoe wedges during cycling: a systematic review

PubMed Central

2014-01-01

Background The use of foot orthoses and in-shoe wedges in cycling are largely based on theoretical benefits and anecdotal evidence. This review aimed to systematically collect all published research on this topic, critically evaluate the methods and summarise the findings. Methods Study inclusion criteria were: all empirical studies that evaluated the effects of foot orthoses or in-shoe wedges on cycling; outcome measures that investigated physiological parameters, kinematics and kinetics of the lower limb, and power; and, published in English. Studies were located by data-base searching (Medline, CINAHL, Embase and SPORTDiscus) and hand-searching in February 2014. Selected studies were assessed for methodological quality using a modified Quality Index. Data were synthesised descriptively. Meta-analysis was not performed as the included studies were not sufficiently homogeneous to provide a meaningful summary. Results Six studies were identified as meeting the eligibility criteria. All studies were laboratory-based and used a repeated measures design. The quality of the studies varied, with Quality Index scores ranging from 7 to 10 out of 14. Five studies investigated foot orthoses and one studied in-shoe wedges. Foot orthoses were found to increase contact area in the midfoot, peak pressures under the hallux and were perceived to provide better arch support, compared to a control. With respect to physiological parameters, contrasting findings have been reported regarding the effect foot orthoses have on oxygen consumption. Further, foot orthoses have been shown to not provide effects on lower limb kinematics and perceived comfort. Both foot orthoses and in-shoe wedges have been shown to provide no effect on power. Conclusion In general, there is limited high-quality research on the effects foot orthoses and in-shoe wedges provide during cycling. At present, there is some evidence that during cycling foot orthoses: increase contact area under the foot and increase plantar pressures under the hallux, but provide no gains in power. Based on available evidence, no definitive conclusions can be made about the effects foot orthoses have on lower limb kinematics and oxygen consumption, and the effect in-shoe wedges have on power during cycling. Future well-designed studies on this topic are warranted. PMID:24955129

Competition and quality in a physiotherapy market with fixed prices.

PubMed

Pekola, Piia; Linnosmaa, Ismo; Mikkola, Hennamari

2017-01-01

Our study focuses on competition and quality in physiotherapy organized and regulated by the Social Insurance Institution of Finland (Kela). We first derive a hypothesis with a theoretical model and then perform empirical analyses of the data. Within the physiotherapy market, prices are regulated by Kela, and after registration eligible firms are accepted to join a pool of firms from which patients choose service providers based on their individual preferences. By using 2SLS estimation techniques, we analyzed the relationship among quality, competition and regulated price. According to the results, competition has a statistically significant (yet weak) negative effect (p = 0.019) on quality. The outcome for quality is likely caused by imperfect information. It seems that Kela has provided too little information for patients about the quality of the service.

Observational Needs for Four-Dimensional Air Quality Characterization

EPA Science Inventory

Surface-based monitoring programs provide the foundation for associating air pollution and causal effects in human health studies, and they support the development of air quality standards and the preparation of emission reduction strategies. While surface oriented networks remai...

Genomics meets applied ecology: Characterizing habitat quality for sloths in a tropical agroecosystem.

PubMed

Fountain, Emily D; Kang, Jung Koo; Tempel, Douglas J; Palsbøll, Per J; Pauli, Jonathan N; Zachariah Peery, M

2018-01-01

Understanding how habitat quality in heterogeneous landscapes governs the distribution and fitness of individuals is a fundamental aspect of ecology. While mean individual fitness is generally considered a key to assessing habitat quality, a comprehensive understanding of habitat quality in heterogeneous landscapes requires estimates of dispersal rates among habitat types. The increasing accessibility of genomic approaches, combined with field-based demographic methods, provides novel opportunities for incorporating dispersal estimation into assessments of habitat quality. In this study, we integrated genomic kinship approaches with field-based estimates of fitness components and approximate Bayesian computation (ABC) procedures to estimate habitat-specific dispersal rates and characterize habitat quality in two-toed sloths (Choloepus hoffmanni) occurring in a Costa Rican agricultural ecosystem. Field-based observations indicated that birth and survival rates were similar in a sparsely shaded cacao farm and adjacent cattle pasture-forest mosaic. Sloth density was threefold higher in pasture compared with cacao, whereas home range size and overlap were greater in cacao compared with pasture. Dispersal rates were similar between the two habitats, as estimated using ABC procedures applied to the spatial distribution of pairs of related individuals identified using 3,431 single nucleotide polymorphism and 11 microsatellite locus genotypes. Our results indicate that crops produced under a sparse overstorey can, in some cases, constitute lower-quality habitat than pasture-forest mosaics for sloths, perhaps because of differences in food resources or predator communities. Finally, our study demonstrates that integrating field-based demographic approaches with genomic methods can provide a powerful means for characterizing habitat quality for animal populations occurring in heterogeneous landscapes. © 2017 John Wiley & Sons Ltd.

Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

PubMed

Rocco, Gaetano; Brunelli, Alessandro

2012-11-01

Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care. Copyright © 2012 Elsevier Inc. All rights reserved.

Managing imperfect competition by pay for performance and reference pricing.

PubMed

Mak, Henry Y

2018-01-01

I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics. However, pay for performance may not outperform prospective payment when consumers are rational and providers are profit maximizing, or when one of the service qualities is not contractible. Copyright © 2017 Elsevier B.V. All rights reserved.

From quality markers to data mining and intelligence assessment: A smart quality-evaluation strategy for traditional Chinese medicine based on quality markers.

PubMed

Bai, Gang; Zhang, Tiejun; Hou, Yuanyuan; Ding, Guoyu; Jiang, Min; Luo, Guoan

2018-05-15

The quality of traditional Chinese medicine (TCM) forms the foundation of its clinical efficacy. The standardization of TCM is the most important task of TCM modernization. In recent years, there has been great progress in the quality control of TCM. However, there are still many issues related to the current quality standards, and it is difficult to objectively evaluate and effectively control the quality of TCM. To face these challenge, we summarized the current quality marker (Q-marker) research based on its characteristics and benefits, and proposed a reasonable and intelligentized quality evaluation strategy for the development and application of Q-markers. Ultra-performance liquid chromatography-quadrupole/time-of-flight with partial least squares-discriminant analysis was suggested to screen the chemical markers from Chinese medicinal materials (CMM), and a bioactive-guided evaluation method was used to select the Q-markers. Near-infrared spectroscopy (NIRS), based on the distinctive wavenumber zones or points from the Q-markers, was developed for its determination. Then, artificial intelligence algorithms were used to clarify the complex relationship between the Q-markers and their integral functions. Internet and mobile communication technology helped us to perform remote analysis and determine the information feedback of test samples. The quality control research, evaluation, standard establishment and quality control of TCM must be based on the systematic analysis of Q-markers to study and describe the material basis of TCM efficacy, define the chemical markers in the plant body, and understand the process of herb drug acquisition, change and transmission laws affecting metabolism and exposure. Based on the advantages of chemometrics, new sensor technologies, including infrared spectroscopy, hyperspectral imaging, chemical imaging, electronic nose and electronic tongue, have become increasingly important in the quality evaluation of CMM. Inspired by the concept of Q-marker, the quantitation can be achieved with the help of artificial intelligence, and these subtle differences can be discovered, allowing the quantitative analysis by NIRS and providing a quick and easy detection method for CMM quality evaluations. The concept of Q-markers focused on unique CMM differences, dynamic changes and their transmission and traceability to establish an overall quality control and traceability system. Based on the basic attributes, an integration model and artificial intelligence research path was proposed, with the hope of providing new ideas and perspectives for the TCM quality management. Copyright © 2018 Elsevier GmbH. All rights reserved.

The ‘Alternative Quality Contract’ in Massachusetts, Based on Global Budgets, Lowered Medical Spending and Improved Quality

PubMed Central

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

2012-01-01

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. Overall, participation in the contract over two years led to a savings of 3.3% (1.9% in year-1, 3.3% in year-2) compared to spending in groups not participating in the contract. The savings were even higher for groups whose previous experience had been only in fee-for-service contracting. Such groups’ quarterly savings over two years averaged 8.2% (6.3% in year-1, 9.9% in year-2). Quality of care also improved within organizations participating in the Alternative Quality Contract compared to control organizations in both years. Chronic care management, adult preventive care, and pediatric care improved from year 1 to year 2 within the contracting groups. These results suggest that global budgets coupled with pay-for-performance can begin to slow the underlying growth in medical spending while improving quality. PMID:22786651

Can current analytical quality performance of UK clinical laboratories support evidence-based guidelines for diabetes and ischaemic heart disease?--A pilot study and a proposal.

PubMed

Jassam, Nuthar; Yundt-Pacheco, John; Jansen, Rob; Thomas, Annette; Barth, Julian H

2013-08-01

The implementation of national and international guidelines is beginning to standardise clinical practice. However, since many guidelines have decision limits based on laboratory tests, there is an urgent need to ensure that different laboratories obtain the same analytical result on any sample. A scientifically-based quality control process will be a pre-requisite to provide this level of analytical performance which will support evidence-based guidelines and movement of patients across boundaries while maintaining standardised outcomes. We discuss the finding of a pilot study performed to assess UK clinical laboratories readiness to work to a higher grade quality specifications such as biological variation-based quality specifications. Internal quality control (IQC) data for HbA1c, glucose, creatinine, cholesterol and high density lipoprotein (HDL)-cholesterol were collected from UK laboratories participating in the Bio-Rad Unity QC programme. The median of the coefficient of variation (CV%) of the participating laboratories was evaluated against the CV% based on biological variation. Except creatinine, the other four analytes had a variable degree of compliance with the biological variation-based quality specifications. More than 75% of the laboratories met the biological variation-based quality specifications for glucose, cholesterol and HDL-cholesterol. Slightly over 50% of the laboratories met the analytical goal for HBA1c. Only one analyte (cholesterol) had a performance achieving the higher quality specifications consistent with 5σ. Our data from IQC do not consistently demonstrate that the results from clinical laboratories meet evidence-based quality specifications. Therefore, we propose that a graded scale of quality specifications may be needed at this stage.

Using SERVQUAL in health libraries across Somerset, Devon and Cornwall.

PubMed

Martin, Susan

2003-03-01

This study provides the results of a survey conducted in the autumn of 2001 by ten NHS library services across Somerset, Devon and Cornwall. The aim of the project was to measure the service quality of each individual library and to provide an overall picture of the quality of library services within the south-west peninsula. The survey was based on SERVQUAL, a diagnostic tool developed in the 1980s, which measures service quality in terms of customer expectations and perceptions of service. The survey results have provided the librarians with a wealth of information about service quality. The service as a whole is perceived to be not only meeting but also exceeding expectations in terms of reliability, responsiveness, empathy and assurance. For the first time, the ten health library services can measure their own service quality as well as benchmark themselves against others.

How consumers evaluate health care quality: Part II.

PubMed

Moore, S T; Bopp, K D

1999-01-01

This article is the second in a series which examines the way in which consumers assess information regarding the quality of health care services. In the previous article it was demonstrated that, in the view of health care consumers, three major perceptions held by health care consumers, are: (1) substantial differences in quality exist among health care providers, (2) little information is available that allows for the comparison of health care providers on issues related to quality, and (3) when such information is available it is found to be useful and often serves as the basis for decision regarding the choice of health care providers. We further discussed the short coming of marketing strategies based on complex quality indicators and the difficulties of image advertising in an age of institutional mistrust. The reader is reminded that these findings relate to the subjective assessments of consumers, not to objective facts concerning health care delivery.

Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

ERIC Educational Resources Information Center

Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

2010-01-01

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

The Quest for Quality: How YoungStar Is Affecting Child Care in Milwaukee County

ERIC Educational Resources Information Center

Mueller, Betsy; Peterangelo, Joe; Henken, Rob

2016-01-01

The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and…

A Statistical Analysis of Education Service Quality Dimensions on Business School Students' Satisfaction

ERIC Educational Resources Information Center

Seng, Ernest Lim Kok; Ling, Tan Pei

2013-01-01

This study aims to investigate student satisfaction on quality education services provided by institutions of higher learning in Malaysia. Their level of satisfaction based primarily on the data collected through five dimensions of education service quality. A random sample of 250 students studying in an institution of higher learning was selected…

Toward a theory of farmer conservation attitudes: Dual interests and willingness to take action to protect water quality

Treesearch

Kristin Floress; Silvestre García de Jalón; Sarah P. Church; Nicholas Babin; Jessica D. Ulrich-Schad; Linda S. Prokopy

2017-01-01

Water quality in the Midwestern United States is threatened as a result of agricultural runoff. Based on self-reported data from a survey of farmers in Indiana, we aim to provide a better understanding of how awareness of water quality problems, farm-as-business attitudes, and stewardship attitudes are related to each other and willingness to improve water quality....

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

PubMed

Blair, C S; Fordyce, M; Barney, S M

1993-10-01

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

Enhancing quality improvements in cancer care through CME activities at a nationally recognized cancer center.

PubMed

Uemura, Marc; Morgan, Robert; Mendelsohn, Mary; Kagan, Jean; Saavedra, Crystal; Leong, Lucille

2013-06-01

Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

Study of Air Pollution from Space Using TOMS: Challenges and Promises for Future Missions

NASA Technical Reports Server (NTRS)

Bhartia, Pawan K.

2002-01-01

A series of TOMS instruments built by NASA has flown on US, Russian, and Japanese satellites in the last 24 years. These instruments are well known for producing spectacular maps of the ozone hole that forms over Antarctica each spring. However, it is less well known that these instruments also provided first evidence that space-based measurements in UV of sufficiently high precision and accuracy can provide valuable information to study global air quality. We will use the TOMS experience to highlight the promises and challenges of future space-based missions designed specifically for air quality studies.

Community-Based Participatory Research and Smoking Cessation Interventions: A Review of the Evidence

PubMed Central

Newman, Susan D.; Heath, Janie; Williams, Lovoria B.; Tingen, Martha S.

2011-01-01

SYNOPSIS This article presents a review of the evidence on the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine: if CBPR improves the quality of research methods and community involvement in cessation intervention studies; and, cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research. PMID:22289400

AIR QUALITY CRITERIA DOCUMENT(S) FOR LEAD

EPA Science Inventory

This collection of documents intend to assess the latest scientific information on the health and environmental fate and effects of lead to provide scientific bases for periodic review and possible revision of the National Ambient Air Quality Standards (NAAQS) for lead.

The Importance of Quality in Ventilation-Perfusion Imaging.

PubMed

Mann, April; DiDea, Mario; Fournier, France; Tempesta, Daniel; Williams, Jessica; LaFrance, Norman

2018-06-01

As the health care environment continues to change and morph into a system focusing on increased quality and evidence-based outcomes, nuclear medicine technologists must be reminded that they play a critical role in achieving high-quality, interpretable images used to drive patient care, treatment, and best possible outcomes. A survey performed by the Quality Committee of the Society of Nuclear Medicine and Molecular Imaging Technologist Section demonstrated that a clear knowledge gap exists among technologists regarding their understanding of quality, how it is measured, and how it should be achieved by all practicing technologists regardless of role and education level. Understanding of these areas within health care, in conjunction with the growing emphasis on evidence-based outcomes, quality measures, and patient satisfaction, will ultimately elevate the role of nuclear medicine technologists today and into the future. The nuclear medicine role now requires technologists to demonstrate patient assessment skills, practice safety procedures with regard to staff and patients, provide patient education and instruction, and provide physicians with information to assist with the interpretation and outcome of the study. In addition, the technologist must be able to evaluate images by performing technical analysis, knowing the demonstrated anatomy and pathophysiology, and assessing overall quality. Technologists must also be able to triage and understand the disease processes being evaluated and how nuclear medicine diagnostic studies may drive care and treatment. Therefore, it is imperative that nuclear medicine technologists understand their role in the achievement of a high-quality, interpretable study by applying quality principles and understanding and using imaging techniques beyond just basic protocols for every type of disease or system being imaged. This article focuses on quality considerations related to ventilation-perfusion imaging. It provides insight on appropriate imaging techniques and protocols, true imaging variants and tracer distributions versus artifacts that may result in a lower-quality or misinterpreted study, and the use of SPECT and SPECT/CT as an alternative providing a high-quality, interpretable study with better diagnostic accuracy and fewer nondiagnostic procedures than historical planar imaging. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese community.

PubMed

Tsai, Jenna; Shi, Leiyu; Yu, Wei-Lung; Lebrun, Lydie A

2010-07-01

This study used a recent patient survey to examine the relationship between having a usual source of care (USC) and the quality of ambulatory medical care experiences in Taiwan, where there is universal health insurance coverage. The study design was a cross-sectional survey of 879 patients in Taichung County, Taiwan. Children and adults visiting hospital-based physicians were included. Quality of care was measured using items from the Primary Care Assessment Tool (PCAT), representing 7 ambulatory medical care domains: first contact (ie, access and utilization), longitudinality (ie, ongoing care), coordination (ie, referrals and information systems), comprehensiveness (ie, services available and provided), family centeredness, community orientation, and cultural competence. USC was defined based on responses to 3 survey items from the PCAT. Having a USC was significantly associated with higher quality of medical care experiences. Specifically, having a USC was associated with improved accessibility and utilization, ongoing care, coordination of referrals, and healthcare providers' family centeredness and cultural competence. However, having a USC was not strongly related with comprehensiveness of services, coordination of information systems, or healthcare providers' community orientation. In a region with universal health insurance, patients with a USC reported higher quality of medical care experiences compared with those without a USC. Beyond the provision of health insurance coverage, efforts to improve quality of care should include policies promoting USC.

Preparing for an epidemic: cancer care in an aging population.

PubMed

Shih, Ya-Chen Tina; Hurria, Arti

2014-01-01

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

Evaluation of programs for adolescents with greater psychosocial needs: community-based Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Law, Moon Y M

2017-02-01

This study examined the perceptions of the Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social programmes) among Chinese secondary school students displaying greater psychosocial needs. Results showed that participants held positive views of program qualities, implementer qualities, as well as the perceived effectiveness of the program. Significant grade differences in terms of various indicators of satisfaction related to program qualities, implementer qualities, and program effectiveness were found. Correlation analyses showed that there were significant inter-relationships amongst program qualities, implementer qualities and program effectiveness. In line with the predictions, both program qualities and implementer qualities were significant predictors of perceived program effectiveness. The present study provides support for the perceived effectiveness of the Tier 2 Program of the Project P.A.T.H.S. in the community-based project context.

Exploring Rating Quality in Rater-Mediated Assessments Using Mokken Scale Analysis

PubMed Central

Wind, Stefanie A.; Engelhard, George

2015-01-01

Mokken scale analysis is a probabilistic nonparametric approach that offers statistical and graphical tools for evaluating the quality of social science measurement without placing potentially inappropriate restrictions on the structure of a data set. In particular, Mokken scaling provides a useful method for evaluating important measurement properties, such as invariance, in contexts where response processes are not well understood. Because rater-mediated assessments involve complex interactions among many variables, including assessment contexts, student artifacts, rubrics, individual rater characteristics, and others, rater-assigned scores are suitable candidates for Mokken scale analysis. The purposes of this study are to describe a suite of indices that can be used to explore the psychometric quality of data from rater-mediated assessments and to illustrate the substantive interpretation of Mokken-based statistics and displays in this context. Techniques that are commonly used in polytomous applications of Mokken scaling are adapted for use with rater-mediated assessments, with a focus on the substantive interpretation related to individual raters. Overall, the findings suggest that indices of rater monotonicity, rater scalability, and invariant rater ordering based on Mokken scaling provide diagnostic information at the level of individual raters related to the requirements for invariant measurement. These Mokken-based indices serve as an additional suite of diagnostic tools for exploring the quality of data from rater-mediated assessments that can supplement rating quality indices based on parametric models. PMID:29795883

Satellite-based virtual buoy system to monitor coastal water quality

NASA Astrophysics Data System (ADS)

Hu, Chuanmin; Barnes, Brian B.; Murch, Brock; Carlson, Paul

2014-05-01

There is a pressing need to assess coastal and estuarine water quality state and anomaly events to facilitate coastal management, but such a need is hindered by lack of resources to conduct frequent ship-based or buoy-based measurements. Here, we established a virtual buoy system (VBS) to facilitate satellite data visualization and interpretation of water quality assessment. The VBS is based on a virtual antenna system (VAS) that obtains low-level satellite data and generates higher-level data products using both National Aeronautics and Space Administration standard algorithms and regionally customized algorithms in near real time. The VB stations are predefined and carefully chosen to cover water quality gradients in estuaries and coastal waters, where multiyear time series at monthly and weekly intervals are extracted for the following parameters: sea surface temperature (°C), chlorophyll-a concentration (mg m-3), turbidity (NTU), diffuse light attenuation at 490 nm [Kd(490), m-1] or secchi disk depth (m), absorption coefficient of colored dissolved organic matter (m-1), and bottom available light (%). The time-series data are updated routinely and provided in both ASCII and graphical formats via a user-friendly web interface where all information is available to the user through a simple click. The VAS and VBS also provide necessary infrastructure to implement peer-reviewed regional algorithms to generate and share improved water quality data products with the user community.

Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries

PubMed Central

Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos

2016-01-01

Background The complexity of modern practice requires health professionals to be active information-seekers. Objective Our aim was to review the quality and progress of point-of-care information summaries—Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. Methods We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. Results We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Conclusions Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time. PMID:26786976

Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries.

PubMed

Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos; Moja, Lorenzo

2016-01-19

The complexity of modern practice requires health professionals to be active information-seekers. Our aim was to review the quality and progress of point-of-care information summaries-Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

Extraction of respiratory signals from the electrocardiogram and photoplethysmogram: technical and physiological determinants.

PubMed

Charlton, Peter H; Bonnici, Timothy; Tarassenko, Lionel; Alastruey, Jordi; Clifton, David A; Beale, Richard; Watkinson, Peter J

2017-05-01

Breathing rate (BR) can be estimated by extracting respiratory signals from the electrocardiogram (ECG) or photoplethysmogram (PPG). The extracted respiratory signals may be influenced by several technical and physiological factors. In this study, our aim was to determine how technical and physiological factors influence the quality of respiratory signals. Using a variety of techniques 15 respiratory signals were extracted from the ECG, and 11 from PPG signals collected from 57 healthy subjects. The quality of each respiratory signal was assessed by calculating its correlation with a reference oral-nasal pressure respiratory signal using Pearson's correlation coefficient. Relevant results informing device design and clinical application were obtained. The results informing device design were: (i) seven out of 11 respiratory signals were of higher quality when extracted from finger PPG compared to ear PPG; (ii) laboratory equipment did not provide higher quality of respiratory signals than a clinical monitor; (iii) the ECG provided higher quality respiratory signals than the PPG; (iv) during downsampling of the ECG and PPG significant reductions in quality were first observed at sampling frequencies of  <250 Hz and  <16 Hz respectively. The results informing clinical application were: (i) frequency modulation-based respiratory signals were generally of lower quality in elderly subjects compared to young subjects; (ii) the qualities of 23 out of 26 respiratory signals were reduced at elevated BRs; (iii) there were no differences associated with gender. Recommendations based on the results are provided regarding device designs for BR estimation, and clinical applications. The dataset and code used in this study are publicly available.

Quality Assessment of TPB-Based Questionnaires: A Systematic Review

PubMed Central

Oluka, Obiageli Crystal; Nie, Shaofa; Sun, Yi

2014-01-01

Objective This review is aimed at assessing the quality of questionnaires and their development process based on the theory of planned behavior (TPB) change model. Methods A systematic literature search for studies with the primary aim of TPB-based questionnaire development was conducted in relevant databases between 2002 and 2012 using selected search terms. Ten of 1,034 screened abstracts met the inclusion criteria and were assessed for methodological quality using two different appraisal tools: one for the overall methodological quality of each study and the other developed for the appraisal of the questionnaire content and development process. Both appraisal tools consisted of items regarding the likelihood of bias in each study and were eventually combined to give the overall quality score for each included study. Results 8 of the 10 included studies showed low risk of bias in the overall quality assessment of each study, while 9 of the studies were of high quality based on the quality appraisal of questionnaire content and development process. Conclusion Quality appraisal of the questionnaires in the 10 reviewed studies was successfully conducted, highlighting the top problem areas (including: sample size estimation; inclusion of direct and indirect measures; and inclusion of questions on demographics) in the development of TPB-based questionnaires and the need for researchers to provide a more detailed account of their development process. PMID:24722323

Developing and Implementing Inquiry-Based, Water Quality Laboratory Experiments for High School Students to Explore Real Environmental Issues Using Analytical Chemistry

ERIC Educational Resources Information Center

Mandler, Daphna; Blonder, Ron; Yayon, Malka; Mamlok-Naaman, Rachel; Hofstein, Avi

2014-01-01

This paper describes the rationale and the implementation of five laboratory experiments; four of them, intended for high-school students, are inquiry-based activities that explore the quality of water. The context of water provides students with an opportunity to study the importance of analytical methods and how they influence our everyday…

Quality of Malaysian Teachers Based on Education and Training: A Benefit and Earnings Returns Analysis Using Human Capital Theory

ERIC Educational Resources Information Center

Ismail, Ramlee; Awang, Marinah

2017-01-01

Purpose: The purpose of this paper is to investigate how the quality of teachers based on education and training provided under new reform policies in Malaysia affects their earnings outcomes. The study conducted a benefit and returns analysis guided by human capital theory. Design/methodology/approach: The study used survey research methods to…

Quality and Characteristics of the North Carolina Pre-Kindergarten Program: 2011-2012 Statewide Evaluation

ERIC Educational Resources Information Center

Peisner-Feinberg, Ellen; Schaaf, Jennifer; Hildebrandt, Lisa; LaForett, Dore

2013-01-01

The North Carolina Pre-Kindergarten Program (NC Pre-K) is a state-funded initiative for at-risk 4-year-olds, designed to provide a high quality, classroom-based educational program during the year prior to kindergarten entry. Children are eligible for NC Pre-K based on age, family income (at or below 75% of state median income), and other risk…

Investigating the Quality of Project-Based Science and Technology Learning Environments in Elementary School: A Critical Review of Instruments

ERIC Educational Resources Information Center

Thys, Miranda; Verschaffel, Lieven; Van Dooren, Wim; Laevers, Ferre

2016-01-01

This paper provides a systematic review of instruments that have the potential to measure the quality of project-based science and technology (S&T) learning environments in elementary school. To this end, a comprehensive literature search was undertaken for the large field of S&T learning environments. We conducted a horizontal bottom-up…

An agent-based simulation model to study accountable care organizations.

PubMed

Liu, Pai; Wu, Shinyi

2016-03-01

Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.

A simulation-based approach for estimating premining water quality: Red Mountain Creek, Colorado

USGS Publications Warehouse

Runkel, Robert L.; Kimball, Briant A; Walton-Day, Katherine; Verplanck, Philip L.

2007-01-01

Regulatory agencies are often charged with the task of setting site-specific numeric water quality standards for impaired streams. This task is particularly difficult for streams draining highly mineralized watersheds with past mining activity. Baseline water quality data obtained prior to mining are often non-existent and application of generic water quality standards developed for unmineralized watersheds is suspect given the geology of most watersheds affected by mining. Various approaches have been used to estimate premining conditions, but none of the existing approaches rigorously consider the physical and geochemical processes that ultimately determine instream water quality. An approach based on simulation modeling is therefore proposed herein. The approach utilizes synoptic data that provide spatially-detailed profiles of concentration, streamflow, and constituent load along the study reach. This field data set is used to calibrate a reactive stream transport model that considers the suite of physical and geochemical processes that affect constituent concentrations during instream transport. A key input to the model is the quality and quantity of waters entering the study reach. This input is based on chemical analyses available from synoptic sampling and observed increases in streamflow along the study reach. Given the calibrated model, additional simulations are conducted to estimate premining conditions. In these simulations, the chemistry of mining-affected sources is replaced with the chemistry of waters that are thought to be unaffected by mining (proximal, premining analogues). The resultant simulations provide estimates of premining water quality that reflect both the reduced loads that were present prior to mining and the processes that affect these loads as they are transported downstream. This simulation-based approach is demonstrated using data from Red Mountain Creek, Colorado, a small stream draining a heavily-mined watershed. Model application to the premining problem for Red Mountain Creek is based on limited field reconnaissance and chemical analyses; additional field work and analyses may be needed to develop definitive, quantitative estimates of premining water quality.

Do Clinical Practice Guidelines Improve Quality?

PubMed

Baldassari, Cristina M

2017-07-01

Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

Water-quality and biologic data for the Blue River basin, Kansas City metropolitan area, Missouri and Kansas, October 2000 to October 2004

USGS Publications Warehouse

Wilkison, Donald H.; Armstrong, Daniel J.; Brown, Rebecca E.; Poulton, Barry C.; Cahill, Jeffrey D.; Zaugg, Steven D.

2005-01-01

This report presents water-quality and biologic data collected in the Blue River Basin, metropolitan Kansas City, Missouri and Kansas, from October 2000 to October 2004. Data were collected in cooperation with the city of Kansas City, Missouri, Water Services Department as part of an ongoing study designed to characterize long-term water-quality trends in the basin and to provide data to support a strategy for combined sewer overflow control. These data include values of physical properties, fecal indicator bacteria densities, suspended sediment, and concentrations of major ions, nutrients, trace elements, organic wastewater compounds, and pharmaceutical compounds in base-flow and stormflow stream samples and bottom sediments. Six surface-water sites in the basin were sampled 13 times during base-flow conditions and during a minimum of 7 storms. Benthic macroinvertebrate communities are described at 10 sites in the basin and 1 site outside the basin. Water-column and bottom-sediment data from impounded reaches of Brush Creek are provided. Continuous specific conductance, pH, water-quality temperature, turbidity, and dissolved oxygen data are provided for two streams-the Blue River and Brush Creek. Sampling, analytical, and quality assurance methods used in data collection during the study also are described in the report.

Is There a Trade-off Between Quality and Profitability in United States Nursing Homes?

PubMed

Godby, Tyler; Saldanha, Sarah; Valle, Jazmine; Paul, David P; Coustasse, Alberto

Nursing home residents across the United States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals who could not perform these tasks for themselves. Not-for-profit (NFP) versus for-profit (FP) nursing homes have been examined for utilization and efficacy; however, it has been shown that NFP nursing homes generally offer higher quality care and generate greater profit margins compared with FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared with FP nursing homes. Benefits and barriers in regard to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it is suggested that NFP nursing homes have achieved higher quality of care because of a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes.

Quality Assurance Through Quality Improvement and Professional Development in the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Siegl, Elvira J.; Miller, Jacqueline W.; Khan, Kris; Harris, Susan E.

2015-01-01

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. PMID:25099901

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

WE-A-BRC-00: The Quality Gap

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Quality and safety in healthcare are inextricably linked. There are compelling data that link poor quality radiation therapy to inferior patient survival. Radiation Oncology clinical trial protocol deviations often involve incorrect target volume delineation or dosing, akin to radiotherapy incidents which also often involve partial geometric miss or improper radiation dosing. When patients with radiation protocol variations are compared to those without significant protocol variations, clinical outcome is negatively impacted. Traditionally, quality assurance in radiation oncology has been driven largely by new technological advances, and safety improvement has been driven by reactive responses to past system failures and prescriptive mandatesmore » recommended by professional organizations and promulgated by regulators. Prescriptive approaches to quality and safety alone often do not address the huge variety of process and technique used in radiation oncology. Risk-based assessments of radiotherapy processes provide a mechanism to enhance quality and safety, both for new and for established techniques. It is imperative that we explore such a paradigm shift at this time, when expectations from patients as well as providers are rising while available resources are falling. There is much we can learn from our past experiences to be applied towards the new risk-based assessments. Learning Objectives: Understand the impact of clinical and technical quality on outcomes Understand the importance of quality care in radiation oncology Learn to assess the impact of quality on clinical outcomes D. Followill, NIH Grant CA180803.« less

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

PubMed

Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

2018-04-06

Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

SUPPORTING PHYSICIANS' PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI) AND QUALITY IMPROVEMENT THROUGH EXPLORATION OF POPULATION-BASED MEDICAL DATA.

PubMed

Baumgart, Leigh A; Bass, Ellen J; Lyman, Jason A; Springs, Sherry; Voss, John; Hayden, Gregory F; Hellems, Martha A; Hoke, Tracey R; Schlag, Katharine A; Schorling, John B

2010-01-01

Participating in self-assessment activities may stimulate improvement in practice behaviors. However, it is unclear how best to support the development of self-assessment skills, particularly in the health care domain. Exploration of population-based data is one method to enable health care providers to identify deficiencies in overall practice behavior that can motivate quality improvement initiatives. At the University of Virginia, we are developing a decision support tool to integrate and present population-based patient data to health care providers related to both clinical outcomes and non-clinical measures (e.g., demographic information). By enabling users to separate their direct impact on clinical outcomes from other factors out of their control, we may enhance the self-assessment process.

SUPPORTING PHYSICIANS’ PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI) AND QUALITY IMPROVEMENT THROUGH EXPLORATION OF POPULATION-BASED MEDICAL DATA

PubMed Central

Baumgart, Leigh A.; Bass, Ellen J.; Lyman, Jason A.; Springs, Sherry; Voss, John; Hayden, Gregory F.; Hellems, Martha A.; Hoke, Tracey R.; Schlag, Katharine A.; Schorling, John B.

2011-01-01

Participating in self-assessment activities may stimulate improvement in practice behaviors. However, it is unclear how best to support the development of self-assessment skills, particularly in the health care domain. Exploration of population-based data is one method to enable health care providers to identify deficiencies in overall practice behavior that can motivate quality improvement initiatives. At the University of Virginia, we are developing a decision support tool to integrate and present population-based patient data to health care providers related to both clinical outcomes and non-clinical measures (e.g., demographic information). By enabling users to separate their direct impact on clinical outcomes from other factors out of their control, we may enhance the self-assessment process. PMID:21874123

British Thoracic Society quality standards for the investigation and management of pulmonary nodules.

PubMed

Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian

2018-01-01

The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations.

British Thoracic Society quality standards for the investigation and management of pulmonary nodules

PubMed Central

Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations. PMID:29682290

An evaluative review of questionnaires recommended for the assessment of quality of life and symptom severity in women with urinary incontinence.

PubMed

Hewison, Ann; McCaughan, Dorothy; Watt, Ian

2014-11-01

To provide an up-to-date assessment of the quality of commonly recommended questionnaires for measuring symptom severity and quality of life in women with urinary incontinence and also to consider their application to practice. Urinary incontinence is a common problem for women. In addition to various physical symptoms, there is a known effect on quality of life. Psychometrically robust questionnaires are reported to be the best way to measure an individual's perceptions of symptom severity and quality of life, and a number of different ones are recommended for use in international and national guidance, which can be confusing for clinicians. Moreover, there are concerns over the applicability of some of these instruments in clinical practice. An evaluative review was carried out examining selected questionnaires measuring symptom severity and/or quality of life. Selection of questionnaires for inclusion in the review was based on the recommendations of evidence-based guidance, followed by systematic scrutiny of the characteristics of the individual recommended questionnaires. Thirteen questionnaires were included in the review, of which three appeared to 'outperform' the remainder in terms of their psychometric properties and other characteristics. This review provides the most up-to-date and comprehensive analysis of the quality and applicability of the included questionnaires and offers the practitioner advice on which to select for use in practice. This review aims to help the practitioner choose a questionnaire based on a sound evaluation of the quality of the questionnaire and its applicability to the clinical setting. © 2013 John Wiley & Sons Ltd.

Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti.

PubMed

Phillips, Erica; Stoltzfus, Rebecca J; Michaud, Lesly; Pierre, Gracia Lionel Fils; Vermeylen, Francoise; Pelletier, David

2017-10-16

Antenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated. To determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women's knowledge and perception of care quality. There were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women's knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models. Although adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services delivered. Efforts to improve provider performance and quality are therefore needed in both models. Mobile clinics must deliver high-quality ANC to improve health and nutrition outcomes.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-01-01

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality. PMID:27175303

Can Western quality improvement methods transform the Russian health care system?

PubMed

Tillinghast, S J

1998-05-01

The Russian health care system largely remains the same system that was in place during the existence of the Soviet Union. It is almost entirely state owned and operated, although ownership and management have developed from the central government to the oblast (province). The ZdravReform (Health Reform) Program (ZRP) in Russia, which began in 1993, included the goal of improving the quality and cost-effectiveness of the health care system. Work on introducing continuous quality improvement (CQI), evidence-based practice guidelines, and indicators of quality was conducted in 1995-1996. INTRODUCING EVIDENCE-BASED MEDICINE: As a result of the poor quality of Russian-language medical journals and the inability to gain access to the knowledge available in Western medical literature, Russian medical practices have not kept up with the rapid evolution of evidence-based medical practice that has begun transforming Western medicine. A number of evidence-based clinical practice guidelines were translated and disseminated to Russian-speaking physicians working in facilities participating in ZRP in Russia and Central Asia. Given the limitations of existing measures of the quality of care, indicators were developed for participating ambulatory polyclinics in several oblasts in Siberia. Russian physicians responsible for quality of care for their respective oblasts formed a working group to develop the indicators. A clinical information system that would provide automated collection and analysis of the indicator data-as well as additional patient record information-was also developed. CQI activities, entailing a multidisciplinary, participatory team approach, were conducted in four oblasts in western Siberia. Projects addressed the management of community-acquired pneumonia and reduction of length of stay after myocardial infarction (MI). One of the oblasts provided an example of a home-grown evidence-based protocol for post-MI care, which was adopted in the other three oblasts. Evidence-based medicine is critically needed to improve the quality of research and publications, medical education, and medical practice. Physicians everywhere are data driven; they change their practices when convinced by good data. The key to successful introduction of evidence-based medicine is understanding the fundamentals of good scientific method as applied to medicine. The Russian health care system's experience in reporting to higher authorities' process and outcomes data that resemble our modern indicators can provide the basis for accurate and valid measures of quality. In contrast with American expectations that a significant cultural change in an organization could take years, even with great effort, Russian physicians and other clinicians rapidly assimilated the new concepts of QI and put them to use. More on-site assistance by international medical consultants will still be needed for several years to hasten the process of change and ensure that it does not become stalled.

[Cost-effectiveness analysis of an alternative for the provision of primary health care for beneficiaries of Seguro Popular in Mexico].

PubMed

Figueroa-Lara, Alejandro; González-Block, Miguel A

2016-01-01

To estimate the cost-effectiveness ratio of public and private health care providers funded by Seguro Popular. A pilot contracting primary care health care scheme in the state of Hidalgo, Mexico, was evaluated through a population survey to assess quality of care and detection decreased of vision. Costs were assessed from the payer perspective using institutional sources.The alternatives analyzed were a private provider with capitated and performance-based payment modalities, and a public provider funded through budget subsidies. Sensitivity analysis was performed using Monte Carlo simulations. The private provider is dominant in the quality and cost-effective detection of decreased vision. Strategic purchasing of private providers of primary care has shown promising results as an alternative to improving quality of health services and reducing costs.

Quality of Educational Support for Children with Autism Spectrum Disorder in Bosnia and Herzegovina--Perception of Parents and Professionals

ERIC Educational Resources Information Center

Mujkanovic, Elvira; Mujkanovic, Edin; Pasalic, Arnela; Biscevic, Inga; Memisevic, Haris

2017-01-01

Children with autism spectrum disorder (ASD) attend regular education schools and special education schools in Bosnia and Herzegovina. Regardless of the setting, it is important to provide early, high quality, programs to children with ASD. High quality educational support must encompass evidence-based programs for these children. The goal of the…

Air Quality Monitoring: Risk-Based Choices

NASA Technical Reports Server (NTRS)

James, John T.

2009-01-01

Air monitoring is secondary to rigid control of risks to air quality. Air quality monitoring requires us to target the credible residual risks. Constraints on monitoring devices are severe. Must transition from archival to real-time, on-board monitoring. Must provide data to crew in a way that they can interpret findings. Dust management and monitoring may be a major concern for exploration class missions.

Santa Margarita Estuary Water Quality Monitoring Data

DTIC Science & Technology

2018-02-01

ADMINISTRATIVE INFORMATION The work described in this report was performed for the Water Quality Section of the Environmental Security Marine Corps Base...water quality model calibration given interest and the necessary resources. The dataset should also inform the stakeholders and Regional Board on...period. Several additional ancillary datasets were collected during the monitoring timeframe that provide key information though they were not collected

Social Justice and School Improvement: Improving the Quality of Schooling in the Poorest Neighbourhoods

ERIC Educational Resources Information Center

Lupton, Ruth

2005-01-01

Social justice in education demands, at the very least, that all students should have access to the same quality of educational processes, even if their outcomes turn out to be unequal. Yet schools in the poorest neighbourhoods are consistently adjudged to provide a lower quality of education than those in more advantaged areas. Based on a…

Long-term forest paired catchment studies: What do they tell us that landscape-level monitoring does not?

Treesearch

Dan Neary

2016-01-01

Forested catchments throughout the world are known for producing high quality water for human use. In the 20th Century, experimental forest catchment studies played a key role in studying the processes contributing to high water quality. The hydrologic processes investigated on these paired catchments have provided the science base for examining water quality...

Exploring nursing e-learning systems success based on information system success model.

PubMed

Chang, Hui-Chuan; Liu, Chung-Feng; Hwang, Hsin-Ginn

2011-12-01

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

PubMed

McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

2013-01-01

In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

PubMed

Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

2016-06-01

Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

Satellite data driven modeling system for predicting air quality and visibility during wildfire and prescribed burn events

NASA Astrophysics Data System (ADS)

Nair, U. S.; Keiser, K.; Wu, Y.; Maskey, M.; Berendes, D.; Glass, P.; Dhakal, A.; Christopher, S. A.

2012-12-01

The Alabama Forestry Commission (AFC) is responsible for wildfire control and also prescribed burn management in the state of Alabama. Visibility and air quality degradation resulting from smoke are two pieces of information that are crucial for this activity. Currently the tools available to AFC are the dispersion index available from the National Weather Service and also surface smoke concentrations. The former provides broad guidance for prescribed burning activities but does not provide specific information regarding smoke transport, areas affected and quantification of air quality and visibility degradation. While the NOAA operational air quality guidance includes surface smoke concentrations from existing fire events, it does not account for contributions from background aerosols, which are important for the southeastern region including Alabama. Also lacking is the quantification of visibility. The University of Alabama in Huntsville has developed a state-of-the-art integrated modeling system to address these concerns. This system based on the Community Air Quality Modeling System (CMAQ) that ingests satellite derived smoke emissions and also assimilates NASA MODIS derived aerosol optical thickness. In addition, this operational modeling system also simulates the impact of potential prescribed burn events based on location information derived from the AFC prescribed burn permit database. A lagrangian model is used to simulate smoke plumes for the prescribed burns requests. The combined air quality and visibility degradation resulting from these smoke plumes and background aerosols is computed and the information is made available through a web based decision support system utilizing open source GIS components. This system provides information regarding intersections between highways and other critical facilities such as old age homes, hospitals and schools. The system also includes satellite detected fire locations and other satellite derived datasets relevant for fire and smoke management.

How to Hit a Home Run with Bundled Payments.

PubMed

Kaldy, Joanne

2015-09-01

As health care payment reform continues to evolve, reimbursement increasingly is being linked to outcomes as well as to expenditures. Toward this end, the Centers for Medicare & Medicaid Services has established models for "bundled" payments to long-term care providers, using predetermined payments based on historical spending rates, in a new pay-for-performance landscape. The goal is to reward providers for quality and cost-effective care as well as penalize them for adverse patient outcomes and hospital readmissions based on the target spending rates. Pharmacists have a role in these new models of care, but need to broaden their partnerships and relationships with providers and be prepared to prove they are contributing both to quality care and to reducing costs.

Assessing Care of Vulnerable Elders – Alzheimer's Disease: A Pilot Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care

PubMed Central

Reuben, David B.; Roth, Carol P.; Frank, Janet C.; Hirsch, Susan H.; Katz, Diane; McCreath, Heather; Younger, Jon; Murawski, Marta; Edgerly, Elizabeth; Maher, Joanne; Maslow, Katie; Wenger, Neil S.

2013-01-01

Objectives To determine whether a practice redesign intervention coupled with referral to local Alzheimer's Association chapters can improve the quality of dementia care. Design Pre-post intervention Setting Two community-based physician practices Participants Five physicians in each practice and their patients age 75 and older with dementia Intervention Adaptation of the Assessing Care of Vulnerable Elders (ACOVE)-2 intervention (screening, efficient collection of clinical data, medical record prompts, patient education/empowerment materials, and physician decision support/education). In addition, physicians faxed referral forms to local Alzheimer's Association chapters who assessed patients, provided counseling and education, and faxed information back to the physicians. Measurements Audits of pre- (5 per physician) and post- (10 per physician) intervention medical records using ACOVE-3 quality indicators for dementia to measure the quality of care provided. Results Based on 47 pre- and 90 post-intervention audits, the percentage of quality indicators satisfied rose from 38% to 46% with significant differences on quality indicators measuring the assessment of functional status (20% versus 51%), discussion of risk/benefits of antipsychotics (32% versus 100%), and counseling caregivers (2% versus 30%). Referral of patients to Alzheimer's Association chapters increased from 0 to 17%. Referred patients had higher quality scores (65% versus 41%) and better counseling about driving (50% versus 14%), caregiver counseling (100% versus 15%) and surrogate decision-maker specification (75% versus 44%). However, some quality indicators related to cognitive assessment and examination did not improve. Conclusions This pilot study suggests that a practice-based intervention can increase referral to AA chapters and improve quality of dementia care. PMID:20374405

Guiding Principles and Checklist for Population-Based Quality Metrics

PubMed Central

Brunelli, Steven M.; Maddux, Franklin W.; Parker, Thomas F.; Johnson, Douglas; Nissenson, Allen R.; Collins, Allan; Lacson, Eduardo

2014-01-01

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. PMID:24558050

Usalpharma: A Cloud-Based Architecture to Support Quality Assurance Training Processes in Health Area Using Virtual Worlds

PubMed Central

García-Peñalvo, Francisco J.; Pérez-Blanco, Jonás Samuel; Martín-Suárez, Ana

2014-01-01

This paper discusses how cloud-based architectures can extend and enhance the functionality of the training environments based on virtual worlds and how, from this cloud perspective, we can provide support to analysis of training processes in the area of health, specifically in the field of training processes in quality assurance for pharmaceutical laboratories, presenting a tool for data retrieval and analysis that allows facing the knowledge discovery in the happenings inside the virtual worlds. PMID:24778593

Streamflow and water-quality data for Little Clearfield Creek basin, Clearfield County, Pennsylvania, December 1987 - November 1988

USGS Publications Warehouse

Kostelnik, K.M.; Durlin, R.R.

1989-01-01

Streamflow and water quality data were collected throughout the Little Clearfield Creek basin, Clearfield County, Pennsylvania, from December 1987 through November 1988, to determine the existing quality of surface water over a range of hydrologic conditions. This data will assist the Pennsylvania Department of Environmental Resources during its review of coal mine permit applications. A water quality station near the mouth of Little Clearfield Creek provided continuous record of stream stage, pH, specific conductance, and water temperature. Monthly water quality samples collected at this station were analyzed for total and dissolved metals, nutrients, major cations, and suspended sediment concentrations. Seventeen partial record sites, located throughout the basin, were similarly sampled four times during the study. Streamflow and water quality data obtained at these sites during a winter base flow, a spring storm event, a low summer base flow, and a more moderate summer base flow also are presented. (Author 's abstract)

Nurses' perception of the quality of care they provide to hospitalized drug addicts: testing the theory of reasoned action.

PubMed

Natan, Merav Ben; Beyil, Valery; Neta, Okev

2009-12-01

A correlational design was used to examine nursing staff attitudes and subjective norms manifested in intended and actual care of drug users based on the Theory of Reasoned Action. One hundred and thirty-five nursing staff from three central Israeli hospitals completed a questionnaire examining theory-based variables as well as sociodemographic and professional characteristics. Most respondents reported a high to very high level of actual or intended care of drug users. Nurses' stronger intentions to provide quality care to drug users were associated with more positive attitudes. Nursing staff members had moderately negative attitudes towards drug users. Nurses were found to hold negative stereotypes of drug addict patients and most considered the management of this group difficult. Positive attitudes towards drug users, perceived expectations of others and perceived correctness of the behaviour are important in their effect on the intention of nurses to provide high-quality care to hospitalized patients addicted to drugs.

Evaluating the content and quality of information about premature ejaculation on the Internet: what are men being exposed to ?

PubMed

Gul, M; Kaynar, M

2017-03-01

Premature ejaculation is one of the most common male sexual dysfunctions; however, only a few patients with premature ejaculation are seeking professional help or advice. Internet has become an important source of knowledge, and thus, more patients are looking online for health information. According to our best knowledge, no study has evaluated the content and quality of websites on premature ejaculation. We, therefore, aimed to evaluate the content and quality of currently available Internet-based information on premature ejaculation. A sample was obtained comprising the 50 top sites retrieved from Google, Bing and Yahoo search engines using the terms 'premature ejaculation'. Each site then was reviewed based on some predefined evaluation criteria to determine the general quality, condition-specific content quality, popularity index and ownership. The websites reviewed were differed highly in terms of quality and ownership. Only a few sites provided comprehensive medical and complete information on premature ejaculation. The online information available is often of uncertain calibre; therefore, men are being exposed to information about premature ejaculation with a highly variable degree quality. This fact should be considered both by health professionals and website owners, and better online resources should be provided for these patients. © 2016 Blackwell Verlag GmbH.

Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

PubMed

Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

2015-06-01

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

[Analysis of commercial specifications and grades of wild and cultivated Gentianae Macrophyllae Radix based on multi-indicative constituents].

PubMed

Yang, Yan-Mei; Lin, Li; Lu, You-Yuan; Ma, Xiao-Hui; Jin, Ling; Zhu, Tian-Tian

2016-03-01

The study is aimed to analyze the commercial specifications and grades of wild and cultivated Gentianae Macrophllae Radix based on multi-indicative constituents. The seven kinds of main chemical components containing in Gentianae Macrophyllae Radix were determined by UPLC, and then the quality levels of chemical component of Gentianae Macrophyllae Radix were clustered and classified by modern statistical methods (canonical correspondence analysis, Fisher discriminant analysis and so on). The quality indices were selected and their correlations were analyzed. Lastly, comprehensively quantitative grade division for quality under different commodity-specifications and different grades of same commodity-specifications of wild and planting were divided. The results provide a basis for a reasonable division of specification and grade of the commodity of Gentianae Macrophyllae Radix. The range of quality evaluation of main index components (gentiopicrin, loganin acid and swertiamarin) was proposed, and the Herbal Quality Index (HQI) was introduced. The rank discriminant function was established based on the quality by Fisher discriminant analysis. According to the analysis, the quality of wild and cultivated Luobojiao, one of the commercial specification of Gentianae Macrophyllae Radix was the best, Mahuajiao, the other commercial specification, was average , Xiaoqinjiao was inferior. Among grades, the quality of first-class cultivated Luobojiao was the worst, of second class secondary, and the third class the best; The quality of the first-class of wild Luobojiao was secondary, and the second-class the best; The quality of the second-class of Mahuajiao was secondary, and the first-class was the best; the quality of first-class Xiaoqinjiao was secondary, and the second-class was the better one between the two grades, but not obvious significantly. The method provides a new idea and method for evaluation of comprehensively quantitative on the quality of Gentianae Macrophyllae Radix. Copyright© by the Chinese Pharmaceutical Association.

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

PubMed

Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

2015-01-01

With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

Decision Support System for Medical Care Quality Assessment Based on Health Records Analysis in Russia.

PubMed

Taranik, Maksim; Kopanitsa, Georgy

2017-01-01

The paper presents developed decision system, oriented for healthcare providers. The system allows healthcare providers to detect and decrease nonconformities in health records and forecast the sum of insurance payments taking into account nonconformities. The components are ISO13606, fuzzy logic and case-based reasoning concept. The result of system implementation allowed to 10% increase insurance payments for healthcare provider.

Quality of Mental Health Care for Nursing Home Residents: A Literature Review

PubMed Central

Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.

2010-01-01

Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943

Near real time water quality monitoring of Chivero and Manyame lakes of Zimbabwe

NASA Astrophysics Data System (ADS)

Muchini, Ronald; Gumindoga, Webster; Togarepi, Sydney; Pinias Masarira, Tarirai; Dube, Timothy

2018-05-01

Zimbabwe's water resources are under pressure from both point and non-point sources of pollution hence the need for regular and synoptic assessment. In-situ and laboratory based methods of water quality monitoring are point based and do not provide a synoptic coverage of the lakes. This paper presents novel methods for retrieving water quality parameters in Chivero and Manyame lakes, Zimbabwe, from remotely sensed imagery. Remotely sensed derived water quality parameters are further validated using in-situ data. It also presents an application for automated retrieval of those parameters developed in VB6, as well as a web portal for disseminating the water quality information to relevant stakeholders. The web portal is developed, using Geoserver, open layers and HTML. Results show the spatial variation of water quality and an automated remote sensing and GIS system with a web front end to disseminate water quality information.

[Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea].

PubMed

Min, Jun Ki; Cha, Jae Myung; Cho, Yu Kyung; Kim, Jie Hyun; Yoon, Soon Man; Im, Jong Pil; Jung, Yunho; Moon, Jeong Seop; Kim, Jin Oh; Jeen, Yoon Tae

2018-05-25

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Financial incentives for quality in breast cancer care.

PubMed

Tisnado, Diana M; Rose-Ash, Danielle E; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2008-07-01

To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers. Cross-sectional observational study. Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%). Physicians were asked whether they were subject to financial incentives for quality (ie, patient satisfaction surveys and adherence to practice guidelines). We examined the prevalence and correlates of incentives and performed multivariate logistic regression analyses to assess predictors of incentives, controlling for other covariates. Twenty percent of respondents reported incentives based on patient satisfaction, and 15% reported incentives based on guideline adherence. The use of incentives for quality in this cohort of oncologists and surgeons was modest and was primarily associated with staff- or group-model health maintenance organization (HMO) settings. In other settings, important predictors were partial physician ownership interest, large practice size, and capitation. Most cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. Those who are, seem more likely to be associated with large practice settings. New approaches are needed to direct financial incentives for quality toward specialists outside of staff- or group-model HMOs if pay-for-performance programs are to succeed in influencing care.

AQMEII: A New International Initiative on Air Quality Model Evaluation

EPA Science Inventory

We provide a conceptual view of the process of evaluating regional-scale three-dimensional numerical photochemical air quality modeling system, based on an examination of existing approached to the evaluation of such systems as they are currently used in a variety of application....

Response of Vibrio fischeri to repeated exposures over time in an Online Toxicity Monitor

EPA Science Inventory

Online Toxicity Monitors have been developed to provide continuous, time-relevant information regarding water quality. These systems measure a physiological or behavioral response of a sentinel organism to changes water quality. One such system, the Microlan Toxcontrol, is base...

Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.

PubMed

Yano, Elizabeth M; Darling, Jill E; Hamilton, Alison B; Canelo, Ismelda; Chuang, Emmeline; Meredith, Lisa S; Rubenstein, Lisa V

2016-07-19

The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. ClinicalTrials.gov, NCT02039856.

A guide to calculating habitat-quality metrics to inform conservation of highly mobile species

USGS Publications Warehouse

Bieri, Joanna A.; Sample, Christine; Thogmartin, Wayne E.; Diffendorfer, James E.; Earl, Julia E.; Erickson, Richard A.; Federico, Paula; Flockhart, D. T. Tyler; Nicol, Sam; Semmens, Darius J.; Skraber, T.; Wiederholt, Ruscena; Mattsson, Brady J.

2018-01-01

Many metrics exist for quantifying the relative value of habitats and pathways used by highly mobile species. Properly selecting and applying such metrics requires substantial background in mathematics and understanding the relevant management arena. To address this multidimensional challenge, we demonstrate and compare three measurements of habitat quality: graph-, occupancy-, and demographic-based metrics. Each metric provides insights into system dynamics, at the expense of increasing amounts and complexity of data and models. Our descriptions and comparisons of diverse habitat-quality metrics provide means for practitioners to overcome the modeling challenges associated with management or conservation of such highly mobile species. Whereas previous guidance for applying habitat-quality metrics has been scattered in diversified tracks of literature, we have brought this information together into an approachable format including accessible descriptions and a modeling case study for a typical example that conservation professionals can adapt for their own decision contexts and focal populations.Considerations for Resource ManagersManagement objectives, proposed actions, data availability and quality, and model assumptions are all relevant considerations when applying and interpreting habitat-quality metrics.Graph-based metrics answer questions related to habitat centrality and connectivity, are suitable for populations with any movement pattern, quantify basic spatial and temporal patterns of occupancy and movement, and require the least data.Occupancy-based metrics answer questions about likelihood of persistence or colonization, are suitable for populations that undergo localized extinctions, quantify spatial and temporal patterns of occupancy and movement, and require a moderate amount of data.Demographic-based metrics answer questions about relative or absolute population size, are suitable for populations with any movement pattern, quantify demographic processes and population dynamics, and require the most data.More real-world examples applying occupancy-based, agent-based, and continuous-based metrics to seasonally migratory species are needed to better understand challenges and opportunities for applying these metrics more broadly.

Development and evaluation of consensus-based sediment quality guidelines for freshwater ecosystems

USGS Publications Warehouse

MacDonald, D.D.; Ingersoll, C.G.; Berger, T.A.

2000-01-01

Numerical sediment quality guidelines (SQGs) for freshwater ecosystems have previously been developed using a variety of approaches. Each approach has certain advantages and limitations which influence their application in the sediment quality assessment process. In an effort to focus on the agreement among these various published SQGs, consensus-based SQGs were developed for 28 chemicals of concern in freshwater sediments (i.e., metals, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and pesticides). For each contaminant of concern, two SQGs were developed from the published SQGs, including a threshold effect concentration (TEC) and a probable effect concentration (PEC). The resultant SQGs for each chemical were evaluated for reliability using matching sediment chemistry and toxicity data from field studies conducted throughout the United States. The results of this evaluation indicated that most of the TECs (i.e., 21 of 28) provide an accurate basis for predicting the absence of sediment toxicity. Similarly, most of the PECs (i.e., 16 of 28) provide an accurate basis for predicting sediment toxicity. Mean PEC quotients were calculated to evaluate the combined effects of multiple contaminants in sediment. Results of the evaluation indicate that the incidence of toxicity is highly correlated to the mean PEC quotient (R2= 0.98 for 347 samples). It was concluded that the consensus-based SQGs provide a reliable basis for assessing sediment quality conditions in freshwater ecosystems.

Quality and Characteristics of the North Carolina Pre-Kindergarten Program: 2011-2012 Statewide Evaluation. Executive Summary

ERIC Educational Resources Information Center

Peisner-Feinberg, Ellen; Schaaf, Jennifer; Hildebrandt, Lisa; LaForett, Dore

2013-01-01

The North Carolina Pre-Kindergarten Program (NC Pre-K) is a state-funded initiative for at-risk 4-year-olds, designed to provide a high quality, classroom-based educational program during the year prior to kindergarten entry. Children are eligible for NC Pre-K based on age, family income (at or below 75% of state median income), and other risk…

Mind the Mode: Differences in Paper vs. Web-Based Survey Modes Among Women With Cancer.

PubMed

Hagan, Teresa L; Belcher, Sarah M; Donovan, Heidi S

2017-09-01

Researchers administering surveys seek to balance data quality, sources of error, and practical concerns when selecting an administration mode. Rarely are decisions about survey administration based on the background of study participants, although socio-demographic characteristics like age, education, and race may contribute to participants' (non)responses. In this study, we describe differences in paper- and web-based surveys administered in a national cancer survivor study of women with a history of cancer to compare the ability of each survey administrative mode to provide quality, generalizable data. We compared paper- and web-based survey data by socio-demographic characteristics of respondents, missing data rates, scores on primary outcome measure, and administrative costs and time using descriptive statistics, tests of mean group differences, and linear regression. Our findings indicate that more potentially vulnerable patients preferred paper questionnaires and that data quality, responses, and costs significantly varied by mode and participants' demographic information. We provide targeted suggestions for researchers conducting survey research to reduce survey error and increase generalizability of study results to the patient population of interest. Researchers must carefully weigh the pros and cons of survey administration modes to ensure a representative sample and high-quality data. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Promoting competition in Swedish primary care.

PubMed

Norén, Lars; Ranerup, Agneta

2015-01-01

The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare. The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents. This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking. The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres. The paper provides insights for politicians on how to use ADs to control competition and regulate choice. The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

PubMed

Chimento, George F; Thomas, Leslie C

2017-09-01

The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

The current state of nursing performance measurement, public reporting, and value-based purchasing.

PubMed

Kurtzman, Ellen T; Dawson, Ellen M; Johnson, Jean E

2008-08-01

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.

Real-time video quality monitoring

NASA Astrophysics Data System (ADS)

Liu, Tao; Narvekar, Niranjan; Wang, Beibei; Ding, Ran; Zou, Dekun; Cash, Glenn; Bhagavathy, Sitaram; Bloom, Jeffrey

2011-12-01

The ITU-T Recommendation G.1070 is a standardized opinion model for video telephony applications that uses video bitrate, frame rate, and packet-loss rate to measure the video quality. However, this model was original designed as an offline quality planning tool. It cannot be directly used for quality monitoring since the above three input parameters are not readily available within a network or at the decoder. And there is a great room for the performance improvement of this quality metric. In this article, we present a real-time video quality monitoring solution based on this Recommendation. We first propose a scheme to efficiently estimate the three parameters from video bitstreams, so that it can be used as a real-time video quality monitoring tool. Furthermore, an enhanced algorithm based on the G.1070 model that provides more accurate quality prediction is proposed. Finally, to use this metric in real-world applications, we present an example emerging application of real-time quality measurement to the management of transmitted videos, especially those delivered to mobile devices.

Smart ventilation energy and indoor air quality performance in residential buildings: A review

DOE PAGES

Guyot, Gaelle; Sherman, Max H.; Walker, Iain S.

2017-12-30

To better address energy and indoor air quality issues, ventilation needs to become smarter. A key smart ventilation concept is to use controls to ventilate more at times it provides either an energy or indoor air quality (IAQ) advantage (or both) and less when it provides a disadvantage. A favorable context exists in many countries to include some of the existing smart ventilation strategies in codes and standards. As a result, demand-controlled ventilation (DCV) systems are widely and easily available on the market, with more than 20 DCV systems approved and available in countries such as Belgium, France and themore » Netherlands. This paper provides a literature review on smart ventilation used in residential buildings, based on energy and indoor air quality performance. This meta-analysis includes 38 studies of various smart ventilation systems with control based on CO 2, humidity, combined CO 2 and total volatile organic compounds (TVOC), occupancy, or outdoor temperature. In conclusion, these studies show that ventilation energy savings up to 60% can be obtained without compromising IAQ, even sometimes improving it. However, the meta-analysis included some less than favorable results, with 26% energy overconsumption in some cases.« less

Total quality management: It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle. Four projects are described that utilize cross-functional, problem-solving teams for identifying requirements and defining tasks and task standards, management participation, attention to critical processes, and measurable long-term goals. The implementation of these projects provides the customer with measurably improved access to information that is provided through several channels: the NASA STI Database, document requests for microfiche and hardcopy, and the Centralized Help Desk.

[Analysis of public quality reports for home care and long-term care with respect to their usefulness for the customer].

PubMed

Sünderkamp, Susanne; Weiß, Christian; Rothgang, Heinz

2014-10-01

Public quality reports, based on new legislative regulations of 2008, were supposed to offer potential customers the possibility to make a well-informed choice of a care provider. This empirical study on marks for long-term care is based on the public quality reports of the Medical Service of the Health Insurance Companies (MDK), of 11 884 home care services and 10 310 nursing homes, which corresponds to a comprehensive survey of almost all care providers in Germany. Descriptive statistical methods and discussion of the results concerning the customer benefit. The analysis of transparency reports reveals a limited value for customers, which is particularly caused by very good quality results with low scattering. In addition, a high amount of missing data - especially in the area of home care providers - leads to a growing influence of service criteria on the final grade. Though deficits in nursing might be compensated by good marks in service criteria, it rarely occurs. At present, a more detailed look at risk criteria hardly improves the customer benefit. The marks for nursing need to be improved to increase their informative value for the customer.

The role of the Standard Days Method in modern family planning services in developing countries.

PubMed

Lundgren, Rebecka I; Karra, Mihira V; Yam, Eileen A

2012-08-01

The mere availability of family planning (FP) services is not sufficient to improve reproductive health; services must also be of adequate quality. The introduction of new contraceptive methods is a means of improving quality of care. The Standard Days Method (SDM) is a new fertility-awareness-based contraceptive method that has been successfully added to reproductive health care services around the world. Framed by the Bruce-Jain quality-of-care paradigm, this paper describes how the introduction of SDM in developing country settings can improve the six elements of quality while contributing to the intrinsic variety of available methods. SDM meets the needs of women and couples who opt not to use other modern methods. SDM providers are sensitised to the potential of fertility-awareness-based contraception as an appropriate choice for these clients. SDM requires the involvement of both partners and thus offers a natural entry point for providers to further explore partner communication, intimate partner violence, condoms, and HIV/STIs. SDM introduction broadens the range of FP methods available to couples in developing countries. SDM counselling presents an opportunity for FP providers to discuss important interpersonal and reproductive health issues with potential users.

Smart ventilation energy and indoor air quality performance in residential buildings: A review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guyot, Gaelle; Sherman, Max H.; Walker, Iain S.

To better address energy and indoor air quality issues, ventilation needs to become smarter. A key smart ventilation concept is to use controls to ventilate more at times it provides either an energy or indoor air quality (IAQ) advantage (or both) and less when it provides a disadvantage. A favorable context exists in many countries to include some of the existing smart ventilation strategies in codes and standards. As a result, demand-controlled ventilation (DCV) systems are widely and easily available on the market, with more than 20 DCV systems approved and available in countries such as Belgium, France and themore » Netherlands. This paper provides a literature review on smart ventilation used in residential buildings, based on energy and indoor air quality performance. This meta-analysis includes 38 studies of various smart ventilation systems with control based on CO 2, humidity, combined CO 2 and total volatile organic compounds (TVOC), occupancy, or outdoor temperature. In conclusion, these studies show that ventilation energy savings up to 60% can be obtained without compromising IAQ, even sometimes improving it. However, the meta-analysis included some less than favorable results, with 26% energy overconsumption in some cases.« less

The quest to standardize hemodialysis care.

PubMed

Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

2011-01-01

A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

The Grassmannian Atlas: A General Framework for Exploring Linear Projections of High-Dimensional Data

DOE PAGES

Liu, S.; Bremer, P. -T; Jayaraman, J. J.; ...

2016-06-04

Linear projections are one of the most common approaches to visualize high-dimensional data. Since the space of possible projections is large, existing systems usually select a small set of interesting projections by ranking a large set of candidate projections based on a chosen quality measure. However, while highly ranked projections can be informative, some lower ranked ones could offer important complementary information. Therefore, selection based on ranking may miss projections that are important to provide a global picture of the data. Here, the proposed work fills this gap by presenting the Grassmannian Atlas, a framework that captures the global structuresmore » of quality measures in the space of all projections, which enables a systematic exploration of many complementary projections and provides new insights into the properties of existing quality measures.« less

Leveraging the real value of laboratory medicine with the value proposition.

PubMed

Price, Christopher P; John, Andrew St; Christenson, Robert; Scharnhorst, Volker; Oellerich, Michael; Jones, Patricia; Morris, Howard A

2016-11-01

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. Copyright © 2016 Elsevier B.V. All rights reserved.

[Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

PubMed

Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

2015-03-01

Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

An Evaluation of Web-Based Clinical Practice Guidelines for Managing Problems Associated with Cannabis Use

PubMed Central

Turner, Michael W; Rooke, Sally E; Langton, Julia M; Gates, Peter J

2012-01-01

Background Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. Objective The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. Methods Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers’ (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods. Results Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46%), and editorial independence (30%). Although examination of AGREE II domain scores demonstrated that the quality of the 7 guidelines could be divided into 3 categories (high quality, acceptable to low quality, and very low quality), review of treatment providers’ quality perceptions indicated all guidelines fell into 1 category (acceptable quality). Based on treatment providers’ familiarity with and usage rates of the CPGs, a combination of peer/colleagues, senior professionals, workshops, and Internet dissemination was deemed to be most effective for promoting cannabis use CPGs. Lack of time, guideline length, conflicts with theoretical orientation, and prior content knowledge were identified as barriers to guideline uptake. Conclusions Developers of CPGs should improve their reporting of development processes, conflicts of interest, and CPGs’ applicability to practice, while remaining cognizant that long guidelines may deter implementation. Treatment providers need to be aware that the quality of cannabis-related CPGs varies substantially. PMID:23249447

Evaluation of the quality of the college library websites in Iranian medical Universities based on the Stover model.

PubMed

Nasajpour, Mohammad Reza; Ashrafi-Rizi, Hasan; Soleymani, Mohammad Reza; Shahrzadi, Leila; Hassanzadeh, Akbar

2014-01-01

Today, the websites of college and university libraries play an important role in providing the necessary services for clients. These websites not only allow the users to access different collections of library resources, but also provide them with the necessary guidance in order to use the information. The goal of this study is the quality evaluation of the college library websites in Iranian Medical Universities based on the Stover model. This study uses an analytical survey method and is an applied study. The data gathering tool is the standard checklist provided by Stover, which was modified by the researchers for this study. The statistical population is the college library websites of the Iranian Medical Universities (146 websites) and census method was used for investigation. The data gathering method was a direct access to each website and filling of the checklist was based on the researchers' observations. Descriptive and analytical statistics (Analysis of Variance (ANOVA)) were used for data analysis with the help of the SPSS software. The findings showed that in the dimension of the quality of contents, the highest average belonged to type one universities (46.2%) and the lowest average belonged to type three universities (24.8%). In the search and research capabilities, the highest average belonged to type one universities (48.2%) and the lowest average belonged to type three universities. In the dimension of facilities provided for the users, type one universities again had the highest average (37.2%), while type three universities had the lowest average (15%). In general the library websites of type one universities had the highest quality (44.2%), while type three universities had the lowest quality (21.1%). Also the library websites of the College of Rehabilitation and the College of Paramedics, of the Shiraz University of Medical Science, had the highest quality scores. The results showed that there was a meaningful difference between the quality of the college library websites and the university types, resulting in college libraries of type one universities having the highest average score and the college libraries of type three universities having the lowest score.

Evaluation of the quality of the college library websites in Iranian medical Universities based on the Stover model

PubMed Central

Nasajpour, Mohammad Reza; Ashrafi-rizi, Hasan; Soleymani, Mohammad Reza; Shahrzadi, Leila; Hassanzadeh, Akbar

2014-01-01

Introduction: Today, the websites of college and university libraries play an important role in providing the necessary services for clients. These websites not only allow the users to access different collections of library resources, but also provide them with the necessary guidance in order to use the information. The goal of this study is the quality evaluation of the college library websites in Iranian Medical Universities based on the Stover model. Material and Methods: This study uses an analytical survey method and is an applied study. The data gathering tool is the standard checklist provided by Stover, which was modified by the researchers for this study. The statistical population is the college library websites of the Iranian Medical Universities (146 websites) and census method was used for investigation. The data gathering method was a direct access to each website and filling of the checklist was based on the researchers’ observations. Descriptive and analytical statistics (Analysis of Variance (ANOVA)) were used for data analysis with the help of the SPSS software. Findings: The findings showed that in the dimension of the quality of contents, the highest average belonged to type one universities (46.2%) and the lowest average belonged to type three universities (24.8%). In the search and research capabilities, the highest average belonged to type one universities (48.2%) and the lowest average belonged to type three universities. In the dimension of facilities provided for the users, type one universities again had the highest average (37.2%), while type three universities had the lowest average (15%). In general the library websites of type one universities had the highest quality (44.2%), while type three universities had the lowest quality (21.1%). Also the library websites of the College of Rehabilitation and the College of Paramedics, of the Shiraz University of Medical Science, had the highest quality scores. Discussion: The results showed that there was a meaningful difference between the quality of the college library websites and the university types, resulting in college libraries of type one universities having the highest average score and the college libraries of type three universities having the lowest score. PMID:25540794

Improving patient care through work-based learning.

PubMed

Chapman, Linda

To record post-registration community nurses' perceptions of the impact of work-based learning on the quality of patient care. Ten nurses were interviewed. Each interviewee, who had successfully completed work-based learning programmes, was asked to describe their impact on the quality of patient care. The participants valued work-based learning. Four themes emerged where work-based learning contributed to improving the quality of care: increased health promotion, increased access to services, increased patient choice and reduced risk of infection. The relevance of studies and distance learning materials were perceived to be the main aspects that influenced changes in practice. The study provides insight into how work-based learning helped staff develop practice. It highlights that time for learning and mentoring are paramount for changes in practice to occur through work-based learning. Further studies are required to establish the best structure and style of distance learning materials needed to meet the needs of post-registration community nurses.

Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers.

PubMed

Sobota, Amy E; Shah, Nishita; Mack, Jennifer W

2017-06-01

Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients. © 2016 Wiley Periodicals, Inc.

The Need for Standardized Assessment of Muscle Quality in Skeletal Muscle Function Deficit and Other Aging-Related Muscle Dysfunctions: A Symposium Report.

PubMed

Correa-de-Araujo, Rosaly; Harris-Love, Michael O; Miljkovic, Iva; Fragala, Maren S; Anthony, Brian W; Manini, Todd M

2017-01-01

A growing body of scientific literature suggests that not only changes in skeletal muscle mass, but also other factors underpinning muscle quality, play a role in the decline in skeletal muscle function and impaired mobility associated with aging. A symposium on muscle quality and the need for standardized assessment was held on April 28, 2016 at the International Conference on Frailty and Sarcopenia Research in Philadelphia, Pennsylvania. The purpose of this symposium was to provide a venue for basic science and clinical researchers and expert clinicians to discuss muscle quality in the context of skeletal muscle function deficit and other aging-related muscle dysfunctions. The present article provides an expanded introduction concerning the emerging definitions of muscle quality and a potential framework for scientific inquiry within the field. Changes in muscle tissue composition, based on excessive levels of inter- and intra-muscular adipose tissue and intramyocellular lipids, have been found to adversely impact metabolism and peak force generation. However, methods to easily and rapidly assess muscle tissue composition in multiple clinical settings and with minimal patient burden are needed. Diagnostic ultrasound and other assessment methods continue to be developed for characterizing muscle pathology, and enhanced sonography using sensors to provide user feedback and improve reliability is currently the subject of ongoing investigation and development. In addition, measures of relative muscle force such as specific force or grip strength adjusted for body size have been proposed as methods to assess changes in muscle quality. Furthermore, performance-based assessments of muscle power via timed tests of function and body size estimates, are associated with lower extremity muscle strength may be responsive to age-related changes in muscle quality. Future aims include reaching consensus on the definition and standardized assessments of muscle quality, and providing recommendations to address critical clinical and technology research gaps within the field.

A quality of life quandary: a framework for navigating parental refusal of treatment for co-morbidities in infants with underlying medical conditions.

PubMed

Kunz, Sarah N; McAdams, Ryan M; Diekema, Douglas S; Opel, Douglas J

2015-01-01

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents' perceptions of their child's projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of parental refusal based upon an infant's projected quality of life. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

An effectiveness analysis of healthcare systems using a systems theoretic approach.

PubMed

Chuang, Sheuwen; Inder, Kerry

2009-10-24

The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provides a systematic search for improving the impact of accreditation on quality of care and hence on the accreditation/performance correlation. There is clear value in developing a theoretical systems approach to achieving quality in health care. The introduction of the systematic surveyor-based search for improvements creates an adaptive-control system to optimize health care quality. It is hoped that these outcomes will stimulate further research in the development of strategic planning using systems theoretic approach for the improvement of quality in health care.

NMRe: a web server for NMR protein structure refinement with high-quality structure validation scores.

PubMed

Ryu, Hyojung; Lim, GyuTae; Sung, Bong Hyun; Lee, Jinhyuk

2016-02-15

Protein structure refinement is a necessary step for the study of protein function. In particular, some nuclear magnetic resonance (NMR) structures are of lower quality than X-ray crystallographic structures. Here, we present NMRe, a web-based server for NMR structure refinement. The previously developed knowledge-based energy function STAP (Statistical Torsion Angle Potential) was used for NMRe refinement. With STAP, NMRe provides two refinement protocols using two types of distance restraints. If a user provides NOE (Nuclear Overhauser Effect) data, the refinement is performed with the NOE distance restraints as a conventional NMR structure refinement. Additionally, NMRe generates NOE-like distance restraints based on the inter-hydrogen distances derived from the input structure. The efficiency of NMRe refinement was validated on 20 NMR structures. Most of the quality assessment scores of the refined NMR structures were better than those of the original structures. The refinement results are provided as a three-dimensional structure view, a secondary structure scheme, and numerical and graphical structure validation scores. NMRe is available at http://psb.kobic.re.kr/nmre/. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

AfterQC: automatic filtering, trimming, error removing and quality control for fastq data.

PubMed

Chen, Shifu; Huang, Tanxiao; Zhou, Yanqing; Han, Yue; Xu, Mingyan; Gu, Jia

2017-03-14

Some applications, especially those clinical applications requiring high accuracy of sequencing data, usually have to face the troubles caused by unavoidable sequencing errors. Several tools have been proposed to profile the sequencing quality, but few of them can quantify or correct the sequencing errors. This unmet requirement motivated us to develop AfterQC, a tool with functions to profile sequencing errors and correct most of them, plus highly automated quality control and data filtering features. Different from most tools, AfterQC analyses the overlapping of paired sequences for pair-end sequencing data. Based on overlapping analysis, AfterQC can detect and cut adapters, and furthermore it gives a novel function to correct wrong bases in the overlapping regions. Another new feature is to detect and visualise sequencing bubbles, which can be commonly found on the flowcell lanes and may raise sequencing errors. Besides normal per cycle quality and base content plotting, AfterQC also provides features like polyX (a long sub-sequence of a same base X) filtering, automatic trimming and K-MER based strand bias profiling. For each single or pair of FastQ files, AfterQC filters out bad reads, detects and eliminates sequencer's bubble effects, trims reads at front and tail, detects the sequencing errors and corrects part of them, and finally outputs clean data and generates HTML reports with interactive figures. AfterQC can run in batch mode with multiprocess support, it can run with a single FastQ file, a single pair of FastQ files (for pair-end sequencing), or a folder for all included FastQ files to be processed automatically. Based on overlapping analysis, AfterQC can estimate the sequencing error rate and profile the error transform distribution. The results of our error profiling tests show that the error distribution is highly platform dependent. Much more than just another new quality control (QC) tool, AfterQC is able to perform quality control, data filtering, error profiling and base correction automatically. Experimental results show that AfterQC can help to eliminate the sequencing errors for pair-end sequencing data to provide much cleaner outputs, and consequently help to reduce the false-positive variants, especially for the low-frequency somatic mutations. While providing rich configurable options, AfterQC can detect and set all the options automatically and require no argument in most cases.

Co-designing for quality: Creating a user-driven tool to improve quality in youth mental health services.

PubMed

Hackett, Christina L; Mulvale, Gillian; Miatello, Ashleigh

2018-04-29

Although high quality mental health care for children and youth is a goal of many health systems, little is known about the dimensions of quality mental health care from users' perspectives. We engaged young people, caregivers and service providers to share experiences, which shed light on quality dimensions for youth mental health care. Using experience-based co-design, we collected qualitative data from young people aged 16-24 with a mental disorder (n = 19), identified caregivers (n = 12) and service providers (n = 14) about their experiences with respect to youth mental health services. Experience data were collected using multiple approaches including interviews, a suite of online and smartphone applications (n = 22), and a co-design event (n = 16) and analysed to extract touch points. These touch points were used to prioritize and co-design a user-driven prototype of a questionnaire to provide feedback to service providers. Young people, caregiver and service provider reports of service experiences were used to identify aspects of care quality at eight mental health service contact points: Access to mental health care; Transfer to/from hospital; Intake into hospital; Services provided; Assessment and treatment; Treatment environment; and Caregiver involvement in care. In some cases, low quality care was harmful to users and their caregivers. Young people co-designed a prototype of a user-driven feedback questionnaire to improve quality of service experiences that was supported by service providers and caregivers at the co-design event. By using EBCD to capture in-depth data regarding experiences of young people, their caregivers and service providers, study participants have begun to establish a baseline for acceptable quality of mental health care for young people. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.

PubMed

Leslie, Hannah H; Gage, Anna; Nsona, Humphreys; Hirschhorn, Lisa R; Kruk, Margaret E

2016-09-01

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve. Project HOPE—The People-to-People Health Foundation, Inc.

How Organizations Can Enhance the Quality of Life of Their Clients and Assess Their Results: The Concept of QOL Enhancement

ERIC Educational Resources Information Center

Reinders, Hans S.; Schalock, Robert L.

2014-01-01

This article presents the framework of a dynamic approach to quality of life (QOL) enhancement based on the conceptualization and measurement of individual-referenced quality of life. Sections of the article summarize the premises of QOL enhancement, provide the rationale for a dynamic approach to QOL enhancement, discuss six components of QOL…

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

PubMed

Scanlon, Dennis P; Alexander, Jeffrey A; Beich, Jeff; Christianson, Jon B; Hasnain-Wynia, Romana; McHugh, Megan C; Mittler, Jessica N; Shi, Yunfeng; Bodenschatz, Laura J

2012-09-01

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. A descriptive overview of the evaluation research design for a multi-site, community based, healthcare quality improvement initiative is provided. The multiphase research design employed by the evaluation team is discussed. 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. 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.

Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

PubMed

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

2008-07-08

Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

PubMed Central

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

2008-01-01

Background Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated. PMID:18611250

jqcML: an open-source java API for mass spectrometry quality control data in the qcML format.

PubMed

Bittremieux, Wout; Kelchtermans, Pieter; Valkenborg, Dirk; Martens, Lennart; Laukens, Kris

2014-07-03

The awareness that systematic quality control is an essential factor to enable the growth of proteomics into a mature analytical discipline has increased over the past few years. To this aim, a controlled vocabulary and document structure have recently been proposed by Walzer et al. to store and disseminate quality-control metrics for mass-spectrometry-based proteomics experiments, called qcML. To facilitate the adoption of this standardized quality control routine, we introduce jqcML, a Java application programming interface (API) for the qcML data format. First, jqcML provides a complete object model to represent qcML data. Second, jqcML provides the ability to read, write, and work in a uniform manner with qcML data from different sources, including the XML-based qcML file format and the relational database qcDB. Interaction with the XML-based file format is obtained through the Java Architecture for XML Binding (JAXB), while generic database functionality is obtained by the Java Persistence API (JPA). jqcML is released as open-source software under the permissive Apache 2.0 license and can be downloaded from https://bitbucket.org/proteinspector/jqcml .

Improving The Quality of Education Through School-Based Management: Learning From International Experiences

NASA Astrophysics Data System (ADS)

Grauwe, Anton De

2005-07-01

School-based management is being increasingly advocated as a shortcut to more efficient management and quality improvement in education. Research, however, has been unable to prove conclusively such a linkage. Especially in developing countries, concerns remain about the possible detrimental impact of school-based management on school quality; equity among different schools in the same system; the motivation of and relationships between principals and teachers; and financial as well as administrative transparency. The present study defines school-based management and, in view of its implementation in different world regions, examines some of its advantages and disadvantages. In particular, the author explores the strategies which must accompany school-based management in order to ensure a positive impact on quality. These are found to include (1) guaranteeing that all schools have certain basic resources; (2) developing an effective school-support system; (3) providing schools with regular information on their performance and advice on how they might improve; and (4) emphasizing the motivational element in the management work of the school principal.

Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it.

PubMed

Goverman, I L

1994-11-01

Group Health Cooperative of Puget Sound (GHC), a large staff-model health maintenance organization based in Seattle, is redesigning its information systems to provide the systems and information needed to support its quality agenda. Long-range planning for GHC's information resources was done in three phases. In assessment, interviews, surveys, and a benchmarking effort identified strengths and weaknesses of the existing information systems. We concluded that we needed to improve clinical care and patient management systems and enhance health plan applications. In direction setting, we developed six objectives (for example, approach information systems in a way that is consistent with quality improvement principles). Detailed planning was used to define projects, timing, and resource allocations. Some of the most important efforts in the resulting five-year plan include the development of (1) a computerized patient record; (2) a provider-based clinical workstation for access to patient information, order entry, results reporting, guidelines, and reminders; (3) a comprehensive set of patient management and service quality systems; (4) reengineered structures, policies, and processes within the health plan, supported by a complete set of integrated information systems; (5) a standardized, high-capacity communications network to provide linkages both within GHC and among its business partners; and (6) a revised oversight structure for information services, which forms partnerships with users. A quality focus ensured that each project not only produced its own benefits but also supported the larger organizational goals associated with "total" quality.

Frequency analysis of urban runoff quality in an urbanizing catchment of Shenzhen, China

NASA Astrophysics Data System (ADS)

Qin, Huapeng; Tan, Xiaolong; Fu, Guangtao; Zhang, Yingying; Huang, Yuefei

2013-07-01

This paper investigates the frequency distribution of urban runoff quality indicators using a long-term continuous simulation approach and evaluates the impacts of proposed runoff control schemes on runoff quality in an urbanizing catchment in Shenzhen, China. Four different indicators are considered to provide a comprehensive assessment of the potential impacts: total runoff depth, event pollutant load, Event Mean Concentration, and peak concentration during a rainfall event. The results obtained indicate that urban runoff quantity and quality in the catchment have significant variations in rainfall events and a very high rate of non-compliance with surface water quality regulations. Three runoff control schemes with the capacity to intercept an initial runoff depth of 5 mm, 10 mm, and 15 mm are evaluated, respectively, and diminishing marginal benefits are found with increasing interception levels in terms of water quality improvement. The effects of seasonal variation in rainfall events are investigated to provide a better understanding of the performance of the runoff control schemes. The pre-flood season has higher risk of poor water quality than other seasons after runoff control. This study demonstrates that frequency analysis of urban runoff quantity and quality provides a probabilistic evaluation of pollution control measures, and thus helps frame a risk-based decision making for urban runoff quality management in an urbanizing catchment.

How do you perceive this author? Understanding and modeling authors’ communication quality in social media

PubMed Central

2018-01-01

In this study, we leverage human evaluations, content analysis, and computational modeling to generate a comprehensive analysis of readers’ evaluations of authors’ communication quality in social media with respect to four factors: author credibility, interpersonal attraction, communication competence, and intent to interact. We review previous research on the human evaluation process and highlight its limitations in providing sufficient information for readers to assess authors’ communication quality. From our analysis of the evaluations of 1,000 Twitter authors’ communication quality from 300 human evaluators, we provide empirical evidence of the impact of the characteristics of the reader (demographic, social media experience, and personality), author (profile and social media engagement), and content (linguistic, syntactic, similarity, and sentiment) on the evaluation of an author’s communication quality. In addition, based on the author and message characteristics, we demonstrate the potential for building accurate models that can indicate an author’s communication quality. PMID:29389979

How do you perceive this author? Understanding and modeling authors' communication quality in social media.

PubMed

Han, Kyungsik

2018-01-01

In this study, we leverage human evaluations, content analysis, and computational modeling to generate a comprehensive analysis of readers' evaluations of authors' communication quality in social media with respect to four factors: author credibility, interpersonal attraction, communication competence, and intent to interact. We review previous research on the human evaluation process and highlight its limitations in providing sufficient information for readers to assess authors' communication quality. From our analysis of the evaluations of 1,000 Twitter authors' communication quality from 300 human evaluators, we provide empirical evidence of the impact of the characteristics of the reader (demographic, social media experience, and personality), author (profile and social media engagement), and content (linguistic, syntactic, similarity, and sentiment) on the evaluation of an author's communication quality. In addition, based on the author and message characteristics, we demonstrate the potential for building accurate models that can indicate an author's communication quality.

Government Quality Conference Proceedings

NASA Technical Reports Server (NTRS)

1992-01-01

The Government Quality Conference was an attempt to bring together executive organizations and senior individuals in the Federal Government that have a desire to improve productivity. It was designed to provide an exchange of ideas based on experience, and to encourage individual management initiatives to tap the capabilities of Federal employees.

Microfilm Permanence and Archival Quality

ERIC Educational Resources Information Center

Avedon, Don M.

1972-01-01

The facts about microfilm permanence and archival quality are presented in simple terms. The major factors, including the film base material, the film emulsion, processing, and storage conditions are reviewed. The designations on the edge of the film are explained and a list of refernces provided. (14 references) (Author)

IN PURSUIT OF AN INTERNATIONAL APPROACH TO QUALITY ASSURANCE FOR ENVIRONMENTAL TECHNOLOGY VERIFICATION

EPA Science Inventory

In the mid-1990's, the USEPA began the Environmental Technology Verification (ETV) Program in order to provide purchasers of environmental technology with independently acquired, quality-assured, test data, upon which to base their purchasing decisions. From the beginning, a str...

42 CFR 480.102 - Statutory bases for acquisition and maintenance of information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... information. 480.102 Section 480.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND... medical necessity and quality of health care services they provide to Medicare patients as required by...

MODEL ANALYSIS OF RIPARIAN BUFFER EFFECTIVENESS FOR REDUCING NUTRIENT INPUTS TO STREAMS IN AGRICULTURAL LANDSCAPES

EPA Science Inventory

Federal and state agencies responsible for protecting water quality rely mainly on statistically-based methods to assess and manage risks to the nation's streams, lakes and estuaries. Although statistical approaches provide valuable information on current trends in water quality...

Thinking through Quality Questioning: Deepening Student Engagement

ERIC Educational Resources Information Center

Walsh, Jackie Acree; Sattes, Beth Dankert

2011-01-01

This groundbreaking book provides teachers with an accessible, research-based blueprint for developing student metacognitive skills and ensuring that students take responsibility for their own learning. The authors use the findings of cognitive scientists to highlight quality questioning behaviors and explain how to apply them for improved student…

Quality effort decision in service supply chain with quality preference based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng; Wang, Jianwei

2015-04-01

Service quality preference behaviors of both members are considered in service supply chain (SSC) including a service integrator and a service provider with stochastic demand. Through analysis of service quality cost and revenue, the utility functions are established on service quality effort degree and service quality preference level in integrated and decentralized SSC. Nash equilibrium and quantum game are used to optimize the models. By comparing the different solutions, the optimal strategies are obtained in SSC with quality preference. Then some numerical examples are studied and the changing trend of service quality effort is further analyzed by the influence of the entanglement operator and quality preferences.

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

Perceptual video quality assessment in H.264 video coding standard using objective modeling.

PubMed

Karthikeyan, Ramasamy; Sainarayanan, Gopalakrishnan; Deepa, Subramaniam Nachimuthu

2014-01-01

Since usage of digital video is wide spread nowadays, quality considerations have become essential, and industry demand for video quality measurement is rising. This proposal provides a method of perceptual quality assessment in H.264 standard encoder using objective modeling. For this purpose, quality impairments are calculated and a model is developed to compute the perceptual video quality metric based on no reference method. Because of the shuttle difference between the original video and the encoded video the quality of the encoded picture gets degraded, this quality difference is introduced by the encoding process like Intra and Inter prediction. The proposed model takes into account of the artifacts introduced by these spatial and temporal activities in the hybrid block based coding methods and an objective modeling of these artifacts into subjective quality estimation is proposed. The proposed model calculates the objective quality metric using subjective impairments; blockiness, blur and jerkiness compared to the existing bitrate only calculation defined in the ITU G 1070 model. The accuracy of the proposed perceptual video quality metrics is compared against popular full reference objective methods as defined by VQEG.

[FQA: A method for floristic quality assessment based on conservatism of plant species].

PubMed

Cao, Li Juan; He, Ping; Wang, Mi; Xui, Jie; Ren, Ying

2018-04-01

FQA, which uses the conservatism of plant species for particular habitats and the species richness of plant communities, is a rapid method for the assessment of habitat quality. This method is based on species composition of quadrats and coefficients of conservatism for species which assigned by experts. Floristic Quality Index (FQI) that reflects vegetation integrity and degradation of a site can be calculated by a simple formula and be used for space-time comparison of habitat quality. It has been widely used in more than ten countries including the United States and Canada. This paper presented the principle, calculation formulas and application cases of this method, with the aim to provide a simple, repeatable and comparable method to assess habitat quality for ecological managers and researchers.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

PubMed

Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J

2018-02-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

PubMed Central

Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

2018-01-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

The Application of an Evidence-Based Clinical Nursing Path for Improving the Preoperative and Postoperative Quality of Care of Pediatric Retroperitoneal Neuroblastoma Patients: A Randomized Controlled Trial at a Tertiary Medical Institution.

PubMed

Liu, Yang; Mo, Lin; Tang, Yan; Wang, Qiuhong; Huang, Xiaoyan

A clinical nursing path (CNP) that encourages patients and their families to become actively involved in healthcare decision-making processes may improve outcomes of pediatric retroperitoneal neuroblastoma (NB) patients. The aim of this study was to evaluate the utility and value of an evidence-based CNP provided to pediatric retroperitoneal NB patients undergoing resection surgery. One hundred twenty NB cases were assigned to a control group or a CNP group. The control group was provided with standard nursing care. The CNP group was provided with nursing care in accordance with an evidence-based CNP. The utility and value of the CNP were compared with standard nursing care. Outcome measures included rates of postoperative complications, lengths of hospital stay, and cost of hospitalization, as well as preoperative and postoperative quality of care and patient satisfaction with care. The rates of postoperative complications, length of preoperative hospitalization, total length of hospital stay, and costs of hospitalization were significantly lower for patients receiving the CNP compared with the control group. Preoperative and postoperative quality of care and patient satisfaction with care were significantly higher in patients receiving the CNP compared with the control group. Adoption of a CNP for preoperative and postoperative care of pediatric retroperitoneal NB patients undergoing resection surgery improves clinical outcomes and patient satisfaction with care. A CNP can increase families' participation in a patient's recovery process, enhance nurses' understanding of the services they are providing, and improve the quality of healthcare received by patients.

A study on mastectomy samples to evaluate breast imaging quality and potential clinical relevance of differential phase contrast mammography.

PubMed

Hauser, Nik; Wang, Zhentian; Kubik-Huch, Rahel A; Trippel, Mafalda; Singer, Gad; Hohl, Michael K; Roessl, Ewald; Köhler, Thomas; van Stevendaal, Udo; Wieberneit, Nataly; Stampanoni, Marco

2014-03-01

Differential phase contrast and scattering-based x-ray mammography has the potential to provide additional and complementary clinically relevant information compared with absorption-based mammography. The purpose of our study was to provide a first statistical evaluation of the imaging capabilities of the new technique compared with digital absorption mammography. We investigated non-fixed mastectomy samples of 33 patients with invasive breast cancer, using grating-based differential phase contrast mammography (mammoDPC) with a conventional, low-brilliance x-ray tube. We simultaneously recorded absorption, differential phase contrast, and small-angle scattering signals that were combined into novel high-frequency-enhanced images with a dedicated image fusion algorithm. Six international, expert breast radiologists evaluated clinical digital and experimental mammograms in a 2-part blinded, prospective independent reader study. The results were statistically analyzed in terms of image quality and clinical relevance. The results of the comparison of mammoDPC with clinical digital mammography revealed the general quality of the images to be significantly superior (P < 0.001); sharpness, lesion delineation, as well as the general visibility of calcifications to be significantly more assessable (P < 0.001); and delineation of anatomic components of the specimens (surface structures) to be significantly sharper (P < 0.001). Spiculations were significantly better identified, and the overall clinically relevant information provided by mammoDPC was judged to be superior (P < 0.001). Our results demonstrate that complementary information provided by phase and scattering enhanced mammograms obtained with the mammoDPC approach deliver images of generally superior quality. This technique has the potential to improve radiological breast diagnostics.

PA.NET International Quality Certification Protocol for blood pressure monitors.

PubMed

Omboni, Stefano; Costantini, Carlo; Pini, Claudio; Bulegato, Roberto; Manfellotto, Dario; Rizzoni, Damiano; Palatini, Paolo; O'brien, Eoin; Parati, Gianfranco

2008-10-01

Although standard validation protocols provide assurance of the accuracy of blood pressure monitors (BPMs), there is no guidance for the consumer as to the overall quality of a device. The PA.NET International Quality Certification Protocol, developed by the Association for Research and Development of Biomedical Technologies and for Continuing Medical Education (ARSMED), a nonprofit organization, with the support of the Italian Society of Hypertension-Italian Hypertension League, and the dabl Educational Trust denotes additional criteria of quality for BPMs that fulfilled basic validation criteria, published in full in peer-reviewed medical journals. The certification is characterized by three phases: (i) to determine that the device fulfilled standard validation criteria; (ii) to determine the technical and functional characteristics of the device (e.g. operativity, display dimension, accessory functions, memory availability, etc.) and (iii) to determine the commercial characteristics (e.g. price-quality ratio, after-sale service, guarantee, etc.). At the end of the certification process, ARSMED attributes a quality index to the device, based on a scale ranging from 1 to 100, and a quality seal with four different grades (bronze, silver, gold and diamond) according to the achieved score. The seal is identified by a unique alphanumeric code. The quality seal may be used on the packaging of the appliance or in advertising. A quality certification is released to the manufacturer and published on www.pressionearteriosa.net and www.dableducational.org. The PA.NET International Quality Certification Protocol represents the first attempt to provide health care personnel and consumers with an independent and objective assessment of BPMs based on their quality.

Governing Healthcare through Performance Measurement in Massachusetts and the Netherlands

PubMed Central

Van der Wees, Philip J.; der Sanden, Maria W.G. Nijhuis-van; van Ginneken, Ewout; Ayanian, John Z.; Schneider, Eric C.; Westert, Gert P.

2016-01-01

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of institutes to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives. PMID:24138729

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A

2017-01-01

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category.

The OA System of College - - Design of the Teaching Quality Monitoring Subsystem

NASA Astrophysics Data System (ADS)

Wu, Hongjuan; Ying, Hong; Jiang, Youyi; Yan, Pei

According to the drawbacks of traditional teaching quality monitoring subsystems and based on the achievements of practical research in the teaching quality monitoring administration in College, this paper provides a design of overall structure of teaching quality monitoring subsystem, that is more suitable for colleges' management. This new system is endowed with the same features as .NET application programes: easy to extend, easy to maintain, flexible, convenient, and it let enterprises, students' parents and excellent graduates participate in teaching quality monitoring administration, have significant effect to ensure the quality of talent training in colleges.

Communication-based services for persons with severe disabilities in schools: a survey of speech-language pathologists.

PubMed

Siegel, Ellin B; Maddox, Laura L; Ogletree, Billy T; Westling, David L

2010-01-01

Speech-language pathologists in school settings were surveyed with an instrument created from the National Joint Committee for the Communication Needs of Persons with Severe Disabilities' quality indicators self-assessment tool. Participants valued practice indicators of quality communication assessment and intervention to a higher degree than their actual practice. These findings appear to suggest that SLPs may not provide best practice services to individuals with severe disabilities. Suggestions for enhancing inservice training and intervention practices of SLPs and team members who work with individuals with severe disabilities are provided. The reader will be able to; (1) understand the value of using the NJC quality indicators to guide SLP practices with individuals with severe disabilities in schools; (2) recognize that research indicates that SLPs working with individuals with severe disabilities in schools may not provide best practice services to the extent that they value these practices; (3) discuss possible strategies to increase the quality of services provided to individuals with severe disabilities in schools.

Archive data base and handling system for the Orbiter flying qualities experiment program

NASA Technical Reports Server (NTRS)

Myers, T. T.; Dimarco, R.; Magdaleno, R. E.; Aponso, B. L.

1986-01-01

The OFQ archives data base and handling system assembled as part of the Orbiter Flying Qualities (OFQ) research of the Orbiter Experiments Program (EOX) are described. The purpose of the OFQ archives is to preserve and document shuttle flight data relevant to vehicle dynamics, flight control, and flying qualities in a form that permits maximum use for qualified users. In their complete form, the OFQ archives contain descriptive text (general information about the flight, signal descriptions and units) as well as numerical time history data. Since the shuttle program is so complex, the official data base contains thousands of signals and very complex entries are required to obtain data. The OFQ archives are intended to provide flight phase oriented data subsets with relevant signals which are easily identified for flying qualities research.

An Ontology of Quality Initiatives and a Model for Decentralized, Collaborative Quality Management on the (Semantic) World Wide Web

PubMed Central

2001-01-01

This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be. PMID:11772549

An ontology of quality initiatives and a model for decentralized, collaborative quality management on the (semantic) World-Wide-Web.

PubMed

Eysenbach, G

2001-01-01

This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be.

Design and implementation of artistic gymnastics training guidance system

NASA Astrophysics Data System (ADS)

Cai, Limin; Luo, Lin

2017-04-01

Artistic gymnastics (AG) has developed into a favorite sports activity among many university students; recent years saw not only the increase of AG learners, but also the emergence of more and more problems in the training. Based on surveys in different forms, students' physical quality and their performance in the AG training were analyzed and summarized; and with the aid of the computer technology, Artistic Gymnastics Training Guidance System was designed and implemented to meet the students' needs for personalized training schemes and improve AG teaching quality. The System can provide convenient ways for scientific training in a targeted and oriented manner on the basis of the differences in physical quality. Also, it can provide teachers with detailed data about the students' physical quality and their AG training; through the visualization of valuable statistical data, it is able to provide a powerful basis for decision makers of teaching departments and thus facilitate the perfection of AG teaching methods.

Validation of an image-based technique to assess the perceptual quality of clinical chest radiographs with an observer study

NASA Astrophysics Data System (ADS)

Lin, Yuan; Choudhury, Kingshuk R.; McAdams, H. Page; Foos, David H.; Samei, Ehsan

2014-03-01

We previously proposed a novel image-based quality assessment technique1 to assess the perceptual quality of clinical chest radiographs. In this paper, an observer study was designed and conducted to systematically validate this technique. Ten metrics were involved in the observer study, i.e., lung grey level, lung detail, lung noise, riblung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm-lung contrast, and subdiaphragm area. For each metric, three tasks were successively presented to the observers. In each task, six ROI images were randomly presented in a row and observers were asked to rank the images only based on a designated quality and disregard the other qualities. A range slider on the top of the images was used for observers to indicate the acceptable range based on the corresponding perceptual attribute. Five boardcertificated radiologists from Duke participated in this observer study on a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions. The observer data were analyzed in terms of the correlations between the observer ranking orders and the algorithmic ranking orders. Based on the collected acceptable ranges, quality consistency ranges were statistically derived. The observer study showed that, for each metric, the averaged ranking orders of the participated observers were strongly correlated with the algorithmic orders. For the lung grey level, the observer ranking orders completely accorded with the algorithmic ranking orders. The quality consistency ranges derived from this observer study were close to these derived from our previous study. The observer study indicates that the proposed image-based quality assessment technique provides a robust reflection of the perceptual image quality of the clinical chest radiographs. The derived quality consistency ranges can be used to automatically predict the acceptability of a clinical chest radiograph.

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

PubMed Central

Jones, Roger; Hunt, Claire; Stevens, Richard; Dalrymple, Jamie; Driscoll, Richard; Sleet, Sarah; Smith, Jonathan Blanchard

2009-01-01

Background Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. Aim To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. Design of study Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. Setting Community-based practice in England, UK. Methods Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. Results A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. Conclusion This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions. PMID:19520018

Defining and evaluating quality for ambulatory care educational programs.

PubMed

Bowen, J L; Stearns, J A; Dohner, C; Blackman, J; Simpson, D

1997-06-01

As the training of medical students and residents increasingly moves to ambulatory care settings, clerkship and program directors must find a way to use their limited resources to guide the development and evaluation of the quality of these ambulatory-based learning experiences. To evaluate quality, directors must first define, in operational and measurable terms, what is meant by the term "quality" as it is applied to ambulatory-based education. Using educational theories and the definition of quality used by health care systems, the authors propose an operational definition of quality for guiding the planning, implementation, and evaluation of ambulatory care educational programs. They assert that quality is achieved through the interaction of an optimal learning environment, defined educational goals and positive outcomes, participant satisfaction, and cost-effectiveness. By describing the components of quality along with examples of measurable indicators, the authors provide a foundation for the evaluation and improvement of instructional innovations in ambulatory care education for the benefit of teachers, learners, and patients.

A Unified Approach for Reporting ARM Measurement Uncertainties Technical Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Campos, E; Sisterson, DL

The Atmospheric Radiation Measurement (ARM) Climate Research Facility is observationally based, and quantifying the uncertainty of its measurements is critically important. With over 300 widely differing instruments providing over 2,500 datastreams, concise expression of measurement uncertainty is quite challenging. The ARM Facility currently provides data and supporting metadata (information about the data or data quality) to its users through a number of sources. Because the continued success of the ARM Facility depends on the known quality of its measurements, the Facility relies on instrument mentors and the ARM Data Quality Office (DQO) to ensure, assess, and report measurement quality. Therefore,more » an easily-accessible, well-articulated estimate of ARM measurement uncertainty is needed.« less

Home-Based Child Care Provider Education and Specialized Training: Associations with Caregiving Quality and Toddler Social-Emotional and Cognitive Outcomes

ERIC Educational Resources Information Center

Schaack, Diana D.; Le, Vi Nhuan; Messan Setodji, Claude

2017-01-01

Research Findings: Although there has been considerable research on the associations between the qualifications of teachers in center-based settings and preschool-age children's developmental outcomes, very little is known about the relationships between home provider qualifications and the developmental outcomes of toddlers who attend licensed…

Safe and Sound: An Educational Leader's Guide to Evidence-Based Social and Emotional Learning (SEL) Programs

ERIC Educational Resources Information Center

Collaborative for Academic, Social, and Emotional Learning (NJ1), 2003

2003-01-01

This guide was developed to provide educators with information about nationally available programs for the classroom that promote social and emotional learning (SEL). It details the costs, the grades covered, evidence base, which most effectively teach core social and emotional skills, and which provide high-quality staff development and support.…

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

Improving sexual health services in the city: can the NHS learn from clients and the service industry

PubMed Central

Patel, Hitesh; Baeza, Juan; Patel, Mitesh; Greene, Linda; Theobald, Nick

2007-01-01

Abstract Objective  Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model. Methods  Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university ‘gay’ society all of which were located in London. Forty‐four high‐risk clients and 11 health service providers underwent semi‐structured face‐to‐face interviews. Results  Both the walk‐in and appointment‐based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health‐care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision. Conclusions  Service quality can be maintained by using both walk‐in and appointment‐based systems. This is because our data, in line with Parasuraman's model of service quality, showed that ‘access’ is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health‐care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment. PMID:17524007

Hybrid Air Quality Modeling Approach for use in the Hear-road Exposures to Urban air pollutant Study(NEXUS)

EPA Science Inventory

The paper presents a hybrid air quality modeling approach and its application in NEXUS in order to provide spatial and temporally varying exposure estimates and identification of the mobile source contribution to the total pollutant exposure. Model-based exposure metrics, associa...

77 FR 65391 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

...) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the..., there is a focused interest in providing quality and value-based healthcare for Medicare beneficiaries...

76 FR 31339 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... extension of the currently approved tool for the collection of ambulatory care clinical performance measure...: Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (``PAT''); Use: This... based system. This system will also provide a platform for developing tools to collect clinical quality...

CBE: The Right Angle for Learning.

ERIC Educational Resources Information Center

Seitz, Fred

Designed for instructors at Beaufort Technical College (BTC) in South Carolina, this handbook provides a brief guide to competency-based education (CBE) and to the available resources at the college for assistance. Section 1 offers introductory comments on the concept of quality control and the five basic components of educational quality control.…

Support for Quality Assurance in End-User Systems.

ERIC Educational Resources Information Center

Klepper, Robert; McKenna, Edward G.

1989-01-01

Suggests an approach that organizations can take to provide centralized support services for quality assurance in end-user information systems, based on the experiences of a support group at Citicorp Mortgage, Inc. The functions of the support group include user education, software selection, and assistance in testing, implementation, and support…

PREDICTING THE IMPACT OF TROPOSPHERIC OZONE ON PLANTS AND ECOSYSTEMS AS A BASIS FOR SETTING NATIONAL AIR QUALITY STANDARDS

EPA Science Inventory

The Clean Air Act provides for establishing National Ambient Air Quality Standards (NAAQS) to protect public welfare (including crops, forests, ecosystems, and soils) from adverse effects of air pollutants, including tropospheric ozone. The formulation of policies is science-base...

NEIGHBORHOOD SCALE MODELING OF PM 2.5 AND AIR TOXICS CONCENTRATION DISTRIBUTIONS TO DRIVE HUMAN EXPOSURE MODELS

EPA Science Inventory

Air quality (AQ) simulation models provide a basis for implementing the National Ambient Air Quality Standards (NAAQS) and are a tool for performing risk-based assessments and for developing environmental management strategies. Fine particulate matter (PM 2.5), its constituent...

POPULATION AT RISK TO VARIOUS AIR POLLUTION EXPOSURES: DATA BASE 'POPATRISK'

EPA Science Inventory

The work reported was undertaken to provide the EPA with a user-oriented data base containing recent county-based information, for all counties in the contiguous United States, on population demographics, population mobility, climatology, emissions, air quality, and age-adjusted ...

Application of an integrated Weather Research and Forecasting (WRF)/CALPUFF modeling tool for source apportionment of atmospheric pollutants for air quality management: A case study in the urban area of Benxi, China.

PubMed

Wu, Hao; Zhang, Yan; Yu, Qi; Ma, Weichun

2018-04-01

In this study, the authors endeavored to develop an effective framework for improving local urban air quality on meso-micro scales in cities in China that are experiencing rapid urbanization. Within this framework, the integrated Weather Research and Forecasting (WRF)/CALPUFF modeling system was applied to simulate the concentration distributions of typical pollutants (particulate matter with an aerodynamic diameter <10 μm [PM 10 ], sulfur dioxide [SO 2 ], and nitrogen oxides [NO x ]) in the urban area of Benxi. Statistical analyses were performed to verify the credibility of this simulation, including the meteorological fields and concentration fields. The sources were then categorized using two different classification methods (the district-based and type-based methods), and the contributions to the pollutant concentrations from each source category were computed to provide a basis for appropriate control measures. The statistical indexes showed that CALMET had sufficient ability to predict the meteorological conditions, such as the wind fields and temperatures, which provided meteorological data for the subsequent CALPUFF run. The simulated concentrations from CALPUFF showed considerable agreement with the observed values but were generally underestimated. The spatial-temporal concentration pattern revealed that the maximum concentrations tended to appear in the urban centers and during the winter. In terms of their contributions to pollutant concentrations, the districts of Xihu, Pingshan, and Mingshan all affected the urban air quality to different degrees. According to the type-based classification, which categorized the pollution sources as belonging to the Bengang Group, large point sources, small point sources, and area sources, the source apportionment showed that the Bengang Group, the large point sources, and the area sources had considerable impacts on urban air quality. Finally, combined with the industrial characteristics, detailed control measures were proposed with which local policy makers could improve the urban air quality in Benxi. In summary, the results of this study showed that this framework has credibility for effectively improving urban air quality, based on the source apportionment of atmospheric pollutants. The authors endeavored to build up an effective framework based on the integrated WRF/CALPUFF to improve the air quality in many cities on meso-micro scales in China. Via this framework, the integrated modeling tool is accurately used to study the characteristics of meteorological fields, concentration fields, and source apportionments of pollutants in target area. The impacts of classified sources on air quality together with the industrial characteristics can provide more effective control measures for improving air quality. Through the case study, the technical framework developed in this study, particularly the source apportionment, could provide important data and technical support for policy makers to assess air pollution on the scale of a city in China or even the world.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

Quality assessment of protein model-structures based on structural and functional similarities.

PubMed

Konopka, Bogumil M; Nebel, Jean-Christophe; Kotulska, Malgorzata

2012-09-21

Experimental determination of protein 3D structures is expensive, time consuming and sometimes impossible. A gap between number of protein structures deposited in the World Wide Protein Data Bank and the number of sequenced proteins constantly broadens. Computational modeling is deemed to be one of the ways to deal with the problem. Although protein 3D structure prediction is a difficult task, many tools are available. These tools can model it from a sequence or partial structural information, e.g. contact maps. Consequently, biologists have the ability to generate automatically a putative 3D structure model of any protein. However, the main issue becomes evaluation of the model quality, which is one of the most important challenges of structural biology. GOBA--Gene Ontology-Based Assessment is a novel Protein Model Quality Assessment Program. It estimates the compatibility between a model-structure and its expected function. GOBA is based on the assumption that a high quality model is expected to be structurally similar to proteins functionally similar to the prediction target. Whereas DALI is used to measure structure similarity, protein functional similarity is quantified using standardized and hierarchical description of proteins provided by Gene Ontology combined with Wang's algorithm for calculating semantic similarity. Two approaches are proposed to express the quality of protein model-structures. One is a single model quality assessment method, the other is its modification, which provides a relative measure of model quality. Exhaustive evaluation is performed on data sets of model-structures submitted to the CASP8 and CASP9 contests. The validation shows that the method is able to discriminate between good and bad model-structures. The best of tested GOBA scores achieved 0.74 and 0.8 as a mean Pearson correlation to the observed quality of models in our CASP8 and CASP9-based validation sets. GOBA also obtained the best result for two targets of CASP8, and one of CASP9, compared to the contest participants. Consequently, GOBA offers a novel single model quality assessment program that addresses the practical needs of biologists. In conjunction with other Model Quality Assessment Programs (MQAPs), it would prove useful for the evaluation of single protein models.

Air Quality Criteria for Ozone and Related Photochemical ...

EPA Pesticide Factsheets

In February 2006, EPA released the final document, Air Quality Criteria for Ozone and Other Photochemical Oxidants. Tropospheric or surface-level ozone (O3) is one of six major air pollutants regulated by National Ambient Air Quality Standards (NAAQS) under the U.S. Clean Air Act. As mandated by the Clean Air Act, the U.S. Environmental Protection Agency (EPA) must periodically review the scientific bases (or criteria) for the various NAAQS by assessing newly available scientific information on a given criteria air pollutant. This document, Air Quality Criteria for Ozone and Other Photochemical Oxidants, is an updated revision of the 1996 Ozone Air Quality Criteria Document (O3 AQCD) that provided scientific bases for the current O3 NAAQS set in 1997. The Clean Air Act mandates periodic review of the National Ambient Air Quality Standards (NAAQS) for six common air pollutants, also referred to as criteria pollutants, including ozone.

[Establishment of industry promotion technology system in Chinese medicine secondary exploitation based on "component structure theory"].

PubMed

Cheng, Xu-Dong; Feng, Liang; Zhang, Ming-Hua; Gu, Jun-Fei; Jia, Xiao-Bin

2014-10-01

The purpose of the secondary exploitation of Chinese medicine is to improve the quality of Chinese medicine products, enhance core competitiveness, for better use in clinical practice, and more effectively solve the patient suffering. Herbs, extraction, separation, refreshing, preparation and quality control are all involved in the industry promotion of Chinese medicine secondary exploitation of industrial production. The Chinese medicine quality improvement and industry promotion could be realized with the whole process of process optimization, quality control, overall processes improvement. Based on the "component structure theory", "multi-dimensional structure & process dynamic quality control system" and systematic and holistic character of Chinese medicine, impacts of whole process were discussed. Technology systems of Chinese medicine industry promotion was built to provide theoretical basis for improving the quality and efficacy of the secondary development of traditional Chinese medicine products.

Technology usage, quality management system, and service quality in Thailand.

PubMed

Sivabrovornvatana, Nilubon; Siengthai, Sununta; Krairit, Donyaprueth; Paul, Himangshu

2005-01-01

This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality. The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals. The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation. The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

PubMed

McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk

2015-01-01

Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Shifting the focus to practice quality improvement in radiation oncology.

PubMed

Crozier, Cheryl; Erickson-Wittmann, Beth; Movsas, Benjamin; Owen, Jean; Khalid, Najma; Wilson, J Frank

2011-09-01

To demonstrate how the American College of Radiology, Quality Research in Radiation Oncology (QRRO) process survey database can serve as an evidence base for assessing quality of care in radiation oncology. QRRO has drawn a stratified random sample of radiation oncology facilities in the USA and invited those facilities to participate in a Process Survey. Information from a prior QRRO Facilities Survey has been used along with data collected under the current National Process Survey to calculate national averages and make statistically valid inferences for national process measures for selected cancers in which radiation therapy plays a major role. These measures affect outcomes important to patients and providers and measure quality of care. QRRO's survey data provides national benchmark data for numerous quality indicators. The Process Survey is "fully qualified" as a Practice Quality Improvement project by the American Board of Radiology under its Maintenance of Certification requirements for radiation oncology and radiation physics. © 2011 National Association for Healthcare Quality.

Working toward quality in obstetric anesthesia: a business approach.

PubMed

Lynde, Grant C

2017-06-01

Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements. The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's. Applying these lessons to the healthcare setting has been slow. Hospitals are only now introducing tools such as failure mode and effect analysis, Lean and Six Sigma into their quality divisions and are seeing significant cost reductions and outcomes improvements. The review will discuss the process for creating an effective quality program for an obstetric anesthesia division. Sustainable improvements in delivered care need to be based on an evaluation of service line needs, defining appropriate metrics, understanding current process flows, changing and measuring those processes, and developing mechanisms to ensure the new processes are maintained.

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

PubMed Central

Chang, Hsin Hsin; Chang, Ching Sheng

2008-01-01

Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. Results The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust. PMID:18419820

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan.

PubMed

Chang, Hsin Hsin; Chang, Ching Sheng

2008-04-17

Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust.

Trial-Based Economic Evaluations in Occupational Health

PubMed Central

van Wier, Marieke F.; Tompa, Emile; Bongers, Paulien M.; van der Beek, Allard J.; van Tulder, Maurits W.; Bosmans, Judith E.

2014-01-01

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions. PMID:24854249

Trial-based economic evaluations in occupational health: principles, methods, and recommendations.

PubMed

van Dongen, Johanna M; van Wier, Marieke F; Tompa, Emile; Bongers, Paulien M; van der Beek, Allard J; van Tulder, Maurits W; Bosmans, Judith E

2014-06-01

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Visual assessment of CPR quality during pediatric cardiac arrest: does point of view matter?

PubMed

Jones, Angela; Lin, Yiqun; Nettel-Aguirre, Alberto; Gilfoyle, Elaine; Cheng, Adam

2015-05-01

In many clinical settings, providers rely on visual assessment when delivering feedback on CPR quality. Little is known about the accuracy of visual assessment of CPR quality. We aimed to determine how accurate pediatric providers are in their visual assessment of CPR quality and to identify the optimal position relative to the patient for accurate CPR assessment. We videotaped high-quality CPR (based on 2010 American Heart Association guidelines) and 3 variations of poor quality CPR in a simulated resuscitation, filmed from the foot, head and the side of the manikin. Participants watched 12 videos and completed a questionnaire to assess CPR quality. One hundred and twenty-five participants were recruited. The overall accuracy of visual assessment of CPR quality was 65.6%. Accuracy was better from the side (70.8%) and foot (68.8%) of the bed when compared to the head of the bed (57.2%; p<0.001). The side was the best position for assessing depth (p<0.001). Rate assessment was equivalent between positions (p=0.58). The side and foot of the bed were superior to the head when assessing chest recoil (p<0.001). Factors associated with increased accuracy in visual assessment of CPR quality included recent CPR course completion (p=0.034) and involvement in more cardiac arrests as a team member (p=0.003). Healthcare providers struggle to accurately assess the quality of CPR using visual assessment. If visual assessment is being used, providers should stand at the side of the bed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Value management: optimizing quality, service, and cost.

PubMed

Makadon, Harvey J; Bharucha, Farzan; Gavin, Michael; Oliveira, Jason; Wietecha, Mark

2010-01-01

Hospitals have wrestled with balancing quality, service, and cost for years--and the visibility and urgency around measuring and communicating real metrics has grown exponentially in the last decade. However, even today, most hospital leaders cannot articulate or demonstrate the "value" they provide to patients and payers. Instead of developing a strategic direction that is based around a core value proposition, they focus their strategic efforts on tactical decisions like physician recruitment, facility expansion, and physician alignment. In the healthcare paradigm of the next decade, alignment of various tactical initiatives will require a more coherent understanding of the hospital's core value positioning. The authors draw on their experience in a variety of healthcare settings to suggest that for most hospitals, quality (i.e., clinical outcomes and patient safety) will become the most visible indicator of value, and introduce a framework to help healthcare providers influence their value positioning based on this variable.

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

PubMed

Steele, Joseph R; Schomer, Don F

2009-07-01

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.

Critical Analysis of Forest Degradation in the Southern Eastern Ghats of India: Comparison of Satellite Imagery and Soil Quality Index

PubMed Central

Ramachandran, Andimuthu; Radhapriya, Parthasarathy; Jayakumar, Shanmuganathan; Dhanya, Praveen; Geetha, Rajadurai

2016-01-01

India has one of the largest assemblages of tropical biodiversity, with its unique floristic composition of endemic species. However, current forest cover assessment is performed via satellite-based forest surveys, which have many limitations. The present study, which was performed in the Eastern Ghats, analysed the satellite-based inventory provided by forest surveys and inferred from the results that this process no longer provides adequate information for quantifying forest degradation in an empirical manner. The study analysed 21 soil properties and generated a forest soil quality index of the Eastern Ghats, using principal component analysis. Using matrix modules and geospatial technology, we compared the forest degradation status calculated from satellite-based forest surveys with the degradation status calculated from the forest soil quality index. The Forest Survey of India classified about 1.8% of the Eastern Ghats’ total area as degraded forests and the remainder (98.2%) as open, dense, and very dense forests, whereas the soil quality index results found that about 42.4% of the total area is degraded, with the remainder (57.6%) being non-degraded. Our ground truth verification analyses indicate that the forest soil quality index along with the forest cover density data from the Forest Survey of India are ideal tools for evaluating forest degradation. PMID:26812397

Model-assisted template extraction SRAF application to contact holes patterns in high-end flash memory device fabrication

NASA Astrophysics Data System (ADS)

Seoud, Ahmed; Kim, Juhwan; Ma, Yuansheng; Jayaram, Srividya; Hong, Le; Chae, Gyu-Yeol; Lee, Jeong-Woo; Park, Dae-Jin; Yune, Hyoung-Soon; Oh, Se-Young; Park, Chan-Ha

2018-03-01

Sub-resolution assist feature (SRAF) insertion techniques have been effectively used for a long time now to increase process latitude in the lithography patterning process. Rule-based SRAF and model-based SRAF are complementary solutions, and each has its own benefits, depending on the objectives of applications and the criticality of the impact on manufacturing yield, efficiency, and productivity. Rule-based SRAF provides superior geometric output consistency and faster runtime performance, but the associated recipe development time can be of concern. Model-based SRAF provides better coverage for more complicated pattern structures in terms of shapes and sizes, with considerably less time required for recipe development, although consistency and performance may be impacted. In this paper, we introduce a new model-assisted template extraction (MATE) SRAF solution, which employs decision tree learning in a model-based solution to provide the benefits of both rule-based and model-based SRAF insertion approaches. The MATE solution is designed to automate the creation of rules/templates for SRAF insertion, and is based on the SRAF placement predicted by model-based solutions. The MATE SRAF recipe provides optimum lithographic quality in relation to various manufacturing aspects in a very short time, compared to traditional methods of rule optimization. Experiments were done using memory device pattern layouts to compare the MATE solution to existing model-based SRAF and pixelated SRAF approaches, based on lithographic process window quality, runtime performance, and geometric output consistency.

The Role of Value-Based Care in Patients with Cirrhosis.

PubMed

Volk, Michael L

2017-02-01

Value-based care means delivering high-quality care while keeping costs at a reasonable level. Many physicians have long viewed quality care and the responsible utilization of resources to be an integral part of their professional responsibilities. As the health care system changes, however, physicians are increasingly being asked to objectively demonstrate value. In this review article, the author describes the reimbursement and regulatory shift toward value-based care, and provides specific strategies for meeting this care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

PubMed

Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

2017-12-01

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan

PubMed Central

2014-01-01

Background This study aimed to clarify how community mental healthcare systems can be improved. Methods We included 79 schizophrenic patients, aged 20 to 80 years, residing in the Tokyo metropolitan area who regularly visited rehabilitation facilities offering assistance to psychiatric patients and were receiving treatment on an outpatient basis. No subjects had severe cognitive disorders or were taking medication with side effects that could prevent the completion of questionnaires. Questionnaires included items related to quality of life, self-efficacy, self-esteem, psychosis based on the Behavior and Symptom Identification Scale, health locus of control, and socio-demographic factors. We performed multiple linear regression analysis with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models. Results Self-efficacy, self-esteem, and degree of psychosis significantly impacted quality of life. Marital status, age, and types of medications also influenced quality of life. Multiple linear regression analysis revealed psychiatric symptoms (Behavior and Symptom Identification Scale-32 [daily living and role functioning] (Beta = −0.537, p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors of total quality of life score. Based on covariance structural analysis, the resulting model was found to exhibit reasonable goodness of fit. Conclusions Self-efficacy had an especially strong and direct impact on QOL. Therefore, it is important to provide more positive feedback to patients, provide social skills training based on cognitive behavioral therapy, and engage patients in role playing to improve self-efficacy and self-concept. PMID:25101143

Asian Care Certificate (ACC): a care quality assurance framework.

PubMed

Talaie, Tony

2018-04-16

Purpose Quality assuring elderly care through a viable and feasible standard framework is a major challenge for Asian governments. Although several attempts have been made to tackle foreign care worker (FCW) shortage, assuring the quality of the care they provide has been overlooked. The original framework allowed a better control over service quality to assure the elderly about their care according to the agreed standards. The paper aims to discuss these issues. Design/methodology/approach Through several Japanese Governmental meetings, a new Asian Care Certificate (ACC) program is discussed based on the Japanese Care Certificate (JCC). The governments' representatives adopted the JCC to form the ACC, which enables the ACC board to evaluate care workers and to intervene whenever the desired quality level is not achieved. Findings The author describes a new program. The findings of this paper will be confirmed when the ACC is implemented. Practical implications Using the ACC framework, the challenge in providing a high-quality care service using FCWs across Asia would be partly resolved. FCWs' quality of life might also gradually improve especially regarding to their human rights. Originality/value The ACC provides a new framework. Its value is recognized if one considers that many Asian populations are rapidly aging and many governments compromise quality by employing overseas workers to solve care worker shortages.

An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes.

PubMed

Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly

2015-01-01

Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs.

Accessibility, nature and quality of health information on the Internet: a survey on osteoarthritis.

PubMed

Maloney, S; Ilic, D; Green, S

2005-03-01

This study aims to determine the quality and validity of information available on the Internet about osteoarthritis and to investigate the best way of sourcing this information. Keywords relevant to osteoarthritis were searched across 15 search engines representing medical, general and meta-search engines. Search engine efficiency was defined as the percentage of unique and relevant websites from all websites returned by each search engine. The quality of relevant information was appraised using the DISCERN tool and the concordance of the information offered by the website with the available evidence about osteoarthritis determined. A total of 3443 websites were retrieved, of which 344 were identified as unique and providing information relevant to osteoarthritis. The overall quality of website information was poor. There was no significant difference between types of search engine in sourcing relevant information; however, the information retrieved from medical search engines was of a higher quality. Fewer than a third of the websites identified as offering relevant information cited evidence to support their recommendations. Although the overall quality of website information about osteoarthritis was poor, medical search engines may provide consumers with the opportunity to source high-quality health information on the Internet. In the era of evidence-based medicine, one of the main obstacles to the Internet reaching its potential as a medical resource is the failure of websites to incorporate and attribute evidence-based information.

Adaptive predictors based on probabilistic SVM for real time disruption mitigation on JET

NASA Astrophysics Data System (ADS)

Murari, A.; Lungaroni, M.; Peluso, E.; Gaudio, P.; Vega, J.; Dormido-Canto, S.; Baruzzo, M.; Gelfusa, M.; Contributors, JET

2018-05-01

Detecting disruptions with sufficient anticipation time is essential to undertake any form of remedial strategy, mitigation or avoidance. Traditional predictors based on machine learning techniques can be very performing, if properly optimised, but do not provide a natural estimate of the quality of their outputs and they typically age very quickly. In this paper a new set of tools, based on probabilistic extensions of support vector machines (SVM), are introduced and applied for the first time to JET data. The probabilistic output constitutes a natural qualification of the prediction quality and provides additional flexibility. An adaptive training strategy ‘from scratch’ has also been devised, which allows preserving the performance even when the experimental conditions change significantly. Large JET databases of disruptions, covering entire campaigns and thousands of discharges, have been analysed, both for the case of the graphite and the ITER Like Wall. Performance significantly better than any previous predictor using adaptive training has been achieved, satisfying even the requirements of the next generation of devices. The adaptive approach to the training has also provided unique information about the evolution of the operational space. The fact that the developed tools give the probability of disruption improves the interpretability of the results, provides an estimate of the predictor quality and gives new insights into the physics. Moreover, the probabilistic treatment permits to insert more easily these classifiers into general decision support and control systems.

Using incentives to improve resource utilization: a quasi-experimental evaluation of an ICU quality improvement program

PubMed Central

Murphy, David J.; Lyu, Peter F.; Gregg, Sara R.; Martin, Greg S.; Hockenberry, Jason M.; Coopersmith, Craig M.; Sterling, Michael; Buchman, Timothy G.; Sevransky, Jonathan

2015-01-01

Objective Healthcare systems strive to provide quality care at lower cost. Arterial blood gas testing (ABGs), chest radiographs (CXRs), and red blood cell transfusions (RBCs) provide an important example of opportunities to reduce excess resource utilization within the ICU. We describe the effect of a multifaceted quality improvement program designed to decrease avoidable ABGs, CXRs, and RBCs utilization on utilization of these resources and patient outcomes. Design Prospective pre-post cohort study Setting Seven ICUs in an academic healthcare system Patients All adult ICU patients admitted to study ICUs during consecutive baseline (n=7,357), intervention (n=7,553), and follow up (n=7,657) years between September 2010 and August 2013. Interventions A multifaceted quality improvement program including provider education, audit and feedback, and unit-based provider financial incentives targeting ABG, CXR, and RBC utilization. Measurements and Main Results The primary outcome was the number of orders for ABGs, CXRs, and RBCs per patient. Compared to the baseline period, unadjusted ABG, CXR, and RBC utilization in the intervention period was reduced by 42%, 26%, and 17%, respectively (p<0.01). After adjusting for potentially relevant patient factors, the intervention was associated with 128 fewer ABGs, 73 fewer CXRs, and 16 fewer RBCs per 100 patients (p<0.01). This effect was durable during the follow up year. This reduction yielded an approximate net savings of $1.5 M in direct costs over the intervention and follow-up years after accounting for the direct costs of the program. Unadjusted hospital mortality decreased from 7% in the baseline period to 5.2% in the intervention period (p<0.01). This reduction remained significant after adjusting for patient factors (OR= 0.43, P<0.01). Conclusions Implementation of a multifaceted quality improvement program including financial incentives was associated with significant improvements in resource utilization. Our findings provide evidence supporting the safety, effectiveness, and sustainability of incentive-based quality improvement interventions. PMID:26496444

What Is Nursing Home Quality and How Is It Measured?

PubMed Central

Castle, Nicholas G.; Ferguson, Jamie C.

2010-01-01

Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. PMID:20631035

A New Model for Solving Time-Cost-Quality Trade-Off Problems in Construction

PubMed Central

Fu, Fang; Zhang, Tao

2016-01-01

A poor quality affects project makespan and its total costs negatively, but it can be recovered by repair works during construction. We construct a new non-linear programming model based on the classic multi-mode resource constrained project scheduling problem considering repair works. In order to obtain satisfactory quality without a high increase of project cost, the objective is to minimize total quality cost which consists of the prevention cost and failure cost according to Quality-Cost Analysis. A binary dependent normal distribution function is adopted to describe the activity quality; Cumulative quality is defined to determine whether to initiate repair works, according to the different relationships among activity qualities, namely, the coordinative and precedence relationship. Furthermore, a shuffled frog-leaping algorithm is developed to solve this discrete trade-off problem based on an adaptive serial schedule generation scheme and adjusted activity list. In the program of the algorithm, the frog-leaping progress combines the crossover operator of genetic algorithm and a permutation-based local search. Finally, an example of a construction project for a framed railway overpass is provided to examine the algorithm performance, and it assist in decision making to search for the appropriate makespan and quality threshold with minimal cost. PMID:27911939

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

PubMed Central

2014-01-01

Background Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome. Methods/Design The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups. Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers. Conclusion The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers. Trial registration The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576, registered June 1, 2014 PMID:25145317

Who's in charge? Challenges in evaluating quality of primary care treatment for low back pain.

PubMed

Wasiak, Radoslaw; Pransky, Glenn S; Atlas, Steven J

2008-12-01

Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation. Established primary care patients with occupational LBP and health care covered by a workers' compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2-year follow-up period. Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non-emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine. Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP-directed interventions or reinforcing guideline adherence may not impact outcomes. A patient-centred model may be necessary to achieve outcome improvements.

Comparison of cost accounting methods from different DRG systems and their effect on health care quality.

PubMed

Leister, Jan Eric; Stausberg, Jürgen

2005-09-28

Diagnosis related groups (DRGs) are a well-established provider payment system. Because of their imminent potential of cost reduction, they have been widely introduced. In addition to cost cutting, several social objectives - e.g., improving overall health care quality - feed into the DRG system. The WHO compared different provider payment systems with regard to the following objectives: prevention of further health problems, providing services and solving health problems, and responsiveness to people's legitimate expectations. However, no study has been published which takes the impact of different cost accounting systems across the DRG systems into account. We compared the impact of different cost accounting methods within DRG-like systems by developing six criteria: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high class evidence based therapy, prohibition of economically founded exclusions, reduction of fragmentation incentives, and improvement of patient oriented treatment. We set up a first overview of potential and actual impacts of the pricing practices within Yale-DRGs, AR-DRGs, G-DRGs, Swiss AP-DRGs adoption and Swiss MIPP. It could be demonstrated that DRGs are not only a 'homogenous' group of similar provider payment systems but quite different by fulfilling major health care objectives connected with the used cost accounting methods. If not only the possible cost reduction is used to put in a good word for DRG-based provider payment systems, maximum accurateness concerning the method of cost accounting should prevail when implementing a new DRG-based provider payment system.

Software for pre-processing Illumina next-generation sequencing short read sequences

PubMed Central

2014-01-01

Background When compared to Sanger sequencing technology, next-generation sequencing (NGS) technologies are hindered by shorter sequence read length, higher base-call error rate, non-uniform coverage, and platform-specific sequencing artifacts. These characteristics lower the quality of their downstream analyses, e.g. de novo and reference-based assembly, by introducing sequencing artifacts and errors that may contribute to incorrect interpretation of data. Although many tools have been developed for quality control and pre-processing of NGS data, none of them provide flexible and comprehensive trimming options in conjunction with parallel processing to expedite pre-processing of large NGS datasets. Methods We developed ngsShoRT (next-generation sequencing Short Reads Trimmer), a flexible and comprehensive open-source software package written in Perl that provides a set of algorithms commonly used for pre-processing NGS short read sequences. We compared the features and performance of ngsShoRT with existing tools: CutAdapt, NGS QC Toolkit and Trimmomatic. We also compared the effects of using pre-processed short read sequences generated by different algorithms on de novo and reference-based assembly for three different genomes: Caenorhabditis elegans, Saccharomyces cerevisiae S288c, and Escherichia coli O157 H7. Results Several combinations of ngsShoRT algorithms were tested on publicly available Illumina GA II, HiSeq 2000, and MiSeq eukaryotic and bacteria genomic short read sequences with the focus on removing sequencing artifacts and low-quality reads and/or bases. Our results show that across three organisms and three sequencing platforms, trimming improved the mean quality scores of trimmed sequences. Using trimmed sequences for de novo and reference-based assembly improved assembly quality as well as assembler performance. In general, ngsShoRT outperformed comparable trimming tools in terms of trimming speed and improvement of de novo and reference-based assembly as measured by assembly contiguity and correctness. Conclusions Trimming of short read sequences can improve the quality of de novo and reference-based assembly and assembler performance. The parallel processing capability of ngsShoRT reduces trimming time and improves the memory efficiency when dealing with large datasets. We recommend combining sequencing artifacts removal, and quality score based read filtering and base trimming as the most consistent method for improving sequence quality and downstream assemblies. ngsShoRT source code, user guide and tutorial are available at http://research.bioinformatics.udel.edu/genomics/ngsShoRT/. ngsShoRT can be incorporated as a pre-processing step in genome and transcriptome assembly projects. PMID:24955109

A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes.

PubMed

Driessen, Sara R C; Van Zwet, Erik W; Haazebroek, Pascal; Sandberg, Evelien M; Blikkendaal, Mathijs D; Twijnstra, Andries R H; Jansen, Frank Willem

2016-12-01

The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance. We report the development and test of a real-time, dynamic, quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Typology of delivery quality: latent profile analysis of teacher engagement and delivery techniques in a school-based prevention intervention, keepin’ it REAL curriculum

PubMed Central

Shin, YoungJu; Miller-Day, Michelle; Pettigrew, Jonathan; Hecht, Michael L.; Krieger, Janice L.

2014-01-01

Enhancing the delivery quality of school-based, evidence-based prevention programs is one key to ensuring uniform program effects on student outcomes. Program evaluations often focus on content dosage when implementing prevention curricula, however, less is known about implementation quality of prevention content, especially among teachers who may or may not have a prevention background. The goal of the current study is to add to the scholarly literature on implementation quality for a school-based substance use prevention intervention. Twenty-five schools in Ohio and Pennsylvania implemented the original keepin’ REAL (kiR) substance use prevention curriculum. Each of the 10, 40–45 min lessons of the kiR curriculum was video recorded. Coders observed and rated a random sample of 276 videos reflecting 78 classes taught by 31 teachers. Codes included teachers’ delivery techniques (e.g. lecture, discussion, demonstration and role play) and engagement with students (e.g. attentiveness, enthusiasm and positivity). Based on the video ratings, a latent profile analysis was run to identify typology of delivery quality. Five profiles were identified: holistic approach, attentive teacher-orientated approach, enthusiastic lecture approach, engaged interactive learning approach and skill practice-only approach. This study provides a descriptive typology of delivery quality while implementing a school-based substance use prevention intervention. PMID:25274721

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

PubMed Central

2011-01-01

Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Conclusions Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality. PMID:21592322

Image quality metrics for volumetric laser displays

NASA Astrophysics Data System (ADS)

Williams, Rodney D.; Donohoo, Daniel

1991-08-01

This paper addresses the extensions to the image quality metrics and related human factors research that are needed to establish the baseline standards for emerging volume display technologies. The existing and recently developed technologies for multiplanar volume displays are reviewed with an emphasis on basic human visual issues. Human factors image quality metrics and guidelines are needed to firmly establish this technology in the marketplace. The human visual requirements and the display design tradeoffs for these prototype laser-based volume displays are addressed and several critical image quality issues identified for further research. The American National Standard for Human Factors Engineering of Visual Display Terminal Workstations (ANSIHFS-100) and other international standards (ISO, DIN) can serve as a starting point, but this research base must be extended to provide new image quality metrics for this new technology for volume displays.

From evidence to action

PubMed Central

Verheyen, Cees CPM; Kerkhoffs, Gino M; Bhandari, Mohit; Schünemann, Holger J

2009-01-01

ABSTRACT Good guidelines will help us to take evidence into practice. In a survey among Dutch orthopedic surgeons, development and use of evidence-based guidelines was perceived as one of the best ways of moving from opinion-based to evidence-based orthopedic practice. The increasing number of guidelines means that knowing how to make a critical appraisal of guidelines is now a key part of every surgeon’s life. This is particularly true because guidelines use varying systems to judge the quality of evidence and the strength of recommendations. In this manuscript we discuss what a guideline is, where we can find guidelines, how to evaluate the quality of guidelines, and finally provide an example on the different steps of guideline development. Thus, we show that good guidelines are a summary of the best available evidence and that they provide a graded recommendation to help surgeons in evidence-based practice. PMID:19234892

An Evidence-Based Approach to Estimating the National and State Costs of PreK-3rd. FCD Policy Brief Advancing PK-3rd. No.10

ERIC Educational Resources Information Center

Picus, Lawrence O.; Odden, Allan; Goetz, Michael

2009-01-01

This study estimates the costs of providing a high-quality PreK-3rd education approach in all 50 states plus the District of Columbia. Relying on an Evidence-Based approach to school finance adequacy, it identifies the staffing resources needed to offer high-quality integrated PreK-3rd programs and then estimates the costs of those resources. By…

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

PubMed

2016-11-14

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

The Development of a Checklist to Enhance Methodological Quality in Intervention Programs.

PubMed

Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana; Sánchez-Martín, Milagrosa

2016-01-01

The methodological quality of primary studies is an important issue when performing meta-analyses or systematic reviews. Nevertheless, there are no clear criteria for how methodological quality should be analyzed. Controversies emerge when considering the various theoretical and empirical definitions, especially in relation to three interrelated problems: the lack of representativeness, utility, and feasibility. In this article, we (a) systematize and summarize the available literature about methodological quality in primary studies; (b) propose a specific, parsimonious, 12-items checklist to empirically define the methodological quality of primary studies based on a content validity study; and (c) present an inter-coder reliability study for the resulting 12-items. This paper provides a precise and rigorous description of the development of this checklist, highlighting the clearly specified criteria for the inclusion of items and a substantial inter-coder agreement in the different items. Rather than simply proposing another checklist, however, it then argues that the list constitutes an assessment tool with respect to the representativeness, utility, and feasibility of the most frequent methodological quality items in the literature, one that provides practitioners and researchers with clear criteria for choosing items that may be adequate to their needs. We propose individual methodological features as indicators of quality, arguing that these need to be taken into account when designing, implementing, or evaluating an intervention program. This enhances methodological quality of intervention programs and fosters the cumulative knowledge based on meta-analyses of these interventions. Future development of the checklist is discussed.

WE-A-BRC-01: Introduction to the Certificate Course

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palta, J.

Quality and safety in healthcare are inextricably linked. There are compelling data that link poor quality radiation therapy to inferior patient survival. Radiation Oncology clinical trial protocol deviations often involve incorrect target volume delineation or dosing, akin to radiotherapy incidents which also often involve partial geometric miss or improper radiation dosing. When patients with radiation protocol variations are compared to those without significant protocol variations, clinical outcome is negatively impacted. Traditionally, quality assurance in radiation oncology has been driven largely by new technological advances, and safety improvement has been driven by reactive responses to past system failures and prescriptive mandatesmore » recommended by professional organizations and promulgated by regulators. Prescriptive approaches to quality and safety alone often do not address the huge variety of process and technique used in radiation oncology. Risk-based assessments of radiotherapy processes provide a mechanism to enhance quality and safety, both for new and for established techniques. It is imperative that we explore such a paradigm shift at this time, when expectations from patients as well as providers are rising while available resources are falling. There is much we can learn from our past experiences to be applied towards the new risk-based assessments. Learning Objectives: Understand the impact of clinical and technical quality on outcomes Understand the importance of quality care in radiation oncology Learn to assess the impact of quality on clinical outcomes D. Followill, NIH Grant CA180803.« less

WE-A-BRC-03: Lessons Learned: IROC Audits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Followill, D.

Quality and safety in healthcare are inextricably linked. There are compelling data that link poor quality radiation therapy to inferior patient survival. Radiation Oncology clinical trial protocol deviations often involve incorrect target volume delineation or dosing, akin to radiotherapy incidents which also often involve partial geometric miss or improper radiation dosing. When patients with radiation protocol variations are compared to those without significant protocol variations, clinical outcome is negatively impacted. Traditionally, quality assurance in radiation oncology has been driven largely by new technological advances, and safety improvement has been driven by reactive responses to past system failures and prescriptive mandatesmore » recommended by professional organizations and promulgated by regulators. Prescriptive approaches to quality and safety alone often do not address the huge variety of process and technique used in radiation oncology. Risk-based assessments of radiotherapy processes provide a mechanism to enhance quality and safety, both for new and for established techniques. It is imperative that we explore such a paradigm shift at this time, when expectations from patients as well as providers are rising while available resources are falling. There is much we can learn from our past experiences to be applied towards the new risk-based assessments. Learning Objectives: Understand the impact of clinical and technical quality on outcomes Understand the importance of quality care in radiation oncology Learn to assess the impact of quality on clinical outcomes D. Followill, NIH Grant CA180803.« less

WE-A-BRC-02: Lessons Learned: Clinical Trials and Operations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Evans, S.

Quality and safety in healthcare are inextricably linked. There are compelling data that link poor quality radiation therapy to inferior patient survival. Radiation Oncology clinical trial protocol deviations often involve incorrect target volume delineation or dosing, akin to radiotherapy incidents which also often involve partial geometric miss or improper radiation dosing. When patients with radiation protocol variations are compared to those without significant protocol variations, clinical outcome is negatively impacted. Traditionally, quality assurance in radiation oncology has been driven largely by new technological advances, and safety improvement has been driven by reactive responses to past system failures and prescriptive mandatesmore » recommended by professional organizations and promulgated by regulators. Prescriptive approaches to quality and safety alone often do not address the huge variety of process and technique used in radiation oncology. Risk-based assessments of radiotherapy processes provide a mechanism to enhance quality and safety, both for new and for established techniques. It is imperative that we explore such a paradigm shift at this time, when expectations from patients as well as providers are rising while available resources are falling. There is much we can learn from our past experiences to be applied towards the new risk-based assessments. Learning Objectives: Understand the impact of clinical and technical quality on outcomes Understand the importance of quality care in radiation oncology Learn to assess the impact of quality on clinical outcomes D. Followill, NIH Grant CA180803.« less

The Development of a Checklist to Enhance Methodological Quality in Intervention Programs

PubMed Central

Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana; Sánchez-Martín, Milagrosa

2016-01-01

The methodological quality of primary studies is an important issue when performing meta-analyses or systematic reviews. Nevertheless, there are no clear criteria for how methodological quality should be analyzed. Controversies emerge when considering the various theoretical and empirical definitions, especially in relation to three interrelated problems: the lack of representativeness, utility, and feasibility. In this article, we (a) systematize and summarize the available literature about methodological quality in primary studies; (b) propose a specific, parsimonious, 12-items checklist to empirically define the methodological quality of primary studies based on a content validity study; and (c) present an inter-coder reliability study for the resulting 12-items. This paper provides a precise and rigorous description of the development of this checklist, highlighting the clearly specified criteria for the inclusion of items and a substantial inter-coder agreement in the different items. Rather than simply proposing another checklist, however, it then argues that the list constitutes an assessment tool with respect to the representativeness, utility, and feasibility of the most frequent methodological quality items in the literature, one that provides practitioners and researchers with clear criteria for choosing items that may be adequate to their needs. We propose individual methodological features as indicators of quality, arguing that these need to be taken into account when designing, implementing, or evaluating an intervention program. This enhances methodological quality of intervention programs and fosters the cumulative knowledge based on meta-analyses of these interventions. Future development of the checklist is discussed. PMID:27917143

Enhancement of the Automated Quality Control Procedures for the International Soil Moisture Network

NASA Astrophysics Data System (ADS)

Heer, Elsa; Xaver, Angelika; Dorigo, Wouter; Messner, Romina

2017-04-01

In-situ soil moisture observations are still trusted to be the most reliable data to validate remotely sensed soil moisture products. Thus, the quality of in-situ soil moisture observations is of high importance. The International Soil Moisture Network (ISMN; http://ismn.geo.tuwien.ac.at/) provides in-situ soil moisture data from all around the world. The data is collected from individual networks and data providers, measured by different sensors in various depths. The data sets which are delivered in different units, time zones and data formats are then transformed into homogeneous data sets. An erroneous behavior of soil moisture data is very difficult to detect, due to annual and daily changes and most significantly the high influence of precipitation and snow melting processes. Only few of the network providers have a quality assessment for their data sets. Therefore, advanced quality control procedures have been developed for the ISMN (Dorigo et al. 2013). Three categories of quality checks were introduced: exceeding boundary values, geophysical consistency checks and a spectrum based approach. The spectrum based quality control algorithms aim to detect erroneous measurements which occur within plausible geophysical ranges, e.g. a sudden drop in soil moisture caused by a sensor malfunction. By defining several conditions which have to be met by the original soil moisture time series and their first and second derivative, such error types can be detected. Since the development of these sophisticated methods many more data providers shared their data with the ISMN and new types of erroneous measurements were identified. Thus, an enhancement of the automated quality control procedures became necessary. In the present work, we introduce enhancements of the existing quality control algorithms. Additionally, six completely new quality checks have been developed, e.g. detection of suspicious values before or after NAN-values, constant values and values that lie in a spectrum where a high majority of values before and after is flagged and therefore a sensor malfunction is certain. For the evaluation of the enhanced automated quality control system many test data sets were chosen, and manually validated to be compared to the existing quality control procedures and the new algorithms. Improvements will be shown that assure an appropriate assessment of the ISMN data sets, which are used for validations of soil moisture data retrieved by satellite data and are the foundation many other scientific publications.

Quality Measures for Dialysis: Time for a Balanced Scorecard

PubMed Central

2016-01-01

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. PMID:26316622

Adaptive Sampling for Urban Air Quality through Participatory Sensing

PubMed Central

Zeng, Yuanyuan; Xiang, Kai

2017-01-01

Air pollution is one of the major problems of the modern world. The popularization and powerful functions of smartphone applications enable people to participate in urban sensing to better know about the air problems surrounding them. Data sampling is one of the most important problems that affect the sensing performance. In this paper, we propose an Adaptive Sampling Scheme for Urban Air Quality (AS-air) through participatory sensing. Firstly, we propose to find the pattern rules of air quality according to the historical data contributed by participants based on Apriori algorithm. Based on it, we predict the on-line air quality and use it to accelerate the learning process to choose and adapt the sampling parameter based on Q-learning. The evaluation results show that AS-air provides an energy-efficient sampling strategy, which is adaptive toward the varied outside air environment with good sampling efficiency. PMID:29099766

Addressing and Presenting Quality of Satellite Data via Web-Based Services

NASA Technical Reports Server (NTRS)

Leptoukh, Gregory; Lynnes, C.; Ahmad, S.; Fox, P.; Zednik, S.; West, P.

2011-01-01

With the recent attention to climate change and proliferation of remote-sensing data utilization, climate model and various environmental monitoring and protection applications have begun to increasingly rely on satellite measurements. Research application users seek good quality satellite data, with uncertainties and biases provided for each data point. However, different communities address remote sensing quality issues rather inconsistently and differently. We describe our attempt to systematically characterize, capture, and provision quality and uncertainty information as it applies to the NASA MODIS Aerosol Optical Depth data product. In particular, we note the semantic differences in quality/bias/uncertainty at the pixel, granule, product, and record levels. We outline various factors contributing to uncertainty or error budget; errors. Web-based science analysis and processing tools allow users to access, analyze, and generate visualizations of data while alleviating users from having directly managing complex data processing operations. These tools provide value by streamlining the data analysis process, but usually shield users from details of the data processing steps, algorithm assumptions, caveats, etc. Correct interpretation of the final analysis requires user understanding of how data has been generated and processed and what potential biases, anomalies, or errors may have been introduced. By providing services that leverage data lineage provenance and domain-expertise, expert systems can be built to aid the user in understanding data sources, processing, and the suitability for use of products generated by the tools. We describe our experiences developing a semantic, provenance-aware, expert-knowledge advisory system applied to NASA Giovanni web-based Earth science data analysis tool as part of the ESTO AIST-funded Multi-sensor Data Synergy Advisor project.

Effects of nutrient profiling and price changes based on NuVal® scores on food purchasing in an online experimental supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric A; Katz, David L; Jankowiak, Noelle; Pudlewski, Corrin; Paluch, Rocco A

2016-08-01

The goal of the present study was to apply experimental economic methods in an online supermarket to examine the effects of nutrient profiling, and differential pricing based on the nutrient profile, on the overall diet quality, energy and macronutrients of the foods purchased, and diet cost. Participants were provided nutrient profiling scores or price adjustments based on nutrient profile scores while completing a hypothetical grocery shopping task. Prices of foods in the top 20 % of nutrient profiling scores were reduced (subsidized) by 25 % while those in the bottom 20 % of scores were increased (taxed) by 25 %. We evaluated the independent and interactive effects of nutrient profiling or price adjustments on overall diet quality of foods purchased as assessed by the NuVal® score, energy and macronutrients purchased and diet cost in a 2×2 factorial design. A large (>10 000 food items) online experimental supermarket in the USA. Seven hundred and eighty-one women. Providing nutrient profiling scores improved overall diet quality of foods purchased. Price changes were associated with an increase in protein purchased, an increase in energy cost, and reduced carbohydrate and protein costs. Price changes and nutrient profiling combined were associated with no unique benefits beyond price changes or nutrient profiling alone. Providing nutrient profile score increased overall NuVal® score without a reduction in energy purchased. Combining nutrient profiling and price changes did not show an overall benefit to diet quality and may be less useful than nutrient profiling alone to consumers who want to increase overall diet quality of foods purchased.

Small drinking water systems under spatiotemporal water quality variability: a risk-based performance benchmarking framework.

PubMed

Bereskie, Ty; Haider, Husnain; Rodriguez, Manuel J; Sadiq, Rehan

2017-08-23

Traditional approaches for benchmarking drinking water systems are binary, based solely on the compliance and/or non-compliance of one or more water quality performance indicators against defined regulatory guidelines/standards. The consequence of water quality failure is dependent on location within a water supply system as well as time of the year (i.e., season) with varying levels of water consumption. Conventional approaches used for water quality comparison purposes fail to incorporate spatiotemporal variability and degrees of compliance and/or non-compliance. This can lead to misleading or inaccurate performance assessment data used in the performance benchmarking process. In this research, a hierarchical risk-based water quality performance benchmarking framework is proposed to evaluate small drinking water systems (SDWSs) through cross-comparison amongst similar systems. The proposed framework (R WQI framework) is designed to quantify consequence associated with seasonal and location-specific water quality issues in a given drinking water supply system to facilitate more efficient decision-making for SDWSs striving for continuous performance improvement. Fuzzy rule-based modelling is used to address imprecision associated with measuring performance based on singular water quality guidelines/standards and the uncertainties present in SDWS operations and monitoring. This proposed R WQI framework has been demonstrated using data collected from 16 SDWSs in Newfoundland and Labrador and Quebec, Canada, and compared to the Canadian Council of Ministers of the Environment WQI, a traditional, guidelines/standard-based approach. The study found that the R WQI framework provides an in-depth state of water quality and benchmarks SDWSs more rationally based on the frequency of occurrence and consequence of failure events.

Public health laboratory quality management in a developing country.

PubMed

Wangkahat, Khwanjai; Nookhai, Somboon; Pobkeeree, Vallerut

2012-01-01

The article aims to give an overview of the system of public health laboratory quality management in Thailand and to produce a strengths, weaknesses, opportunities and threats (SWOT) analysis that is relevant to public health laboratories in the country. The systems for managing laboratory quality that are currently employed were described in the first component. The second component was a SWOT analysis, which used the opinions of laboratory professionals to identify any areas that could be improved to meet quality management systems. Various quality management systems were identified and the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the opportunities and strengths factors offered the best chance to improve laboratory quality management in the country. The results are based on observations and brainstorming with medical laboratory professionals who can assist laboratories in accomplishing quality management. The factors derived from the analysis can help improve laboratory quality management in the country. This paper provides viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories.

Isolated Power Generation System Using Permanent Magnet Synchronous Generator with Improved Power Quality

NASA Astrophysics Data System (ADS)

Arya, Sabha Raj; Patel, Ashish; Giri, Ashutosh

2018-06-01

This paper deals wind energy based power generation system using Permanent Magnet Synchronous Generator (PMSG). It is controlled using advanced enhanced phase-lock loop for power quality features using distribution static compensator to eliminate the harmonics and to provide KVAR compensation as well as load balancing. It also manages rated potential at the point of common interface under linear and non-linear loads. In order to have better efficiency and reliable operation of PMSG driven by wind turbine, it is necessary to analyze the governing equation of wind based turbine and PMSG under fixed and variable wind speed. For handling power quality problems, power electronics based shunt connected custom power device is used in three wire system. The simulations in MATLAB/Simulink environment have been carried out in order to demonstrate this model and control approach used for the power quality enhancement. The performance results show the adequate performance of PMSG based power generation system and control algorithm.

Isolated Power Generation System Using Permanent Magnet Synchronous Generator with Improved Power Quality

NASA Astrophysics Data System (ADS)

Arya, Sabha Raj; Patel, Ashish; Giri, Ashutosh

2018-03-01

This paper deals wind energy based power generation system using Permanent Magnet Synchronous Generator (PMSG). It is controlled using advanced enhanced phase-lock loop for power quality features using distribution static compensator to eliminate the harmonics and to provide KVAR compensation as well as load balancing. It also manages rated potential at the point of common interface under linear and non-linear loads. In order to have better efficiency and reliable operation of PMSG driven by wind turbine, it is necessary to analyze the governing equation of wind based turbine and PMSG under fixed and variable wind speed. For handling power quality problems, power electronics based shunt connected custom power device is used in three wire system. The simulations in MATLAB/Simulink environment have been carried out in order to demonstrate this model and control approach used for the power quality enhancement. The performance results show the adequate performance of PMSG based power generation system and control algorithm.

Assessing Family Planning Service Quality And User Experiences In Social Franchising Programme - Case Studies From Two Rural Districts In Pakistan.

PubMed

Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Awan, Muhammad Ali

2018-01-01

Studies have documented the impact of quality family planning services on improved contraceptive uptake and continuation, however, relatively little is known about their quality of service provision especially in the context of social franchising. This study examined the quality of clinical services and user experiences among two models in franchised service providers in rural Pakistan. This facility-based assessment was carried out during May-June 2015 at the 20 randomly selected social franchise providers from Chakwal and Faisalabad. In our case, a franchise health facility was a private clinic (mostly) run by a single provider, supported by an assistant. Within the selected health facilities, a total 39 user-provider interactions were observed and same users were interviewed separately. Most of the health facilities were in the private sector. Comparatively, service providers at Greenstar Social Marketing/Population Services International (GSM/PSI) model franchised facilities had higher number of rooms and staff employed, with more providers' ownership. Quality of service indices showed high scores for both Marie Stopes Society (MSS) and GSM/PSI franchised providers. MSS franchised providers demonstrated comparative edge in terms of clinical governance, better method mix and they were more user-focused, while PSI providers offered broader range of non-FP services. Quality of counselling services were similar among both models. Service providers performed well on all indicators of interpersonal care however overall low scores were noted in technical care. For both models, service providers attained an average score of 6.7 (out of the maximum value of 8) on waste disposal mechanism, supplies 12.5 (out of the maximum value of 15), user-centred facility 2.7 (out of the maximum value of 4), and clinical governance 6.5 (out of the maximum value of 11) and respecting clients' privacy. The exit interviews yielded high user satisfaction in both service models. The findings seem suggesting that the MSS and GSM/PSI service providers were maintaining high quality standards in provision of family planning information, services, and commodities but overall there was not much difference between the two models in terms of quality and satisfaction. The results demonstrate that service quality and client satisfaction are an important determinant of use of clinical contraceptive methods in Pakistan.

The Effect of Hospital Service Quality on Patient's Trust.

PubMed

Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

2015-01-01

The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient's trust is the service quality. This study aimed to examine the effect of quality of services provided in private hospitals on the patient's trust. In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P < 0.001) were the strongest factors in predicting patient's trust, but the quality of the environment had no significant effect on the patients' degree of trust. The interaction quality and process quality were the key determinants of patient's trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff.

Reducing Operating Costs by Optimizing Space in Facilities

DTIC Science & Technology

2012-03-01

Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

Serengeti real estate: density vs. fitness-based indicators of lion habitat quality.

PubMed

Mosser, Anna; Fryxell, John M; Eberly, Lynn; Packer, Craig

2009-10-01

Habitat quality is typically inferred by assuming a direct relationship between consumer density and resource abundance, although it has been suggested that consumer fitness may be a more accurate measure of habitat quality. We examined density vs. fitness-based measures of habitat quality for lions in the Serengeti National Park, Tanzania. A 40-year average of female reproductive success (yearling cubs per female) was best explained by proximity to river confluences, whereas patterns of productivity (yearling cubs per km(2)) and adult female density (individuals per km(2)) were associated with more general measures of habitat quality and areas of shelter in poor habitat. This suggests that density may not accurately distinguish between high-quality 'source' areas and low-quality sites that merely provide refuges for effectively non-reproductive individuals. Our results indicate that density may be a misleading indicator of real estate value, particularly for populations that do not conform to an ideal free distribution.

Mixed methods research in music therapy research.

PubMed

Bradt, Joke; Burns, Debra S; Creswell, John W

2013-01-01

Music therapists have an ethical and professional responsibility to provide the highest quality care possible to their patients. Much of the time, high quality care is guided by evidence-based practice standards that integrate the most current, available research in making decisions. Accordingly, music therapists need research that integrates multiple ways of knowing and forms of evidence. Mixed methods research holds great promise for facilitating such integration. At this time, there have not been any methodological articles published on mixed methods research in music therapy. The purpose of this article is to introduce mixed methods research as an approach to address research questions relevant to music therapy practice. This article describes the core characteristics of mixed methods research, considers paradigmatic issues related to this research approach, articulates major challenges in conducting mixed methods research, illustrates four basic designs, and provides criteria for evaluating the quality of mixed methods articles using examples of mixed methods research from the music therapy literature. Mixed methods research offers unique opportunities for strengthening the evidence base in music therapy. Recommendations are provided to ensure rigorous implementation of this research approach.

Air pollution and public health: a guidance document for risk managers.

PubMed

Craig, Lorraine; Brook, Jeffrey R; Chiotti, Quentin; Croes, Bart; Gower, Stephanie; Hedley, Anthony; Krewski, Daniel; Krupnick, Alan; Krzyzanowski, Michal; Moran, Michael D; Pennell, William; Samet, Jonathan M; Schneider, Jurgen; Shortreed, John; Williams, Martin

2008-01-01

This guidance document is a reference for air quality policymakers and managers providing state-of-the-art, evidence-based information on key determinants of air quality management decisions. The document reflects the findings of five annual meetings of the NERAM (Network for Environmental Risk Assessment and Management) International Colloquium Series on Air Quality Management (2001-2006), as well as the results of supporting international research. The topics covered in the guidance document reflect critical science and policy aspects of air quality risk management including i) health effects, ii) air quality emissions, measurement and modeling, iii) air quality management interventions, and iv) clean air policy challenges and opportunities.

Summary Report of the Seventh Annual NASA/Contractors Conference on Quality and Productivity: "Total Quality Leadership"

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity on October 12-13, 1990, in Grenelefe, Florida. The panel presentations and keynote speeches revolving around the theme of 'Total Quality Leadership" provided a solid base of understanding of the importance, benefits, and principles of total quality management. The implementation of these strategies is critical if we are to effectively pursue our mission of continuous quality improvement and reliability in our products, processes, and services. The annual NASA/contractors conferences serve as catalysts for achieving success in this mission.

Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

PubMed

Jacobson, Therese M; Thompson, Susan L; Halvorson, Anna M; Zeitler, Kristine

2016-01-01

Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

Using dental care resources optimally: quality-efficiency trade-offs in a competitive private market.

PubMed

Prasad, Banuru Muralidhara; Varatharajan, D

2011-01-01

Modern lifestyle changes led to increased dental care needs in India. Consequently, there has been a sharp rise in dentist numbers. Karnataka state alone produces 2,500 dentists annually, who are engaged in the non-government sector owing to inadequate public sector opportunities. This article aims to assess Karnataka private dental clinic quality and efficiency. Dentists were interviewed using a close-ended, structured interview schedule and their clinics were assessed using a checklist adopted from guidelines for providing machinery and equipment under the National Oral Health Care Programme (NOHCP). Dental "hotel" and clinical quality were scored based on this checklist. Clinical quality was "excellent" in 12 per cent of clinics and poor in 49 per cent. Clinics with better infrastructure charged higher price (p < 0.05). Multi-chair clinics charging fixed rates were high (81 per cent). According to 59.5 per cent of dentists, competition did not improve quality while 27 per cent felt that competition increased price, not quality. About 30.9 per cent of the poor quality clinics, 41 per cent average quality clinics and 26 per cent good quality clinics were technically efficient. The multi chair clinics offered better quality at higher prices and single chair clinics provided poorer quality at lower prices. In other words, they had a sub-optimal price-quality mix. Therefore, there is a need to regulate price and quality in all clinics to arrive at an optimal price-quality mix so that clients are not overburdened financially even while receiving good quality dental care. The article advocates that resources are used optimally as a way to achieve value for money and to achieve break-even points thereby providing quality care in a competitive market. Factors that influence dental practitioner behaviour are evaluated.

Economic models for prevention: making a system work for patients

PubMed Central

2015-01-01

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality. PMID:26391814

A comparative study of quality and safety of Atlantic cod (Gadus morhua) fillets during cold storage, as affected by different thawing methods of pre‐rigor frozen headed and gutted fish

PubMed Central

Jónsson, Ásbjörn; Backi, Christoph Josef; Lunestad, Bjørn Tore; Karlsdóttir, Magnea G

2017-01-01

Abstract BACKGROUND The catch of marine whitefish is typically seasonal, whereas the land‐based processing industry has a need for all‐year stable supply of raw materials. This challenge can be met by applying fish frozen at sea. When using frozen fish, the methods employed for thawing may influence the safety and quality of the final product. This study aimed to investigate the applicability of novel thawing strategies in order to provide an all‐year supply of high‐quality and safe cod products. RESULTS Comparative investigations of quality and safety factors after thawing in water, with and without air circulation, and contact thawing were performed. The parameters included water‐holding capacity, thawing loss, drip loss, cooking yield, sensory evaluation and microbiological analyses (including total volatile bases nitrogen). Water thawing with air circulation provided faster thawing than water thawing without air circulation and contact thawing. For all three methods, the quality of the thawed fish was acceptable and the shelf life of the fillets during chilled storage was between 10 and 14 days post‐filleting. CONCLUSION The results show that controlled freezing of cod, followed by appropriate thawing, may provide the processing industry with an all‐year delivery of raw materials, without compromising quality and safety of the final product. © 2017 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:28862323

Recent progress in the development of ISO 19751

NASA Astrophysics Data System (ADS)

Farnand, Susan P.; Dalal, Edul N.; Ng, Yee S.

2006-01-01

A small number of general visual attributes have been recognized as essential in describing image quality. These include micro-uniformity, macro-uniformity, colour rendition, text and line quality, gloss, sharpness, and spatial adjacency or temporal adjacency attributes. The multiple-part International Standard discussed here was initiated by the INCITS W1 committee on the standardization of office equipment to address the need for unambiguously documented procedures and methods, which are widely applicable over the multiple printing technologies employed in office applications, for the appearance-based evaluation of these visually significant image quality attributes of printed image quality. 1,2 The resulting proposed International Standard, for which ISO/IEC WD 19751-1 3 presents an overview and an outline of the overall procedure and common methods, is based on a proposal that was predicated on the idea that image quality could be described by a small set of broad-based attributes. 4 Five ad hoc teams were established (now six since a sharpness team is in the process of being formed) to generate standards for one or more of these image quality attributes. Updates on the colour rendition, text and line quality, and gloss attributes are provided.

Conformance Testing: Measurement Decision Rules

NASA Technical Reports Server (NTRS)

Mimbs, Scott M.

2010-01-01

The goal of a Quality Management System (QMS) as specified in ISO 9001 and AS9100 is to provide assurance to the customer that end products meet specifications. Measuring devices, often called measuring and test equipment (MTE), are used to provide the evidence of product conformity to specified requirements. Unfortunately, processes that employ MTE can become a weak link to the overall QMS if proper attention is not given to the measurement process design, capability, and implementation. Documented "decision rules" establish the requirements to ensure measurement processes provide the measurement data that supports the needs of the QMS. Measurement data are used to make the decisions that impact all areas of technology. Whether measurements support research, design, production, or maintenance, ensuring the data supports the decision is crucial. Measurement data quality can be critical to the resulting consequences of measurement-based decisions. Historically, most industries required simplistic, one-size-fits-all decision rules for measurements. One-size-fits-all rules in some cases are not rigorous enough to provide adequate measurement results, while in other cases are overly conservative and too costly to implement. Ideally, decision rules should be rigorous enough to match the criticality of the parameter being measured, while being flexible enough to be cost effective. The goal of a decision rule is to ensure that measurement processes provide data with a sufficient level of quality to support the decisions being made - no more, no less. This paper discusses the basic concepts of providing measurement-based evidence that end products meet specifications. Although relevant to all measurement-based conformance tests, the target audience is the MTE end-user, which is anyone using MTE other than calibration service providers. Topics include measurement fundamentals, the associated decision risks, verifying conformance to specifications, and basic measurement decisions rules.

Effect-Based Screening Methods for Water Quality Characterization Will Augment Conventional Analyte-by-Analyte Chemical Methods in Research As Well As Regulatory Monitoring

EPA Science Inventory

Conventional approaches to water quality characterization can provide data on individual chemical components of each water sample. This analyte-by-analyte approach currently serves many useful research and compliance monitoring needs. However these approaches, which require a ...

Using Total Quality Management Principles To Implement School-Based Management.

ERIC Educational Resources Information Center

Terry, Paul M.

Those engaged in school restructuring can find direction in the philosophy of W. Edwards Deming, which has guided the operations of many American corporations. This paper provides an overview of Deming's Fourteen Points of Total Quality Management (TQM) and discusses their applications to education. To develop a successful TQM system, the school…

Factors Affecting Success of Training Companies

ERIC Educational Resources Information Center

Rogala, Piotr; Batko, Roman; Wawak, Slawomir

2017-01-01

This study aims to identify the key factors which influence the functioning quality and success of training companies. Based on an analysis of the requirements included in the quality management system standards for providers of education and training services, a set of twenty factors has been developed. This was followed by a survey for…

Quality Internships for School Leaders: Meeting the Challenge

ERIC Educational Resources Information Center

Gaudreau, Patricia A.; Kufel, Andrew P.; Parks, David J.

2006-01-01

An internship is essential for the development of competency-based leadership. Variation in the quality of time spent in clinical settings depends on the use of approaches that provide interns with opportunities to observe, participate in, and reflect on the problems of leadership and management found in schools. In essence, the internship is an…

Finding Quality Geometry Apps: Not as Simple as a[superscript 2] + b[superscript 2] = c[superscript 2

ERIC Educational Resources Information Center

Larkin, Kevin

2016-01-01

Trying to find quality apps for use in mathematics classes can be time consuming and bewildering. This article outlines a process for evaluating apps and provides teachers with access to comprehensive qualitative evaluations of 53 geometrical apps based on pedagogical, mathematical and cognitive fidelities.

Understanding quality improvement is more important now than ever before.

PubMed

Watkins, R W

2014-01-01

With provider payments being adjusted for performance and emphasis being placed on value-based care, large health care systems are already developing the resources necessary to pursue quality improvement (QI) in their practices. This article explains why smaller and/or rural practices also need to learn about and implement QI.

DEVELOPMENT OF QUALITY ASSURANCE AND QUALITY CONTROL GUIDANCE FOR GROUND-BASED REMOTE SENSORS FOR USE IN REGULATORY MONITORING

EPA Science Inventory

The U.S. Environmental Protection Agency's (EPA) authority for enhanced monitoring activities is provided for in Title I, Section 182 of the Clean Air Act Amendment of 1990. or example, the Photochemical Assessment Monitoring Station (PAMS) network is one such program which requi...

Dewey: A Panacea for the 'Schoolification' Epidemic

ERIC Educational Resources Information Center

Ring, Emer; O'Sullivan, Lisha

2018-01-01

High quality early years' education is associated with providing a child-centred curriculum based on a knowledge of how young children learn. The global 'schoolification epidemic' has led to an increasing focus on prescribed curricula and presents as a serious threat to the quality of children's early years' experiences. Findings from research in…

Infant and Toddler Child Care Quality Measures: Bibliography

ERIC Educational Resources Information Center

Ferguson, Daniel

2016-01-01

The Research Connections collection contains records for more than 1,300 instruments that have been used to conduct studies in the child care and early education field. This bibliography provides records for instruments in the collection that can be used to observe child care quality in center-based settings serving infants and toddlers. In…

Strategic Plan. Vermont State Board of Education: Department of Education

ERIC Educational Resources Information Center

Vermont Department of Education, 2004

2004-01-01

The five-year plan is expressed in the five goals listed below, which are based on the respective Board and department roles and responsibilities. (1) Support high-quality, innovative instruction to improve student achievement; (2) Provide and promote high-quality educational leadership; (3) Promote safe and positive learning environments; (4)…

Well-construction, water-level, geophysical, and water-quality data for ground-water monitoring wells for Arnold Air Force Base, Tennessee

USGS Publications Warehouse

Hough, C.J.; Mahoney, E.N.; Robinson, J.A.

1992-01-01

Sixty-five wells were installed at 39 sites in the Arnold Air Force Base area in Coffee and Franklin Counties, Tennessee. The wells were installed to provide information on subsurface lithology, aquifer characteristics, ground-water levels, and ground-water quality. Well depths ranged from 11 to 384 feet. Water-quality samples were collected from 60 wells and analyzed for common inorganic ions, trace metals, and volatile organic compounds. The median dissolved-solids concentrations were 60 milligrams per liter in the shallow aquifer, 48 million gallons per liter in the Manchester aquifer, 1,235 milligrams per liter in the Fort Payne aquifer, and 1,712 milligrams per liter in the upper Central Basin aquifer. Caliper, temperature, natural gamma, electric, neutron porosity, gamma-gamma density, and acoustic velocity borehole-geophysical logs were obtained for the six deep wells completed below the Chattanooga Shale. Petrographic and modal analysis were performed on rock samples from each deep well. These six deep wells provide the first information in the study area on hydraulic head and water quality from below the Chattanooga Shale.

Application of a tablet film coating model to define a process-imposed transition boundary for robust film coating.

PubMed

van den Ban, Sander; Pitt, Kendal G; Whiteman, Marshall

2018-02-01

A scientific understanding of interaction of product, film coat, film coating process, and equipment is important to enable design and operation of industrial scale pharmaceutical film coating processes that are robust and provide the level of control required to consistently deliver quality film coated product. Thermodynamic film coating conditions provided in the tablet film coating process impact film coat formation and subsequent product quality. A thermodynamic film coating model was used to evaluate film coating process performance over a wide range of film coating equipment from pilot to industrial scale (2.5-400 kg). An approximate process-imposed transition boundary, from operating in a dry to a wet environment, was derived, for relative humidity and exhaust temperature, and used to understand the impact of the film coating process on product formulation and process control requirements. This approximate transition boundary may aid in an enhanced understanding of risk to product quality, application of modern Quality by Design (QbD) based product development, technology transfer and scale-up, and support the science-based justification of critical process parameters (CPPs).

Disaster mental health training programmes in New York City following September 11, 2001.

PubMed

Gill, Kimberly B; Gershon, Robyn R

2010-07-01

The need for mental health resources to provide care to the community following large-scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community-based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided.

Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review

PubMed Central

Prince, Lisa K.; Little, Dustin J.; Schexneider, Katherine I.

2017-01-01

The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice–based learning and systems–based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty–specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty–specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology–specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds—specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved nephrology clinical care within the institution and introduced new educational and assessment tools to the training program. All have been opportunities for quality improvement scholarship. The curriculum prepares fellows to apply quality improvement principals in independent clinical practice—while showing milestone advancement and divisional compliance with Clinical Learning Environment Review requirements. PMID:28174318

Implementing the NPDES program: An update on the WET ...

EPA Pesticide Factsheets

The U.S. EPA has utilized the Clean Water Act - National Pollutant Discharge Elimination System permitting program to protect waters of the U.S for over 40 years. NPDES permit effluent limitations serve as the primary mechanism for controlling discharges of pollutants to receiving waters. When developing effluent limitations for an NPDES permit, a permit writer must consider limits based on both the technology available to control the pollutants (i.e., technology-based effluent limits) and limits that are protective of the water quality standards of the receiving water (i.e., water quality-based effluent limits). WET testing is one of the water quality-based effluent limitation mechanisms available to permit writers that is useful in determining how the additive, synergistic and compounding effects of toxic effluents effect streams. This presentation will provide an overview of the current EPA NPDES permit program direction for increasing the efficacy of NPDES permits program administered by the U.S. EPA and States. The training implementation plan is expected to provide permit writers with a clearer understanding of WET requirements as established via the U.S. EPA WET test manuals, NPDES permitting regulatory authorities, and the WET science which has been long established. not applicable

[Construction of NIRS-based total quality control system for compound Ejiao oral liquid and relative thinking].

PubMed

Zhang, Yan; Zhang, Lu; Tian, Shou-Sheng; Zhou, Xiang-Shan; Li, Wen-Long; Qu, Hai-Bin

2016-10-01

In this paper, near infrared spectroscopy (NIRS)-based total quality control system of compound Ejiao oral liquid is introduced briefly, including the quality control of raw traditional Chinese medicine (TCM) materials, monitoring and control of the extract and the alkaline precipitation technics, and also the inspection of finished products in both open bottle and non-opening modes. By analyzing and summing up the significance and difficulties, several important problems in the practical applications of NIRS technology are proposed, which will provide references for the similar studies of other TCM products. Copyright© by the Chinese Pharmaceutical Association.

Analysis of evidence within the AUA's clinical practice guidelines.

PubMed

Antoine, Samuel G; Small, Alexander C; McKiernan, James M; Shah, Ojas

2018-02-01

Surgical subspecialty societies release clinical practice guidelines (CPGs) to provide topic-specific recommendations to healthcare providers. We hypothesize that there may be significant differences in statement strength and evidence quality both within the American Urological Association (AUA) guidelines and compared to those published by the American Academy of Orthopedic Surgeons (AAOS) and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). CPGs issued through 2017 were extracted from the AUAnet.org. Statements were characterized by evidence basis, strength, and evidence quality. CPGs were compared among urologic subspecialties and to those from the AAOS and AAO-HNS. Analysis used Fisher's exact tests and Student's t-tests with significance p < 0.05. A total of 25 AUA CPGs (672 statements) were reviewed and 34.6% were non-evidence based with the highest proportions in pediatrics (47.5%) and sexual medicine (46.5%). The AUA has published over twice as many statements as the AAOS and quadruple that of the AAO-HNS. A smaller proportion of the AUA statements were evidence-based (65.4%) compared to the AAOS (80.5%, p < 0.001) and AAO-HNS (99.8%, p < 0.001), and fewer used "high" quality evidence (AUA 7.2% versus AAOS 21.2%, p < 0.001; versus AAO-HNS 16.1%, p < 0.001). The AUA has published broad CPGs that far exceed those from the AAOS and AAO-HNS. The AUA has utilized extensive resources to provide guidance to help standardize care among urologists. The AAOS and AAO-HNS may not provide guidelines when evidence is limited. With the continued increase of high quality clinical trials, the AUA will be able to continue improving its robust set of evidence-based CPGs.

Web-based provision of information on infectious diseases: a systems study.

PubMed

Roy, Anjana; Kostkova, Patty; Catchpole, Michael; Carson, Ewart

2006-12-01

The National electronic Library for Health (NeLH) is an Internet medical information resources portal, principally for healthcare professionals, within which the National electronic Library of Infection (NeLI) is one of NeLH Specialist Libraries providing evidence on infectious diseases. In this article, we describe a systems-based evaluation of NeLI based on a soft systems methodology. User feedback and other data for the analysis were obtained using online questionnaires. This evaluation, which is a pilot study aimed at demonstrating proof of concept, provided evidence for improving three systems that are crucial to effective NeLI provision. These are navigation of the site, quality and tagging of information provided by NeLI, and information regarding users and their usage of the system. On the basis of a soft systems analysis, an action plan was formulated identifying areas where improvement is needed. Actions for consideration included simplifying terminologies to improve the navigation, enhancing the provision of research assessments, quality tagging NeLI documents, provided by experts in the field, and attracting a broader cross-section of healthcare professional user.

Scientifically Based Reading Research Strategies in the Preschool Classroom: An Investigation into Quality Early Childhood Reading Practices and Literacy Acquisition in One Northern Michigan Early Reading First Program

ERIC Educational Resources Information Center

McCool, Yvonne Donohoe

2013-01-01

A growing body of research has emerged to support the concept of providing early childhood education as a quality investment for our children, unlocking early potential and creating lasting impacts related to school success and beyond. Several landmark studies indicated that a quality education targeted at our youngest learners has the ability to…

An exploratory study of live vs. web-based delivery of a phlebotomy program.

PubMed

Fydryszewski, Nadine A; Scanlan, Craig; Guiles, H Jesse; Tucker, Ann

2010-01-01

Changes in student population and increased Web-based education offerings provided the impetus to assess pedagogy, cognitive outcomes and perceptions of course quality. This study explored cognitive outcomes and students' perception of course quality related to the Seven Principles for Good Practice in Undergraduate Education between live classroom delivery, compared to a Web-based delivery of a phlebotomy program. Quasi-experimental; students self-selected to enroll in live or Web-based program. For cognitive outcomes, no significant difference was found between the groups. Student perception of course quality differed only for Principle One (student-instructor contact). Students in the live classroom rated Principle One higher for the Part I course compared to the Web-based group. For the Part II course, there was no significant difference in perception of course quality related to any of the Seven Principles. The more constructivist pedagogy in the Part II course did not improve cognitive outcomes however, it may have contributed to knowledge retention. The live group rated Principle One in the Part II course evaluation relatively the same as they did for the Part I course evaluation. However, the Web-based group rated Principle One considerable higher for the Part II course than for Part I course. Future studies with a larger sample could explore improved course quality assessment instruments.

Development of Quality Indicators to Address Abuse and Neglect in Home-Based Primary Care and Palliative Care.

PubMed

Sheehan, Orla C; Ritchie, Christine S; Fathi, Roya; Garrigues, Sarah K; Saliba, Debra; Leff, Bruce

2016-12-01

To develop candidate quality indicators (QIs) for the quality standard of "addressing abuse and neglect" in the setting of home-based medical care. Systematic literature review of both the peer-reviewed and gray literature. Home-based primary and palliative care practices. Homebound community-dwelling older adults. Articles were identified to inform the development of candidate indicators of the quality by which home-based primary and palliative care practices addressed abuse and neglect. The literature guided the development of patient-level QIs and practice-level quality standards. A technical expert panel (TEP) representing exemplary home-based primary care and palliative care providers then participated in a modified Delphi process to assess the validity and feasibility of each measure and identify candidate QIs suitable for testing in the field. The literature review yielded 4,371 titles and abstracts that were reviewed; 25 publications met final inclusion criteria and informed development of nine candidate QIs. The TEP rated all but one of the nine candidate indicators as having high validity and feasibility. Translating the complex problem of addressing abuse and neglect into QIs may ultimately serve to improve care delivered to vulnerable home-limited adults who receive home-based medical care. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

The National Accreditation Board for Hospital and Health Care Providers accreditation programme in India.

PubMed

Gyani, Girdhar J; Krishnamurthy, B

2014-01-01

Quality in health care is important as it is directly linked with patient safety. Quality as we know is driven either by regulation or by market demand. Regulation in most developing countries has not been effective, as there is shortage of health care providers and governments have to be flexible. In such circumstances, quality has taken a back seat. Accreditation symbolizes the framework for quality governance of a hospital and is based on optimum standards. Not only is India establishing numerous state of the art hospitals, but they are also experiencing an increase in demand for quality as well as medical tourism. India launched its own accreditation system in 2006, conforming to standards accredited by ISQua. This article shows the journey to accreditation in India and describes the problems encountered by hospitals as well as the benefits it has generated for the industry and patients.

Insurers' medical loss ratios and quality improvement spending in 2011.

PubMed

Hall, Mark A; McCue, Michael J

2013-03-01

The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.

Quality Indicators in Radiation Oncology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Albert, Jeffrey M.; Das, Prajnan, E-mail: prajdas@mdanderson.org

Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts tomore » define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the “big picture” of oncologic quality assessment efforts.« less

MO-E-9A-01: Risk Based Quality Management: TG100 In Action

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huq, M; Palta, J; Dunscombe, P

2014-06-15

One of the goals of quality management in radiation therapy is to gain high confidence that patients will receive the prescribed treatment correctly. To accomplish these goals professional societies such as the American Association of Physicists in Medicine (AAPM) has published many quality assurance (QA), quality control (QC), and quality management (QM) guidance documents. In general, the recommendations provided in these documents have emphasized on performing device-specific QA at the expense of process flow and protection of the patient against catastrophic errors. Analyses of radiation therapy incidents find that they are most often caused by flaws in the overall therapymore » process, from initial consult through final treatment, than by isolated hardware or computer failures detectable by traditional physics QA. This challenge is shared by many intrinsically hazardous industries. Risk assessment tools and analysis techniques have been developed to define, identify, and eliminate known and/or potential failures, problems, or errors, from a system, process and/or service before they reach the customer. These include, but are not limited to, process mapping, failure modes and effects analysis (FMEA), fault tree analysis (FTA), and establishment of a quality management program that best avoids the faults and risks that have been identified in the overall process. These tools can be easily adapted to radiation therapy practices because of their simplicity and effectiveness to provide efficient ways to enhance the safety and quality of treatment processes. Task group 100 (TG100) of AAPM has developed a risk-based quality management program that uses these tools. This session will be devoted to a discussion of these tools and how these tools can be used in a given radiotherapy clinic to develop a risk based QM program. Learning Objectives: Learn how to design a process map for a radiotherapy process. Learn how to perform a FMEA analysis for a given process. Learn what Fault tree analysis is all about. Learn how to design a quality management program based upon the information obtained from process mapping, FMEA and FTA.« less

Review and Evaluation of Mindfulness-Based iPhone Apps

PubMed Central

Kavanagh, David J; Hides, Leanne; Stoyanov, Stoyan R

2015-01-01

Background There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness. PMID:26290327

Review and Evaluation of Mindfulness-Based iPhone Apps.

PubMed

Mani, Madhavan; Kavanagh, David J; Hides, Leanne; Stoyanov, Stoyan R

2015-08-19

There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. A search for "mindfulness" was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. The "mindfulness" search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness.

Methods for the guideline-based development of quality indicators--a systematic review

PubMed Central

2012-01-01

Background Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development. Methods We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables. Results From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement. Conclusions Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork. PMID:22436067

[En bloc resection and vaporization techniques for the treatment of bladder cancer].

PubMed

Struck, J P; Karl, A; Schwentner, C; Herrmann, T R W; Kramer, M W

2018-04-12

Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization). The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes. A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors. In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90-100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting. ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.

Introducing annuals in grazed pastures

USDA-ARS?s Scientific Manuscript database

Annual cover crops provide ecosystem benefits to perennial-based pasture systems by introducing quality forage at opportune times of the year, creating a more diverse farm habitat, and providing opportunities to renovate overused or underutilized areas of the farm. This workshop will cover opportun...

Guiding principles and checklist for population-based quality metrics.

PubMed

Krishnan, Mahesh; Brunelli, Steven M; Maddux, Franklin W; Parker, Thomas F; Johnson, Douglas; Nissenson, Allen R; Collins, Allan; Lacson, Eduardo

2014-06-06

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. Copyright © 2014 by the American Society of Nephrology.

Interprofessional Care and Teamwork in the ICU.

PubMed

Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

2018-06-01

We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.

Dynamic selection mechanism for quality of service aware web services

NASA Astrophysics Data System (ADS)

D'Mello, Demian Antony; Ananthanarayana, V. S.

2010-02-01

A web service is an interface of the software component that can be accessed by standard Internet protocols. The web service technology enables an application to application communication and interoperability. The increasing number of web service providers throughout the globe have produced numerous web services providing the same or similar functionality. This necessitates the use of tools and techniques to search the suitable services available over the Web. UDDI (universal description, discovery and integration) is the first initiative to find the suitable web services based on the requester's functional demands. However, the requester's requirements may also include non-functional aspects like quality of service (QoS). In this paper, the authors define a QoS model for QoS aware and business driven web service publishing and selection. The authors propose a QoS requirement format for the requesters, to specify their complex demands on QoS for the web service selection. The authors define a tree structure called quality constraint tree (QCT) to represent the requester's variety of requirements on QoS properties having varied preferences. The paper proposes a QoS broker based architecture for web service selection, which facilitates the requesters to specify their QoS requirements to select qualitatively optimal web service. A web service selection algorithm is presented, which ranks the functionally similar web services based on the degree of satisfaction of the requester's QoS requirements and preferences. The paper defines web service provider qualities to distinguish qualitatively competitive web services. The paper also presents the modelling and selection mechanism for the requester's alternative constraints defined on the QoS. The authors implement the QoS broker based system to prove the correctness of the proposed web service selection mechanism.

A Quality Screening Service for Remote Sensing Data

NASA Technical Reports Server (NTRS)

Lynnes, Christopher; Olsen, Edward; Fox, Peter; Vollmer, Bruce; Wolfe, Robert; Samadi, Shahin

2010-01-01

NASA provides a wide variety of Earth-observing satellite data products to a diverse community. These data are annotated with quality information in a variety of ways, with the result that many users struggle to understand how to properly account for quality when dealing with satellite data. To address this issue, a Data Quality Screening Service (DQSS) is being implemented for a number of datasets. The DQSS will enable users to obtain data files in which low-quality pixels have been filtered out, based either on quality criteria recommended by the science team or on the user s particular quality criteria. The objective is to increase proper utilization of this critical quality data in science data analysis of satellite data products.

Providing Total Quality Fundamentals: 1995 Workshops for the NASA Lewis Research Center's Technical Services Directorate

NASA Technical Reports Server (NTRS)

Antczak, Paul; Jacinto,Gilda; Simek, Jimmy

1997-01-01

The National Aeronautics and Space Administration's (NASA) agency-wide movement to cultivate a quality workplace is the basis for Lewis Research Center to implement Total Quality Fundamentals (TQF) initiatives. The Lewis Technical Services Directorate (TSD) introduced the Total Quality Fundamentals (TQF) workshops to its work force as an opportunity to introduce the concepts and principles of TQF. These workshops also provided the participants with the opportunity to dialogue with fellow TSD employees and managers. This report describes, through the perspective of the Lewis TSD TQF Coaches, how the TQF work- shop process was accomplished in TSD. It describes the structure for addressing the need, implementation process, input the TSD Coaches provided, common themes and concerns raised, conclusions, and recommendations. The Coaches concluded that these types of workshops could be the key to open the communication channels that are necessary to help everyone at Lewis understand where they fit in the organization. TQF workshops can strengthen the participant's connection with the Mission, Vision of the Center, and Vision of the Agency. Reconunendations are given based on these conclusions that can help the TSD Quality Board develop attainable measures towards a quality workplace.

Certification of production-quality gLite Job Management components

NASA Astrophysics Data System (ADS)

Andreetto, P.; Bertocco, S.; Capannini, F.; Cecchi, M.; Dorigo, A.; Frizziero, E.; Giacomini, F.; Gianelle, A.; Mezzadri, M.; Molinari, E.; Monforte, S.; Prelz, F.; Rebatto, D.; Sgaravatto, M.; Zangrando, L.

2011-12-01

With the advent of the recent European Union (EU) funded projects aimed at achieving an open, coordinated and proactive collaboration among the European communities that provide distributed computing services, more strict requirements and quality standards will be asked to middleware providers. Such a highly competitive and dynamic environment, organized to comply a business-oriented model, has already started pursuing quality criteria, thus requiring to formally define rigorous procedures, interfaces and roles for each step of the software life-cycle. This will ensure quality-certified releases and updates of the Grid middleware. In the European Middleware Initiative (EMI), the release management for one or more components will be organized into Product Team (PT) units, fully responsible for delivering production ready, quality-certified software and for coordinating each other to contribute to the EMI release as a whole. This paper presents the certification process, with respect to integration, installation, configuration and testing, adopted at INFN by the Product Team responsible for the gLite Web-Service based Computing Element (CREAM CE) and for the Workload Management System (WMS). The used resources, the testbeds layout, the integration and deployment methods, the certification steps to provide feedback to developers and to grant quality results are described.

Monitoring Error Rates In Illumina Sequencing.

PubMed

Manley, Leigh J; Ma, Duanduan; Levine, Stuart S

2016-12-01

Guaranteeing high-quality next-generation sequencing data in a rapidly changing environment is an ongoing challenge. The introduction of the Illumina NextSeq 500 and the depreciation of specific metrics from Illumina's Sequencing Analysis Viewer (SAV; Illumina, San Diego, CA, USA) have made it more difficult to determine directly the baseline error rate of sequencing runs. To improve our ability to measure base quality, we have created an open-source tool to construct the Percent Perfect Reads (PPR) plot, previously provided by the Illumina sequencers. The PPR program is compatible with HiSeq 2000/2500, MiSeq, and NextSeq 500 instruments and provides an alternative to Illumina's quality value (Q) scores for determining run quality. Whereas Q scores are representative of run quality, they are often overestimated and are sourced from different look-up tables for each platform. The PPR's unique capabilities as a cross-instrument comparison device, as a troubleshooting tool, and as a tool for monitoring instrument performance can provide an increase in clarity over SAV metrics that is often crucial for maintaining instrument health. These capabilities are highlighted.

Solar Technology Acceleration Center (SolarTAC): Solar Resource & Meteorological Assessment Project (SOLRAMP)

DOE Data Explorer

Andreas, Afshin; Wilcox, Steve

2016-03-14

Located in Colorado, near Denver International Airport, SolarTAC is a private, member-based, 74-acre outdoor facility where the solar industry tests, validates, and demonstrates advanced solar technologies. SolarTAC was launched in 2008 by a public-private consortium, including Midwest Research Institute (MRI). As a supporting member of SolarTAC, the U.S. Department of Energy National Renewable Energy Laboratory (NMREL) has established a high quality solar and meteorological measurement station at this location. This Solar Resource and Meteorological Assessment Project (SOLRMAP) provides high quality measurements to support deployment of power projects in the United States. The no-funds-exchanged collaboration brings NREL solar resource assessment expertise together with industry needs for measurements. The end result is high quality data sets to support the financing, design, and monitoring of large scale solar powered projects for industry in addition to research-quality data for NREL model development. NREL provides consultation for instrumentation and station deployment, along with instrument calibrations, data acquisition, quality assessment, data distribution, and summary reports. Industry participants provide equipment, infrastructure, and station maintenance.

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Is non-linear frequency compression amplification beneficial to adults and children with hearing loss? A systematic review.

PubMed

Akinseye, Gladys Atinuke; Dickinson, Ann-Marie; Munro, Kevin J

2018-04-01

To conduct a systematic review of the benefits of non-linear frequency compression (NLFC) in adults and children. Ten databases were searched for studies comparing the effects of NLFC and conventional processing (CP) for the period January 2008 to September 2017. Twelve articles were included in this review: four adults and school-aged only, one pre-school only and three with both adults and school-aged children. A two-stage process was implemented to grade the evidence. The individual studies were graded based on their study type (from 1 = highest quality of evidence to 5 = the lowest quality) and then sub-graded based on their quality ("a" for "good quality" or "b" for "lesser quality"). All studies were awarded 4a, except the single pre-school study, which was awarded 2a. The overall evidence for each population was graded based on the quality, quantity and consistency of the studies. The body of evidence was rated as very low for both adults and school-aged children, but high for pre-school children. The low number (and quality) of studies means that evidence supporting the benefit from NLFC is inconclusive. Further high-quality RCTs are required to provide a conclusive answer to this question.

How organizations can enhance the quality of life of their clients and assess their results: the concept of QOL enhancement.

PubMed

Reinders, Hans S; Schalock, Robert L

2014-07-01

This article presents the framework of a dynamic approach to quality of life (QOL) enhancement based on the conceptualization and measurement of individual-referenced quality of life. Sections of the article summarize the premises of QOL enhancement, provide the rationale for a dynamic approach to QOL enhancement, discuss six components of QOL enhancement, and discuss the parameters of an emerging theory of quality of life and the contributions such a theory would make to service delivery, policy development, and QOL-related research.

FUNDAMENTAL AREAS OF PHENOMENOLOGY(INCLUDING APPLICATIONS): Experimental Investigation of Quality of Lensless Ghost Imaging with Pseudo-Thermal Light

NASA Astrophysics Data System (ADS)

Shen, Xia; Bai, Yan-Feng; Qin, Tao; Han, Shen-Sheng

2008-11-01

Factors influencing the quality of lensless ghost imaging are investigated. According to the experimental results, we find that the imaging quality is determined by the number of independent sub light sources on the imaging plane of the reference arm. A qualitative picture based on advanced wave optics is presented to explain the physics behind the experimental phenomena. The present results will be helpful to provide a basis for improving the quality of ghost imaging systems in future works.

[In-house team seminars: working together as a team--from data and statistics to quality development].

PubMed

Berlage, Silvia; Wenzlaff, Paul; Damm, Gabriele; Sens, Brigitte

2010-01-01

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Surface segregation effects of erbium in GaAs growth and their implications for optical devices containing ErAs nanostructures

NASA Astrophysics Data System (ADS)

Crook, Adam M.; Nair, Hari P.; Bank, Seth R.

2011-03-01

We report on the integration of semimetallic ErAs nanoparticles with high optical quality GaAs-based semiconductors, grown by molecular beam epitaxy. Secondary ion mass spectrometry and photoluminescence measurements provide evidence of surface segregation and incorporation of erbium into layers grown with the erbium cell hot, despite the closed erbium source shutter. We establish the existence of a critical areal density of the surface erbium layer, below which the formation of ErAs precipitates is suppressed. Based upon these findings, we demonstrate a method for overgrowing ErAs nanoparticles with III-V layers of high optical quality, using subsurface ErAs nanoparticles as a sink to deplete the surface erbium concentration. This approach provides a path toward realizing optical devices based on plasmonic effects in an epitaxially-compatible semimetal/semiconductor system.

Do doctors under-provide, over-provide or do both? Exploring the quality of medical treatment in the Philippines.

PubMed

James, C D; Hanson, K; Solon, O; Whitty, C J M; Peabody, J

2011-08-01

To assess the quality of medical treatment by disaggregating quality into components that distinguish between insufficient and unnecessary care. Randomly selected doctors were asked how they would treat a sick child. Their responses were disaggregated into how much of an evidence-based essential treatment plan was completed and the number of additional non-essential treatments that were given. Key variables included the expected cost, the health consequences of insufficient and unnecessary care and comparisons between public and private physicians. Responses to 160 clinical performance vignettes (CPVs) were analysed. Philippines. One hundred and forty-three public and private physicians in the Philippines, collected in November 2003-December 2004 and September 2006-June 2007. CPVs administered to physicians. Process quality measures (accounting for the possibility of both over-treatment and under-treatment). Based on CPVs, doctors gave both insufficient and unnecessary treatment to under-five children in 69% of cases. Doctors who provided the least sufficient care were also the most likely to give costly or harmful unnecessary care. Insufficient care typically had potentially worse health consequences for the patient than unnecessary care, though unnecessary care remains a concern because of overuse of antibiotics (47%) and unnecessary hospitalization (34%). Quality of care is complex, but over- and under-treatment coexist and, in our analysis physicians that were more likely to under-treat a sick child were also those more likely to over-treat.

Structural barriers to South African volunteer home-based caregivers providing quality care: the need for a policy for caregivers not affiliated to primary healthcare clinics.

PubMed

Morton, David; Mayekiso, Thoko; Cunningham, Peter

2018-03-01

Community home-based care (CHBC) is a critical component of non-formal care in communities in Africa that have a high prevalence of HIV and tuberculosis (TB). Community carers consisting primarily of volunteers are critical role players in African healthcare systems and particularly in South Africa's strategy to fight HIV and AIDS. This paper explores the structural barriers volunteer caregivers need to overcome to provide quality CHBC. The researchers used two focus group discussions with key informants (each with four participants), and semi-structured interviews with six key informants to collect data relating to the meaning of quality CHBC. The data were coded using Tesch's data analysis technique. A major theme that emerged from the results was "Addressing structural challenges to improve the quality of CHBC". Subthemes underpinning this theme were: 1) lack of standardised training of volunteer caregivers; 2) the need for a scope of practice, parameters and legal boundaries; 3) lack of monitoring and evaluation (M&E) of CHBC; and 4) the importance of mentoring and supervision in CHBC. CHBC policy should address the need for standardised training programmes for caregivers, so that they are equipped with multiple skills. Furthermore CHBC policy must emphasise mentoring as well as M&E to encourage quality care. Finally, the policy should provide a clear scope of practice for caregivers to regulate their competencies and boundaries.

JPEG2000 encoding with perceptual distortion control.

PubMed

Liu, Zhen; Karam, Lina J; Watson, Andrew B

2006-07-01

In this paper, a new encoding approach is proposed to control the JPEG2000 encoding in order to reach a desired perceptual quality. The new method is based on a vision model that incorporates various masking effects of human visual perception and a perceptual distortion metric that takes spatial and spectral summation of individual quantization errors into account. Compared with the conventional rate-based distortion minimization JPEG2000 encoding, the new method provides a way to generate consistent quality images at a lower bit rate.

Variability in energy density of forage fishes from the Bay of Biscay (north-east Atlantic Ocean): reliability of functional grouping based on prey quality.

PubMed

Spitz, J; Jouma'a, J

2013-06-01

Energy densities of 670 fishes belonging to nine species were measured to evaluate intraspecific variability. Functional groups based on energy density appeared to be sufficiently robust to individual variability to provide a classification of forage fish quality applicable in a variety of ecological fields including ecosystem modelling. © 2013 The Authors. Journal of Fish Biology © 2013 The Fisheries Society of the British Isles.

Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement.

PubMed

Burton, Christopher R; Rycroft-Malone, Jo

2014-08-01

Evaluating the investment that healthcare organisations make in quality improvement requires knowledge of impact at multiple levels, including patient care, workforce and other organisational resources. The degree to which these resources help organisations to survive and thrive in the challenging contexts in which healthcare is designed and delivered is unknown. Investigating this question from the perspective of the Resource Based View (RBV) of the Firm may provide insights, although is not without challenge.

A deblocking algorithm based on color psychology for display quality enhancement

NASA Astrophysics Data System (ADS)

Yeh, Chia-Hung; Tseng, Wen-Yu; Huang, Kai-Lin

2012-12-01

This article proposes a post-processing deblocking filter to reduce blocking effects. The proposed algorithm detects blocking effects by fusing the results of Sobel edge detector and wavelet-based edge detector. The filtering stage provides four filter modes to eliminate blocking effects at different color regions according to human color vision and color psychology analysis. Experimental results show that the proposed algorithm has better subjective and objective qualities for H.264/AVC reconstructed videos when compared to several existing methods.

Manufacturing Bms/Iso System Review

NASA Technical Reports Server (NTRS)

Gomez, Yazmin

2004-01-01

The Quality Management System (QMS) is one that recognizes the need to continuously change and improve an organization s products and services as determined by system feedback, and corresponding management decisions. The purpose of a Quality Management System is to minimize quality variability of an organization's products and services. The optimal Quality Management System balances the need for an organization to maintain flexibility in the products and services it provides with the need for providing the appropriate level of discipline and control over the processes used to provide them. The goal of a Quality Management System is to ensure the quality of the products and services while consistently (through minimizing quality variability) meeting or exceeding customer expectations. The GRC Business Management System (BMS) is the foundation of the Center's ISO 9001:2000 registered quality system. ISO 9001 is a quality system model developed by the International Organization for Standardization. BMS supports and promote the Glenn Research Center Quality Policy and wants to ensure the customer satisfaction while also meeting quality standards. My assignment during this summer is to examine the manufacturing processes used to develop research hardware, which in most cases are one of a kind hardware, made with non conventional equipment and materials. During this process of observation I will make a determination, based on my observations of the hardware development processes the best way to meet customer requirements and at the same time achieve the GRC quality standards. The purpose of my task is to review the manufacturing processes identifying opportunities in which to optimize the efficiency of the processes and establish a plan for implementation and continuous improvement.

Adaptive compressed sensing of remote-sensing imaging based on the sparsity prediction

NASA Astrophysics Data System (ADS)

Yang, Senlin; Li, Xilong; Chong, Xin

2017-10-01

The conventional compressive sensing works based on the non-adaptive linear projections, and the parameter of its measurement times is usually set empirically. As a result, the quality of image reconstruction is always affected. Firstly, the block-based compressed sensing (BCS) with conventional selection for compressive measurements was given. Then an estimation method for the sparsity of image was proposed based on the two dimensional discrete cosine transform (2D DCT). With an energy threshold given beforehand, the DCT coefficients were processed with both energy normalization and sorting in descending order, and the sparsity of the image can be achieved by the proportion of dominant coefficients. And finally, the simulation result shows that, the method can estimate the sparsity of image effectively, and provides an active basis for the selection of compressive observation times. The result also shows that, since the selection of observation times is based on the sparse degree estimated with the energy threshold provided, the proposed method can ensure the quality of image reconstruction.

Adaptive compressed sensing of multi-view videos based on the sparsity estimation

NASA Astrophysics Data System (ADS)

Yang, Senlin; Li, Xilong; Chong, Xin

2017-11-01

The conventional compressive sensing for videos based on the non-adaptive linear projections, and the measurement times is usually set empirically. As a result, the quality of videos reconstruction is always affected. Firstly, the block-based compressed sensing (BCS) with conventional selection for compressive measurements was described. Then an estimation method for the sparsity of multi-view videos was proposed based on the two dimensional discrete wavelet transform (2D DWT). With an energy threshold given beforehand, the DWT coefficients were processed with both energy normalization and sorting by descending order, and the sparsity of the multi-view video can be achieved by the proportion of dominant coefficients. And finally, the simulation result shows that, the method can estimate the sparsity of video frame effectively, and provides an active basis for the selection of compressive observation times. The result also shows that, since the selection of observation times is based on the sparsity estimated with the energy threshold provided, the proposed method can ensure the reconstruction quality of multi-view videos.

Any qualified provider: a qualitative case study of one community NHS Trust's response

PubMed Central

Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

2016-01-01

Objective To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Design Intrinsic case study combining qualitative analysis of interviews and field notes. Setting An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013–2014. Participants NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Findings Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. Conclusions AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. PMID:26908521

Any qualified provider: a qualitative case study of one community NHS Trust's response.

PubMed

Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

2016-02-23

To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Intrinsic case study combining qualitative analysis of interviews and field notes. An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013-2014. NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.

PubMed

Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W

2012-11-19

There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

Interacting coastal based ecosystem services: recreation and water quality in Puget Sound, WA

USGS Publications Warehouse

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments.

Examining the accessibility of high-quality physical activity behaviour change support freely available online for men with prostate cancer.

PubMed

Short, Camille E; Gelder, Charlotte; Binnewerg, Lena; McIntosh, Megan; Turnbull, Deborah

2018-02-01

While the internet is considered a promising avenue for providing physical activity support to prostate cancer survivors, little is known about the accessibility of quality websites in the real world. This work aimed to explore what websites prostate cancer survivors are likely to find when seeking physical activity support online and to evaluate their quality using evidenced-based criteria. A search strategy was developed in consultation with prostate cancer survivors (n = 44) to reflect the most common ways they are likely to search the internet. The search was then conducted by a single reviewer, and identified websites were assessed for quality by two reviewers using an evidence-based quality assessment tool developed for this study. Discrepancies were resolved by a third reviewer. Of the 45 identified websites, 13 (29%) received a high quality rating, 22 (49%) received a moderate rating and 10 (22%) received a low quality rating. Higher-quality websites tended to have a .org or .gov domain and tended to be located using searches specific to prostate cancer or prostate cancer and exercise. Very few websites contained complete information regarding the physical activity guidelines for cancer survivors, and no websites provided comprehensive behaviour change support. There are some good-quality physical activity websites accessible to men with prostate cancer. However, they may be difficult to find and/or require updating to include complete recommendations and more behaviour change support. Efforts to improve physical activity information online and strategies to direct prostate cancer survivors to higher-quality websites and support services are needed to ensure safety and efficacy.

Interacting Coastal Based Ecosystem Services: Recreation and Water Quality in Puget Sound, WA

PubMed Central

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments. PMID:23451067

dictyBase 2015: Expanding data and annotations in a new software environment.

PubMed

Basu, Siddhartha; Fey, Petra; Jimenez-Morales, David; Dodson, Robert J; Chisholm, Rex L

2015-08-01

dictyBase is the model organism database for the social amoeba Dictyostelium discoideum and related species. The primary mission of dictyBase is to provide the biomedical research community with well-integrated high quality data, and tools that enable original research. Data presented at dictyBase is obtained from sequencing centers, groups performing high throughput experiments such as large-scale mutagenesis studies, and RNAseq data, as well as a growing number of manually added functional gene annotations from the published literature, including Gene Ontology, strain, and phenotype annotations. Through the Dicty Stock Center we provide the community with an impressive amount of annotated strains and plasmids. Recently, dictyBase accomplished a major overhaul to adapt an outdated infrastructure to the current technological advances, thus facilitating the implementation of innovative tools and comparative genomics. It also provides new strategies for high quality annotations that enable bench researchers to benefit from the rapidly increasing volume of available data. dictyBase is highly responsive to its users needs, building a successful relationship that capitalizes on the vast efforts of the Dictyostelium research community. dictyBase has become the trusted data resource for Dictyostelium investigators, other investigators or organizations seeking information about Dictyostelium, as well as educators who use this model system. © 2015 Wiley Periodicals, Inc.

A web tool for STORET/WQX water quality data retrieval and Best Management Practice scenario suggestion.

PubMed

Park, Youn Shik; Engel, Bernie A; Kim, Jonggun; Theller, Larry; Chaubey, Indrajeet; Merwade, Venkatesh; Lim, Kyoung Jae

2015-03-01

Total Maximum Daily Load is a water quality standard to regulate water quality of streams, rivers and lakes. A wide range of approaches are used currently to develop TMDLs for impaired streams and rivers. Flow and load duration curves (FDC and LDC) have been used in many states to evaluate the relationship between flow and pollutant loading along with other models and approaches. A web-based LDC Tool was developed to facilitate development of FDC and LDC as well as to support other hydrologic analyses. In this study, the FDC and LDC tool was enhanced to allow collection of water quality data via the web and to assist in establishing cost-effective Best Management Practice (BMP) implementations. The enhanced web-based tool provides use of water quality data not only from the US Geological Survey but also from the Water Quality Portal for the U.S. via web access. Moreover, the web-based tool identifies required pollutant reductions to meet standard loads and suggests a BMP scenario based on ability of BMPs to reduce pollutant loads, BMP establishment and maintenance costs. In the study, flow and water quality data were collected via web access to develop LDC and to identify the required reduction. The suggested BMP scenario from the web-based tool was evaluated using the EPA Spreadsheet Tool for the Estimation of Pollutant Load model to attain the required pollutant reduction at least cost. Copyright © 2014 Elsevier Ltd. All rights reserved.

Total quality management - It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle.

Development of an integrated data base for land use and water quality planning

NASA Technical Reports Server (NTRS)

Adams, J.; Vanschayk, C.; Istvan, L. B.

1977-01-01

To help understand the role played by different land resources in water quality management a computer based data system was created. The Land Resource Information System (LRIS) allows data to be readily retrieved or statistically analyzed for a variety of purposes. It is specifically formatted to perform coordination of water quality data with logy, etc. New understanding of the region gained through the use of LRIS has gone well beyond the initial purpose of assessing water quality conditions. The land use and natural features information has provided a well defined starting point for a systematic evaluation of proposed land uses, transportation, housing, and other public investments. It has laid the foundation for a comprehensive and integrated approach to many different planning and investment programs presently underway.

Evaluation of the NASA Quality Surveillance System Pilot in Meeting Requirements for Contractor Surveillance Under Performance Based Contracting

NASA Technical Reports Server (NTRS)

Schmahl, Karen E.

2002-01-01

The use of performance-based contracting at Kennedy Space Center has necessitated a shift from intrusive oversight of contractor activities to an insight surveillance role. This paper describes the results of a pilot implementation of the NASA Quality Surveillance System (NQSS) in the Space Shuttle Main Engines Processing Facility. The NQSS is a system to sample contractor activities using documented procedures, specifications, drawings and observations of work in progress to answer the question "Is the contractor doing what they said they would do?" The concepts of the NQSS are shown to be effective in providing assurance of contractor quality. Many of the concepts proven in the pilot are being considered for incorporation into an overall KSC Quality Surveillance System.

Evaluation Of The NASA Quality Surveillance System Pilot In Meeting Requirements For Contractor Surveillance Under Performance Based Contracting

NASA Technical Reports Server (NTRS)

Schmahl, Karen E.

2001-01-01

The use of performance-based contracting at Kennedy Space Center has necessitated a shift from intrusive oversight of contractor activities to an insight surveillance role. This paper describes the results of a pilot implementation of the NASA Quality Surveillance System (NQSS) in the Space Shuttle Main Engines Processing Facility. The NQSS is a system to sample contractor activities using documented procedures, specifications, drawings and observations of work in progress to answer the question "Is the contractor doing what they said they would do?" The concepts of the NQSS are shown to be effective in providing assurance of contractor quality. Many of the concepts proven in the pilot are being considered for incorporation into an overall KSC Quality Surveillance System.

Comparison of de novo assembly statistics of Cucumis sativus L.

NASA Astrophysics Data System (ADS)

Wojcieszek, Michał; Kuśmirek, Wiktor; Pawełkowicz, Magdalena; PlÄ der, Wojciech; Nowak, Robert M.

2017-08-01

Genome sequencing is the core of genomic research. With the development of NGS and lowering the cost of procedure there is another tight gap - genome assembly. Developing the proper tool for this task is essential as quality of genome has important impact on further research. Here we present comparison of several de Bruijn assemblers tested on C. sativus genomic reads. The assessment shows that newly developed software - dnaasm provides better results in terms of quantity and quality. The number of generated sequences is lower by 5 - 33% with even two fold higher N50. Quality check showed reliable results were generated by dnaasm. This provides us with very strong base for future genomic analysis.

Designing nursing excellence through a National Quality Forum nurse scholar program.

PubMed

Neumann, Julie A; Brady-Schluttner, Katherine A; Attlesey-Pries, Jacqueline M; Twedell, Diane M

2010-01-01

Closing the knowledge gap for current practicing nurses in the Institute of Medicine (IOM) core competencies is critical to providing safe patient care. The National Quality Forum (NQF) nurse scholar program is one organization's journey to close the gap in the IOM core competencies in a large teaching organization. The NQF nurse scholar program is positioned to provide a plan to assist current nurses to accelerate their learning about quality improvement, evidence-based practice, and informatics, 3 of the core competencies identified by the IOM, and focus on application of skills to NQF nurse-sensitive measures. Curriculum outline, educational methodologies, administrative processes, and aims of the project are discussed.

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... high quality, research-based, and specifically designed to increase the academic achievement of... State's approved provider list; (ii) Parent recommendations or results from parent surveys, if any... results from parent surveys regarding the success of the provider's instructional program in increasing...

Service quality of delivered care from the perception of women with caesarean section and normal delivery.

PubMed

Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal

2014-01-01

Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

Global chemical profiling based quality evaluation approach of rhubarb using ultra performance liquid chromatography with tandem quadrupole time-of-flight mass spectrometry.

PubMed

Zhang, Li; Liu, Haiyu; Qin, Lingling; Zhang, Zhixin; Wang, Qing; Zhang, Qingqing; Lu, Zhiwei; Wei, Shengli; Gao, Xiaoyan; Tu, Pengfei

2015-02-01

A global chemical profiling based quality evaluation approach using ultra performance liquid chromatography with tandem quadrupole time-of-flight mass spectrometry was developed for the quality evaluation of three rhubarb species, including Rheum palmatum L., Rheum tanguticum Maxim. ex Balf., and Rheum officinale Baill. Considering that comprehensive detection of chemical components is crucial for the global profile, a systemic column performance evaluation method was developed. Based on this, a Cortecs column was used to acquire the chemical profile, and Chempattern software was employed to conduct similarity evaluation and hierarchical cluster analysis. The results showed R. tanguticum could be differentiated from R. palmatum and R. officinale at the similarity value 0.65, but R. palmatum and R. officinale could not be distinguished effectively. Therefore, a common pattern based on three rhubarb species was developed to conduct the quality evaluation, and the similarity value 0.50 was set as an appropriate threshold to control the quality of rhubarb. A total of 88 common peaks were identified by their accurate mass and fragmentation, and partially verified by reference standards. Through the verification, the newly developed method could be successfully used for evaluating the holistic quality of rhubarb. It would provide a reference for the quality control of other herbal medicines. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Idaho

USGS Publications Warehouse

Packard, F.A.

1996-01-01

To ensure continued confidence in its products, the Water Resources Division of the U.S. Geological Survey implemented a policy that all its scientific work be performed in accordance with a centrally managed quality-assurance program. This report establishes and documents a formal policy for current (1995) quality assurance within the Idaho District of the U.S. Geological Survey. Quality assurance is formalized by describing district organization and operational responsibilities, documenting the district quality-assurance policies, and describing district functions. The districts conducts its work through offices in Boise, Idaho Falls, Twin Falls, Sandpoint, and at the Idaho National Engineering Laboratory. Data-collection programs and interpretive studies are conducted by two operating units, and operational and technical assistance is provided by three support units: (1) Administrative Services advisors provide guidance on various personnel issues and budget functions, (2) computer and reports advisors provide guidance in their fields, and (3) discipline specialists provide technical advice and assistance to the district and to chiefs of various projects. The district's quality-assurance plan is based on an overall policy that provides a framework for defining the precision and accuracy of collected data. The plan is supported by a series of quality-assurance policy statements that describe responsibilities for specific operations in the district's program. The operations are program planning; project planning; project implementation; review and remediation; data collection; equipment calibration and maintenance; data processing and storage; data analysis, synthesis, and interpretation; report preparation and processing; and training. Activities of the district are systematically conducted under a hierarchy of supervision an management that is designed to ensure conformance with Water Resources Division goals quality assurance. The district quality-assurance plan does not describe detailed technical activities that are commonly termed "quality-control procedures." Instead, it focuses on current policies, operations, and responsibilities that are implemented at the management level. Contents of the plan will be reviewed annually and updated as programs and operations change.

Value-added strategy models to provide quality services in senior health business.

PubMed

Yang, Ya-Ting; Lin, Neng-Pai; Su, Shyi; Chen, Ya-Mei; Chang, Yao-Mao; Handa, Yujiro; Khan, Hafsah Arshed Ali; Elsa Hsu, Yi-Hsin

2017-06-20

The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. A total of 33 senior health enterprises in Taiwan. Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. None. Core values and vision, organization structure, quality services provided, strategies for quality services. This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Application of online measures to monitor and evaluate multiplatform fusion performance

NASA Astrophysics Data System (ADS)

Stubberud, Stephen C.; Kowalski, Charlene; Klamer, Dale M.

1999-07-01

A primary concern of multiplatform data fusion is assessing the quality and utility of data shared among platforms. Constraints such as platform and sensor capability and task load necessitate development of an on-line system that computes a metric to determine which other platform can provide the best data for processing. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. Entropy measures quality of processed information such as localization, classification, and ambiguity in measurement-to-track association. Lower entropy scores imply less uncertainty about a particular target. When new information is provided, we compuete the level of improvement a particular track obtains from one measurement to another. The measure permits us to evaluate the utility of the new information. We couple entropy with intelligent agents that provide two main data gathering functions: estimation of another platform's performance and evaluation of the new measurement data's quality. Both functions result from the entropy metric. The intelligent agent on a platform makes an estimate of another platform's measurement and provides it to its own fusion system, which can then incorporate it, for a particular target. A resulting entropy measure is then calculated and returned to its own agent. From this metric, the agent determines a perceived value of the offboard platform's measurement. If the value is satisfactory, the agent requests the measurement from the other platform, usually by interacting with the other platform's agent. Once the actual measurement is received, again entropy is computed and the agent assesses its estimation process and refines it accordingly.

Quality of online information on type 2 diabetes: a cross-sectional study.

PubMed

Weymann, Nina; Härter, Martin; Dirmaier, Jörg

2015-12-01

Evidence-based health information is a prerequisite for patients with type 2 diabetes to engage in self-management and to make informed medical decisions. The Internet is an important source of health information. In the present study, we systematically assessed formal quality, quality of decision support and usability of German and English language websites on type 2 diabetes. The search term 'type 2 diabetes' was entered in the two most popular search engines. Descriptive data on website quality are presented. Additionally, associations between website quality and affiliation (commercial vs. non-commercial), presence of the HON code quality seal and website traffic were explored. Forty-six websites were included. Most websites provided basic information necessary for decision-making, while only one website also provided decision support. Websites with a HON code had significantly better formal quality than websites without HON code. We found a highly significant correlation between usability and website traffic and a significant correlation between formal quality and website traffic. Most websites do not provide sufficient information to support patients in medical decision-making. Our finding that usability and website traffic are tightly associated is consistent with previous research indicating that design is the most important cue for users assessing website credibility. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Resident attractiveness: an influential factor in the quality of care in nursing homes.

PubMed

Campbell, Sara L

2005-08-01

Studying the characteristics considered attractive in residents in long-term care can provide an innovative picture of how nursing staff may perceive and inadvertently respond to residents based on those characteristics. It may be difficult to believe that attractiveness can affect the quality of residents' care. However, being open to the discovery of all factors that may influence the quality of care is important to promote positive changes in resident outcomes in nursing homes.

Interventions in Schools' Curricula to Achieve Quality in Learning: Experiences from the Commonwealth Caribbean

ERIC Educational Resources Information Center

Jennings, Zellynne

2017-01-01

For some four decades governments in Commonwealth Caribbean (CC) countries have been introducing interventions in their school systems to provide quality education for all. Examples of these are learner-centred teaching pedagogy and the integration of technology into teaching and learning. The data for the paper is based on published research and…

DEVELOPMENT OF MESOSCALE AIR QUALITY SIMULATION MODELS. VOLUME 1. COMPARATIVE SENSITIVITY STUDIES OF PUFF, PLUME, AND GRID MODELS FOR LONG DISTANCE DISPERSION

EPA Science Inventory

This report provides detailed comparisons and sensitivity analyses of three candidate models, MESOPLUME, MESOPUFF, and MESOGRID. This was not a validation study; there was no suitable regional air quality data base for the Four Corners area. Rather, the models have been evaluated...

Standards Based Design: Teaching K-12 Educators to Build Quality Online Courses

ERIC Educational Resources Information Center

Quiroz, René E.; Ritter, Nicola L.; Li, Yun; Newton, Rhonda C.; Palkar, Trupti

2016-01-01

The number of online courses, programs, and schools are growing exponentially in K-12 education. Given the unique nature of online courses and the distinct skills necessary to create a quality online course, it is essential that effective professional development be provided for teachers designing online courses. Online courses need to be of the…

Genotyping by sequencing for SNP-based linkage analysis and identification of QTLs linked to fruit quality traits in Japanese plum (Prunus salicina Lindl.)

USDA-ARS?s Scientific Manuscript database

Marker-assisted selection (MAS) in stone fruit (Prunus species) breeding is currently difficult to achieve due to the polygenic nature of themost relevant agronomic traits linked to fruit quality. Genotyping by sequencing (GBS), however, provides a large quantity of useful data suitable for finemapp...

Riparian buffer design guidelines for water quality and wildlife habitat functions on agricultural landscapes in the Intermountain West

Treesearch

Craig W. Johnson; Susan Buffler

2008-01-01

Intermountain West planners, designers, and resource managers are looking for science-based procedures for determining buffer widths and management techniques that will optimize the benefits riparian ecosystems provide. This study reviewed the riparian buffer literature, including protocols used to determine optimum buffer widths for water quality and wildlife habitat...

Systems Science in Support of Total Quality Management,

DTIC Science & Technology

Quality Management (TQM). This paper bridges the gap between these two subjects to illustrate specific means by which systems science can begin to augment TQM. This construction is based upon the consideration of two topics. First, a brief introduction to systems science is provided. Second, systems science is applied through the concept of the Conant-Ashby

Utah Educational Quality Indicators. The Fifth in the Report Series: How Good Are Utah Public Schools?

ERIC Educational Resources Information Center

Nelson, David E.

This report, the fifth in a series assessing educational quality in Utah public schools, focuses on students' achievements and provides performance measures based on statewide results of various testing programs and special studies. The report presents three types of data relevant to major state board of education programs (such as Utah…

Forage resource evaluation system for habitat—deer: an interactive deer habitat model

Treesearch

Thomas A. Hanley; Donald E. Spalinger; Kenrick J. Mock; Oran L. Weaver; Grant M. Harris

2012-01-01

We describe a food-based system for quantitatively evaluating habitat quality for deer called the Forage Resource Evaluation System for Habitat and provide its rationale and suggestions for use. The system was developed as a tool for wildlife biologists and other natural resource managers and planners interested in evaluating habitat quality and, especially, comparing...

Results for Learning Report 2012: Fostering Evidence-Based Dialogue to Monitor Access and Quality in Education

ERIC Educational Resources Information Center

Cortese, Lauren; Crouch, Luis; Pinto, Nancy; Salgado, Vania; Schmidt, Caroline; Soman, Kouassi; Thiam, Mamadou; Chaluda, Ania; Omoeva, Carina

2012-01-01

The Global Partnership for Education (GPE) works with low-income countries around the world to help them provide basic education of good quality to all of their children. Countries develop education sector plans that set clear targets and commitments; their partners including donors, multilateral agencies, civil society and the private sector…

Hydraulic actuation technology for full- and semi-active railway suspensions

NASA Astrophysics Data System (ADS)

Goodall, Roger; Freudenthaler, Gerhard; Dixon, Roger

2014-12-01

The paper describes a simulation study that provides a comprehensive comparison between full-active and semi-active suspensions for improving the vertical ride quality of railway vehicles. It includes an assessment of the ride quality benefits that can theoretically be achieved with idealised devices, and also examines the impact of real devices based upon hydraulic actuation technology.