Characteristics of national registries for occupational diseases: international development and validation of an audit tool (ODIT).

PubMed

Spreeuwers, Dick; de Boer, Angela G E M; Verbeek, Jos H A M; van Dijk, Frank J H

2009-10-23

The aim of the study was to develop quality indicators that can be used for quality assessment of registries of occupational diseases in relation to preventive policy on a national level. The research questions were: 1. Which indicators determine the quality of national registries of occupational diseases with respect to their ability to provide appropriate information for preventive policy? 2. What are the criteria that can distinguish low quality from high quality? First, we performed a literature search to assess which output of registries can be considered appropriate for preventive policy and to develop a set of preliminary indicators and criteria. Second, final indicators and criteria were assessed and their content validity was tested in a Delphi study, for which experts from the 25 EU Member States were invited. The literature search revealed two different types of information output to be appropriate for preventive policy: monitor and alert information. For the evaluation of the quality of the monitor and alert function we developed ten indicators and criteria. Sixteen of the twenty-five experts responded in the first round of the Delphi study, and eleven in the second round. Based on their comments, we assessed the final nine indicators: the completeness of the notification form, coverage of registration, guidelines or criteria for notification, education and training of reporting physicians, completeness of registration, statistical methods used, investigation of special cases, presentation of monitor information, and presentation of alert information. Except for the indicator "coverage of registration" for the alert function, all the indicators met the preset requirements of content validity. We have developed quality indicators and criteria to evaluate registries for occupational diseases on the ability to provide appropriate information for preventive policy on a national level. Together, these indicators form a tool which can be used for quality improvement of registries of occupational diseases.

Evaluating the Quality of Colorectal Cancer Care across the Interface of Healthcare Sectors

PubMed Central

Ludt, Sabine; Urban, Elisabeth; Eckardt, Jörg; Wache, Stefanie; Broge, Björn; Kaufmann-Kolle, Petra; Heller, Günther; Miksch, Antje; Glassen, Katharina; Hermann, Katja; Bölter, Regine; Ose, Dominik; Campbell, Stephen M.; Wensing, Michel; Szecsenyi, Joachim

2013-01-01

Background Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing. Methods Indicators were developed following a systematic 10 step modified ‘RAND/UCLA Appropriateness Method’ which involved a multidisciplinary panel of thirteen participants. For each indicator in the final set, data specifications relating to sources of quality information, data collection procedures, analysis and feedback were described. Results The final indicator set included 52 indicators covering diagnostic procedures (11 indicators), therapeutic management (28 indicators) and follow-up (6 indicators). In addition, 7 indicators represented patient perspectives. Primary surgical tumor resection and pre-operative radiation (rectum carcinoma only) were perceived as most useful tracer procedures initiating quality data collection. To assess the quality of CRC care across sectors, various data sources were identified: medical records, administrative inpatient and outpatient data, sickness-funds billing code systems and patient survey. Conclusion In Germany, a set of 52 quality indicators, covering necessary aspects across the interfaces and pathways relevant to CRC-care has been developed. Combining different sectors and sources of health care in quality assessment is an innovative and challenging approach but reflects better the reality of the patient pathway and experience of CRC-care. PMID:23658684

The use of indicators to improve the quality of intensive care: theoretical aspects and experiences from the Dutch intensive care registry.

PubMed

van der Voort, P H J; van der Veer, S N; de Vos, M L G

2012-10-01

In the concept of total quality management that was originally developed in industry, the use of quality indicators is essential. The implementation of quality indicators in the intensive care unit to improve the quality of care is a complex process. This process can be described in seven subsequent steps of an indicator-based quality improvement (IBQI) cycle. With this IBQI cycle, a continuous quality improvement can be achieved with the use of indicator data in a benchmark setting. After the development of evidence-based indicators, a sense of urgency has to be created, registration should start, raw data must be analysed, feedback must be given, and interpretation and conclusions must be made, followed by a quality improvement plan. The last step is the implementation of changes that needs a sense of urgency, and this completes the IBQI cycle. Barriers and facilitators are found in each step. They should be identified and addressed in a multifaceted quality improvement strategy. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Identifying models of delivery, care domains and quality indicators relevant to palliative day services: a scoping review protocol.

PubMed

O'Connor, Seán R; Dempster, Martin; McCorry, Noleen K

2017-05-16

With an ageing population and increasing numbers of people with life-limiting illness, there is a growing demand for palliative day services. There is a need to measure and demonstrate the quality of these services, but there is currently little agreement on which aspects of care should be used to do this. The aim of the scoping review will be to map the extent, range and nature of the evidence around models of delivery, care domains and existing quality indicators used to evaluate palliative day services. Electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) will be searched for evidence using consensus development methods; randomised or quasi-randomised controlled trials; mixed methods; and prospective, longitudinal or retrospective case-control studies to develop or test quality indicators for evaluating palliative care within non-residential settings, including day hospices and community or primary care settings. At least two researchers will independently conduct all searches, study selection and data abstraction procedures. Meta-analyses and statistical methods of synthesis are not planned as part of the review. Results will be reported using numerical counts, including number of indicators in each care domain and by using qualitative approach to describe important indicator characteristics. A conceptual model will also be developed to summarise the impact of different aspects of quality in a palliative day service context. Methodological quality relating to indicator development will be assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Overall strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Final decisions on quality assessment will be made via consensus between review authors. Identifying, developing and implementing evidence-based quality indicators is critical to the evaluation and continued improvement of palliative care. Review findings will be used to support clinicians and policymakers make decisions on which quality indicators are most appropriate for evaluating day services at the patient and service level, and to identify areas for further research.

Quality Assessment in Oncology

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

Albert, Jeffrey M.; Das, Prajnan, E-mail: prajdas@mdanderson.org

2012-07-01

The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involvesmore » many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.« less

Using the Delphi method to develop nursing-sensitive quality indicators for the NICU.

PubMed

Chen, Lin; Huang, Li-Hua; Xing, Mei-Yuan; Feng, Zhi-Xian; Shao, Le-Wen; Zhang, Mei-Yun; Shao, Rong-Ya

2017-02-01

To develop nursing-sensitive quality indicators consistent with current medical practices in Chinese neonatal intensive care units. The development of nursing-sensitive quality indicators has become a top priority in nursing management. To the best of our knowledge, there has been no objective, scientific and sensitive evaluation of the quality of neonatal intensive care unit nursing in China. A modified Delphi technique was used to seek opinions from experts about what should be used and prioritised as indicators of quality care in neonatal intensive care unit nursing. Based on a literature review, we identified 21 indicators of nursing-sensitive quality in the neonatal intensive care unit. Our group of 11 consultants chose 13 indicators to be discussed using the Delphi method. In October and November 2014, 39 neonatal intensive care unit experts in 18 tertiary hospitals spread across six provinces participated in two rounds of Delphi panels. Of the 13 indicators discussed, 11 were identified as indicators of nursing-sensitive quality in the neonatal intensive care unit: rate of nosocomial infections, rate of accidental endotracheal extubation, rate of errors in medication administration, rate of treatment for pain, rate of peripheral venous extravasation, rate of compliance with handwashing techniques, incidence of pressure ulcers, incidence of noise, the bed-to-care ratio, the proportion of nurses with greater than five years neonatal intensive care unit experience and incidence of retinopathy. The 11 neonatal intensive care unit nursing-sensitive indicators identified by the Delphi method integrated with basic Chinese practices provide a basis for nursing management and the monitoring of nursing quality. This study identified nursing-sensitive quality indicators for neonatal intensive care unit care that are suitable for current clinical practice in China. © 2016 John Wiley & Sons Ltd.

[The Development of Quality Indicators for Management of Patients with ADHD in Social Paediatrics].

PubMed

Skrundz, M; Borusiak, P; Hameister, K A; Geraedts, M

2015-12-01

Attention deficit/hyperactivity disorder (ADHD) with an estimated prevalence of 5% and its increased risk for comorbidities is of significant relevance for the health care system and is as well of socio-political significance. There is a lack of established methods for the evaluation of the diagnostic and therapeutic treatment of the patients. In this study, we have developed a set of evidence- and consensus-based meaningful indicators for the treatment of children with ADHD. Following a thorough examination of the literature and published Guidelines, a first set of 90 quality indicators was created after redundancy reduction and addition of newly developed indicators. The further development of the indicator set was based on a modified version of the 2-step RAND/UCLA expert evaluation method. After assessment in 2 rounds of ratings, a set of 39 homogeneously positively rated indicators was established. 28 indicators apply to the quality of the diagnostic and therapeutic process, 4 to structural conditions and 3 rely on outcome. This is the first study covering the aspect of quality measurement in children with developmental disorders, especially ADHD. For the next step a pilot evaluation is necessary to complete the evaluation of the quality indicators. © Georg Thieme Verlag KG Stuttgart · New York.

Assessment of eco-environmental quality of Western Taiwan Straits Economic Zone.

PubMed

Ma, He; Shi, Longyu

2016-05-01

Regional eco-environmental quality is the key and foundation to the sustainable socio-economic development of a region. Eco-environmental quality assessment can reveal the capacity of sustainable socio-economic development in a region and the degree of coordination between social production and the living environment. As part of a new development strategy for Fujian Province, the Western Taiwan Straits Economic Zone (hereafter referred to as the Economic Zone) provides an important guarantee for the development of China's southeastern coastal area. Based on ecological and remote sensing data on the Economic Zone obtained in 2000, 2005, and 2010, this study investigated county-level administrative regions with a comprehensive index of eco-environmental indicators. An objective weighting method was used to determine the importance of each indicator. This led to the development of an indicator system to assess the eco-environmental quality of the economic zone. ArcGIS software was used to assess the eco-environmental quality of the economic zone based on each indicator. The eco-environmental quality index (EQI) of the county-level administrative regions was calculated. The overall eco-environmental quality of the Economic Zone during the period studied is described and analyzed. The results show that the overall eco-environmental quality of the Economic Zone is satisfactory, but significant intraregional differences still exist. The key to improving the overall eco-environmental quality of this area is to restore vegetation and preserve biodiversity.

Evidence-based quality indicators for stroke rehabilitation.

PubMed

Grube, Maike M; Dohle, Christian; Djouchadar, Diana; Rech, Petra; Bienek, Karen; Dietz-Fricke, Ursula; Jöbges, Michael; Kohler, Martin; Missala, Isabelle; Schönherr, Bertram; Werner, Cordula; Zeytountchian, Helen; Wissel, Jörg; Heuschmann, Peter U

2012-01-01

Previous stroke performance measures consider aspects of postacute treatment, but there are only few specific quality indicators or standards for poststroke rehabilitation. The purpose of this study was to develop a set of indicators for measuring the quality of postacute stroke rehabilitation in inpatient and outpatient facilities using a standardized evidence-based approach. Quality indicators were developed between January 2009 and February 2010 by an interdisciplinary board of healthcare professionals from rehabilitation centers cooperating in the Berlin Stroke Alliance. The Berlin Stroke Alliance is a regional network of >40 providers of acute treatment, rehabilitation, and aftercare aiming to improve stroke services within Berlin and Brandenburg. The indicators were developed according to published international recommendations and predefined methodological requirements. The applied standards included a systematic literature review, a rating of published evidence, an external peer review, and the evaluation in a pilot study before implementation. Of an initial list of 33 indicators, 20 indicators were rated as being appropriate. After completion of the pilot phase, we agreed on a set of 18 indicators. The indicators measure processes (9 indicators), outcomes (5 indicators), and structures (4 indicators) in the following domains of stroke rehabilitation: completion of diagnostics; secondary prevention; cognition and affect; speech and swallowing; management of complications; sensorimotor functions and mobility; discharge status; and aftercare. Documentation of evidence-based quality indicators for stroke rehabilitation in clinical routine is feasible and can serve as a first step toward implementing standardized cross-institutional quality assurance programs for stroke rehabilitation.

Development of Indicators to Assess Quality of Care for Prostate Cancer.

PubMed

Nag, Nupur; Millar, Jeremy; Davis, Ian D; Costello, Shaun; Duthie, James B; Mark, Stephen; Delprado, Warick; Smith, David; Pryor, David; Galvin, David; Sullivan, Frank; Murphy, Áine C; Roder, David; Elsaleh, Hany; Currow, David; White, Craig; Skala, Marketa; Moretti, Kim L; Walker, Tony; De Ieso, Paolo; Brooks, Andrew; Heathcote, Peter; Frydenberg, Mark; Thavaseelan, Jeffery; Evans, Sue M

2016-02-20

The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicators in PCa care. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Using Quality of Student Life Indicators at Three Cooperating Colleges: The Cycles Survey.

ERIC Educational Resources Information Center

Royer, Paula Nassif; Kegan, Daniel

The problems of developing a low cost, quality institutional research program capable of longitudinal research, continuous broad bandwidth monitoring and data comparisons with other institutions, led to the development of the Hampshire Cycles Survey as an initial set of student quality of life indicators. Cycles is a multidimensional survey…

Development and application of a tyrosinase-based time-temperature indicator (TTI) for determining the quality of turbot sashimi

NASA Astrophysics Data System (ADS)

Xu, Fengjuan; Ge, Lei; Li, Zhenxing; Lin, Hong; Mao, Xiangzhao

2017-10-01

Time-temperature indicators (TTIs) are convenient intuitive devices that are widely used to predict food quality. The aim of this study is to develop a new simple device which can be attached to food packages as a quality indicator for turbot sashimi. In this study, a solid TTI based on the reaction between tyrosinase and tyrosine was developed. The Arrhenius behavior of this enzymatic TTI was studied. The kinetics of the tyrosinase-based TTI was investigated in the form of color change from colorless to dark black induced by the enzymatic reaction. The mathematical formula for the color alterations as a function of time and temperature was established. The longest indication time for the developed TTI was 50 hours at 4°C. The activation energy of the tyrosinase-based TTI was 0.409 kJ mol-1. The suitability of the tyrosinase-based TTI was validated for turbot sashimi using total plate count. The feasibility of using this TTI as a quality indicator for turbot sashimi was assessed based on the activation energy and indication time. Therefore, the tyrosinasebased TTI system developed in this study could be used as an effective tool for monitoring the quality changes of turbot sashimi during the distribution and storage.

Methodology for developing quality indicators for the care of older people in the Emergency Department

PubMed Central

2013-01-01

Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department. Methods/design Following input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process. Discussion The predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. PMID:24314126

Development of vegetation based soil quality indices for mineralized terrane in arid and semi-arid regions

Treesearch

S. W. Blecker; L. L. Stillings; M. C. Amacher; J. A. Ippolito; N. M. DeCrappeo

2012-01-01

Soil quality indices (SQIs) are often management driven and attempt to describe key relationships between above- and below-ground parameters. In terrestrial systems, indices that were initially developed and modified for agroecosystems have been applied to non-agricultural systems in increasing number. We develop an SQI in arid and semi-arid ecosystems of the Western...

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

PubMed Central

Tripathi, Vandana; Stanton, Cynthia; Strobino, Donna; Bartlett, Linda

2015-01-01

Background High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. Methods and Findings Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. Conclusions As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement. PMID:26107655

Indices for the assessment of nutritional quality of meals: a systematic review.

PubMed

Gorgulho, B M; Pot, G K; Sarti, F M; Marchioni, D M

2016-06-01

This systematic review aimed to synthesise information on indices developed to evaluate nutritional quality of meals. A strategy for systematic search of the literature was developed using keywords related to assessment of meal quality. Databases searched included ScienceDirect, PubMed, Lilacs, SciELO, Scopus, Cochrane, Embase and Google Scholar. The literature search resulted in seven different meal quality indices. Each article was analysed in order to identify the following items: authors, country, year, study design, population characteristics, type of meal evaluated, dietary assessment method, characteristics evaluated (nutrients or food items), score range, index components, nutritional references, correlations performed, validation and relationship with an outcome (if existing). Two studies developed instruments to assess the quality of breakfast, three analysed lunch, one evaluated dinner and one was applied to all types of meals and snacks. All meal quality indices reviewed were based on the evaluation of presence or absence of food groups and relative contributions of nutrients, according to food-based guidelines or nutrient references, adapting the daily dietary recommendations to one specific meal. Most of the indices included three items as components for meal quality assessment: (I) total fat or some specific type of fat, (II) fruits and vegetables and (III) cereals or whole grains. This systematic review indicates aspects that need further research, particularly the numerous approaches to assessing meals considering different foods and nutrients, and the need for validation studies of meal indices.

Comparing clinical quality indicators for asthma management in children with outcome measures used in randomised controlled trials: a protocol.

PubMed

Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B; Coiera, Enrico

2015-09-08

Clinical quality indicators are necessary to monitor the performance of healthcare services. The development of indicators should, wherever possible, be based on research evidence to minimise the risk of bias which may be introduced during their development, because of logistic, ethical or financial constraints alone. The development of automated methods to identify the evidence base for candidate indicators should improve the process of indicator development. The objective of this study is to explore the relationship between clinical quality indicators for asthma management in children with outcome and process measurements extracted from randomised controlled clinical trial reports. National-level indicators for asthma management in children will be extracted from the National Quality Measures Clearinghouse (NQMC) database and the National Institute for Health and Care Excellence (NICE) quality standards. Outcome measures will be extracted from published English language randomised controlled trial (RCT) reports for asthma management in children aged below 12 years. The two sets of measures will be compared to assess any overlap. The study will provide insights into the relationship between clinical quality indicators and measurements in RCTs. This study will also yield a list of measurements used in RCTs for asthma management in children, and will find RCT evidence for indicators used in practice. Ethical approval is not necessary because this study will not include patient data. Findings will be disseminated through peer-reviewed publications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Evaluation of the quality of antenatal care using electronic health record information in family medicine clinics of Mexico City.

PubMed

Doubova, Svetlana V; Pérez-Cuevas, Ricardo; Ortiz-Panozo, Eduardo; Hernández-Prado, Bernardo

2014-05-16

Evaluation of the quality of antenatal care (ANC) using indicators should be part of the efforts to improve primary care services in developing countries. The growing use of the electronic health record (EHR) has the potential of making the evaluation more efficient. The objectives of this study were: (a) to develop quality indicators for ANC and (b) to evaluate the quality of ANC using EHR information in family medicine clinics (FMCs) of Mexico City. We used a mixed methods approach including: (a) in-depth interviews with health professionals; (b) development of indicators following the RAND-UCLA method; (c) a retrospective cohort study of quality of care provided to 5342 women aged 12-49 years who had completed their pregnancy in 2009 and attended to at least one ANC visit with their family doctor. The study took place in four FMCs located in Mexico City. The source of information was the EHR. SAS statistical package served for programing and performing the descriptive statistical analysis. 14 ANC quality indicators were developed. The evaluation showed that 40.6% of women began ANC in the first trimester; 63.5% with low-risk pregnancy attended four or more ANC visits; 4.4% were referred for routine obstetric ultrasound, and 41.1% with vaginal infection were prescribed metronidazole. On average, the percentage of recommended care that women received was 32.7%. It is feasible to develop quality indicators suitable for evaluating the quality of ANC using routine EHR data. The study identified the ANC areas that require improvement; which can guide future strategies aimed at improving ANC quality.

[Integrated Quality Management System (IQMS): a model for improving the quality of reproductive health care in rural Kenya].

PubMed

Herrler, Claudia; Bramesfeld, Anke; Brodowski, Marc; Prytherch, Helen; Marx, Irmgard; Nafula, Maureen; Richter-Aairijoki, Heide; Musyoka, Lucy; Marx, Michael; Szecsenyi, Joachim

2015-01-01

To develop a model aiming to improve the quality of services for reproductive health care in rural Kenya and designed to measure the quality of reproductive health services in such a way that allows these services to identify measures for improving their performance. The Integrated Quality Management System (IQMS) was developed on the basis of a pre-existing and validated model for quality promotion, namely the European Practice Assessment (EPA). The methodology for quality assessment and feedback of assessment results to the service teams was adopted from the EPA model. Quality assessment methodology included data assessment through staff, patient surveys and service visitation. Quality is assessed by indicators, and so indicators had to be developed that were appropriate for assessing reproductive health care in rural Kenya. A search of the Kenyan and international literature was conducted to identify potential indicators. These were then rated for their relevance and clarity by a panel of Kenyan experts. 260 indicators were rated as relevant and assigned to 29 quality dimensions and 5 domains. The implementation of IQMS in ten facilities showed that IQMS is a feasible model for assessing the quality of reproductive health services in rural Kenya. IQMS enables these services to identify quality improvement targets and necessary improvement measures. Both strengths and limitations of IQMS will be discussed. Copyright © 2015. Published by Elsevier GmbH.

Developing and implementing a computerized nursing quality control system in a tertiary general medical center in Israel.

PubMed

Kagan, Ilya; Cohen, Rachel; Fish, Miri; Mezare, Henia Perry

2014-01-01

This article describes the development and implementation of the Nursing Quality Indicators Scale and a quality control system for hospital nursing care, which allows universal access to all external and internal audit results, thus ensuring complete data transparency. Standardized indicators make departments' performance comparable. Key to the new system is nurses' self-audit and responsibility for making quality improvements at the ward level.

Quality in the provision of headache care. 2: defining quality and its indicators.

PubMed

Peters, Michele; Jenkinson, Crispin; Perera, Suraj; Loder, Elizabeth; Jensen, Rigmor; Katsarava, Zaza; Gil Gouveia, Raquel; Broner, Susan; Steiner, Timothy

2012-08-01

The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of focus-group consultations with key stakeholders (doctors, nurses and patients) in headache care. From the findings we proposed a large number of putative quality indicators, and refined these and reduced their number in consultations with larger international groups of stakeholder representatives. We formulated a definition of quality from the quality indicators. Five main themes were identified: (1) headache services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache care: "Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe." Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings.

[Development of quality of care indicators to support chronic disease management].

PubMed

Beaulieu, Marie-dominique; Pomey, Marie-pascale; Del Grande, Claudio; Côté, Brigitte; Tremblay, Éric; Ghorbel, Monia; Hua, Phuong

2015-01-01

This article presents the results of a project conducted by the Institut national d'excellence en santé et en services sociaux of Québec to develop quality of care indicators for the management of six chronic illnesses. Indicators were identified through literature searches and analysis of clinical practice guidelines (CPGs). Interdisciplinary expert panels assessed their validity and the strength of the evidence on which they were based. Representatives of patients (N = 19) and professionals (N = 29) were consulted on their relevance and acceptability. Indicators were categorized according to the Chronic Care Model (CCM). A total of 164 indicators were developed, 126 specific to the illnesses under study and 38 on processes and outcomes generic to the CCM. There was convergence between patients and professionals on the relevance of a majority of indicators. Professionals expressed concerns on the indicators measured by means of patient surveys that they considered to be too subjective. The importance given to CPGs as the main source of indicators resulted in a great number of indicators of the technical quality ofcare. Using the CCM contributed to a broader perspective of quality. The consultation process identified some of the concerns of professionals about indicator measurement, thusguidingfuture implementation initiatives.

Scoping review of potential quality indicators for hip fracture patient care

PubMed Central

Pitzul, Kristen B; Munce, Sarah E P; Perrier, Laure; Beaupre, Lauren; Morin, Suzanne N; McGlasson, Rhona; Jaglal, Susan B

2017-01-01

Objective The purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture. Design Scoping review. Setting All care settings. Search strategy English peer-reviewed studies published from January 2000 to January 2016 were included. Literature search strategies were developed, and the search was peer-reviewed. Two reviewers independently piloted all forms, and all articles were screened in duplicate. Results The search yielded 2729 unique articles, of which 302 articles were included (11.1%). When indicators (eg, in-hospital mortality, acute care length of stay) and potential indicators (eg, comorbidities developed in hospital, walking ability) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures (process). There was heterogeneity in definitions within constructs between studies. There was also a paucity of indicators and potential indicators in the postacute period. Conclusions To improve quality of care for patients with hip fracture and create a more efficient healthcare system, mechanisms for the measurement of quality of care across the entire continuum, not just during the acute period, are required. Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the postacute period. PMID:28325859

European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery.

PubMed

Querleu, Denis; Planchamp, François; Chiva, Luis; Fotopoulou, Christina; Barton, Desmond; Cibula, David; Aletti, Giovanni; Carinelli, Silvestro; Creutzberg, Carien; Davidson, Ben; Harter, Philip; Lundvall, Lene; Marth, Christian; Morice, Philippe; Rafii, Arash; Ray-Coquard, Isabelle; Rockall, Andrea; Sessa, Cristiana; van der Zee, Ate; Vergote, Ignace; du Bois, Andreas

2016-09-01

The surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO). Quality indicators were based on scientific evidence and/or expert consensus. A 4-step evaluation process included a systematic literature search for the identification of potential QIs and the documentation of scientific evidence, physical meetings of an ad hoc multidisciplinarity International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients. Ten structural, process, or outcome indicators were selected. Quality indicators 1 to 3 are related to achievement of complete cytoreduction, caseload in the center, training, and experience of the surgeon. Quality indicators 4 to 6 are related to the overall management, including active participation to clinical research, decision-making process within a structured multidisciplinary team, and preoperative workup. Quality indicator 7 addresses the high value of adequate perioperative management. Quality indicators 8 to 10 highlight the need of recording pertinent information relevant to improvement of quality. An ESGO-approved template for the operative report has been designed. Quality indicators were described using a structured format specifying what the indicator is measuring, measurability specifications, and targets. Each QI was associated with a score, and an assessment form was built. The ESGO quality criteria can be used for self-assessment, for institutional or governmental quality assurance programs, and for the certification of centers. Quality indicators and corresponding targets give practitioners and health administrators a quantitative basis for improving care and organizational processes in the surgical management of advanced ovarian cancer.

Development of quality indicators for physiotherapy for patients with PAOD in the Netherlands: a Delphi study.

PubMed

Gijsbers, H J H; Lauret, G J; van Hofwegen, A; van Dockum, T A; Teijink, J A W; Hendriks, H J M

2016-06-01

The aim of the study was to develop quality indicators (QIs) for physiotherapy management of patients with intermittent claudication (IC) in the Netherlands. As part of an international six-step method to develop QIs, an online survey Delphi-procedure was completed. After two Delphi-rounds a validation round was performed. Twenty-six experts were recruited to participate in this study. Twenty-four experts completed two Delphi-rounds. A third round was conducted inviting 1200 qualified and registered physiotherapists of the Dutch integrated care network 'Claudicationet' to validate a draft set of quality indicators. Out of 83 potential QIs in the Dutch physiotherapy guideline on 'Intermittent claudication', consensus among the experts selected nine indicators. All nine quality indicators were validated by 300 physiotherapists. A final set of nine indicators was derived from (1) a Dutch evidence-based physiotherapy guideline, (2) an expert Delphi procedure and (3) a validation by 300 physiotherapists. This set of indicators should be validated in clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

[Quality Indicators of Primary Health Care Facilities in Austria].

PubMed

Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

2017-07-11

Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain.

PubMed

Gratacós, Jordi; Luelmo, Jesús; Rodríguez, Jesús; Notario, Jaume; Marco, Teresa Navío; de la Cueva, Pablo; Busquets, Manel Pujol; Font, Mercè García; Joven, Beatriz; Rivera, Raquel; Vega, Jose Luis Alvarez; Álvarez, Antonio Javier Chaves; Parera, Ricardo Sánchez; Carrascosa, Jose Carlos Ruiz; Martínez, Fernando José Rodríguez; Sánchez, José Pardo; Olmos, Carlos Feced; Pujol, Conrad; Galindez, Eva; Barrio, Silvia Pérez; Arana, Ana Urruticoechea; Hergueta, Mercedes; Coto, Pablo; Queiro, Rubén

2018-06-01

To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands.

PubMed

van der Ploeg, E; Depla, M F I A; Shekelle, P; Rigter, H; Mackenbach, J P

2008-08-01

Measurement of the quality of healthcare is a first step for quality improvement. To measure quality of healthcare, a set of quality indicators is needed. We describe the adaptation of a set of systematically developed US quality indicators for healthcare for vulnerable elders in The Netherlands. We also compare the US and the Dutch set to see if quality indicators can be transferred between countries, as has been done in two studies in the UK, with mixed results. 108 US quality indicators on GP care for vulnerable elders, covering eight conditions, were assessed by a panel of nine clinical experts in The Netherlands. A modified version of the RAND/UCLA appropriateness method was used. The panel members received US literature reviews, extended with more recent and Dutch literature, summarising the evidence for each quality indicator. 72 indicators (67% of US set) were (nearly) identical in the Dutch and US sets. For some conditions, this percentage was much lower. For undernutrition, only half of the US indicators were included in the Dutch set. For depression, many indicators were discarded or changed in a significant way, with the result that only five of the original 17 indicators (29%) are the same in the Dutch and the US set. Quality indicators can be transferred between countries, but with caution, because in two of the three studies on transferring indicators between the US and Europe, 33-44% of the indicators were discarded. For some conditions in the current study, this percentage is much higher. For undernutrition, there is hardly any evidence, and differences between the indicator sets can be attributed to differences in expert opinion between the countries. For depression, it seems that different evidence is considered important in the US and in The Netherlands, of which the Dutch body of knowledge is not known in the US.

Quality Indicators for Global Benchmarking of Localized Prostate Cancer Management.

PubMed

Sampurno, Fanny; Zheng, Jia; Di Stefano, Lydia; Millar, Jeremy L; Foster, Claire; Fuedea, Ferran; Higano, Celestia; Hulan, Hartwig; Mark, Stephen; Moore, Caroline; Richardson, Alison; Sullivan, Frank; Wenger, Neil S; Wittmann, Daniela; Evans, Sue

2018-03-01

We sought to develop a core set of clinical indicators to enable international benchmarking of localized prostate cancer management using data available in the TrueNTH (True North) Global Registry. An international expert panel completed an online survey and participated in a face to face meeting. Participants included 3 urologists, 3 radiation oncologists, 2 psychologists, 1 medical oncologist, 1 nurse and 1 epidemiologist with prostate cancer expertise from a total of 7 countries. Current guidelines on prostate cancer treatment and potential quality indicators were identified from a literature review. These potential indicators were refined and developed through a modified Delphi process during which each panelist independently and repeatedly rated each indicator based on importance (satisfying the indicator demonstrated a provision of high quality care) and feasibility (the likelihood that data used to construct the indicator could be collected at a population level). The main outcome measure was items with panel agreement indicted by a disagreement index less 1, median importance 8.5 or greater and median feasibility 9 or greater. The expert panel endorsed 33 indicators. Seven of these 33 prostate cancer quality indicators assessed care relating to diagnosis, 7 assessed primary treatment, 1 assessed salvage treatment and 18 assessed health outcomes. We developed a set of quality indicators to measure prostate cancer care using numerous international evidence-based clinical guidelines. These indicators will be pilot tested in the TrueNTH Global Registry. Reports comparing indicator performance will subsequently be distributed to groups at participating sites with the purpose of improving the consistency and quality of prostate cancer management on a global basis. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Quality Measurement Recommendations Relevant to Clinical Guidelines in Germany and the United Kingdom: (What) Can We Learn From Each Other?

PubMed Central

Petzold, Thomas; Deckert, Stefanie; Williamson, Paula R.; Schmitt, Jochen

2018-01-01

We conducted a systematic review of clinical guidelines (CGs) to examine the methodological approaches of quality indicator derivation in CGs, the frequency of quality indicators to check CG recommendations in routine care, and clinimetric properties of quality indicators. We analyzed the publicly available CG databases of the Association of the Scientific Medical Societies in Germany (AWMF) and National Institute for Health and Care Excellence (NICE). Data on the methodology of subsequent quality indicator derivation, the content and definition of recommended quality indicators, and clinimetric properties of measurement instruments were extracted. In Germany, no explicit methodological guidance exists, but 3 different approaches are used. For NICE, a general approach is used for the derivation of quality indicators out of quality standards. Quality indicators were defined in 34 out of 87 CGs (39%) in Germany and for 58 out of 133 (43%) NICE CGs. Statements regarding measurement properties of instruments for quality indicator assessment were missing in German and NICE documents. Thirteen pairs of CGs (32%) have associated quality indicators. Thirty-four quality indicators refer to the same aspect of the quality of care, which corresponds to 27% of the German and 7% of NICE quality indicators. The development of a standardized and internationally accepted methodology for the derivation of quality indicators relevant to CGs is needed to measure and compare quality of care in health care systems. PMID:29591538

Development of the information model for consumer assessment of key quality indicators by goods labelling

NASA Astrophysics Data System (ADS)

Koshkina, S.; Ostrinskaya, L.

2018-04-01

An information model for “key” quality indicators of goods has been developed. This model is based on the assessment of f standardization existing state and the product labeling quality. According to the authors’ opinion, the proposed “key” indicators are the most significant for purchasing decision making. Customers will be able to use this model through their mobile technical devices. The developed model allows to decompose existing processes in data flows and to reveal the levels of possible architectural solutions. In-depth analysis of the presented information model decomposition levels will allow determining the stages of its improvement and to reveal additional indicators of the goods quality that are of interest to customers in the further research. Examining the architectural solutions for the customer’s information environment functioning when integrating existing databases will allow us to determine the boundaries of the model flexibility and customizability.

Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy

PubMed Central

Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dubé, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland

2012-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy. PMID:22308578

Quality indicators for the assessment and management of pain in the emergency department: a systematic review.

PubMed

Stang, Antonia Schirmer; Hartling, Lisa; Fera, Cassandra; Johnson, David; Ali, Samina

2014-01-01

Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures. To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED. Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included. The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population. Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.

Applying Quality Indicators to Single-Case Research Designs Used in Special Education: A Systematic Review

ERIC Educational Resources Information Center

Moeller, Jeremy D.; Dattilo, John; Rusch, Frank

2015-01-01

This study examined how specific guidelines and heuristics have been used to identify methodological rigor associated with single-case research designs based on quality indicators developed by Horner et al. Specifically, this article describes how literature reviews have applied Horner et al.'s quality indicators and evidence-based criteria.…

[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.

Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

PubMed

Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo

2017-09-22

In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.

Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review

PubMed Central

Boulkedid, Rym; Abdoul, Hendy; Loustau, Marine; Sibony, Olivier; Alberti, Corinne

2011-01-01

Objective Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. Methodology and Main Finding Three electronic data bases were searched over a 30 years period (1978–2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. Conclusion The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys. PMID:21694759

Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.

PubMed

Boulkedid, Rym; Abdoul, Hendy; Loustau, Marine; Sibony, Olivier; Alberti, Corinne

2011-01-01

Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. Three electronic data bases were searched over a 30 years period (1978-2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.

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

[Method for the quality assessment of data collection processes in epidemiological studies].

PubMed

Schöne, G; Damerow, S; Hölling, H; Houben, R; Gabrys, L

2017-10-01

For a quantitative evaluation of primary data collection processes in epidemiological surveys based on accompaniments and observations (in the field), there is no description of test criteria and methodologies in relevant literature and thus no known application in practice. Therefore, methods need to be developed and existing procedures adapted. The aim was to identify quality-relevant developments within quality dimensions by means of inspection points (quality indicators) during the process of data collection. As a result we seek to implement and establish a methodology for the assessment of overall survey quality supplementary to standardized data analyses. Monitors detect deviations from standard primary data collection during site visits by applying standardized checklists. Quantitative results - overall and for each dimension - are obtained by numerical calculation of quality indicators. Score results are categorized and color coded. This visual prioritization indicates necessity for intervention. The results obtained give clues regarding the current quality of data collection. This allows for the identification of such sections where interventions for quality improvement are needed. In addition, process quality development can be shown over time on an intercomparable basis. This methodology for the evaluation of data collection quality can identify deviations from norms, focalize quality analyses and help trace causes for significant deviations.

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.

A first-approximation urban-air-quality indicator

Treesearch

David M. Paproski; Julian R. Walker

1977-01-01

Development of the first-approximation-urban-air-quality indicator was reported by the Economic Council of Canada. The indicator takes account of ambient concentrations of five pollutants: sulfur dioxide, particulate matter, oxides of nitrogen, carbon monoxide, and total oxidants. Epidemiological evidence indicating the potential impact of these pollutants on human...

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.

Developing a national framework of quality indicators for public hospitals.

PubMed

Simou, Effie; Pliatsika, Paraskevi; Koutsogeorgou, Eleni; Roumeliotou, Anastasia

2014-01-01

The current study describes the development of a preliminary set of quality indicators for public Greek National Health System (GNHS) hospitals, which were used in the "Health Monitoring Indicators System: Health Map" (Ygeionomikos Chartis) project, with the purpose that these quality indicators would assess the quality of all the aspects relevant to public hospital healthcare workforce and services provided. A literature review was conducted in the MEDLINE database to identify articles referring to international and national hospital quality assessment projects, together with an online search for relevant projects. Studies were included if they were published in English, from 1980 to 2010. A consensus panel took place afterwards with 40 experts in the field and tele-voting procedure. Twenty relevant projects and their 1698 indicators were selected through the literature search, and after the consensus panel process, a list of 67 indicators were selected to be implemented for the assessment of the public hospitals categorized under six distinct dimensions: Quality, Responsiveness, Efficiency, Utilization, Timeliness, and Resources and Capacity. Data gathered and analyzed in this manner provided a novel evaluation and monitoring system for Greece, which can assist decision-makers, healthcare professionals, and patients in Greece to retrieve relevant information, with the long-term goal to improve quality in care in the GNHS hospital sector. Copyright © 2014 John Wiley & Sons, Ltd.

Prediction of wastewater quality indicators at the inflow to the wastewater treatment plant using data mining methods

NASA Astrophysics Data System (ADS)

Szeląg, Bartosz; Barbusiński, Krzysztof; Studziński, Jan; Bartkiewicz, Lidia

2017-11-01

In the study, models developed using data mining methods are proposed for predicting wastewater quality indicators: biochemical and chemical oxygen demand, total suspended solids, total nitrogen and total phosphorus at the inflow to wastewater treatment plant (WWTP). The models are based on values measured in previous time steps and daily wastewater inflows. Also, independent prediction systems that can be used in case of monitoring devices malfunction are provided. Models of wastewater quality indicators were developed using MARS (multivariate adaptive regression spline) method, artificial neural networks (ANN) of the multilayer perceptron type combined with the classification model (SOM) and cascade neural networks (CNN). The lowest values of absolute and relative errors were obtained using ANN+SOM, whereas the MARS method produced the highest error values. It was shown that for the analysed WWTP it is possible to obtain continuous prediction of selected wastewater quality indicators using the two developed independent prediction systems. Such models can ensure reliable WWTP work when wastewater quality monitoring systems become inoperable, or are under maintenance.

Taking the pulse of Colorado's Front Range: Developing regional indicators of environmental and quality of life condition

USGS Publications Warehouse

Baron, Jill S.

2005-01-01

Indicators are routinely used to report the status and trends of human health, economy, educational achievement, and quality of life. Some environmental indicators, such as for water and air quality, are routinely reported and used to inform personal, management, or policy decisions. Other environmental indicators, particularly those that do not relate directly to human well-being, have been harder to define, interpret, or use. These indicators may be just as useful and important in describing the ability to provide ecosystem good and services, or less tangible quality of life measures, but they may be suspect because of the quality of data or even the source of the information.

Impact of urban sprawl on water quality in eastern Massachusetts, USA.

PubMed

Tu, Jun; Xia, Zong-Guo; Clarke, Keith C; Frei, Allan

2007-08-01

A study of water quality, land use, and population variations over the past three decades was conducted in eastern Massachusetts to examine the impact of urban sprawl on water quality using geographic information system and statistical analyses. Since 1970, eastern Massachusetts has experienced pronounced urban sprawl, which has a substantial impact on water quality. High spatial correlations are found between water quality indicators (especially specific conductance, dissolved ions, including Ca, Mg, Na, and Cl, and dissolved solid) and urban sprawl indicators. Urbanized watersheds with high population density, high percentage of developed land use, and low per capita developed land use tended to have high concentrations of water pollutants. The impact of urban sprawl also shows clear spatial difference between suburban areas and central cities: The central cities experienced lower increases over time in specific conductance concentration, compared to suburban and rural areas. The impact of urban sprawl on water quality is attributed to the combined effects of population and land-use change. Per capita developed land use is a very important indicator for studying the impact of urban sprawl and improving land use and watershed management, because inclusion of this indicator can better explain the temporal and spatial variations of more water quality parameters than using individual land use or/and population density.

Improving HIV outcomes in resource-limited countries: the importance of quality indicators.

PubMed

Ahonkhai, Aima A; Bassett, Ingrid V; Ferris, Timothy G; Freedberg, Kenneth A

2012-11-24

Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.

Methods and Sources of Data Used to Develop Selected Water-Quality Indicators for Streams and Ground Water for EPA's 2007 Report on the Environment: Science Report

USGS Publications Warehouse

Baker, Nancy T.; Wilson, John T.; Moran, Michael J.

2008-01-01

The U.S. Geological Survey (USGS) was one of numerous governmental agencies, private organizations, and the academic community that provided data and interpretations for the U.S. Environmental Protection Agency?s (USEPA) 2007 Report on the Environment: Science Report. This report documents the sources of data and methods used to develop selected water?quality indicators for the 2007 edition of the report compiled by USEPA. Stream and ground?water?quality data collected nationally in a consistent manner as part of the USGS?s National Water?Quality Assessment Program (NAWQA) were provided for several water?quality indicators, including Nitrogen and Phosphorus in Streams in Agricultural Watersheds; Pesticides in Streams in Agricultural Watersheds; and Nitrate and Pesticides in Shallow Ground Water in Agricultural Watersheds. In addition, the USGS provided nitrate (nitrate plus nitrite) and phosphorus riverine load estimates calculated from water?quality and streamflow data collected as part of its National Stream Water Quality Accounting Network (NASQAN) and its Federal?State Cooperative Program for the Nitrogen and Phosphorus Discharge from Large Rivers indicator.

Key Performance Indicators of Public Universities Based on Quality Assessment Criteria in Thailand

ERIC Educational Resources Information Center

Sukboonyasatit, Kritsana; Thanapaisarn, Chaiwit; Manmar, Lampang

2011-01-01

The research objective was to develop public universities' key performance indicators. Qualitative research and interviews were employed with each public university's senior executive and quality assessors. The sample group was selected by the office of the public sector development commission and Thailand's public universities can be separated…

The development of learning media of acid-base indicator from extract of natural colorant as an alternative media in learning chemistry

NASA Astrophysics Data System (ADS)

Nurhadi, Mukhamad; Wirhanuddin, Erwin, Muflihah, Erika, Farah; Widiyowati, Iis Intan

2017-03-01

The development of learning media of acid base indicator from extract of natural colorants as an alternative media in chemistry learning; acid-base solution by using creative problem solving model at SMA N 10 Samarinda has been done. This research aimed to create and develop the learning media from extract of natural colorants, measure its quality and effectiveness, and measure the quality of student learning outcome in acid-base solution topic by using that media. The development process used Analysis, Design, Development, Implementation, and Evaluation (ADDIE) method. The learning media of acid-base indicator was created in the form of box experiment. Its quality was in the range of very good and it was effectively applied in the learning and gave positive impact on the achievement of learning goals.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

Predicting synoptic water quality indicators of wadeable streams in the U.S. using National Soil Database

EPA Science Inventory

Nationwide assessment of water quality is a goal of the United States Environmental Protection Agency (USEPA), and the EPA’s Wadeable Stream Assessment (WSA) was developed in response to that goal. The observed chemical, physical, and biological water quality indicators (WQI) fro...

Predicting synoptic water quality indicators of wadeable streams in the U.S. using national soil database - Shirazi

EPA Science Inventory

Nationwide assessment of water quality is a goal of the United States Environmental Protection Agency (USEPA), and the EPA’s Wadeable Stream Assessment (WSA) was developed in response to that goal. The observed chemical, physical, and biological water quality indicators (WQI) fro...

A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium.

PubMed

Helsloot, Kaat; Walraevens, Mieke; Besauw, Saskia Van; Van Parys, An-Sofie; Devos, Hanne; Holsbeeck, Ann Van; Roelens, Kristien

2017-05-01

to develop a set of quality indicators for postnatal care after discharge from the hospital, using a systematic approach. key elements of qualitative postnatal care were defined by performing a systematic review and the literature was searched for potential indicators (step 1). The potential indicators were evaluated by five criteria (validity, reliability, sensitivity, feasibility and acceptability) and by making use of the 'Appraisal of Guidelines for Research and Evaluation', the AIRE-instrument (step 2). In a modified Delphi-survey, the quality indicators were presented to a panel of experts in the field of postnatal care using an online tool (step 3). The final results led to a Flemish model of postnatal care (step 4). Flanders, Belgium PARTICIPANTS: health care professionals, representatives of health care organisations and policy makers with expertise in the field of postnatal care. after analysis 57 research articles, 10 reviews, one book and eight other documents resulted in 150 potential quality indicators in seven critical care domains. Quality assessment of the indicators resulted in 58 concept quality indicators which were presented to an expert-panel of health care professionals. After two Delphi-rounds, 30 quality indicators (six structure, 17 process, and seven outcome indicators) were found appropriate to monitor and improve the quality of postnatal care after discharge from the hospital. KEY CONCLUSIONS AND IMPLICATIONS FOR CLINICAL PRACTICE: the quality indicators resulted in a Flemish model of qualitative postnatal care that was implemented by health authorities as a minimum standard in the context of shortened length of stay. Postnatal care should be adjusted to a flexible length of stay and start in pregnancy with an individualised care plan that follows mother and new-born throughout pregnancy, childbirth and postnatal period. Criteria for discharge and local protocols about the organisation and content of care are essential to facilitate continuity of care. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

Development and pilot test of a new set of good practice indicators for chronic non-malignant pain management.

PubMed

Saturno, Pedro Jesus; Angel-García, Daniel; Martínez-Nicolás, Ismael; López Soriano, Francisco; Escolar Reina, Maria Pilar; Guerrero Díaz, María Beatriz; Ros Martínez, María Encarnación; Medina Mirapeix, Francesc; Saturno Marcos, Mayo

2018-06-08

This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic non-malignant pain. We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot-tested for feasibility, reliability (kappa) and usefulness to identify quality problems, using the Lot Quality Acceptance method, α≤0.05 y β≤0.01, for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. The study reviews clinical records from a primary-care centre, a medium-size hospital (250 beds) and a large hospital (500 beds). Forty-six indicators were developed (six general and forty condition-specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa>0.7). Regarding compliance, four quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach and appropriate use of neuro-image tests; while sixteen obtained compliance scores under 15% (six with 0% compliance). The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic non-malignant pain, by monitoring and evaluating quality of care. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Developing clinical indicators for the secondary health system in India.

PubMed

Thakur, Harshad; Chavhan, S; Jotkar, Raju; Mukherjee, Kanchan

2008-08-01

One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.

[High-quality nursing health care environment: the patient safety perspective].

PubMed

Tu, Yu-Ching; Wang, Ruey-Hsia

2011-06-01

Patient safety is regarded as an important indicator of nursing care quality, and nurses hold frontline responsibility to maintain patient safety. Many countries now face healthcare provider shortfalls, and recognize a close correlation between adequate manpower and patient safety. Many healthcare organizations work to foster positive work environments in order to improve health service quality. The active participation and "buy in" of nurses, patients and policymakers are critical to maximize healthcare environment quality and improve patient safety. This article adopts Donabedian's theoretical "Structure-Process-Outcome" model of quality (Donabedian, 1988) and presumes all high-quality healthcare environment indicators to be linked to patient safety. In addition to raising public awareness regarding the influence of healthcare environment quality on patient safety, this research suggests certain indicators for tracking and assessing healthcare environment quality. Future research may design an empirical study based on these indicators to help further enhance healthcare environment quality and the professional development of nurses.

Baby-MONITOR: A Composite Indicator of NICU Quality

PubMed Central

Kowalkowski, Marc A.; Zupancic, John A. F.; Pietz, Kenneth; Richardson, Peter; Draper, David; Hysong, Sylvia J.; Thomas, Eric J.; Petersen, Laura A.; Gould, Jeffrey B.

2014-01-01

BACKGROUND AND OBJECTIVES: NICUs vary in the quality of care delivered to very low birth weight (VLBW) infants. NICU performance on 1 measure of quality only modestly predicts performance on others. Composite measurement of quality of care delivery may provide a more comprehensive assessment of quality. The objective of our study was to develop a robust composite indicator of quality of NICU care provided to VLBW infants that accurately discriminates performance among NICUs. METHODS: We developed a composite indicator, Baby-MONITOR, based on 9 measures of quality chosen by a panel of experts. Measures were standardized, equally weighted, and averaged. We used the California Perinatal Quality Care Collaborative database to perform across-sectional analysis of care given to VLBW infants between 2004 and 2010. Performance on the Baby-MONITOR is not an absolute marker of quality but indicates overall performance relative to that of the other NICUs. We used sensitivity analyses to assess the robustness of the composite indicator, by varying assumptions and methods. RESULTS: Our sample included 9023 VLBW infants in 22 California regional NICUs. We found significant variations within and between NICUs on measured components of the Baby-MONITOR. Risk-adjusted composite scores discriminated performance among this sample of NICUs. Sensitivity analysis that included different approaches to normalization, weighting, and aggregation of individual measures showed the Baby-MONITOR to be robust (r = 0.89–0.99). CONCLUSIONS: The Baby-MONITOR may be a useful tool to comprehensively assess the quality of care delivered by NICUs. PMID:24918221

The quality and availability of hardwood logging residue based on developed quality levels

Treesearch

Floyd G. Timson

1980-01-01

Hardwood logging residue was examined for salvageable quality material. Four quality levels (QL 1 to QL 4), based on four sets of specifications, were developed. The specifications used surface indicators, sweep, center decay, and piece size to determine quality. Twenty-six percent of the total logging residue (residue ≥ 4 inches in diameter outside bark at...

Indices of Quality in the Undergraduate Experience. AAHE-ERIC/Higher Education Research Report No. 4.

ERIC Educational Resources Information Center

Kuh, George D.

Indices and manifestations of quality in undergraduate education are considered and a four-part framework is developed. Context indices represent institutional characteristics that remain relatively stable over time (e.g., expenditures per student and size of student body), while input indices reflect characteristics of entering students (e.g.,…

Housing quality and access to material and learning resources within the home environment in developing countries.

PubMed

Bradley, Robert H; Putnick, Diane L

2012-01-01

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials a little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Private healthcare quality: applying a SERVQUAL model.

PubMed

Butt, Mohsin Muhammad; de Run, Ernest Cyril

2010-01-01

This paper seeks to develop and test the SERVQUAL model scale for measuring Malaysian private health service quality. The study consists of 340 randomly selected participants visiting a private healthcare facility during a three-month data collection period. Data were analyzed using means, correlations, principal component and confirmatory factor analysis to establish the modified SERVQUAL scale's reliability, underlying dimensionality and convergent, discriminant validity. Results indicate a moderate negative quality gap for overall Malaysian private healthcare service quality. Results also indicate a moderate negative quality gap on each service quality scale dimension. However, scale development analysis yielded excellent results, which can be used in wider healthcare policy and practice. Respondents were skewed towards a younger population, causing concern that the results might not represent all Malaysian age groups. The study's major contribution is that it offers a way to assess private healthcare service quality. Second, it successfully develops a scale that can be used to measure health service quality in Malaysian contexts.

OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion.

PubMed

Marshall, Martin; Klazinga, Niek; Leatherman, Sheila; Hardy, Charlie; Bergmann, Eckhard; Pisco, Luis; Mattke, Soeren; Mainz, Jan

2006-09-01

This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. Existing quality indicators from around the world were mapped to an organizing framework which related primary care, prevention, and health promotion. The indicators were judged against the US Institute of Medicine's assessment criteria of importance and scientific soundness, and only those which met these criteria and were likely to be feasible were included. An initial large set of indicators was reduced by the primary care expert panel using a modified Delphi process. A set of 27 indicators was produced. Six of them were related to health promotion, covering health-related behaviours that are typically targeted by health education and outreach campaigns, 13 to preventive care with a focus on prenatal care and immunizations and eight to primary clinical care mainly addressing activities related to risk reduction. The indicators selected placed a strong emphasis on the public health aspects of primary care. This project represents an important but preliminary step towards a set of measures to evaluate and compare primary care quality. Further work is required to assess the operational feasibility of the indicators and the validity of any benchmarking data drawn from international comparisons. A conceptual framework needs to be developed that comprehensively captures the complex construct of primary care as a basis for the selection of additional indicators.

Water quality indicators: bacteria, coliphages, enteric viruses.

PubMed

Lin, Johnson; Ganesh, Atheesha

2013-12-01

Water quality through the presence of pathogenic enteric microorganisms may affect human health. Coliform bacteria, Escherichia coli and coliphages are normally used as indicators of water quality. However, the presence of above-mentioned indicators do not always suggest the presence of human enteric viruses. It is important to study human enteric viruses in water. Human enteric viruses can tolerate fluctuating environmental conditions and survive in the environment for long periods of time becoming causal agents of diarrhoeal diseases. Therefore, the potential of human pathogenic viruses as significant indicators of water quality is emerging. Human Adenoviruses and other viruses have been proposed as suitable indices for the effective identification of such organisms of human origin contaminating water systems. This article reports on the recent developments in the management of water quality specifically focusing on human enteric viruses as indicators.

Stakeholders' perspectives on quality indicators for diabetes care: a qualitative study.

PubMed

Markhorst, Joekie; Martirosyan, Liana; Calsbeek, Hiske; Braspenning, Jozé

2012-01-01

Transparency in diabetes care requires quality indicators that are of interest to stakeholders in order to optimise their usage. Indicator development is often focused on consensus, and little is known about stakeholders' preferences for information on quality. To explore the preferences of consumers, providers, purchasers and policy makers for different quality domains and indicators in relation to the intended use of quality indicators. Between June and December 2009, 14 semi-structured interviews were held with stakeholders who have a decisive vote in the selection of the national indicator set for diabetes care in the Netherlands. The following subjects were explored: (1) the aims of using information on quality; (2) the interpretation of and preferences for the quality domains of safety, timeliness, effectiveness and patient-centredness in relation to the user aims; and (3) the preferences for structure, process or outcome indicators. Content analysis was used to analyse qualitative data. Stakeholders had similar and different aims according to their roles. The interpretations of quality domains varied greatly between the stakeholders. Besides differences in interpretation, their preferences were similar. Most stakeholders prioritised patient-centredness above the other domains of quality, ranked in order of priority as safety, effectiveness and timeliness, whereas purchasers also prioritised efficiency. All stakeholders preferred to use process indicators or a mix of process and outcome indicators. The preferences of the stakeholders for quality indicators seem to be neither well-refined nor congruent. The implementation of an indicator set can probably be improved if the stakeholders' definitions and preferences for quality domains become more explicit during the selection process for indicators.

[Construction and implementation of two quality indicators in nursing services].

PubMed

de Moura, Gisela Maria Schebela Souto; Juchem, Beatriz Cavalcanti; Falk, Maria Lucia Rodrigues; de Magalhães, Ana Maria Muller; Suzuki, Lyliam Midori

2009-03-01

Indicators monitor the quality of services and improve the attention offered to the patients. Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil, has been developing strategies to assess its services according to its institutional management policy of quality The present study aims to report the experience at this university hospital with the construction and implementation of quality indicators in its nursing services. In 2006, four indicators were established: incidence of pressure ulcer, with a goal of < or = 10:1000 patients per day/month and incidence of falls from bed whose goal was established as < or = 2:1000 patients per day/month. Our challenge was to build and implement these indicators as management tools to assess the quality of nursing services, for this is a large hospital.

Evaluating sustainable water quality management in the U.S.: Urban, Agricultural, and Environmental Protection Practices

NASA Astrophysics Data System (ADS)

van Oel, P. R.; Alfredo, K. A.; Russo, T. A.

2015-12-01

Sustainable water management typically emphasizes water resource quantity, with focus directed at availability and use practices. When attention is placed on sustainable water quality management, the holistic, cross-sector perspective inherent to sustainability is often lost. Proper water quality management is a critical component of sustainable development practices. However, sustainable development definitions and metrics related to water quality resilience and management are often not well defined; water quality is often buried in large indicator sets used for analysis, and the policy regulating management practices create sector specific burdens for ensuring adequate water quality. In this research, we investigated the methods by which water quality is evaluated through internationally applied indicators and incorporated into the larger idea of "sustainability." We also dissect policy's role in the distribution of responsibility with regard to water quality management in the United States through evaluation of three broad sectors: urban, agriculture, and environmental water quality. Our research concludes that despite a growing intention to use a single system approach for urban, agricultural, and environmental water quality management, one does not yet exist and is even hindered by our current policies and regulations. As policy continues to lead in determining water quality and defining contamination limits, new regulation must reconcile the disparity in requirements for the contaminators and those performing end-of-pipe treatment. Just as the sustainable development indicators we researched tried to integrate environmental, economic, and social aspects without skewing focus to one of these three categories, policy cannot continue to regulate a single sector of society without considering impacts to the entire watershed and/or region. Unequal distribution of the water pollution burden creates disjointed economic growth, infrastructure development, and policy enactment across the sectors preventing a holistic approach to water quality management and, thus, rendering our system unsustainable.

Indicators of Program Quality, Measures of Performance & Standards. Adult Basic Education and ESL Programs in NJ. Summary Report.

ERIC Educational Resources Information Center

Merkel-Keller, Claudia; Streeter-Scrupski, Sandra

In 1992, adult education staff and adult literacy volunteer organizations developed 8 indicators of program quality to be used for evaluating adult basic education and English as a Second Language (ESL) programs in New Jersey. Performance standards were developed to match the standards. An evaluation was conducted to determine how the indicators…

[Development and validation of quality standards for colonoscopy].

PubMed

Sánchez Del Río, Antonio; Baudet, Juan Salvador; Naranjo Rodríguez, Antonio; Campo Fernández de Los Ríos, Rafael; Salces Franco, Inmaculada; Aparicio Tormo, Jose Ramón; Sánchez Muñoz, Diego; Llach, Joseph; Hervás Molina, Antonio; Parra-Blanco, Adolfo; Díaz Acosta, Juan Antonio

2010-01-30

Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of chi(2). Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening. Copyright (c) 2009 Elsevier España, S.L. All rights reserved.

Housing Quality and Access to Material and Learning Resources within the Home Environment in Developing Countries

PubMed Central

Bradley, Robert H.; Putnick, Diane L.

2011-01-01

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. PMID:22277008

Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol)

PubMed Central

2011-01-01

Background Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities. Methods We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed. Discussion We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement. Trial registration NTR2496 (Netherlands National Trial Register, http://www.trialregister.nl). PMID:21554691

An innovative index for evaluating water quality in streams.

PubMed

Said, Ahmend; Stevens, David K; Sehlke, Gerald

2004-09-01

A water quality index expressed as a single number is developed to describe overall water quality conditions using multiple water quality variables. The index consists of water quality variables: dissolved oxygen, specific conductivity, turbidity, total phosphorus, and fecal coliform. The objectives of this study were to describe the preexisting indices and to define a new water quality index that has advantages over these indices. The new index was applied to the Big Lost River Watershed in Idaho, and the results gave a quantitative picture for the water quality situation. If the new water quality index for the impaired water is less than a certain number, remediation-likely in the form of total maximum daily loads or changing the management practices-may be needed. The index can be used to assess water quality for general beneficial uses. Nevertheless, the index cannot be used in making regulatory decisions, indicate water quality for specific beneficial uses, or indicate contamination from trace metals, organic contaminants, and toxic substances.

Pursuing Quality Evidence: Applying Single-Subject Quality Indicators to Non-Experimental Qualitative Educational Research

ERIC Educational Resources Information Center

Stodden, Robert A.; Yamamoto, Kathryn K.; Folk, Eric; Kong, Eran; Otsuji, Derek N.

2013-01-01

The need for quality evidence in support of strategies used while working with persons with autism and intellectual disability (ID) has been long been recognized by researchers and practitioners. The authors reviewed and applied a number of evidence-based indicators, developed through the "What Works Clearinghouse" (WWC), to the conduct…

Home Care Quality Indicators (HCQIS) Based on the MDS-HC

ERIC Educational Resources Information Center

Hirdes, John P.; Fries, Brant E.; Morris, John N.; Ikegami, Naoki; Zimmerman, David; Dalby, Dawn M.; Aliaga, Pablo; Hammer, Suzanne; Jones, Richard

2004-01-01

Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed…

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

Developing quality indicators for older adults: transfer from the USA to the UK is feasible.

PubMed

Steel, N; Melzer, D; Shekelle, P G; Wenger, N S; Forsyth, D; McWilliams, B C

2004-08-01

Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective health care interventions in both primary and secondary care. One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.

[Indicators of water microbial pollution: problems and perspectives].

PubMed

Nusca, A; D'Alessandro, D; Funari, E

2008-01-01

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

[The importance of an early accompanying evaluation of new care forms for the development of indicators for quality assurance in outpatient psychiatric integrated care].

PubMed

Hausen, A; Glaeske, G

2015-05-01

Aim of this contribution is to illustrate the imp-ortance of an early accompanying evaluation of new care forms for the development of indicators. The illustration uses the experience of the accompanying evaluation of the integrated care model for optimisation of outpatient psychiatric care. For the integrated care model we could develop potential indicators by using medical-psychiatric and insured-related routine data, but all potential indicators need further development to enable reliable statements about achieved quality targets. It is shown that the development of indicators in the outpatient psychiatric integrated care is affected by many different factors such as vague target agreements in the contract and missing contractual agreements for the data. As a result it is illustrated that in this project the evaluation was introduced after implementation of this new form of care and the already established contract and the data management impeded the development of indicators. © Georg Thieme Verlag KG Stuttgart · New York.

Developing a multidisciplinary robotic surgery quality assessment program.

PubMed

Gonsenhauser, Iahn; Abaza, Ronney; Mekhjian, Hagop; Moffatt-Bruce, Susan D

2012-01-01

The objective of this study was to test the feasibility of a novel quality-improvement (QI) program designed to incorporate multiple robotic surgical sub-specialties in one health care system. A robotic surgery quality assessment program was developed by The Ohio State University College of Medicine (OSUMC) in conjunction with The Ohio State University Medical Center Quality Improvement and Operations Department. A retrospective review of cases was performed using data interrogated from the OSUMC Information Warehouse from January 2007 through August 2009. Robotic surgery cases (n=2200) were assessed for operative times, length of stay (LOS), conversions, returns to surgery, readmissions and cancellations as potential quality indicators. An actionable and reproducible framework for the quality measurement and assessment of a multidisciplinary and interdepartmental robotic surgery program was successfully completed demonstrating areas for improvement opportunities. This report supports that standard quality indicators can be applied to multiple specialties within a health care system to develop a useful quality tracking and assessment tool in the highly specialized area of robotic surgery. © 2012 National Association for Healthcare Quality.

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan.

PubMed

Virdun, Claudia; Luckett, Tim; Lorenz, Karl A; Phillips, Jane

2018-06-01

The importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision. A systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the 'quality of care' category of the 2015 Quality of Death Index study; and snowballing from Index experts. Ten countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%). Measurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Is CO2 emission a side effect of financial development? An empirical analysis for China.

PubMed

Hao, Yu; Zhang, Zong-Yong; Liao, Hua; Wei, Yi-Ming; Wang, Shuo

2016-10-01

Based on panel data for 29 Chinese provinces from 1995 to 2012, this paper explores the relationship between financial development and environmental quality in China. A comprehensive framework is utilized to estimate both the direct and indirect effects of financial development on CO 2 emissions in China using a carefully designed two-stage regression model. The first-difference and orthogonal-deviation Generalized Method of Moments (GMM) methods are used to control for potential endogeneity and introduce dynamics. To ensure the robustness of the estimations, two indicators measuring financial development-financial depth and financial efficiency-are used. The empirical results indicate that the direct effects of financial depth and financial efficiency on environmental quality are positive and negative, respectively. The indirect effects of both indicators are U shaped and dominate the shape of the total effects. These findings suggest that the influences of the financial development on environment depend on the level of economic development. At the early stage of economic growth, financial development is environmentally friendly. When the economy is highly developed, a higher level of financial development is harmful to the environmental quality.

Defining quality indicators for best-practice management of inflammatory bowel disease in Canada

PubMed Central

Nguyen, Geoffrey C; Devlin, Shane M; Afif, Waqqas; Bressler, Brian; Gruchy, Steven E; Kaplan, Gilaad G; Oliveira, Liliana; Plamondon, Sophie; Seow, Cynthia H; Williams, Chadwick; Wong, Karen; Yan, Brian M; Jones, Jennifer

2014-01-01

BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management. METHODS: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members. RESULTS: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy. CONCLUSIONS: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes. PMID:24839622

Quality indicators for the management of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium.

PubMed

Sharma, Prateek; Katzka, David A; Gupta, Neil; Ajani, Jaffer; Buttar, Navtej; Chak, Amitabh; Corley, Douglas; El-Serag, Hashem; Falk, Gary W; Fitzgerald, Rebecca; Goldblum, John; Gress, Frank; Ilson, David H; Inadomi, John M; Kuipers, Ernest J; Lynch, John P; McKeon, Frank; Metz, David; Pasricha, Pankaj J; Pech, Oliver; Peek, Richard; Peters, Jeffrey H; Repici, Alessandro; Seewald, Stefan; Shaheen, Nicholas J; Souza, Rhonda F; Spechler, Stuart J; Vennalaganti, Prashanth; Wang, Kenneth

2015-11-01

The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters by which we measure quality, which will likely affect reimbursements. Barrett's esophagus remains a particularly important disease entity for which we should maintain up-to-date guidelines, given its commonality, potentially lethal outcomes, and controversies regarding screening and surveillance. To achieve this goal, a relatively large group of international experts was assembled and, using the modified Delphi method, evaluated the validity of multiple candidate quality indicators for the diagnosis and management of Barrett's esophagus. Several candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett's esophagus. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Quality Indicators for the Management of Barrett’s Esophagus, Dysplasia, and Esophageal Adenocarcinoma: International Consensus Recommendations from the American Gastroenterological Association Symposium

PubMed Central

Sharma, Prateek; Katzka, David A.; Gupta, Neil; Ajani, Jaffer; Buttar, Navtej; Chak, Amitabh; Corley, Douglas; El-Serag, Hashem; Falk, Gary W.; Fitzgerald, Rebecca; Goldblum, John; Gress, Frank; Ilson, David H.; Inadomi, John M.; Kuipers, Ernest J.; Lynch, John P.; McKeon, Frank; Metz, David; Pasricha, Pankaj J.; Pech, Oliver; Peek, Richard; Peters, Jeffrey H.; Repici, Alessandro; Seewald, Stefan; Shaheen, Nicholas J.; Souza, Rhonda F.; Spechler, Stuart J.; Vennalaganti, Prashanth; Wang, Kenneth

2016-01-01

The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters by which we measure quality, which will likely affect reimbursements. Barrett’s esophagus remains a particularly important disease entity for which we should maintain up-to-date guidelines, given its commonality, potentially lethal outcomes, and controversies regarding screening and surveillance. To achieve this goal, a relatively large group of international experts was assembled and, using the modified Delphi method, evaluated the validity of multiple candidate quality indicators for the diagnosis and management of Barrett’s esophagus. Several candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett’s esophagus. PMID:26296479

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

Progress on the Journey to Total Quality Management: Using the Myers-Briggs Type Indicator and the Adjective Check List in Management Development.

ERIC Educational Resources Information Center

Mani, Bonnie G.

1995-01-01

In an Internal Revenue Service office using total quality management (TQM), the management development program uses Myers Briggs Type Indicator and Adjective Check List for manager self-assessment. Because management commitment is essential to TQM, the process is a way of enhancing leadership skills and demonstrating appreciation of diversity. (SK)

Methods and Sources of Data Used to Develop Selected Water-Quality Indicators for Streams and Ground Water for the 2007 Edition of The State of the Nation's Ecosystems Report with Comparisons to the 2002 Edition

USGS Publications Warehouse

Wilson, John T.; Baker, Nancy T.; Moran, Michael J.; Crawford, Charles G.; Nowell, Lisa H.; Toccalino, Patricia L.; Wilber, William G.

2008-01-01

The U.S. Geological Survey (USGS) was one of numerous governmental, private, and academic entities that provided input to the report The State of the Nation?s Ecosystems published periodically by the Heinz Center. This report describes the sources of data and methods used by the USGS to develop selected water?quality indicators for the 2007 edition of the Heinz Center report and documents modifications in the data sources and interpretations between the 2002 and 2007 editions of the Heinz Center report. Stream and ground?water quality data collected nationally as part of the USGS National Water-Quality Assessment Program were used to develop the ecosystem indicators for the Heinz Center report, including Core National indicators for the Movement of Nitrogen and Chemical Contamination and for selected ecosystems classified as Farmlands, Forest, Grasslands and Shrublands, Freshwater, and Urban and Suburban. In addition, the USGS provided water?quality and streamflow data collected as part of the National Stream Water Quality Accounting Network and the Federal?State Cooperative Program. The documentation provided herein serves not only as a reference for current and future editions of The State of the Nation?s Ecosystems but also provides critical information for future assessments of changes in contaminant occurrence in streams and ground water of the United States.

Development of Quality Indicators to Assess Oral Anticoagulant Management in Community Pharmacies for Patients with Atrial Fibrillation.

PubMed

Chartrand, Mylène; Guénette, Line; Brouillette, Denis; Côté, Stéphane; Huot, Roger; Landry, Jérôme; Martineau, Josée; Perreault, Sylvie; White-Guay, Brian; Williamson, David; Martin, Élisabeth; Gagnon, Marie-Mireille; Lalonde, Lyne

2018-04-01

Few studies have evaluated the quality of oral anticoagulant management by community pharmacists. There is no complete set of quality indicators available for this purpose. To develop a set of specific quality indicators to assess oral anticoagulant management by community pharmacists for patients with atrial fibrillation (AF). Quality indicators were developed in 3 phases. In phase 1, potential quality indicators were generated based on clinical guidelines and a literature review. In phase 2, a modified RAND appropriateness method involving 2 rounds was implemented with 9 experts, who judged the appropriateness of quality indicators generated in phase 1 based on the extent to which they were accurate, based on evidence, relevant, representative of best practices, and measurable in community pharmacies. Phase 3 consisted of a feasibility assessment in 5 community pharmacies on 2 patients each. The final set included 38 quality indicators grouped into 6 categories: documentation (n = 29), risk assessment (n = 3), clinical control (n = 1), clinical follow-up (n = 15), choice of therapy (n = 11), and interaction management (n = 8). The quality indicators referred to process of care (n = 34), clinical outcomes (n = 2), or structure of care (n = 2). There were 24 quality indicators related to vitamin K antagonists (VKAs), and 17 were related to direct oral anticoagulants (DOACs). To assess quality indicators, a questionnaire was developed for completion by community pharmacists for each patient, which included 17 questions about VKA patients and 12 questions about DOAC patients. A first set of quality indicators is now available to assess the quality of oral anticoagulant management by community pharmacists for patients with AF. This research was supported by the Réseau Québécois de recherche sur le médicament (RQRM); the Blueprint for Pharmacy in collaboration with Pfizer Canada; and the Cercle du Doyen of the Faculty of Pharmacy, University of Montreal. The study sponsors were not involved in the study design, data collection, data interpretation, the writing of the article, or the decision to submit the report for publication. Chartrand received a scholarship from the Fonds de Recherche du Québec en Santé (FRQ-S), the Réseau Québécois de recherche sur l'usage des médicaments with Pfizer, and the Faculty of Pharmacy, University of Montreal. Guénette holds a Junior-1 Clinician Researcher Award from the FRQ-S in partnership with the Société québécoise d'hypertension artérielle. Williamson holds a Junior-1 Career Award from the FRQ-S. Côté reported being a medical speaker for Bayer, Boehringer Ingelheim Canada, and Pfizer Canada. The other authors reported no conflicts of interest. Study concept and design were contributed by Lalonde, Chartrand, and Martin. Chartrand, Martin, and Lalonde collected the data, along with Brouillette, Côté, Huot, Landry, Martineau, Perreault, Williamson, and White-Guay. Data interpretation was performed by Chartrand, Gagnon, and Lalonde, along with Guénette and Martin. The manuscript was primarily written by Chartrand, along with Guénette and Lalonde, and revised by Chartrand, Guénette, and Lalonde, along with the other authors. A portion of this study's results was presented at the 4th RQRM Annual Meeting on September 22-23, 2014, in Orford, Quebec, Canada, in the form of an abstract, which was published in the Journal of Population Therapeutics and Clinical Pharmacology, 2014;21(2):e312.

Needs Assessment for the Use of NASA Remote Sensing Data in the Development and Implementation of Estuarine and Coastal Water Quality Standards

NASA Technical Reports Server (NTRS)

Spiering, Bruce; Underwood, Lauren; Ellis, Chris; Lehrter, John; Hagy, Jim; Schaeffer, Blake

2010-01-01

The goals of the project are to provide information from satellite remote sensing to support numeric nutrient criteria development and to determine data processing methods and data quality requirements to support nutrient criteria development and implementation. The approach is to identify water quality indicators that are used by decision makers to assess water quality and that are related to optical properties of the water; to develop remotely sensed data products based on algorithms relating remote sensing imagery to field-based observations of indicator values; to develop methods to assess estuarine water quality, including trends, spatial and temporal variability, and seasonality; and to develop tools to assist in the development and implementation of estuarine and coastal nutrient criteria. Additional slides present process, criteria development, typical data sources and analyses for criteria process, the power of remote sensing data for the process, examples from Pensacola Bay, spatial and temporal variability, pixel matchups, remote sensing validation, remote sensing in coastal waters, requirements for remotely sensed data products, and needs assessment. An additional presentation examines group engagement and information collection. Topics include needs assessment purpose and objectives, understanding water quality decision making, determining information requirements, and next steps.

Normative standards for wildlife viewing in parks and protected areas

Treesearch

Laura Anderson; Robert Manning; William Valliere; Jeffrey Hallo

2010-01-01

With increasing public interest in wildlife watching, there is a need to develop methods to inform the management of high-quality viewing opportunities. In this study, normative methods using indicators and standards of quality were applied at a national park in Alaska and a wildlife refuge in New Hampshire. Four potential indicators of quality are identified that can...

Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care

PubMed Central

2011-01-01

Background Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD), patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio), we have developed and tested a set of standardized measures, linked to previously developed quality indicators. Methods A structured stepwise procedure was followed to develop measures. First, the research team allocated 106 validated quality indicators to one of the three target populations (established CVD, at high risk, at low risk) and to different data-collection methods (data abstraction from the medical records, a patient survey, an interview with lead practice GP/a practice survey). Secondly, we selected a number of other validated measures to enrich the assessment. A pilot study was performed to test the feasibility. Finally, we revised the measures based on the findings. Results The EPA-Cardio measures consisted of abstraction forms from the medical-records data of established Coronary Heart Disease (CHD)-patients - and high-risk groups, a patient questionnaire for each of the 3 groups, an interview questionnaire for the lead GP and a questionnaire for practice teams. The measures were feasible and accepted by general practices from different countries. Conclusions An internationally standardized measure of cardiovascular risk management, linked to validated quality indicators and tested for feasibility in general practice, is now available. Careful development and pilot testing of the measures are crucial in international studies of quality of healthcare. PMID:21473758

The Psychometric Properties and the Development of the Indicators of Quality Nursing Work Environments in Taiwan.

PubMed

Lin, Chiou-Fen; Lu, Meei-Shiow; Huang, Hsiu-Ying

2016-03-01

The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan. This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool. Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2, we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability. The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0, whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%. The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.

The Representation of Library Value in Extra-Institutional Evaluations of University Quality

ERIC Educational Resources Information Center

Jackson, Brian

2017-01-01

The ways in which university quality assessments are developed reveal a great deal about value constructs surrounding higher education. Measures developed and consumed by external stakeholders, in particular, indicate which elements of academia are broadly perceived to be most reflective of quality. This paper examines the historical context of…

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…

Water quality guidelines for the Great Barrier Reef World Heritage Area: a basis for development and preliminary values.

PubMed

Moss, Andrew; Brodie, Jon; Furnas, Miles

2005-01-01

The Australian and New Zealand Guidelines for Fresh and Marine Water Quality (ANZECC Guidelines) provide default national guideline values for a wide range of indicators of relevance to the protection of the ecological condition of natural waters. However, the ANZECC Guidelines also place a strong emphasis on the need to develop more locally relevant guidelines. Using a structured framework, this paper explores indicators and regional data sets that can be used to develop more locally relevant guidelines for the Great Barrier Reef World Heritage Area (GBRWHA). The paper focuses on the water quality impacts of adjacent catchments on the GBRWHA with the key stressors addressed being nutrients, sediments and agricultural chemicals. Indicators relevant to these stressors are discussed including both physico-chemical pressure indicators and biological condition indicators. Where adequate data sets are available, guideline values are proposed. Generally, data were much more readily available for physico-chemical pressure indicators than for biological condition indicators. Specifically, guideline values are proposed for the major nutrients nitrogen (N) and phosphorus (P) and for chlorophyll-a. More limited guidelines are proposed for sediment related indicators. For most agricultural chemicals, the ANZECC Guidelines are likely to remain the default of choice for some time but it is noted that there is data in the literature that could be used to develop more locally relevant guidelines.

Sound quality indicators for urban places in Paris cross-validated by Milan data.

PubMed

Ricciardi, Paola; Delaitre, Pauline; Lavandier, Catherine; Torchia, Francesca; Aumond, Pierre

2015-10-01

A specific smartphone application was developed to collect perceptive and acoustic data in Paris. About 3400 questionnaires were analyzed, regarding the global sound environment characterization, the perceived loudness of some emergent sources and the presence time ratio of sources that do not emerge from the background. Sound pressure level was recorded each second from the mobile phone's microphone during a 10-min period. The aim of this study is to propose indicators of urban sound quality based on linear regressions with perceptive variables. A cross validation of the quality models extracted from Paris data was carried out by conducting the same survey in Milan. The proposed sound quality general model is correlated with the real perceived sound quality (72%). Another model without visual amenity and familiarity is 58% correlated with perceived sound quality. In order to improve the sound quality indicator, a site classification was performed by Kohonen's Artificial Neural Network algorithm, and seven specific class models were developed. These specific models attribute more importance on source events and are slightly closer to the individual data than the global model. In general, the Parisian models underestimate the sound quality of Milan environments assessed by Italian people.

Comparability of fish-based ecological quality assessments for geographically distinct Iberian regions.

PubMed

Segurado, P; Caiola, N; Pont, D; Oliveira, J M; Delaigue, O; Ferreira, M T

2014-04-01

In this work we compare two Iberian and a pan-European fish-based methods to assess ecological quality in rivers: the Fish-based Index of Biotic Integrity for Portuguese Wadeable Streams (F-IBIP), the Mediterranean Index of Biotic Integrity (IBIMED) and the pan-European Fish Index (EFI+). The results presented herein were developed in the context of the 2nd phase of the Intercalibration Exercise (IC), as required by the Water Frame Directive (WFD). The IC is aimed at ensuring comparability of the quality boundaries among the different WFD assessment methods developed by the Member States for each biological quality element. Although the two national assessment methods were developed for very distinct regions of Iberia (Western and Eastern Iberian Peninsula) they share the same methodological background: both are type-specific and guild-based multimetric indices. EFI+ is a multimetric guild-based model, but it is site-specific and uses a predictive modelling approach. The three indices were computed for all sites included in the Iberian Intercalibration database to allow the direct comparison, by means of linear regressions, of the resulting three quality values per site. The quality boundary harmonization between the two Iberian methods was only possible through an indirect comparison between the two indices, using EFI+ as a common metric. The three indices were also shown to be responsive to a common set of human induced pressures. This study highlights the need to develop general assessment methods adapted to wide geographical ranges with high species turnover to help intercalibrating assessment methods tailored for geographically more restricted regions. © 2013.

[Quality management in a clinical research facility: Evaluation of changes in quality in-house figures and the appraisal of in-house quality indicators].

PubMed

Aden, Bile; Allekotte, Silke; Mösges, Ralph

2016-12-01

For long-term maintenance and improvement of quality within a clinical research institute, the implementation and certification of a quality management system is suitable. Due to the implemented quality management system according to the still valid DIN EN ISO 9001:2008 desired quality objectives are achieved effectively. The evaluation of quality scores and the appraisal of in-house quality indicators make an important contribution in this regard. In order to achieve this and draw quality assurance conclusions, quality indicators as sensible and sensitive as possible are developed. For this, own key objectives, the retrospective evaluation of quality scores, a prospective follow-up and also discussions establish the basis. In the in-house clinical research institute the measures introduced by the quality management led to higher efficiency in work processes, improved staff skills, higher customer satisfaction and overall to more successful outcomes in relation to the self-defined key objectives. Copyright © 2016. Published by Elsevier GmbH.

A Measure of Quality

ERIC Educational Resources Information Center

Environmental Science and Technology, 1976

1976-01-01

Recent national surveys conducted by the Council on Environmental Quality and others uncovered inconsistencies and confusion in the manner environmental quality parameters were used and reported. A standard air pollution index, comparative guide to water quality indicators and biological monitoring information are being developed. (BT)

GIS ANALYSIS FOR EPIDEMIOLOGIC RECREATIONAL WATER SUTDIES

EPA Science Inventory

Introduction: The Beaches Act of 2000 requires that the Agency develop new rapid method water quality indicators (2 hours or less) that predict whether or not coastal water is safe for swimming. This new set of water quality indicators must be validated through the epidemiologi...

INTEGRATING INDICATORS OF ECOLOGICAL CONDITION, STRESSOR EXPOSURE, AND QUALITY OF LIFE TOWARDS AN ASSESSMENT OF REGIONAL VULNERABILITY

EPA Science Inventory

The U.S. Environmental Protection's Regional Vulnerability Assessment (REVA) Program is developing and evaluating approaches to integrate information on environmental condition, estimated stressor exposures, and quality of life indicators so that regional risks can be prioritized...

[The evaluation of physical development of students].

PubMed

2012-01-01

The article demonstrates that physical health of university students is conditioned by the aggregate of morpho-functional indices and depends on the development of physical qualities of students. The evaluation of mass/height indicators of female students demonstrates the increase of total body size and weakness of body build. The testing of physical readiness testified the ambiguity of high-speed and high-speed/power qualities and results of stamina evaluation.

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.

Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review

PubMed Central

de Boer, Karin; Burggraaf, Henriëtte; Derks, Jan B.; van Dijk, Det; van Dillen, Jeroen; Dirksen, Carmen D.; Duvekot, Johannes J.; Franx, Arie; Hasaart, Tom H. M.; Huisjes, Anjoke J. M.; Kolkman, Diny; Kwee, Anneke; Mol, Ben W.; van Pampus, Mariëlle G.; de Roon-Immerzeel, Alieke; van Roosmalen, Jos J. M.; Roumen, Frans J. M. E.; Smid-Koopman, Ellen; Spaans, Wilbert A.; Visser, Harry; van Wijngaarden, Wim J.; Willekes, Christine; Wouters, Maurice G. A. J.

2016-01-01

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adherence 46%), 2) non-progressive labour (frequency 12%, CS performed too early in over 75%), 3) continuous support during labour (frequency 88%, adherence 37%) and 4) previous CS (frequency 12%), with adequate counselling in 15%. Conclusions We identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide. PMID:26783742

Water Quality Standards for Coral Reef Protection | Science ...

EPA Pesticide Factsheets

The U.S. Clean Water Act provides a legal framework to protect coastal biological resources such as coral reefs, mangrove forests, and seagrass meadows from the damaging effects of human activities. Even though many resources are protected under this authority, water quality standards have not been effectively applied to coral reefs. The Environmental Protection Agency is promoting biocriteria and other water quality standards through collaborative development of bioassessment procedures, indicators and monitoring strategies. To support regulatory action, bioassessment indicators must be biologically meaningful, relevant to management, responsive to human disturbance, and relatively immune to natural variability. A rapid bioassessment protocol for reef-building stony corals was developed and tested for regulatory applicability. Preliminary testing in the Florida Keys found indicators had sufficient precision and provided information relevant to coral reef management. Sensitivity to human disturbance was demonstrated in the U.S. Virgin Islands for five of eight indicators tested. Once established, monitoring programs using these indicators can provide valuable, long-term records of coral condition and regulatory compliance. Development of a rapid bioassement protocol for reef-building stony corals was tested for regulatory applicability.

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon.

PubMed

Kedikoglou, Simos; Syrigos, Konstantinos; Skalkidis, Yannis; Ploiarchopoulou, Fani; Dessypris, Nick; Petridou, Eleni

2005-08-01

The quality improvement effort in clinical practice has focused mostly on 'performance quality', i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the 'conformance quality', i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A 'learning curve' phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

Development, evaluation, and application of sediment quality targets for assessing and managing contaminated sediments in Tampa Bay, Florida

USGS Publications Warehouse

MacDonald, D.D.; Carr, R.S.; Eckenrod, D.; Greening, H.; Grabe, S.; Ingersoll, C.G.; Janicki, S.; Janicki, T.; Lindskoog, R.A.; Long, E.R.; Pribble, R.; Sloane, G.; Smorong, D.E.

2004-01-01

Tampa Bay is a large, urban estuary that is located in west central Florida. Although water quality conditions represent an important concern in this estuary, information from numerous sources indicates that sediment contamination also has the potential to adversely affect aquatic organisms, aquatic-dependent wildlife, and human health. As such, protecting relatively uncontaminated areas of the bay from contamination and reducing the amount of toxic chemicals in contaminated sediments have been identified as high-priority sediment management objectives for Tampa Bay. To address concerns related to sediment contamination in the bay, an ecosystem-based framework for assessing and managing sediment quality conditions was developed that included identification of sediment quality issues and concerns, development of ecosystem goals and objectives, selection of ecosystem health indicators, establishment of metrics and targets for key indicators, and incorporation of key indicators, metrics, and targets into watershed management plans and decision-making processes. This paper describes the process that was used to select and evaluate numerical sediment quality targets (SQTs) for assessing and managing contaminated sediments. These SQTs included measures of sediment chemistry, whole-sediment and pore-water toxicity, and benthic invertebrate community structure. In addition, the paper describes how the SQTs were used to develop site-specific concentration-response models that describe how the frequency of adverse biological effects changes with increasing concentrations of chemicals of potential concern. Finally, a key application of the SQTs for defining sediment management areas is discussed.

Feasibility of evaluating quality cancer care using registry data and electronic health records: a population-based study.

PubMed

Caldarella, Adele; Amunni, Gianni; Angiolini, Catia; Crocetti, Emanuele; Di Costanzo, Francesco; Di Leo, Angelo; Giusti, Francesco; Pegna, Andrea Lopes; Mantellini, Paola; Luzzatto, Lucio; Paci, Eugenio

2012-08-01

To evaluate the quality of patients care, a set of indicators of the standards of cancer care were defined. We developed a set of indicators to assess the implementation in daily practice of recommendation produced by a regional network (Istituto Toscano Tumori). This set was tested in a retrospective study in the resident population of the Tuscany Region; the regional health system is organized on 12 local health authorities which refer to three macro areas (Area Vasta). The study included incident colorectal, lung and breast cancer cases listed in 2004 for the Tuscan Cancer Registry, a population-based registry which collected tumor cases diagnosed in all residents in Tuscany. Electronic data from registry database were used to determine the compliance with each indicator for patients in 2004. To validate the results, an ad hoc clinical survey including the same geographical area for the year 2006 was performed. None. The proportion of patients who fulfilled each of the indicators. Our study showed the feasibility of the evaluation of the quality of cancer care using cancer registry population-based data and major computerized information systems. The estimation of the selected indicators confirmed a good homogeneity among areas, and globally revealed a good intraregional performance. Further work is needed to develop specific quality measures, particularly about structural data and to continually revise indicators of quality of care. Data from a cancer registry, however, can be useful to evaluate quality of cancer care.

Emergency Medicine and Critical Care Blogs and Podcasts: Establishing an International Consensus on Quality.

PubMed

Thoma, Brent; Chan, Teresa M; Paterson, Quinten S; Milne, W Kenneth; Sanders, Jason L; Lin, Michelle

2015-10-01

This study identified the most important quality indicators for online educational resources such as blogs and podcasts. A modified Delphi process that included 2 iterative surveys was used to build expert consensus on a previously defined list of 151 quality indicators divided into 3 themes: credibility, content, and design. Aggregate social media indicators were used to identify an expert population of editors from a defined list of emergency medicine and critical care blogs and podcasts. Survey 1 consisted of the quality indicators and a 7-point Likert scale. The mean score for each quality indicator was included in survey 2, which asked participants whether to "include" or "not include" each quality indicator. The cut point for consensus was defined at greater than 70% "include." Eighty-three percent (20/24) of bloggers and 90.9% (20/22) of podcasters completed survey 1 and 90% (18/20) of bloggers and podcasters completed survey 2. The 70% inclusion criteria were met by 44 and 80 quality indicators for bloggers and podcasters, respectively. Post hoc, a 90% cutoff was used to identify a list of 14 and 26 quality indicators for bloggers and podcasters, respectively. The relative importance of quality indicators for emergency medicine blogs and podcasts was determined. This will be helpful for resource producers trying to improve their blogs or podcasts and for learners, educators, and academic leaders assessing their quality. These results will inform broader validation studies and attempts to develop user-friendly assessment instruments for these resources. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The methodological quality of nurse-sensitive indicators in Dutch hospitals: A descriptive exploratory research study.

PubMed

Kieft, R A M M; Stalpers, D; Jansen, A P M; Francke, A L; Delnoij, D M J

2018-06-01

Nurse-sensitive indicators (NSIs) are increasingly being developed and used to establish quality of nursing care in Western countries. The objective was to gain insights into the methodological quality of mandatory NSIs in Dutch hospitals, including indicators for pain, wound care, malnutrition and delirium. A descriptive exploratory design was used, starting with desk research into publicly available documents and reports describing the development of the NSIs included in this study. We used the validated Appraisal of Indicators through Research and Evaluation (AIRE) instrument to evaluate the methodological quality. Although the purpose and relevance of each individual NSI have been described, no detailed information about the criteria for selecting these topics is available. It is not clear which specific stakeholders participated and how their input was used. We found no information about the process of collecting and compiling scientific evidence. It is unclear whether and to what extent the usability of NSIs has been tested. The methodological quality of NSIs used in Dutch hospitals is less than optimal in various ways and it is therefore questionable if the indicators are accurate enough to identify changes or improve nursing practice. Our study also provides an example of how the methodological quality of NSIs can be assessed systematically, which is relevant considering the increasing use of NSIs in various countries. Copyright © 2018 Elsevier B.V. All rights reserved.

Levels of Indicator Development for Education for Sustainable Development

ERIC Educational Resources Information Center

Rode, Horst; Michelsen, Gerd

2008-01-01

The article summarizes some considerations about the development of indicators for education for sustainable development (ESD). It reflects the present state of discussion, especially from a German perspective, and includes present developments in the area of quality criteria and standards for ESD. These discussion threads only denote the…

Potential palliative care quality indicators in heart disease patients: A review of the literature.

PubMed

Mizuno, Atsushi; Miyashita, Mitsunori; Hayashi, Akitoshi; Kawai, Fujimi; Niwa, Koichiro; Utsunomiya, Akemi; Kohsaka, Shun; Kohno, Takashi; Yamamoto, Takeshi; Takayama, Morimasa; Anzai, Toshihisa

2017-10-01

In spite of the increasing interest in palliative care for heart disease, data on the detailed methods of palliative care and its efficacy specifically in heart disease are still lacking. A structured PubMed literature review revealed no quality indicators of palliative care in heart disease. Therefore, we performed a narrative overview of the potential quality indicators in heart disease by reviewing previous literature concerning quality indicators in cancer patients. We summarize seven potential categories of quality indicators in heart disease: (1) presence and availability of a palliative care unit, palliative care team, and outpatient palliative care; (2) human resources such as number of skilled staff; (3) infrastructure; (4) presence and frequency of documentation or family survey; (5) patient-reported outcome measure (PROM) data and disease-specific patient quality of life such as The Kansas City Cardiomyopathy Questionnaire (KCCQ); (6) questionnaires and interviews about the quality of palliative care after death, including bereaved family surveys; and (7) admission-related outcomes such as place of death and intensive care unit length of stay. Although detailed measurements of palliative care quality have not been validated in heart disease, many indicators developed in cancer patients might also be applicable to heart disease. This new categorization might be useful to determine quality indicators in heart disease patients. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Identifying individual changes in performance with composite quality indicators while accounting for regression to the mean.

PubMed

Gajewski, Byron J; Dunton, Nancy

2013-04-01

Almost a decade ago Morton and Torgerson indicated that perceived medical benefits could be due to "regression to the mean." Despite this caution, the regression to the mean "effects on the identification of changes in institutional performance do not seem to have been considered previously in any depth" (Jones and Spiegelhalter). As a response, Jones and Spiegelhalter provide a methodology to adjust for regression to the mean when modeling recent changes in institutional performance for one-variable quality indicators. Therefore, in our view, Jones and Spiegelhalter provide a breakthrough methodology for performance measures. At the same time, in the interests of parsimony, it is useful to aggregate individual quality indicators into a composite score. Our question is, can we develop and demonstrate a methodology that extends the "regression to the mean" literature to allow for composite quality indicators? Using a latent variable modeling approach, we extend the methodology to the composite indicator case. We demonstrate the approach on 4 indicators collected by the National Database of Nursing Quality Indicators. A simulation study further demonstrates its "proof of concept."

Designing a Method with Physician Participation to Assess and Improve Quality of Healthcare in Otolaryngology.

PubMed

Arce, José M; Martín Cleary, Catalina; Cenjor, Carlos; Ramos, Ángel; Ortiz, Alberto

2017-04-01

Patient choice of healthcare centers to be treated for specific diseases is compromised by the low accessibility of understandable information. Physicians are rarely involved in healthcare quality assessment, despite their potentially valuable input. The purpose of this study was to develop a methodology for evaluating the quality of care that specifically incorporates advice from medical specialists and provides accessible information for patients in search of high-quality healthcare. A pilot Delphi study was conducted among 28 Spanish otolaryngology experts, seeking their opinion on the quality-of-care indicators and on their ability to recommend the most suitable department for the treatment of specific otolaryngologic diseases. The average acceptance rate was 91.9% for quality-of-care indicator and 96.5% for the resources needed for improving the quality of care. Furthermore, 93% experts reported that patients frequently ask for physician advice on which center provides better care for a specific disease, 92.6% experts believe they could recommend the best centers for specific otolaryngologic diseases, and 80% experts agreed that expert opinion on the quality of care offered by different centers would be a valuable addition to quality-of-care assessment. The incorporation of physician advice into healthcare quality assessment may improve the usefulness of healthcare quality indicators for patients. Assessment tools incorporating physician advice should be developed and validated.

Building Quality Foundations: Indicators and Instruments to Measure the Quality of Vocational Education and Training

ERIC Educational Resources Information Center

Coates, Hamish

2009-01-01

Vocational education and training plays a major and increasing role in developing the knowledge and skills that underpin Australia's economy and society. It is vital, accordingly, that training outcomes are of high quality. This paper reports work undertaken to develop a new evidence-based and outcomes-focused national approach to monitoring and…

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

PubMed Central

Coenen, Samuel; Ferech, Matus; Haaijer‐Ruskamp, Flora M; Butler, Chris C; Stichele, Robert H Vander; Verheij, Theo J M; Monnet, Dominique L; Little, Paul; Goossens, Herman

2007-01-01

Background and objective Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug‐specific quality indicators for outpatient antibiotic use in Europe, derived from European Surveillance of Antimicrobial Consumption (ESAC) data. Methods 27 experts (15 countries), in a European Science Foundation workshop, built on the expertise within the European Drug Utilisation Research Group, the General Practice Respiratory Infections Network, the ESCMID Study Group on Primary Care Topics, the Belgian Antibiotic Policy Coordination Committee, the World Health Organization, ESAC, and other experts. A set of proposed indicators was developed using 1997–2003 ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA‐RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1–6 interval and if there was consensus (number of scores within the 1–3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators—values were updated with 2004 ESAC data. Results 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. Conclusion 12 of the proposed ESAC‐based quality indicators for outpatient antibiotic use in Europe have face validity and are potentially applicable. These indicators could be used to better describe antibiotic use in ambulatory care and assess the quality of national antibiotic prescribing patterns in Europe. PMID:18055888

Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study.

PubMed

Peter, W F; Hurkmans, E J; van der Wees, P J; Hendriks, E J M; van Bodegom-Vos, L; Vliet Vlieland, T P M

2016-12-01

The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.

Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions.

PubMed

Davies, Sheryl; Schultz, Ellen; Raven, Maria; Wang, Nancy Ewen; Stocks, Carol L; Delgado, Mucio Kit; McDonald, Kathryn M

2017-10-01

To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases. Empirical analyses and structured panel reviews. Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs). ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated. The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research. © Health Research and Educational Trust.

Interpreting drinking water quality in the distribution system using Dempster-Shafer theory of evidence.

PubMed

Sadiq, Rehan; Rodriguez, Manuel J

2005-04-01

Interpreting water quality data routinely generated for control and monitoring purposes in water distribution systems is a complicated task for utility managers. In fact, data for diverse water quality indicators (physico-chemical and microbiological) are generated at different times and at different locations in the distribution system. To simplify and improve the understanding and the interpretation of water quality, methodologies for aggregation and fusion of data must be developed. In this paper, the Dempster-Shafer theory also called theory of evidence is introduced as a potential methodology for interpreting water quality data. The conceptual basis of this methodology and the process for its implementation are presented by two applications. The first application deals with the interpretation of spatial water quality data fusion, while the second application deals with the development of water quality index based on key monitored indicators. Based on the obtained results, the authors discuss the potential contribution of theory of evidence as a decision-making tool for water quality management.

Developing quality indicators and auditing protocols from formal guideline models: knowledge representation and transformations.

PubMed

Advani, Aneel; Goldstein, Mary; Shahar, Yuval; Musen, Mark A

2003-01-01

Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a model representation and algorithm for deriving structured quality indicators and auditing protocols from formalized specifications of guidelines used in decision support systems. We apply the model and algorithm to the assessment of physician concordance with a guideline knowledge model for hypertension used in a decision-support system. The properties of our solution include the ability to derive automatically context-specific and case-mix-adjusted quality indicators that can model global or local levels of detail about the guideline parameterized by defining the reliability of each indicator or element of the guideline.

Predicting soil quality indices with near infrared analysis in a wildfire chronosequence.

PubMed

Cécillon, Lauric; Cassagne, Nathalie; Czarnes, Sonia; Gros, Raphaël; Vennetier, Michel; Brun, Jean-Jacques

2009-01-15

We investigated the power of near infrared (NIR) analysis for the quantitative assessment of soil quality in a wildfire chronosequence. The effect of wildfire disturbance and soil engineering activity of earthworms on soil organic matter quality was first assessed with principal component analysis of NIR spectra. Three soil quality indices were further calculated using an adaptation of the method proposed by Velasquez et al. [Velasquez, E., Lavelle, P., Andrade, M. GISQ, a multifunctional indicator of soil quality. Soil Biol Biochem 2007; 39: 3066-3080.], each one addressing an ecosystem service provided by soils: organic matter storage, nutrient supply and biological activity. Partial least squares regression models were developed to test the predicting ability of NIR analysis for these soil quality indices. All models reached coefficients of determination above 0.90 and ratios of performance to deviation above 2.8. This finding provides new opportunities for the monitoring of soil quality, using NIR scanning of soil samples.

First Dutch Consensus of Pain Quality Indicators for Pain Treatment Facilities.

PubMed

de Meij, Nelleke; van Grotel, Marloes; Patijn, Jacob; van der Weijden, Trudy; van Kleef, Maarten

2016-01-01

There is a general consensus about the need to define and improve the quality of pain treatment facilities. Although guidelines and recommendations to improve the quality of pain practice management have been launched, provision of appropriate pain treatment is inconsistent and the quality of facilities varies widely. The aim of the study was to develop an expert-agreed list of quality indicators applicable to pain treatment facilities. The list was also intended to be used as the basis for a set of criteria for registered status of pain treatment facilities. The University Pain Center Maastricht at the Department of Anesthesiology and Pain Management of the Maastricht University Medical Center conducted a 3-round Delphi study in collaboration with the Board of the Pain Section of the Dutch Society of Anesthesiologists (NVA). Twenty-five quality indicators were selected as relevant to 2 types of pain treatment facilities, pain clinics and pain centers. The final expert-agreed list consisted of 22 quality indicators covering 7 quality domains: supervision, availability of care, staffing level and patient load, quality policy, multidisciplinarity, regionalization, and research and education. This set of quality indicators may facilitate organizational evaluation and improve insight into service quality from the perspectives of patients, pain specialists, and other healthcare professionals. Recommendations for improvements to the current set of quality indicators are made. In 2014 the process of registering pain treatment facilities in the Netherlands started; facilities can register as a pain clinic or pain center. © 2015 World Institute of Pain.

Environmental quality indicators and financial development in Malaysia: unity in diversity.

PubMed

Alam, Arif; Azam, Muhammad; Abdullah, Alias Bin; Malik, Ihtisham Abdul; Khan, Anwar; Hamzah, Tengku Adeline Adura Tengku; Faridullah; Khan, Muhammad Mushtaq; Zahoor, Hina; Zaman, Khalid

2015-06-01

Environmental quality indicators are crucial for responsive and cost-effective policies. The objective of the study is to examine the relationship between environmental quality indicators and financial development in Malaysia. For this purpose, the number of environmental quality indicators has been used, i.e., air pollution measured by carbon dioxide emissions, population density per square kilometer of land area, agricultural production measured by cereal production and livestock production, and energy resources considered by energy use and fossil fuel energy consumption, which placed an impact on the financial development of the country. The study used four main financial indicators, i.e., broad money supply (M2), domestic credit provided by the financial sector (DCFS), domestic credit to the private sector (DCPC), and inflation (CPI), which each financial indicator separately estimated with the environmental quality indicators, over a period of 1975-2013. The study used the generalized method of moments (GMM) technique to minimize the simultaneity from the model. The results show that carbon dioxide emissions exert the positive correlation with the M2, DCFC, and DCPC, while there is a negative correlation with the CPI. However, these results have been evaporated from the GMM estimates, where carbon emissions have no significant relationship with any of the four financial indicators in Malaysia. The GMM results show that population density has a negative relationship with the all four financial indicators; however, in case of M2, this relationship is insignificant to explain their result. Cereal production has a positive relationship with the DCPC, while there is a negative relationship with the CPI. Livestock production exerts the positive relationship with the all four financial indicators; however, this relationship with the CPI has a more elastic relationship, while the remaining relationship is less elastic with the three financial indicators in a country. Energy resources comprise energy use and fossil fuel energy consumption, both have distinct results with the financial indicators, as energy demand have a positive and significant relationship with the DCFC, DCPC, and CPI, while fossil fuel energy consumption have a negative relationship with these three financial indicators. The results of the study are of value to both environmentalists and policy makers.

Anthropogenic activities and coastal environmental quality: a regional quantitative analysis in southeast China with management implications.

PubMed

Chen, Kai; Liu, Yan; Huang, Dongren; Ke, Hongwei; Chen, Huorong; Zhang, Songbin; Yang, Shengyun; Cai, Minggang

2018-02-01

Regional analysis of environmental issues has always been a hot topic in the field of sustainable development. Because the different levels of economic growth, urbanization, resource endowments, etc. in different regions generate apparently different ecological responses, a better description and comparison across different regions will provide more valuable implications for ecological improvement and policymaking. In this study, seven typical bays in southeast China that are a rapid developing area were selected to quantitatively analyze the relationship between socioeconomic development and coastal environmental quality. Based on the water quality data from 2007 to 2015, the multivariate statistical method was applied to analyze the potential environmental risks and to classify the seven bays based on their environmental quality status. The possible variation trends of environmental indices were predicted based on the cross-regional panel data by Environmental Kuznets Curve. The results showed that there were significant regional differences among the seven bays, especially Quanzhou, Xiamen, and Luoyuan Bays, suffered from severer artificial disturbances than other bays, despite their different development patterns. Socioeconomic development level was significantly associated with some water quality indices (pH, DIN, PO 4 -P); the association was roughly positive: the areas with higher GDP per capita have some worse water quality indices. In addition, the decreasing trend of pH values and the increasing trend of nutrient concentration in the seven bays will continue in the foreseeable future. In consideration of the variation trends, the limiting nutrient strategy should be implemented to mitigate the deterioration of the coastal environments.

Quality Indicators: Developing "MOOCs" in the European Higher Education Area

ERIC Educational Resources Information Center

Yepes-Baldó, Montserrat; Romeo, Marina; Martín, Carolina; García, María Ángeles; Monzó, Gemma; Besolí, Andrés

2016-01-01

The objective of this research is to design an integrated system of evaluation of the quality of the Massive Open Online Courses (MOOC) taking into account the features of this type of courses. The criteria included in the evaluation of the quality of e-learning training in a broad sense are considered, and specifically those developed for the…

Development and pilot test of a new set of good practice indicators for chronic cancer pain management.

PubMed

Saturno, P J; Martinez-Nicolas, I; Robles-Garcia, I S; López-Soriano, F; Angel-García, D

2015-01-01

Pain is among the most important symptoms in terms of prevalence and cause of distress for cancer patients and their families. However, there is a lack of clearly defined measures of quality pain management to identify problems and monitor changes in improvement initiatives. We built a comprehensive set of evidence-based indicators following a four-step model: (1) review and systematization of existing guidelines to list evidence-based recommendations; (2) review and systematization of existing indicators matching the recommendations; (3) development of new indicators to complete a set of measures for the identified recommendations; and (4) pilot test (in hospital and primary care settings) for feasibility, reliability (kappa), and usefulness for the identification of quality problems using the lot quality acceptance sampling (LQAS) method and estimates of compliance. Twenty-two indicators were eventually pilot tested. Seventeen were feasible in hospitals and 12 in all settings. Feasibility barriers included difficulties in identifying target patients, deficient clinical records and low prevalence of cases for some indicators. Reliability was mostly very good or excellent (k > 0.8). Four indicators, all of them related to medication and prevention of side effects, had acceptable compliance at 75%/40% LQAS level. Other important medication-related indicators (i.e., adjustment to pain intensity, prescription for breakthrough pain) and indicators concerning patient-centred care (i.e., attention to psychological distress and educational needs) had very low compliance, highlighting specific quality gaps. A set of good practice indicators has been built and pilot tested as a feasible, reliable and useful quality monitoring tool, and underscoring particular and important areas for improvement. © 2014 European Pain Federation - EFIC®

Quality indicators to compare accredited independent pharmacies and accredited chain pharmacies in Thailand.

PubMed

Arkaravichien, Wiwat; Wongpratat, Apichaya; Lertsinudom, Sunee

2016-08-01

Background Quality indicators determine the quality of actual practice in reference to standard criteria. The Community Pharmacy Association (Thailand), with technical support from the International Pharmaceutical Federation, developed a tool for quality assessment and quality improvement at community pharmacies. This tool has passed validity and reliability tests, but has not yet had feasibility testing. Objective (1) To test whether this quality tool could be used in routine settings. (2) To compare quality scores between accredited independent and accredited chain pharmacies. Setting Accredited independent pharmacies and accredited chain pharmacies in the north eastern region of Thailand. Methods A cross sectional study was conducted in 34 accredited independent pharmacies and accredited chain pharmacies. Quality scores were assessed by observation and by interviewing the responsible pharmacists. Data were collected and analyzed by independent t-test and Mann-Whitney U test as appropriate. Results were plotted by histogram and spider chart. Main outcome measure Domain's assessable scores, possible maximum scores, mean and median of measured scores. Results Domain's assessable scores were close to domain's possible maximum scores. This meant that most indicators could be assessed in most pharmacies. The spider chart revealed that measured scores in the personnel, drug inventory and stocking, and patient satisfaction and health promotion domains of chain pharmacies were significantly higher than those of independent pharmacies (p < 0.05). There was no statistical difference between independent pharmacies and chain pharmacies in the premise and facility or dispensing and patient care domains. Conclusion Quality indicators developed by the Community Pharmacy Association (Thailand) could be used to assess quality of practice in pharmacies in routine settings. It is revealed that the quality scores of chain pharmacies were higher than those of independent pharmacies.

Quality of care indicators for the rehabilitation of children with traumatic brain injury.

PubMed

Rivara, Frederick P; Ennis, Stephanie K; Mangione-Smith, Rita; MacKenzie, Ellen J; Jaffe, Kenneth M

2012-03-01

To develop measurement tools for assessing compliance with identifiable processes of inpatient care for children with traumatic brain injury (TBI) that are reliable, valid, and amenable to implementation. Literature review and expert panel using the RAND/UCLA Appropriateness Method and a Delphi technique. Not applicable. Children with TBI. Not applicable. Quality of care indicators. A total of 119 indicators were developed across the domains of general management; family-centered care; cognitive-communication, speech, language, and swallowing impairments; gross and fine motor skill impairments; neuropsychologic, social, and behavioral impairments; school reentry; and community integration. There was a high degree of agreement on these indicators as valid and feasible quality measures for children with TBI. These indicators are an important step toward building a better base of evidence about the effectiveness and efficiency of the components of acute inpatient rehabilitation for pediatric patients with TBI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2016-01-01

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

How do performance-based financing programmes measure quality of care? A descriptive analysis of 68 quality checklists from 28 low- and middle-income countries

PubMed Central

Josephson, Erik; Gergen, Jessica; Coe, Martha; Ski, Samantha; Madhavan, Supriya; Bauhoff, Sebastian

2017-01-01

Abstract This paper seeks to systematically describe the length and content of quality checklists used in performance-based financing programmes, their similarities and differences, and how checklists have evolved over time. We compiled a list of supply-side, health facility-based performance-based financing (PBF) programmes in low- and lower middle-income countries based on a document review. We then solicited PBF manuals and quality checklists from implementers and donors of these PBF mechanisms. We entered each indicator from each quality checklist into a database verbatim in English, and translated into English from French where appropriate, and categorized each indicator according to the Donabedian framework and an author-derived categorization. We extracted 8,490 quality indicators from 68 quality checklists across 32 PBF implementations in 28 countries. On average, checklists contained 125 indicators; within the same program, checklists tend to grow as they are updated. Using the Donabedian framework, 80% of indicators were structure-type, 19% process-type, and less than 1% outcome-type. The author-derived categorization showed that 57% of indicators relate to availability of resources, 24% to managing the facility and 17% assess knowledge and effort. There is a high degree of similarity in a narrow set of indicators used in checklists for common service types such as maternal, neonatal and child health. We conclude that performance-based financing offers an appealing approach to targeting specific quality shortfalls and advancing toward the Sustainable Development Goals of high quality coverage. Currently most indicators focus on structural issues and resource availability. There is scope to rationalize and evolve the quality checklists of these programs to help achieve national and global goals to improve quality of care. PMID:28549142

Quality of patient health information on the Internet: reviewing a complex and evolving landscape.

PubMed

Fahy, Eamonn; Hardikar, Rohan; Fox, Adrian; Mackay, Sean

2014-01-01

The popularity of the Internet has enabled unprecedented access to health information. As a largely unregulated source, there is potential for inconsistency in the quality of information that reaches the patient. To review the literature relating to the quality indicators of health information for patients on the Internet. A search of English language literature was conducted using PubMed, Google Scholar and EMBASE databases. Many articles have been published which assess the quality of information relating to specific medical conditions. Indicators of quality have been defined in an attempt to predict higher quality health information on the Internet. Quality evaluation tools are scoring systems based on indicators of quality. Established tools such as the HONcode may help patients navigate to more reliable information. Google and Wikipedia are important emerging sources of patient health information. The Internet is crucial for modern dissemination of health information, but it is clear that quality varies significantly between sources. Quality indicators for web-information have been developed but there is no agreed standard yet. We envisage that reliable rating tools, effective search engine ranking and progress in crowd-edited websites will enhance patient access to health information on the Internet.

Predicting Fecal Indicator Bacteria Fate and Removal in Urban Stormwater at the Watershed Scale

NASA Astrophysics Data System (ADS)

Wolfand, J.; Hogue, T. S.; Luthy, R. G.

2016-12-01

Urban stormwater is a major cause of water quality impairment, resulting in surface waters that fail to meet water quality standards and support their designated uses. Of the many stormwater pollutants, fecal indicator bacteria are particularly important to track because they are directly linked to pathogens which jeopardize public health; yet, their fate and transport in urban stormwater is poorly understood. Monitoring fecal bacteria in stormwater is possible, but due to the high variability of fecal indicators both spatially and temporally, single grab or composite samples do not fully capture fecal indicator loading. Models have been developed to predict fecal indicator bacteria at the watershed scale, but they are often limited to agricultural areas, or areas that receive frequent rainfall. Further, it is unclear whether best management practices (BMPs), such as bioretention or engineered wetlands, are able to reduce bacteria to meet water quality standards at watershed outlets. This research seeks to develop a model to predict fecal indicator bacteria in urban stormwater in a semi-arid climate at the watershed scale. Using the highly developed Ballona Creek watershed (89 mi2) located in Los Angeles County as a case study, several existing mechanistic models are coupled with a hydrologic model to predict fecal indicator concentrations (E. coli, enterococci, fecal coliform, and total coliform) at the outfall of Ballona Creek watershed, Santa Monica Bay. The hydrologic model was developed using InfoSWMM Sustain, calibrated for flow from WY 1998-2006 (NSE = 0.94; R2 = 0.95), and validated from WY 2007-2015 (NSE = 0.93; R2 = 0.95). The developed coupled model is being used to predict fecal indicator fate and transport and evaluate how BMPs can be optimized to reduce fecal indicator loading to surface waters and recreational beaches.

The Microbial Fecal Indicator Paradigm: Tools in the Toolbox Applications in Recreational Waters

EPA Science Inventory

Summary of ORD’s recent research to develop tools for assessing microbial water quality in recreational waters. Methods discussed include the development of health associations between microbial fecal indicators and the development of culture, and molecular methods for fec...

Lactic acid bacteria associated with a heat-processed pork product and sources of variation affecting chemical indices of spoilage and sensory characteristics.

PubMed

Laursen, B G; Byrne, D V; Kirkegaard, J B; Leisner, J J

2009-02-01

To evaluate the potential for developing a quality index for a Danish modified atmosphere packaged (MAP) heat-processed and naturally contaminated pork meat product stored at 5 degrees C. The composition of the predominating microflora and changes in contents of tyramine, arginine, organic acids and sensory characteristics were analysed. The microflora was predominated by Lactobacillus sakei, Leuconostoc carnosum and Carnobacterium divergens. The presence of each species varied between products and batches resulting in limited usefulness of the concentrations of these bacteria or their metabolites as indices of quality. Furthermore, the three species differed in their metabolic activities as shown by use of a model meat extract. However, when MAP storage of the processed pork product was followed by aerobic storage then acetic acid showed some potential as a chemical indicator of sensory quality. Variation in processing parameters and spoilage microbiota limited the usefulness of concentrations of micro-organisms and their metabolites as indices of spoilage for the studied processed MAP pork product. The present study contributes to an understanding of the difficulties experienced in developing quality indices to be used in the control of microbial spoilage of processed MAP meat products.

Identification of regional soil quality factors and indicators: a case study on an alluvial plain (central Turkey)

NASA Astrophysics Data System (ADS)

Şeker, Cevdet; Hüseyin Özaytekin, Hasan; Negiş, Hamza; Gümüş, İlknur; Dedeoğlu, Mert; Atmaca, Emel; Karaca, Ümmühan

2017-05-01

Sustainable agriculture largely depends on soil quality. The evaluation of agricultural soil quality is essential for economic success and environmental stability in rapidly developing regions. In this context, a wide variety of methods using vastly different indicators are currently used to evaluate soil quality. This study was conducted in one of the most important irrigated agriculture areas of Konya in central Anatolia, Turkey, to analyze the soil quality indicators of Çumra County in combination with an indicator selection method, with the minimum data set using a total of 38 soil parameters. We therefore determined a minimum data set with principle component analysis to assess soil quality in the study area and soil quality was evaluated on the basis of a scoring function. From the broad range of soil properties analyzed, the following parameters were chosen: field capacity, bulk density, aggregate stability, and permanent wilting point (from physical soil properties); electrical conductivity, Mn, total nitrogen, available phosphorus, pH, and NO3-N (from chemical soil properties); and urease enzyme activity, root health value, organic carbon, respiration, and potentially mineralized nitrogen (from biological properties). According to the results, the chosen properties were found as the most sensitive indicators of soil quality and they can be used as indicators for evaluating and monitoring soil quality at a regional scale.

RAPIDLY MEASURED INDICATORS OF RECREATIONAL WATER QUALITY ARE PREDICTIVE OF SWIMMING ASSOCIATED GASTROINTESTINAL ILLNESS

EPA Science Inventory

Standard methods to measure recreational water quality require at least 24 hours to obtain results making it impossible to assess the quality of water within a single day. Methods to measure recreational water quality in two hours or less have been developed. Application of rapid...

Identification of Key Indicators of Quality in Afterschool Programs. CRESST Report 748

ERIC Educational Resources Information Center

Huang, Denise; La Torre, Deborah; Harven, Aletha; Huber, Lindsay Perez; Jiang, Lu; Leon, Seth; Oh, Christine

2008-01-01

Researchers and policymakers are increasingly interested in the issue of school accountability. Despite this, program standards for afterschool programs are not as fully developed as they are in other fields. This study bridges that gap and presents the results from a study that identifies benchmarks and indicators for high quality afterschool…

Performance Indicators and the Management of Quality in Education.

ERIC Educational Resources Information Center

Cuttance, Peter

Issues that affect the use of performance indicators in managing educational quality are discussed in this paper. Recent changes in public-sector organizational management include the development of strategies for the management of change itself and the changing role of the public sector. A trend within the public sector is an increase in the…

A ground-water-quality monitoring program for Nevada

USGS Publications Warehouse

Nowlin, Jon O.

1986-01-01

A program was designed for the systematic monitoring of ground-water quality in Nevada. Basic hydrologic and water-quality principles are discussed in the formulation of a rational approach to developing a statewide monitoring program. A review of ground-water monitoring efforts in Nevada through 1977 indicates that few requirements for an effective statewide program are being met. A suggested program has been developed that consists of five major elements: (1) A Background-Quality Network to assess the existing water quality in Nevada aquifers, (2) a Contamination Source Inventory of known or potential threats to ground-water quality, (3) Surveillance Networks to monitor ground-water quality in selected hydrographic areas, (4) Intensive Surveys of individual instances of known or potential ground-water contamination, and (5) Ground-Water Data File to manage data generated by the other monitoring elements. Two indices have been developed to help assign rational priorities for monitoring ground water in the 255 hydrographic areas of Nevada: (1) A Hydrographic-Area Priority Index for surveillance monitoring, and (2) A Development-Potential Index for background monitoring of areas with little or no current development. Requirements for efficient management of data from ground-water monitoring are discussed and the three major systems containing Nevada ground-water data are reviewed. More than 11,000 chemical analyses of ground water have been acquired from existing systems and incorporated into a prototype data base.

Nurse practitioners as attending providers for workers with uncomplicated back injuries: using administrative data to evaluate quality and process of care.

PubMed

Sears, Jeanne M; Wickizer, Thomas M; Franklin, Gary M; Cheadle, Allen D; Berkowitz, Bobbie

2007-08-01

The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers' compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs). Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression. This study found little evidence of differences between NP and PCP claims in case mix or quality of care. The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement.

The use of multiple tracers to evaluate the impact of sewered and non-sewered development on coastal water quality in a rural area of Florida.

PubMed

Meeroff, Daniel E; Bloetscher, Frederick; Long, Sharon C; Bocca, Thais

2014-05-01

When onsite wastewater treatment and disposal systems (OSTDS) are not sited appropriately or installed properly, wastewater constituents can be a source of adverse environmental impacts to soil and groundwater, which can lead to potential public health risks. A paired monitoring design developed to compare water quality in sewered and non-sewered areas is presented here. It is suggested as a possible monitoring scheme for assessing the impact of sewer installation projects. As such, two sets of single-family, rural residential Florida neighborhoods were evaluated over a two-year period to gain insight into the effects of small-community use of OSTDS on coastal water quality. One set of two neighborhoods were connected to the sanitary sewer network and the other set of two were served exclusively by OSTDS. Water quality sampling was conducted at the paired sites during seasonal high water table (SHWT) and seasonal low water table (SLWT) events. Measured surface water quality during the SHWT showed indications of environmental impacts from OSTDS in terms of nutrients, microbial pathogen indicators, and other water quality measures, such as turbidity and conductivity. However, during the SLWT events, no obvious impacts attributable to OSTDS were detected. The water quality results indicate that OSTDS impacts may be measureable in rural areas. Other factors, such as microbial indicator survival and regrowth potential, may confound the understanding of water quality impacts of sewer projects. For example, the microbial indicators Escherichia coli and enterococci were found to persist over time and therefore did not always represent true comparisons of OSTDS and sewered areas between seasons. The timeframe for evaluating the effects of sewer projects may be longer than anticipated because of this survival and regrowth phenomenon.

Developing Quality Indicators and Auditing Protocols from Formal Guideline Models: Knowledge Representation and Transformations

PubMed Central

Advani, Aneel; Goldstein, Mary; Shahar, Yuval; Musen, Mark A.

2003-01-01

Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a model representation and algorithm for deriving structured quality indicators and auditing protocols from formalized specifications of guidelines used in decision support systems. We apply the model and algorithm to the assessment of physician concordance with a guideline knowledge model for hypertension used in a decision-support system. The properties of our solution include the ability to derive automatically (1) context-specific and (2) case-mix-adjusted quality indicators that (3) can model global or local levels of detail about the guideline (4) parameterized by defining the reliability of each indicator or element of the guideline. PMID:14728124

Quantitative assessment of desertification in south of Iran using MEDALUS method.

PubMed

Sepehr, A; Hassanli, A M; Ekhtesasi, M R; Jamali, J B

2007-11-01

The main aim of this study was the quantitative assessment of desertification process in the case study area of the Fidoye-Garmosht plain (Southern Iran). Based on the MEDALUS approach and the characteristics of study area a regional model developed using GIS. Six main factors or indicators of desertification including: soil, climate, erosion, plant cover, groundwater and management were considered for evaluation. Then several sub-indicators affecting the quality of each main indicator were identified. Based on the MEDALUS approach, each sub-indicator was quantified according to its quality and given a weighting of between 1.0 and 2.0. ArcGIS 9 was used to analyze and prepare the layers of quality maps using the geometric mean to integrate the individual sub-indicator maps. In turn the geometric mean of all six quality maps was used to generate a single desertification status map. Results showed that 12% of the area is classified as very severe, 81% as severe and 7% as moderately affected by desertification. In addition the plant cover and groundwater indicators were the most important factors affecting desertification process in the study area. The model developed may be used to assess desertification process and distinguish the areas sensitive to desertification in the study region and in regions with the similar characteristics.

HON label and DISCERN as content quality indicators of health-related websites.

PubMed

Khazaal, Yasser; Chatton, Anne; Zullino, Daniele; Khan, Riaz

2012-03-01

Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into 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 (evidence-based information). "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China.

PubMed

Wu, Qi; Huang, Li-Hua; Xing, Mei-Yuan; Feng, Zhi-Xian; Shao, Le-Wen; Zhang, Mei-Yun; Shao, Rong-Ya

2017-01-01

Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking. This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China. Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR. Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count. Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Perceptions and misconceptions regarding the Joint Commission's view of quality monitoring.

PubMed

Patterson, C H

1989-10-01

The Joint Commission recently has revised its hospital standards for infection control to reflect more accurately current state-of-the-art practices. In addition, the Joint Commission's Agenda for Change initiatives include the development of clinical indicators; one of the topics that will be included in those clinical indicator sets will be infection control. How the hospital chooses to organize itself to conduct the historically required monitoring and evaluation of clinical patient care currently required by the standards of the Joint Commission is at the option of the hospital. How the hospital will organize and collect data specific to infection control indicators yet to be developed by the Joint Commission has not been determined and will not be defined until specific research and development projects are completed. The hospital is expected to have in place infection prevention, surveillance, and control programs; it also is expected to have in place a quality assurance program that focuses not only on solving identified problems but also on the improvement of patient care quality. How the hospitals organize and/or integrate these activities is also at its option. It is expected that qualified professionals will direct and enforce infection prevention, surveillance, and control practices; indicators for infection control can provide data that will help assess the relative success of those practices and activities. The Joint Commission is not developing the capability to judge, on its own part, the actual quality of care provided by an organization seeking accreditation. Rather, the Joint Commission is committed to developing more accurate means to evaluate the structures, processes, and outcomes of diagnosis and treatment activities, as well as their interrelationships. Clinical excellence is supported by quality in the organizational environment and the managerial and leadership contexts within which patient care is delivered. Both clinical and organizational excellence are essential components of quality, and the Joint Commission is convinced that it is appropriate and timely to undertake more direct assessments of both.

Usability Evaluation and Implementation of a Health Information Technology Dashboard of Evidence-Based Quality Indicators.

PubMed

Schall, Mark Christopher; Cullen, Laura; Pennathur, Priyadarshini; Chen, Howard; Burrell, Keith; Matthews, Grace

2017-06-01

Health information technology dashboards that integrate evidence-based quality indicators can efficiently and accurately display patient risk information to promote early intervention and improve overall quality of patient care. We describe the process of developing, evaluating, and implementing a dashboard designed to promote quality care through display of evidence-based quality indicators within an electronic health record. Clinician feedback was sought throughout the process. Usability evaluations were provided by three nurse pairs and one physician from medical-surgical areas. Task completion times, error rates, and ratings of system usability were collected to compare the use of quality indicators displayed on the dashboard to the indicators displayed in a conventional electronic health record across eight experimental scenarios. Participants rated the dashboard as "highly usable" following System Usability Scale (mean, 87.5 [SD, 9.6]) and Poststudy System Usability Questionnaire (mean, 1.7 [SD, 0.5]) criteria. Use of the dashboard led to reduced task completion times and error rates in comparison to the conventional electronic health record for quality indicator-related tasks. Clinician responses to the dashboard display capabilities were positive, and a multifaceted implementation plan has been used. Results suggest application of the dashboard in the care environment may lead to improved patient care.

Quality indicators for musculoskeletal injury management in the emergency department: a systematic review.

PubMed

Strudwick, Kirsten; Nelson, Mark; Martin-Khan, Melinda; Bourke, Michael; Bell, Anthony; Russell, Trevor

2015-02-01

There is increasing importance placed on quality of health care for musculoskeletal injuries in emergency departments (EDs). This systematic review aimed to identify existing musculoskeletal quality indicators (QIs) developed for ED use and to critically evaluate their methodological quality. MEDLINE, EMBASE, CINAHL, and the gray literature, including relevant organizational websites, were searched in 2013. English-language articles were included that described the development of at least one QI related to the ED care of musculoskeletal injuries. Data extraction of each included article was conducted. A quality assessment was then performed by rating each relevant QI against the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument. QIs with similar definitions were grouped together and categorized according to the health care quality frameworks of Donabedian and the Institute of Medicine. The search revealed 1,805 potentially relevant articles, of which 15 were finally included in the review. The number of relevant QIs per article ranged from one to 11, resulting in a total of 71 QIs overall. Pain (n = 17) and fracture management (n = 13) QIs were predominant. Ten QIs scored at least 50% across all AIRE Instrument domains, and these related to pain management and appropriate imaging of the spine. Methodological quality of the development of most QIs is poor. Recommendations for a core set of QIs that address the complete spectrum of musculoskeletal injury management in emergency medicine is not possible, and more work is needed. Currently, QIs with highest methodological quality are in the areas of pain management and medical imaging. © 2015 by the Society for Academic Emergency Medicine.

[Patient Participation in Development of Quality Indicators using the Example of National Disease Management Guidelines for Chronic Heart Failure - A Qualitative Analysis of Collective Perspectives].

PubMed

Herzberg, H; Bernateck, K; Welti, F; Joos, S; Pohontsch, N J; Blozik, E; Scherer, M

2016-06-01

In this qualitative study it was investigated by group discussions with patients suffering from chronic heart failure, how relevant the existing quality indicators of the National Disease Management Guidelines for Chronic Heart Failure are being estimated. 6 group discussions were performed. The sample was formed from 4 mixed-gender groups, a male group and a female group. Participants were recruited from local heart sports groups. For the interpretation a method similar to the grounded theory was used. The main conclusion is that in principle quality indicators are accepted. However, many of these indicators neglect the everyday aspects of patients' life. Participants show a disposition of "yes - but" regarding the quality indicators. This phenomenon could be theoretically grasped using the concept of order of knowledge. While participants keep referring to an order of everyday knowledge, quality indicators make recourse to a medical order of knowledge. Both orders of knowledge may compete with each other. The professional knowledge order of medicine needs to open up to a patients' knowledge order. Patient representatives in health care bodies need to be trained to develop a reflexive point of view to different knowledge orders enabling them to represent patients' everyday knowledge more confidently. Otherwise there is danger of conformation to the professional knowledge order of medicine only for reasons of being recognised as equal partners. © Georg Thieme Verlag KG Stuttgart · New York.

The quality improvement attitude survey: Development and preliminary psychometric characteristics.

PubMed

Dunagan, Pamela B

2017-12-01

To report the development of a tool to measure nurse's attitudes about quality improvement in their practice setting and to examine preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Human factors such as nursing attitudes of complacency have been identified as root causes of sentinel events. Attitudes of nurses concerning use of Quality and Safety Education for nurse's competencies can be most challenging to teach and to change. No tool has been developed measuring attitudes of nurses concerning their role in quality improvement. A descriptive study design with preliminary psychometric evaluation was used to examine the preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Registered bedside clinical nurses comprised the sample for the study (n = 57). Quantitative data were analysed using descriptive statistics and Cronbach's alpha reliability. Total score and individual item statistics were evaluated. Two open-ended items were used to collect statements about nurses' feelings regarding their experience in quality improvement efforts. Strong support for the internal consistency reliability and face validity of the Quality Improvement Nursing Attitude Scale was found. Total scale scores were high indicating nurse participants valued Quality and Safety Education for Nurse competencies in practice. However, item-level statistics indicated nurses felt powerless when other nurses deviate from care standards. Additionally, the sample indicated they did not consistently report patient safety issues and did not have a feeling of value in efforts to improve care. Findings suggested organisational culture fosters nurses' reporting safety issues and feeling valued in efforts to improve care. Participants' narrative comments and item analysis revealed the need to generate new items for the Quality Improvement Nursing Attitude Scale focused on nurses' perception of their importance in quality and safety and their power to enact principles. The Quality Improvement Nursing Attitude Scale-Revised edition was designed to help in understanding nurses' attitudes and values. It can be used to further explore broad concepts of quality improvement efforts. © 2017 John Wiley & Sons Ltd.

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

PubMed Central

2011-01-01

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes. PMID:22185479

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

The use of medical quality indices as a performance-enhancement tool for community clinics.

PubMed

Elhayany, A

2001-12-01

One of the most important issues for a country, its population and doctors is the effective use of its health system. The extensive variation in doctors' performance leads to a tremendous waste of resources. To combat this, and at the same time ensure that medical quality plays a role when making decisions on interventions, it is essential to equip doctors and clinic directors with information on the quality of the medical care they are providing. In order to assist clinic directors in maintaining medical quality, Clalit Health Services has developed comparative medical indices enabling doctors to compare their performance to that of their colleagues, as well as to the standard and their performance over time. The development of an index to evaluate the quality of medical treatment offered in clinics provides doctors and the health system with an essential tool to lessen the existing variation among doctors and to enhance and evaluate performance.

A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

PubMed Central

2012-01-01

Background Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use of prescribing quality indicators. Methods Between June and December 2009 we conducted semi structured interviews with 16 key-informants representing eight different organizations in the Netherlands involved in healthcare quality measurement and improvement. The interview guide included topics on participants’ opinions and preferences regarding existing types of prescribing quality indicators in relation to their aim of using quality information. Content analysis methods were used to process the resulting transcripts following the framework of predetermined themes. Results Findings from this qualitative study of stakeholder preferences showed that indicators focusing on undertreatment are found important by all participants. Furthermore, health care providers and policy makers valued prescribing safety indicators, insurance companies prioritized indicators focusing on prescribing costs, and patients’ organization representatives valued indicators focusing on interpersonal side of prescribing. Representatives of all stakeholders preferred positive formulation of the indicators to motivate health care providers to participate in health improvement programs. A composite score was found to be most useful by all participants as a starting point of prescribing quality assessment. Lack of information on reasons for deviating from guidelines recommendations appeared to be the most important barrier for using prescribing quality indicators. According to the health care providers, there are many legitimate reasons for not prescribing the recommended treatment and these reasons are not always taken into account by external evaluators. The latter may cause mistrust of health care providers towards external stakeholders and limit the use of PQI in external quality improvement programs. Conclusion Prescribing quality indicators are considered to be an important tool for assessing quality of provided diabetes care by all participants, although the preferences for specific types of indicators may differ by stakeholder depending on their user aim. Introduction of information systems to register the reasons for deviating from the recommended drug treatment may contribute to a more widespread use of PQI for assessment of provided health care quality to diabetic patents. This study identified the potential preferences regarding quality indicators for diabetes care, and this could be used for development of questionnaires to conduct a survey among a larger group of participants. PMID:22769967

Soil Quality Indicator: a new concept

NASA Astrophysics Data System (ADS)

Barão, Lúcia; Basch, Gottlieb

2017-04-01

During the last century, cultivated soils have been intensively exploited for food and feed production. This exploitation has compromised the soils' natural functions and many of the soil-mediated ecosystems services, including its production potential for agriculture. Also, soils became increasingly vulnerable and less resilient to a wide range of threats. To overcome this situation, new and better management practices are needed to prevent soil from degradation. However, to adopt the best management practices in a specific location, it is necessary to evaluate the soil quality status first. Different soil quality indicators have been suggested over the last decades in order to evaluate the soil status, and those are often based on the performance of soil chemical, physical and biological properties. However, the direct link between these properties and the associated soil functions or soil vulnerability to threats appears more difficult to be established. This present work is part of the iSQAPER project- Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience, where new soil quality concepts are explored to provide better information regarding the effects of the most promising agricultural management practices on soil quality. We have developed a new conceptual soil quality indicator which determines the soil quality status, regarding its vulnerability towards different threats. First, different indicators were specifically developed for each of the eight threats considered - Erosion, SOM decline, Poor Structure, Poor water holding capacity, Compaction, N-Leaching, Soil-borne pests and diseases and Salinization. As an example for the case of Erosion, the RUSLE equation for the estimate of the soil annual loss was used. Secondly, a reference classification was established for each indicator to integrate all possible results into a Good, Intermediate or Bad classification. Finally, all indicators were combined to return a single evaluation of the soil status, using different techniques that are dependent on the final use of the soil quality indicator. Some of the advantages of this new concept include the evaluation of soil quality based on its vulnerability to threats, together with the evaluation of soil properties in a given context while also suggesting soil management practices that are directly capable to mitigate soil vulnerability towards specific threats. Keywords: Soil Quality, Agriculture, Sustainability, Soil threats

Sustainable Housing in the Urban Context: International Sustainable Development Indicator Sets and Housing

ERIC Educational Resources Information Center

Winston, Nessa; Pareja Eastaway, Montserrat

2008-01-01

Housing, an essential aspect of quality of life, is also significant for sustainable development (SD). All of the major international statements on SD refer to housing or settlement strategies. However, indicator sets derived from these statements often fail to include good indicators of sustainable housing. This article outlines the…

Improving quality of care in general practices by self-audit, benchmarking and quality circles.

PubMed

Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

2016-10-01

Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

Utilizing Depth of Colonization of Seagrasses to Develop Numeric Water Quality Criteria for Florida Estuaries

EPA Science Inventory

US EPA is working with state and local partners in Florida to develop numeric water quality criteria to protect estuaries from nutrient pollution. Similar to other nutrient management programs in Florida, EPA is considering status of seagrass habitats as an indicator of biologic...

Collaborative Online Professional Development for Teachers in Higher Education

ERIC Educational Resources Information Center

Teräs, Hanna

2016-01-01

Enhancing teaching quality has become a priority for many universities. The need for high-quality professional development for university teachers is therefore crucial. Earlier research has indicated that isolated workshops often fail to result in significant changes in teaching practice. It has been suggested that the desired transformation…

[Assessing the balance of quality indicator sets of external quality assurance according to SGB V section 136].

PubMed

Doebler, Klaus; Geraedts, Max

2017-12-20

The value and usefulness of the results of indicator-based performance measurement in healthcare for different purposes do not only depend on the methodological quality of the individual indicators but also on the composition of the indicator sets. So far, the balance of the currently used indicator sets of the German mandatory national performance measurement system for hospitals has not been systematically analyzed. Due to the lack of a methodological gold standard for the assessment of balance and orientation of indicator sets we adapted the OECD concept of quality dimensions and defined four categories: 1) "Achieving primary goals of treatment", 2) "Avoiding adverse events", 3) "Indication" and 4) "Patient-centeredness". We defined rules for the assignment to the categories and analyzed the distribution of the 239 indicators from 29 medical areas in relation to these categories. 63 indicators (26.4 %) were assigned to the category "Achieving primary goals of treatment", 153 (64.0 %) to the category "Avoiding adverse events", 18 (7.5 %) to the category "Indication", one indicator (0.4 %) to the category "Patient-centeredness". Four indicators (1.7 %) addressed documentation quality. 12 of the 29 indicator sets only covered one OECD quality dimension by at least one indicator. The current indicator sets seem to be unbalanced with a strong focus on the category "Avoiding adverse events". As regards the goal of monitoring the compliance with minimal safety standards and performing improvement interventions, the direction of the indicator sets seems to be appropriate. With respect to other goals, such as for example the identification of "excellence", further development efforts are required. One relevant reason for the dominant focus on the category "Avoiding adverse events" seems to be that data sources for a follow-up and for the inclusion of the patient perspective have not been available until recently. There is a strong demand for the consequent use of these data sources to optimize the interpretability and value of the current performance measurement. The methodological approach presented may offer useful information to assess the value of indicator sets for different purposes although further development and research is necessary. Copyright © 2017. Published by Elsevier GmbH.

Water quality assessment of Australian ports using water quality evaluation indices

PubMed Central

Jahan, Sayka

2017-01-01

Australian ports serve diverse and extensive activities, such as shipping, tourism and fisheries, which may all impact the quality of port water. In this work water quality monitoring at different ports using a range of water quality evaluation indices was applied to assess the port water quality. Seawater samples at 30 stations in the year 2016–2017 from six ports in NSW, Australia, namely Port Jackson, Botany, Kembla, Newcastle, Yamba and Eden, were investigated to determine the physicochemical and biological variables that affect the port water quality. The large datasets obtained were designed to determine the Water Quality Index, Heavy metal Evaluation Index, Contamination Index and newly developed Environmental Water Quality Index. The study revealed medium water quality index and high and medium heavy metal evaluation index at three of the study ports and high contamination index in almost all study ports. Low level dissolved oxygen and higher level of total dissolved solids, turbidity, fecal coliforms, copper, iron, lead, zinc, manganese, cadmium and cobalt are mainly responsible for the poor water qualities of the port areas. Good water quality at the background samples indicated that various port activities are the likely cause for poor water quality inside the port area. PMID:29244876

Quality of care and variability in lung cancer management across Belgian hospitals: a population-based study using routinely available data.

PubMed

Vrijens, France; De Gendt, Cindy; Verleye, Leen; Robays, Jo; Schillemans, Viki; Camberlin, Cécile; Stordeur, Sabine; Dubois, Cécile; Van Eycken, Elisabeth; Wauters, Isabelle; Van Meerbeeck, Jan P

2018-05-01

To evaluate the quality of care for all patients diagnosed with lung cancer in Belgium based on a set of evidence-based quality indicators and to study the variability of care between hospitals. A retrospective study based on linked data from the cancer registry, insurance claims and vital status for all patients diagnosed with lung cancer between 2010 and 2011. Evidence-based quality indicators were identified from a systematic literature search. A specific algorithm to attribute patients to a centre was developed, and funnel plots were used to assess variability of care between centres. None. The proportion of patients who received appropriate care as defined by the indicator. Secondary outcome included the variability of care between centres. Twenty indicators were measured for a total of 12 839 patients. Good results were achieved for 60-day post-surgical mortality (3.9%), histopathological confirmation of diagnosis (93%) and for the use of PET-CT before treatment with curative intent (94%). Areas to be improved include the reporting of staging information to the Belgian Cancer Registry (80%), the use of brain imaging for clinical stage III patients eligible for curative treatment (79%), and the time between diagnosis and start of first active treatment (median 20 days). High variability between centres was observed for several indicators. Twenty-three indicators were found relevant but could not be measured. This study highlights the feasibility to develop a multidisciplinary set of quality indicators using population-based data. The main advantage of this approach is that not additional registration is required, but the non-measurability of many relevant indicators is a hamper. It allows however to easily point to areas of large variability in care.

Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care.

PubMed

Blackburn, Steven; Higginbottom, Adele; Taylor, Robert; Bird, Jo; Østerås, Nina; Hagen, Kåre Birger; Edwards, John J; Jordan, Kelvin P; Jinks, Clare; Dziedzic, Krysia

2016-01-01

People with osteoarthritis desire high quality care, support and information. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators can be used to benefit patients by measuring whether minimum standards of quality care are being met from a patient perspective. The aim of this study was to describe how a Research User Group (RUG) worked alongside researchers to co-produce a set of self-reported quality indicators for people with osteoarthritis when visiting their general practitioner or practice nurse (primary care). These were required in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE quality standards for OA. This article describes the public involvement in the MOSAICS study. This was 1) the co-development by RUG members and researchers of an Osteoarthritis Quality Indicators United Kingdom (OA QI (UK)) questionnaire for use in primary care, and 2) the comparison of the OA QI (UK) with a similar questionnaire developed in Norway. This study shows how important and effective a research user group can be in working with researchers in developing quality care indicators for osteoarthritis for use in a research study and, potentially, routine use in primary care. The questionnaire is intended to benefit patients by enabling the assessment of the quality of primary care for osteoarthritis from a patient's perspective. The OA QI (UK) has been used to examine differences in the quality of osteoarthritis care in four European countries. Background People with osteoarthritis (OA) desire high quality care, support and information about OA. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators (QI) can be used to benefit patients by measuring whether minimum standards of quality care (e.g. NICE quality standards) are being met from a patient perspective. A Research User Group (RUG) worked with researchers to co-produce a set of self-report, patient-generated QIs for OA. The QIs were intended for use in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE guidelines. We report on 1) the co-development of the OA QI (UK) questionnaire for primary care; and 2) the comparison of the content of the OA QI (UK) questionnaire with a parallel questionnaire developed in Norway for the Musculoskeletal Pain in Ullensaker (MUST) study. Methods Researchers were invited to OA RUG meetings. Firstly, RUG members were asked to consider factors important to patients consulting their general practitioner (GP) for OA and then each person rated their five most important. RUG members then discussed these in relation to a systematic review of OA QIs in order to form a list of OA QIs from a patient perspective. RUG members suggested wording and response options for a draft OA QI (UK) questionnaire to assess the QIs. Finally RUG members commented on draft and final versions of the questionnaire and how it compared with a translated Norwegian OA-QI questionnaire. Results RUG members (5 males, 5 females; aged 52-80 years) attended up to four meetings. RUG members ranked 20 factors considered most important to patients consulting their GP for joint pain. Following discussion, a list of eleven patient-reported QIs for OA consultations were formed. RUG members then suggested the wording and response options of 16 draft items - four QIs were split into two or more questionnaire items to avoid multiple dimensions of care quality within a single item. On comparison of this to the Norwegian OA-QI questionnaire, RUG members commented that both questionnaires contained seven similar QIs. The RUG members and researchers agreed to adopt the Norwegian OA-QI wording for four of these items. RUG members also recommended adopting an additional seven items from the Norwegian OA-QI with some minor word changes to improve their suitability for patients in the UK. One other item from the draft OA QI (UK) questionnaire was retained and eight items were excluded, resulting in a 15-item final version. Conclusions This study describes the development of patient-reported quality indicators for OA primary care derived by members of a RUG group, working in partnership with the research team throughout the study. The OA QI (UK) supports the NICE quality standards for OA and they have been successfully used to assess the quality of OA consultations in primary care in the MOSAICS study. The OA QI (UK) has the potential for routine use in primary care to assess the quality of OA care provided to patients. Ongoing research using both the UK and Norwegian OA-QI questionnaires is assessing the self-reported quality of OA care in different European populations.

The Use of Remote Sensing Data for Modeling Air Quality in the Cities

NASA Astrophysics Data System (ADS)

Putrenko, V. V.; Pashynska, N. M.

2017-12-01

Monitoring of environmental pollution in the cities by the methods of remote sensing of the Earth is actual area of research for sustainable development. Ukraine has a poorly developed network of monitoring stations for air quality, the technical condition of which is deteriorating in recent years. Therefore, the possibility of obtaining data about the condition of air by remote sensing methods is of great importance. The paper considers the possibility of using the data about condition of atmosphere of the project AERONET to assess the air quality in Ukraine. The main pollution indicators were used data on fine particulate matter (PM2.5) and nitrogen dioxide (NO2) content in the atmosphere. The main indicator of air quality in Ukraine is the air pollution index (API). We have built regression models the relationship between indicators of NO2, which are measured by remote sensing methods and ground-based measurements of indicators. There have also been built regression models, the relationship between the data given to the land of NO2 and API. To simulate the relationship between the API and PM2.5 were used geographically weighted regression model, which allows to take into account the territorial differentiation between these indicators. As a result, the maps that show the distribution of the main types of pollution in the territory of Ukraine, were constructed. PM2.5 data modeling is complicated with using existing indicators, which requires a separate organization observation network for PM2.5 content in the atmosphere for sustainable development in cities of Ukraine.

Method applied to the background analysis of energy data to be considered for the European Reference Life Cycle Database (ELCD).

PubMed

Fazio, Simone; Garraín, Daniel; Mathieux, Fabrice; De la Rúa, Cristina; Recchioni, Marco; Lechón, Yolanda

2015-01-01

Under the framework of the European Platform on Life Cycle Assessment, the European Reference Life-Cycle Database (ELCD - developed by the Joint Research Centre of the European Commission), provides core Life Cycle Inventory (LCI) data from front-running EU-level business associations and other sources. The ELCD contains energy-related data on power and fuels. This study describes the methods to be used for the quality analysis of energy data for European markets (available in third-party LC databases and from authoritative sources) that are, or could be, used in the context of the ELCD. The methodology was developed and tested on the energy datasets most relevant for the EU context, derived from GaBi (the reference database used to derive datasets for the ELCD), Ecoinvent, E3 and Gemis. The criteria for the database selection were based on the availability of EU-related data, the inclusion of comprehensive datasets on energy products and services, and the general approval of the LCA community. The proposed approach was based on the quality indicators developed within the International Reference Life Cycle Data System (ILCD) Handbook, further refined to facilitate their use in the analysis of energy systems. The overall Data Quality Rating (DQR) of the energy datasets can be calculated by summing up the quality rating (ranging from 1 to 5, where 1 represents very good, and 5 very poor quality) of each of the quality criteria indicators, divided by the total number of indicators considered. The quality of each dataset can be estimated for each indicator, and then compared with the different databases/sources. The results can be used to highlight the weaknesses of each dataset and can be used to guide further improvements to enhance the data quality with regard to the established criteria. This paper describes the application of the methodology to two exemplary datasets, in order to show the potential of the methodological approach. The analysis helps LCA practitioners to evaluate the usefulness of the ELCD datasets for their purposes, and dataset developers and reviewers to derive information that will help improve the overall DQR of databases.

A pressure ulcer and fall rate quality composite index for acute care units: A measure development study.

PubMed

Boyle, Diane K; Jayawardhana, Ananda; Burman, Mary E; Dunton, Nancy E; Staggs, Vincent S; Bergquist-Beringer, Sandra; Gajewski, Byron J

2016-11-01

Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index. Two-phase measure development study. 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors ® during the year 2013. The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. The Pressure Ulcer and Fall Rate Quality Composite Index=100-PUR-FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. The Pressure Ulcer and Fall Rate Quality Composite Index is a step toward providing a more holistic perspective of unit level nursing quality than individual measures and may help nurses nursing administrators obtain a broader view of which patient care units are the higher and lower performers. Further study is needed to examine the usability of the Pressure Ulcer and Fall Rate Quality Composite Index. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A PRESSURE ULCER AND FALL RATE QUALITY COMPOSITE INDEX FOR ACUTE CARE UNITS: A MEASURE DEVELOPMENT STUDY

PubMed Central

Jayawardhana, Ananda; Burman, Mary E.; Dunton, Nancy E.; Staggs, Vincent S.; Bergquist-Beringer, Sandra; Gajewski, Byron J.

2016-01-01

Background Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. Objective The study objective was to develop a unit-level inpatient composite nursing care quality performance index – the Pressure Ulcer and Fall Rate Quality Composite Index. Design Two-phase measure development study. Settings 5,144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013. Methods The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. Results The Pressure Ulcer and Fall Rate Quality Composite Index = 100 − PUR − FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Conclusions The Pressure Ulcer and Fall Rate Quality Composite Index is a step toward providing a more holistic perspective of unit level nursing quality than individual measures and may help nurses nursing administrators obtain a broader view of which patient care units are the higher and lower performers. Further study is needed to examine the usability of the Pressure Ulcer and Fall Rate Quality Composite Index. PMID:27607602

A Satellite-Based Multi-Pollutant Index of Global Air Quality

NASA Technical Reports Server (NTRS)

Cooper, Mathew J.; Martin, Randall V.; vanDonkelaar, Aaron; Lamsal, Lok; Brauer, Michael; Brook, Jeffrey R.

2012-01-01

Air pollution is a major health hazard that is responsible formillions of annual excess deaths worldwide. Simpleindicators are useful for comparative studies and to asses strends over time. The development of global indicators hasbeen impeded by the lack of ground-based observations in vast regions of the world. Recognition is growing of the need for amultipollutant approach to air quality to better represent human exposure. Here we introduce the prospect of amultipollutant air quality indicator based on observations from satellite remote sensing.

Technical Note: Independent component analysis for quality assurance in functional MRI.

PubMed

Astrakas, Loukas G; Kallistis, Nikolaos S; Kalef-Ezra, John A

2016-02-01

Independent component analysis (ICA) is an established method of analyzing human functional MRI (fMRI) data. Here, an ICA-based fMRI quality control (QC) tool was developed and used. ICA-based fMRI QC tool to be used with a commercial phantom was developed. In an attempt to assess the performance of the tool relative to preexisting alternative tools, it was used seven weeks before and eight weeks after repair of a faulty gradient amplifier of a non-state-of-the-art MRI unit. More specifically, its performance was compared with the AAPM 100 acceptance testing and quality assurance protocol and two fMRI QC protocols, proposed by Freidman et al. ["Report on a multicenter fMRI quality assurance protocol," J. Magn. Reson. Imaging 23, 827-839 (2006)] and Stocker et al. ["Automated quality assurance routines for fMRI data applied to a multicenter study," Hum. Brain Mapp. 25, 237-246 (2005)], respectively. The easily developed and applied ICA-based QC protocol provided fMRI QC indices and maps equally sensitive to fMRI instabilities with the indices and maps of other established protocols. The ICA fMRI QC indices were highly correlated with indices of other fMRI QC protocols and in some cases theoretically related to them. Three or four independent components with slow varying time series are detected under normal conditions. ICA applied on phantom measurements is an easy and efficient tool for fMRI QC. Additionally, it can protect against misinterpretations of artifact components as human brain activations. Evaluating fMRI QC indices in the central region of a phantom is not always the optimal choice.

Empirical Modeling of Microbial Indicators at a South Carolina Beach

EPA Science Inventory

Public concerns about water quality at beaches have prompted the development of multiple linear regression and other models that can be used to "nowcast" levels of bacterial indicators. Hydrometeorological and biogeochemical data from summer, 2009 were used to develop empirical m...

Improvement of a stability-indicating method by Quality-by-Design versus Quality-by-Testing: a case of a learning process.

PubMed

Hubert, C; Lebrun, P; Houari, S; Ziemons, E; Rozet, E; Hubert, Ph

2014-01-01

The understanding of the method is a major concern when developing a stability-indicating method and even more so when dealing with impurity assays from complex matrices. In the presented case study, a Quality-by-Design approach was applied in order to optimize a routinely used method. An analytical issue occurring at the last stage of a long-term stability study involving unexpected impurities perturbing the monitoring of characterized impurities needed to be resolved. A compliant Quality-by-Design (QbD) methodology based on a Design of Experiments (DoE) approach was evaluated within the framework of a Liquid Chromatography (LC) method. This approach allows the investigation of Critical Process Parameters (CPPs), which have an impact on Critical Quality Attributes (CQAs) and, consequently, on LC selectivity. Using polynomial regression response modeling as well as Monte Carlo simulations for error propagation, Design Space (DS) was computed in order to determine robust working conditions for the developed stability-indicating method. This QbD compliant development was conducted in two phases allowing the use of the Design Space knowledge acquired during the first phase to define the experimental domain of the second phase, which constitutes a learning process. The selected working condition was then fully validated using accuracy profiles based on statistical tolerance intervals in order to evaluate the reliability of the results generated by this LC/ESI-MS stability-indicating method. A comparison was made between the traditional Quality-by-Testing (QbT) approach and the QbD strategy, highlighting the benefit of this QbD strategy in the case of an unexpected impurities issue. On this basis, the advantages of a systematic use of the QbD methodology were discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

Lichen-based indices to quantify responses to climate and air pollution across northeastern U.S.A

Treesearch

Susan Will-Wolf; Sarah Jovan; Peter Neitlich; JeriLynn E. Peck; Roger Rosentreter

2015-01-01

Lichens are known to be indicators for air quality; they also respond to climate. We developed indices for lichen response to climate and air quality in forests across the northeastern United States of America (U.S.A.), using 218–250 plot surveys with 145–161 macrolichen taxa from the Forest Inventory and Analysis (FIA) Program of the U.S. Department of Agriculture,...

Integrating resource, social, and managerial indicators of quality into carrying capacity decision-making

USGS Publications Warehouse

Newman, P.; Marion, J.; Cahill, K.

2001-01-01

In park and wilderness management, integrating social and resource indicators is essential to meet park mandates that require the protection of both experiential and resource conditions. This paper will address the challenges we face in integrating social and resource data and outline a study in progress in Yosemite National Park. This study will develop and apply a management model that integrates resource, social and managerial indicators of quality into carrying capacity decisionmaking.

Empirical Evaluation Indicators in Thai Higher Education: Theory-Based Multidimensional Learners' Assessment

ERIC Educational Resources Information Center

Sritanyarat, Dawisa; Russ-Eft, Darlene

2016-01-01

This study proposed empirical indicators which can be validated and adopted in higher education institutions to evaluate quality of teaching and learning, and to serve as an evaluation criteria for human resource management and development of higher institutions in Thailand. The main purpose of this study was to develop empirical indicators of a…

A Social Report for Carroll County: Social Indicators for Rural Development. Sociology Report 134G.

ERIC Educational Resources Information Center

Marshall, Chris; And Others

Since the burden of improving quality of life is often squarely placed on the shoulders of public decision makers, this report (one of the products of Project 2142) provides a basis for assisting county-level decision makers in the planning process. Statistics that "indicate" the social well being or quality of life experienced by people…

Indicators and standards of quality for the Schoodic Peninsula section of Acadia National Park, Maine

Treesearch

James Bacon; Robert Manning; Steven Lawson; William Valliere; Daniel Laven

2003-01-01

A multi-year research initiative was undertaken to inform park planning and management efforts at the Schoodic Peninsula Section of Acadia National Park, Maine. This research focused on developing information that will enable formulation of indicators and standards of quality. The first phase of research in the summer of 2000 obtained descriptive information on visitor...

[Educational Quality Indicators: Taking Stock.] Proceedings of the Conference (Los Angeles, California, October 12-13, 1989).

ERIC Educational Resources Information Center

CRESST Evaluation Comment, 1989

1989-01-01

An overview of an international conference held on the campus of the University of California at Los Angeles (UCLA) to take stock of the development and use of educational quality indicator systems at the local, state, national, and international levels is provided. Major implications and findings of the education summit held at the University of…

Indicators of standards of the quality of the visitor experience at a heavily-used national park

Treesearch

Robert E. Manning; David W. Lime; Richard F. McMonagle

1995-01-01

Contemporary approaches to determining and managing carrying capacity of national parks and similar areas focus on indicators and standards of quality. The National Park Service is currently developing the Visitor Experience and Resource Protection process which adopts this approach to carrying capacity. This process is being applied to Arches National Park, Utah,...

A Method of Assembling Cross-Sectional Indicators into a Community Quality of Life

ERIC Educational Resources Information Center

Epley, Donald R.; Menon, Mohan

2008-01-01

This study develops a new method of measuring quality of life at the local and state level. Further, it presents a methodology that combines heterogeneous indicators from different fields, such as economics, social, and health, into one total measurement. The technique shown can be used to compare one region with another, or compare one metro area…

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal

PubMed Central

Norton, Peter G; Murray, Michael; Doupe, Malcolm B; Cummings, Greta G; Poss, Jeff W; Squires, Janet E; Teare, Gary F; Estabrooks, Carole A

2014-01-01

Objectives To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility. Design Calculation of adjusted Resident Assessment Instrument – Minimum Data Set 2.0 (RAI–MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2–4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts). Setting A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces. Measurements Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared. Results In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions. Conclusions Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI–MDS 2.0 data, and quite probably from any RAI measures. PMID:24523428

Quantitative analysis of aircraft multispectral-scanner data and mapping of water-quality parameters in the James River in Virginia

NASA Technical Reports Server (NTRS)

Johnson, R. W.; Bahn, G. S.

1977-01-01

Statistical analysis techniques were applied to develop quantitative relationships between in situ river measurements and the remotely sensed data that were obtained over the James River in Virginia on 28 May 1974. The remotely sensed data were collected with a multispectral scanner and with photographs taken from an aircraft platform. Concentration differences among water quality parameters such as suspended sediment, chlorophyll a, and nutrients indicated significant spectral variations. Calibrated equations from the multiple regression analysis were used to develop maps that indicated the quantitative distributions of water quality parameters and the dispersion characteristics of a pollutant plume entering the turbid river system. Results from further analyses that use only three preselected multispectral scanner bands of data indicated that regression coefficients and standard errors of estimate were not appreciably degraded compared with results from the 10-band analysis.

[Evaluation method with radiographic image quality indicator for internal defects of dental casting metallic restoration].

PubMed

Li, Y; Zheng, G; Lin, H

2014-12-18

To develop a new kind of dental radiographic image quality indicator (IQI) for internal quality of casting metallic restoration to influence on its usage life. Radiographic image quality indicator method was used to evaluate the depth of the defects region and internal quality of 127 casting metallic restoration and the accuracy was compared with that of conventional callipers method. In the 127 cases of casting metallic restoration, 9 were found the thickness less than 0.7 mm and the thinnest thickness only 0.2 mm in 26 casting metallic crowns or bridges' occlusal defects region. The data measured by image quality indicator were consistent with those measured by conventional gauging. Two metal inner crowns were found the thickness less than 0.3 mm in 56 porcelain crowns or bridges. The thickness of casting removable partial denture was more than 1.0 mm, but thinner regions were not found. It was found that in a titanium partial denture, the X-ray image of clasp was not uniform and there were internal porosity defects in the clasp. Special dental image quality indicator can solve the visual error problems caused by different observing backgrounds and estimate the depth of the defects region in the casting.

State of the art metrics for aspect oriented programming

NASA Astrophysics Data System (ADS)

Ghareb, Mazen Ismaeel; Allen, Gary

2018-04-01

The quality evaluation of software, e.g., defect measurement, gains significance with higher use of software applications. Metric measurements are considered as the primary indicator of imperfection prediction and software maintenance in various empirical studies of software products. However, there is no agreement on which metrics are compelling quality indicators for novel development approaches such as Aspect Oriented Programming (AOP). AOP intends to enhance programming quality, by providing new and novel constructs for the development of systems, for example, point cuts, advice and inter-type relationships. Hence, it is not evident if quality pointers for AOP can be derived from direct expansions of traditional OO measurements. Then again, investigations of AOP do regularly depend on established coupling measurements. Notwithstanding the late reception of AOP in empirical studies, coupling measurements have been adopted as useful markers of flaw inclination in this context. In this paper we will investigate the state of the art metrics for measurement of Aspect Oriented systems development.

European beef consumers' interest in a beef eating-quality guarantee Insights from a qualitative study in four EU countries.

PubMed

Verbeke, Wim; Van Wezemael, Lynn; de Barcellos, Marcia D; Kügler, Jens O; Hocquette, Jean-François; Ueland, Øydis; Grunert, Klaus G

2010-04-01

Consumer demand in relation to food is shifting towards products that are safe, nutritious, and of good eating quality. Beef consumers are demanding for experience quality that matches their expectations, particularly with respect to beef tenderness. The development of a beef quality grading and guarantee system obtained through muscle profiling research, can allow the beef industry to meet these demands. A qualitative consumer study has been carried out with beef consumers in France, Spain, United Kingdom and Germany to assess their opinions about beef muscle profiling and their interest in a beef eating-quality guarantee. Findings indicate that both concepts are well accepted by European beef consumers, although not unconditional. Participants express some reserve related to the possible upgrading of lower value cuts, too much standardisation, and the fact that tenderness is to some extent subjective. They further require the system to be simple, sufficiently documented and independent-party controlled. This study indicates good opportunities for the development of a beef eating-quality guarantee system in Europe. As an increase in consumers' satisfaction could lead to higher consumption rates and industry profitability, the introduction of an eating-quality guarantee system can contribute to market development and improved competitiveness of the European beef industry. Copyright 2009 Elsevier Ltd. All rights reserved.

Industry Quality Teams--a Collegewide Approach to Economic Development that Impacts Central Florida's Workforce.

ERIC Educational Resources Information Center

Nicholson, Ruth

1995-01-01

Describes the Industry Quality Teams (IQTs) at Florida's Valencia Community College, an institution-wide effort to link the needs of a contemporary workforce to the classroom curriculum. Reviews the structure and functions of the college's six IQTs, indicating that they work to revise curricula, develop partnerships, implement marketing…

NUTRIENT AND HABITAT INDICATORS FOR CRITERIA DEVELOPMENT IN GREAT LAKES COASTAL WETLANDS

EPA Science Inventory

EPA's Mid-Continent Ecology Division is testing indicators and establishing stressor - response relationships to support development of nutrient and habitat criteria for Great Lakes coastal wetlands. Our focus is on water quality changes, food web shifts, and vegetation loss as ...

Development of a Web-Based Quality Dashboard Including a Toolbox to Improve Pain Management in Dutch Intensive Care.

PubMed

Roos-Blom, Marie-José; Gude, Wouter T; de Jonge, Evert; Spijkstra, Jan Jaap; van der Veer, Sabine N; Dongelmans, Dave A; de Keizer, Nicolette F

2017-01-01

Audit and feedback (A&F) is a common strategy to improve quality of care. Meta-analyses have indicated that A&F may be more effective in realizing desired change when baseline performance is low, it is delivered by a supervisor or colleague, it is provided frequently and in a timely manner, it is delivered in both verbal and written formats, and it includes specific targets and an action plan. However, there is little information to guide operationalization of these factors. Researchers have consequently called for A&F interventions featuring well-described and carefully justified components, with their theoretical rationale made explicit. This paper describes the rationale and development of a quality dashboard including an improvement toolbox for four previous developed pain indicators, guided by Control Theory.

Protocol for a scoping review study to identify and classify patient-centred quality indicators.

PubMed

Jolley, Rachel J; Lorenzetti, Diane L; Manalili, Kimberly; Lu, Mingshan; Quan, Hude; Santana, Maria J

2017-01-05

The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centred approach. In this paper, we outline our scoping review protocol to systematically review published and unpublished literature specific to patient-centred quality indicators that have been implemented and evaluated across various care settings. Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. We will search electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts), grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. 2 reviewers will independently screen all abstracts and full-text studies for inclusion. We will include any study which focuses on quality indicators in the context of PCC. All bibliographic data, study characteristics and indicators will be collected and analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. The scoping review will synthesise patient-centred quality indicators and their characteristics as described in the literature. This review will be the first step to formally identify what quality indicators have been used to evaluate PCC across the healthcare continuum, and will be used to inform a stakeholder consensus process exploring the development of a generic set of patient-centred quality indicators applicable to multiple care settings. The results will be disseminated through a peer-reviewed publication, conference presentations and a one-day stakeholder meeting. 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/.

Application of two quality indices as monitoring and management tools of rivers. Case study: the Imera Meridionale River, Italy.

PubMed

Bonanno, Giuseppe; Lo Giudice, Rosa

2010-04-01

On the basis of the European Water Framework Directive (2000/60), the water resources of the member states of the European Community should reach good quality standards by 2015. Although such regulations illustrate the basic points for a comprehensive and effective policy of water monitoring and management, no practical tools are provided to face and solve the issues concerning freshwater ecosystems such as rivers. The Italian government has developed a set of regulations as adoption of the European Directive but failed to indicate feasible procedures for river monitoring and management. On a local scale, Sicilian authorities have implemented monitoring networks of watersheds, aiming at describing the general conditions of rivers. However, such monitoring programs have provided a relatively fragmentary picture of the ecological conditions of the rivers. In this study, the integrated use of environmental quality indices is proposed as a methodology able to provide a practical approach to river monitoring and management. As a case study, the Imera Meridionale River, Sicily's largest river, was chosen. The water quality index developed by the U.S. National Sanitation Foundation and the floristic quality index based on the Wilhelm method were applied. The former enabled us to describe the water quality according to a spatial-temporal gradient, whereas the latter focused on the ecological quality of riparian vegetation. This study proposes a holistic view of river ecosystems by considering biotic and abiotic factors in agreement with the current European regulations. How the combined use of such indices can guide sustainable management efforts is also discussed.

CEER 2014 Dedicated Session Proposal: Restoring Water Quality along with Restoring the Gulf of Mexico

EPA Science Inventory

This session focuses on the importance of restoring water quality as part of the larger Gulf of Mexico restoration efforts. Water quality has been identified as a significant indicator of water body condition, and Gulf waters have been impacted by increased urban development, agr...

Global Influences on National Definitions of Quality Education: Examples from Spain and Italy

ERIC Educational Resources Information Center

Engel, Laura C.; Rutkowski, David

2014-01-01

There is increasing attention worldwide to advancing quality education. Beyond a rhetorical aim, many international organizations and national education systems have articulated a commitment to promoting measures of quality education through the development of educational indicators. This article broadly explores the global influences on national…

Quality indicators in laboratory medicine: a fundamental tool for quality and patient safety.

PubMed

Plebani, Mario; Sciacovelli, Laura; Marinova, Mariela; Marcuccitti, Jessica; Chiozza, Maria Laura

2013-09-01

The identification of reliable quality indicators (QIs) is a crucial step in enabling users to quantify the quality of laboratory services. The current lack of attention to extra-laboratory factors is in stark contrast with the body of evidence pointing to the multitude of errors that continue to occur in the pre- and post-analytical phases. Different QIs and terminologies are currently used and, therefore, there is the need to harmonize proposed QIs. A model of quality indicators (MQI) has been consensually developed by a group of clinical laboratories according to a project launched by a working group of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The model includes 57 QIs related to key processes (35 pre-, 7 intra- and 15 post-analytical phases) and 3 to support processes. The developed MQI and the data collected provide evidence of the feasibility of the project to harmonize currently available QIs, but further efforts should be done to involve more clinical laboratories and to collect a more consistent amount of data. Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Selecting clinical quality indicators for laboratory medicine.

PubMed

Barth, Julian H

2012-05-01

Quality in laboratory medicine is often described as doing the right test at the right time for the right person. Laboratory processes currently operate under the oversight of an accreditation body which gives confidence that the process is good. However, there are aspects of quality that are not measured by these processes. These are largely focused on ensuring that the most clinically appropriate test is performed and interpreted correctly. Clinical quality indicators were selected through a two-phase process. Firstly, a series of focus groups of clinical scientists were held with the aim of developing a list of quality indicators. These were subsequently ranked in order by an expert panel of primary and secondary care physicians. The 10 top indicators included the communication of critical results, comprehensive education to all users and adequate quality assurance for point-of-care testing. Laboratories should ensure their tests are used to national standards, that they have clinical utility, are calibrated to national standards and have long-term stability for chronic disease management. Laboratories should have error logs and demonstrate evidence of measures introduced to reduce chances of similar future errors. Laboratories should make a formal scientific evaluation of analytical quality. This paper describes the process of selection of quality indicators for laboratory medicine that have been validated sequentially by deliverers and users of the service. They now need to be converted into measureable variables related to outcome and validated in practice.

FRAMEWORK FOR DEVELOPING SUSPENDED AND BEDDED SEDIMENT (SABS) WATER QUALITY CRITERIA: STEP 4 - DEFINE POTENTIAL RANGES IN VALUE OF THE SABS AND RESPONSE INDICATORS, AND CLASSIFICATION OF WATERBODIES USING AN EMPIRICAL APPROACH

EPA Science Inventory

After reviewing existing water quality criteria and consulting stakeholders, EPA developed a process that states, tribes, and regions can use to develop scientifically defensible SABS criteria. The process is flexible, can be adapted to utilize existing data sets, and can be gea...

Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PubMed

Ritchey, Jamie; Gay, E Greer; Spencer, Benjamin A; Miller, David C; Wallner, Lauren P; Stewart, Andrew K; Dunn, Rodney L; Litwin, Mark S; Wei, John T

2012-09-01

Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Feeling Heard & Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients with Advanced Cancer Before and After Palliative Care Consultation.

PubMed

Ingersoll, Luke T; Saeed, Fahad; Ladwig, Susan; Norton, Sally A; Anderson, Wendy; Alexander, Stewart C; Gramling, Robert

2018-05-02

Maximizing value in palliative care requires continued development and standardization of communication quality indicators. To describe the basic epidemiology of a newly-adopted patient-centered communication quality indicator for hospitalized palliative care patie9nts with advanced cancer. Cross-sectional analysis of 207 advanced cancer patients who received palliative care consultation at two medical centers in the United States. Participants completed the Heard & Understood quality indicator immediately before and the day following the initial palliative care consultation: "Over the past two days ["24 hours" for the post-consultation version], how much have you felt heard and understood by the doctors, nurses and hospital staff? Completely/Quite a Bit/Moderately/Slightly/Not at All". We categorized "Completely" as indicating ideal quality. Approximately one-third indicated ideal Heard & Understood quality before palliative care consultation. Age, financial security, emotional distress, preferences for comfort-longevity tradeoffs at end-of-life, and prognosis expectations were associated with pre-consultation quality. Among those with less-than-ideal quality at baseline, 56% rated feeling more Heard & Understood the day following palliative care consultation. The greatest pre-post improvement was among people who had unformed end-of-life treatment preferences or who reported having "no idea" about their prognosis at baseline. Most patients felt incompletely heard and understood at the time of referral to palliative care consultation and more than half improved following consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience. Copyright © 2018. Published by Elsevier Inc.

[Quality of care indicators for the care of human immunodeficiency virus-infected individuals, adapted to the pediatric age].

PubMed

Soler-Palacín, Pere; Provens, Ana Clara; Martín-Nalda, Andrea; Espiau, María; Fernández-Polo, Aurora; Figueras, Concepció

2014-03-01

Since infection with human immunodeficiency virus (HIV) was first described, there have been many advances in its diagnosis, monitoring and treatment. However, few contributions are related to the area of health care quality. In this sense, the Spanish Study Group on AIDS (GESIDA) has developed a set of quality care indicators for adult patients living with HIV infection that includes a total of 66 indicators, 22 of which are considered to be relevant. Standards were calculated for each of them in order to reflect the level of the quality of care offered to these patients. Similar documents for pediatric patients are currently lacking. Preparation of a set of quality care indicators applicable to pediatric patients based on the GESIDA document and the Spanish Guidelines for monitoring of pediatric patients infected with HIV. Each indicator was analysed with respect to the required standards in all patients under 18 years of age followed-up in our Unit, with the aim of evaluating the quality of care provided. A total of 61 indicators were collected (51 from the GESIDA document and 10 from currently available pediatric guidelines), 30 of which were considered to be relevant. An overall compliance of 81%-83% was obtained when assessing the relevant indicators. The availability of health care quality standards is essential for the care of pediatric HIV-infected patients. The assessment of these indicators in our Unit yielded satisfactory results. Copyright © 2012 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

The Development of Performance Indicators for Prison Libraries.

ERIC Educational Resources Information Center

Lithgow, Susan D.

This report describes a study to investigate the improved efficiency and effectiveness of prison library provision in England and Wales, through the development and validation of relevant performance indicators to be used as part of quality assurance programs. Prison libraries perform important educational, rehabilitative, and recreational…

Performance and quality indicators for the management of non-cancer chronic pain: a scoping review protocol.

PubMed

Zidarov, Diana; Visca, Regina; Gogovor, Amédé; Ahmed, Sara

2016-02-19

Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations' websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies, including 2 stakeholder meetings, publication and presentation at conferences. 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/

Evaluation of the psychometric properties of the main meal quality index when applied in the UK population.

PubMed

Gorgulho, B M; Pot, G K; Marchioni, D M

2017-05-01

The aim of this study was to evaluate the validity and reliability of the Main Meal Quality Index when applied on the UK population. The indicator was developed to assess meal quality in different populations, and is composed of 10 components: fruit, vegetables (excluding potatoes), ratio of animal protein to total protein, fiber, carbohydrate, total fat, saturated fat, processed meat, sugary beverages and desserts, and energy density, resulting in a score range of 0-100 points. The performance of the indicator was measured using strategies for assessing content validity, construct validity, discriminant validity and reliability, including principal component analysis, linear regression models and Cronbach's alpha. The indicator presented good reliability. The Main Meal Quality Index has been shown to be valid for use as an instrument to evaluate, monitor and compare the quality of meals consumed by adults in the United Kingdom.

Consensus building on the development of a stress-based indicator for LCA-based impact assessment of water consumption: outcome of the expert workshops

EPA Science Inventory

The WULCA group, active since 2007 on Water Use in LCA, commenced the development of consensus-based indicators in January 2014. This activity is planned to last 2 years and covers human health, ecosystem quality, and a stress-based indicator. This latter encompasses potential de...

Quality of Smartphone Apps Related to Alcohol Use Disorder.

PubMed

Penzenstadler, Louise; Chatton, Anne; Van Singer, Mathias; Khazaal, Yasser

2016-01-01

Apps for smartphones are opening an important range of opportunities for improving the care of people with alcohol use disorders (AUDs). This study aimed to evaluate the quality of English language apps for AUDs and to compare paid and free apps. The keywords 'alcohol', 'alcohol addiction', 'alcohol help' and 'stop drinking' were entered into the iTunes Store search engine. Apps were evaluated using a standardized assessment designed to rate the quality of apps in terms of accountability, interactivity, self-help score and evidence-based content. The Brief DISCERN score and the criteria of the 'Health on the Net' label were also used as content quality indicators. Of the 137 unique apps identified, 52 met the inclusion criteria. Overall, the content quality and self-help scores of these AUD apps were poor. The main quality indicators were not linked to payment status. Multiple linear regressions showed that the Brief DISCERN score significantly predicted content quality. Poor content quality and self-help scores of AUD smartphone apps underline the gap between their potential promises and the overall quality of available products in stores. The quality indicators used in the present study may be used for further app developments. © 2016 S. Karger AG, Basel.

An evaluation of the quality of obstetric morbidity coding using an objective assessment tool, the Performance Indicators For Coding Quality (PICQ).

PubMed

Lamb, Mary K; Innes, Kerry; Saad, Patricia; Rust, Julie; Dimitropoulos, Vera; Cumerlato, Megan

The Performance Indicators for Coding Quality (PICQ) is a data quality assessment tool developed by Australia's National Centre for Classification in Health (NCCH). PICQ consists of a number of indicators covering all ICD-10-AM disease chapters, some procedure chapters from the Australian Classification of Health Intervention (ACHI) and some Australian Coding Standards (ACS). The indicators can be used to assess the coding quality of hospital morbidity data by monitoring compliance of coding conventions and ACS; this enables the identification of particular records that may be incorrectly coded, thus providing a measure of data quality. There are 31 obstetric indicators available for the ICD-10-AM Fourth Edition. Twenty of these 31 indicators were classified as Fatal, nine as Warning and two Relative. These indicators were used to examine coding quality of obstetric records in the 2004-2005 financial year Australian national hospital morbidity dataset. Records with obstetric disease or procedure codes listed anywhere in the code string were extracted and exported from the SPSS source file. Data were then imported into a Microsoft Access database table as per PICQ instructions, and run against all Fatal and Warning and Relative (N=31) obstetric PICQ 2006 Fourth Edition Indicators v.5 for the ICD-10- AM Fourth Edition. There were 689,905 gynaecological and obstetric records in the 2004-2005 financial year, of which 1.14% were found to have triggered Fatal degree errors, 3.78% Warning degree errors and 8.35% Relative degree errors. The types of errors include completeness, redundancy, specificity and sequencing problems. It was found that PICQ is a useful initial screening tool for the assessment of ICD-10-AM/ACHI coding quality. The overall quality of codes assigned to obstetric records in the 2004- 2005 Australian national morbidity dataset is of fair quality.

Education, Human Development and Quality of Life: Measurement Issues and Implications for India

ERIC Educational Resources Information Center

Narayana, M. R.

2009-01-01

This paper analyses and compares the measurement of indicators and variables in the construction of education index in Human Development Index (HDI) at the global, national and 18 sub-national human development reports in India since 1990. The results show non-comparability of measurement of the education indicators and variables. This implies…

Ecosystem health in mineralized terrane; data from podiform chromite (Chinese Camp mining district, California), quartz alunite (Castle Peak and Masonic mining districts, Nevada/California), and Mo/Cu porphyry (Battle Mountain mining district, Nevada) deposits

USGS Publications Warehouse

Blecker, Steve W.; Stillings, Lisa L.; Amacher, Michael C.; Ippolito, James A.; DeCrappeo, Nicole M.

2010-01-01

The myriad definitions of soil/ecosystem quality or health are often driven by ecosystem and management concerns, and they typically focus on the ability of the soil to provide functions relating to biological productivity and/or environmental quality. A variety of attempts have been made to create indices that quantify the complexities of soil quality and provide a means of evaluating the impact of various natural and anthropogenic disturbances. Though not without their limitations, indices can improve our understanding of the controls behind ecosystem processes and allow for the distillation of information to help link scientific and management communities. In terrestrial systems, indices were initially developed and modified for agroecosystems; however, the number of studies implementing such indices in nonagricultural systems is growing. Soil quality indices (SQIs) are typically composed of biological (and sometimes physical and chemical) parameters that attempt to reduce the complexity of a system into a metric of a soil’s ability to carry out one or more functions.The indicators utilized in SQIs can be as varied as the studies themselves, reflecting the complexity of the soil and ecosystems in which they function. Regardless, effective soil quality indicators should correlate well with soil or ecosystem processes, integrate those properties and processes, and be relevant to management practices. Commonly applied biological indicators include measures associated with soil microbial activity or function (for example, carbon and nitrogen mineralization, respiration, microbial biomass, enzyme activity. Cost, accessibility, ease of interpretation, and presence of existing data often dictate indicator selection given the number of available measures. We employed a large number of soil biological, chemical, and physical measures, along with measures of vegetation cover, density, and productivity, in order to test the utility and sensitivity of these measures within various mineralized terranes. We were also interested in examining these relations in the context of determining appropriate reference conditions with which to compare reclamation efforts.The purpose of this report is to present the data used to develop indices of soil and ecosystem quality associated with mineralized terranes (areas enriched in metal-bearing minerals), specifically podiform chromite, quartz alunite, and Mo/Cu porphyry systems. Within each of these mineralized terranes, a nearby unmineralized counterpart was chosen for comparison. The data consist of soil biological, chemical, and physical parameters, along with vegetation measurements for each of the sites described below. Synthesis of these data and index development will be the subject of future publications.

Classifying indicators of quality: a collaboration between Dutch and English regulators.

PubMed

Mears, Alex; Vesseur, Jan; Hamblin, Richard; Long, Paul; Den Ouden, Lya

2011-12-01

Many approaches to measuring quality in healthcare exist, generally employing indicators or metrics. While there are important differences, most of these approaches share three key areas of measurement: safety, effectiveness and patient experience. The European Partnership for Supervisory Organisations in Health Services and Social Care (EPSO) exists as a working group and discussion forum for European regulators. This group undertook to identify a common framework within which European approaches to indicators could be compared. A framework was developed to classify indicators, using four sets of criteria: conceptualization of quality, Donabedian definition (structure, process, outcome), data type (derivable, collectable from routine sources, special collections, samples) and data use (judgement (singular or part of framework) benchmarking, risk assessment). Indicators from English and Dutch hospital measurement programmes were put into the framework, showing areas of agreement and levels of comparability. In the first instance, results are only illustrative. The EPSO has been a powerful driver for undertaking cross-European research, and this project is the first of many to take advantage of the access to international expertize. It has shown that through development of a framework that deconstructs national indicators, commonalities can be identified. Future work will attempt to incorporate other nations' indicators, and attempt cross-national comparison.

Towards Integrating Soil Quality Monitoring Targets as Measures of Soil Natural Capital Stocks with the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Taylor, M. D.; Mackay, A. D.; Dominati, E.; Hill, R. B.

2012-04-01

This paper presents the process used to review soil quality monitoring in New Zealand to better align indicators and indicator target ranges with critical values of change in soil function. Since its inception in New Zealand 15 year ago, soil quality monitoring has become an important state of the environment reporting tool for Regional Councils. This tool assists councils to track the condition of soils resources, assess the impact of different land management practices, and provide timely warning of emerging issues to allow early intervention and avoid irreversible loss of natural capital stocks. Critical to the effectiveness of soil quality monitoring is setting relevant, validated thresholds or target ranges. Provisional Target Ranges were set in 2003 using expert knowledge available and data on production responses. Little information was available at that time for setting targets for soil natural capital stocks other than those for food production. The intention was to revise these provisional ranges as further information became available and extend target ranges to cover the regulating and cultural services provided by soils. A recently developed ecosystems service framework was used to explore the feasibility of linking soil natural capital stocks measured by the current suite of soil quality indicators to the provision of ecosystem services by soils. Importantly the new approach builds on and utilises the time series data sets collected by current suite of soil quality indicators, adding value to the current effort, and has the potential to set targets ranges based on the economic and environmental outcomes required for a given farm, catchment or region. It is now timely to develop a further group of environmental indicators for measuring specific soil issues. As with the soil quality indicators, these environmental indicators would be aligned with the provision of ecosystem services. The toolbox envisaged is a set of indicators for specific soil issues with appropriate targets tied to ecosystem services and changes in critical soil function. Such indicators would be used for specific purposes for limited periods, rather than long-term, continuous monitoring. Some examples will be presented. An important step needed to successfully initiate and complete the review was assigning national oversight. Reigniting scientific interest (which had declined with the cessation of funding in 2003) and documentation of the process were other important steps. We had to extend the recently developed ecosystem service approach to accommodate the catchment scale. This required additional attributes in the framework and recognition that some of the proxies will change with scale as will the techniques to value the services. The framework was originally developed for use at the farm scale. Macroporosity, one of the two indicators used to monitor the physical condition of the soil, was used to illustrate how the ecosystem service framework could be used to link a change in the physical condition of the soil with the provision of services. The sum of the dollar values of selected soil ecosystem services were used to inform the state of soil natural capital stocks. This estimate provides a new insight into the value of the soil quality indicators and existing target ranges. Doing so will enable targets to be more closely aligned and integrated with the provision of a range of ecosystem services, going far beyond food production.

Quality indicators in inflammatory bowel disease.

PubMed

Berry, Sameer K; Melmed, Gil Y

2018-01-01

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, debilitating, and expensive condition affecting millions of people globally. There is significant variation in the quality of care for patients with IBD across North America, Europe, and Asia; this variation suggests poor quality of care due to overuse, underuse, or misuse of health services and disparity of outcomes. Several initiatives have been developed to reduce variation in care delivery and improve processes of care, patient outcomes, and reduced healthcare costs. These initiatives include the development of quality indicator sets to standardize care across organizations, and learning health systems to enable data sharing between doctors and patients, and sharing of best practices among providers. These programs have been variably successful in improving patient outcomes and reducing healthcare utilization. Further studies are needed to demonstrate the long-term impact and applicability of these efforts in different geographic areas around the world, as regional variations in patient populations, societal preferences, and costs should inform local quality improvement efforts.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

PubMed

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.

Disparities in Health Care Quality Indicators among US Children with Special Health Care Needs According to Household Language Use.

PubMed

Yu, Stella; Lin, Sue; Strickland, Bonnie

2015-01-01

Lower health care utilization and less favorable health outcomes have been demonstrated in children from Non-English Primary Language households (NEPL) in previous studies. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN) and their association with household language use. We used data from the 2009-2010 National Survey of Children with Special Health Care Needs, restricted to an analytic sample of 40,242 children. Logistic regression models were used to examine the effects of primary household language on the attainment of the 6 health care quality indicators for CSHCN. Compared to CSHCN from English primary language households (EPL), CSHCN from NEPL households had 31% higher odds of not feeling like partners in health care decision-making. They had 67% higher odds of lacking care through a medical home and 42% higher odds of reporting inadequate health insurance. NEPL children had 32% higher odds of not receiving early and continuous screening for special health care needs. NEPL youths had 69% higher odds of not receiving services for transition to adulthood. Minority race/ethnicity, lower income and families other than two biological parents all conferred additional risks to not attaining quality indicators. Publicly insured or uninsured CSHCN were also at higher risk. Our study provides compelling evidence that significant disparities exist for CSHCN by primary household language status across all health care quality indicators. Establishment of effective surveillance systems and targeting of outreach programs in both developed and developing countries may lead to improved understanding of health care needs and quality of services and reduction of health disparities for this underserved population.

[Coupling coordination evaluation method between eco-environment quality and economic development level in contiguous special poverty-stricken areas of China].

PubMed

Wang, Yan-hui; Li, Jing-yi

2015-05-01

It is one of the important strategies in the new period of national poverty alleviation and development to maintain the basic balance between the ecological environment and economic development, and to promote the coordinated sustainable development of economy and ecological environment. Taking six contiguous special poverty-stricken areas as the study areas, a coupling coordination evaluation method between eco-environment quality and economic development level in contiguous special poverty-stricken areas was explored in this paper. The region' s ecological poverty index system was proposed based on the natural attribute of ecological environment, and the ecological environment quality evaluation method was built up by using AHP weighting method, followed by the design of the coupling coordination evaluation method between the ecological environment indices and the county economic poverty comprehensive indices. The coupling coordination degrees were calculated and their spatial representation differentiations were analyzed respectively at district, province, city, and county scales. Results showed that approximately half of the counties in the study areas achieved the harmoniously coordinated development. However, the ecological environmental quality and the economic development in most counties could not be synchronized, where mountains, rivers and other geographic features existed roughly as a dividing line of the coordinated development types. The phenomena of dislocation between the ecological environment and economic development in state-level poor counties were more serious than those of local poor counties.

Evaluation of drinking quality of groundwater through multivariate techniques in urban area.

PubMed

Das, Madhumita; Kumar, A; Mohapatra, M; Muduli, S D

2010-07-01

Groundwater is a major source of drinking water in urban areas. Because of the growing threat of debasing water quality due to urbanization and development, monitoring water quality is a prerequisite to ensure its suitability for use in drinking. But analysis of a large number of properties and parameter to parameter basis evaluation of water quality is not feasible in a regular interval. Multivariate techniques could streamline the data without much loss of information to a reasonably manageable data set. In this study, using principal component analysis, 11 relevant properties of 58 water samples were grouped into three statistical factors. Discriminant analysis identified "pH influence" as the most distinguished factor and pH, Fe, and NO₃⁻ as the most discriminating variables and could be treated as water quality indicators. These were utilized to classify the sampling sites into homogeneous clusters that reflect location-wise importance of specific indicator/s for use to monitor drinking water quality in the whole study area.

Soil quality standards and guidelines for forest sustainability in northwestern North America

Treesearch

Deborah Page-Dumroese; Martin Jurgensen; William Elliot; Thomas Rice; John Nesser; Thomas Collins; Robert Meurisse

2000-01-01

Soil quality standards and guidelines of the USDA Forest Service were some of the first in the world to be developed to evaluate changes in forest soil productivity and sustainability after harvesting and site preparation. International and national development of criteria and indicators for maintenance of soil productivity make it imperative to have adequate threshold...

Essential Organizational Supports for Early Education: The Development of a New Survey Tool to Measure Organizational Conditions. Survey Development Brief

ERIC Educational Resources Information Center

Ehrlich, Stacy B.; Pacchiano, Debra M.; Stein, Amanda G.; Luppescu, Stuart

2016-01-01

Decades of research evidence indicate that high-quality early education can positively affect the learning trajectories of disadvantaged young children. However, despite significant investments to improve what happens in the classroom, publicly funded pre-kindergarten programs continue to display instructional quality that is too weak to prepare…

Determinants of embryo development and quality in beef cattle: Effect of pre-ovulatory follicle size, CL volume, and serum concentrations of progesterone

USDA-ARS?s Scientific Manuscript database

Previous research indicates cows ovulating a small dominant follicle (<_ 12 mm) had lower pregnancy rates than cows ovulating a large follicle (> 12 mm). We hypothesized cows ovulating a small follicle would have delayed embryo development and decreased embryo quality. Objectives of this study wer...

Indicators of the quality of general practice care of patients with chronic illness: a step towards the real involvement of patients in the assessment of the quality of care.

PubMed Central

Wensing, M; Grol, R; van Montfort, P; Smits, A

1996-01-01

OBJECTIVE--To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality. DESIGN--Qualitative study with focus group interviews and a written consensus procedure. SETTING--General practice in the Netherlands in 1993. SUBJECTS--34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys. MAIN MEASURES--Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care. RESULTS--Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿ CONCLUSIONS--Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners. IMPLICATIONS-- Qualitative methods can contribute to the selection of indicators for assessment of the quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important. PMID:10158595

Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages

NASA Astrophysics Data System (ADS)

Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

2017-04-01

Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages.

PubMed

Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

2017-04-01

Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

Does Maternal Employment Influence Poor Children's Social Development?

ERIC Educational Resources Information Center

Fuller, Bruce; Caspary, Gretchen; Kagan, Sharon Lynn; Gauthier, Christiane; Hnang, Danny Shih-Cheng; Carroll, Judith; McCarthy, Jan

2002-01-01

This study examined the relation between young children's social development and maternal employment among women who entered welfare-to-work programs. Structural equation models provided evidence that indicators of economic security, such as food security and job quality indicators, but not recent employment per se, operated through parenting…

Quality in Higher Education: The Contribution of Edward Demings Principles

ERIC Educational Resources Information Center

Redmond, Richard; Curtis, Elizabeth; Noone, Tom; Keenan, Paul

2008-01-01

Purpose--There can be little doubt about the importance and relevance of quality for any service industry. One of the most influential contributors to service quality developments was W. Edwards Deming (1900-1993). An important component of Demings philosophy is reflected in his 14-principles for transforming a service as they indicate what…

[Healthy life years (HLY) comprehensive indicator of health situation--recommended by European Union].

PubMed

Gromulska, Lucyna; Wysocki, Mirosław J; Goryński, Paweł

2008-01-01

This article presents Healthy Life Years (HLY) indicator of functional health status, its application in the field of public health research and monitoring, method of calculation, idea of its construction and relation of HLY to other health status indicators e.g. life expectancy, quality adjusted life years. Current data on HLY in the EU member states are also presented. HLY indicator is one of structural indicators, recommended by European Council to deliver information on the progress of implementation of the Lisbon Strategy resolutions, which main principle is development of knowledge-based economy characterised by growth, social cohesion and respect for environment. HLY shifts the focus from quantity of years of life to its quality, full-productivity health of the population, thus conveying information not only on health status but also referring to the fields--other than medicine or social sciences--such as: finances, economy, politics, development.

[Risk adjusted assessment of quality of perinatal centers - results of perinatal/neonatal quality surveillance in Saxonia].

PubMed

Koch, R; Gmyrek, D; Vogtmann, Ch

2005-12-01

The weak point of the country-wide perinatal/neonatal quality surveillance as a tool for evaluation of achievements of a distinct clinic, is the ignorance of interhospital differences in the case-mix of patients. Therefore, that approach can not result in a reliable bench marking. To adjust the results of quality assessment of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal data base of 12.783 newborns of the saxonian quality surveillance from 1998 to 2000 was analyzed. 4 relevant quality indicators of newborn outcome -- a) severe intraventricular hemorrhage in preterm infants < 1500 g, b) death in hospital of preterm infants < 1500 g, c) death in newborns with birth weight > 2500 g and d) hypoxic-ischemic encephalopathy -- were targeted to find out specific risk predictors by considering 26 risk factors. A logistic regression model was used to develop the risk predictors. Risk predictors for the 4 quality indicators could be described by 3 - 9 out of 26 analyzed risk factors. The AUC (ROC)-values for these quality indicators were 82, 89, 89 and 89 %, what signifies their reliability. Using the new specific predictors for calculation the risk adjusted incidence rates of quality indicator yielded in some remarkable changes. The apparent differences in the outcome criteria of analyzed hospitals were found to be much less pronounced. The application of the proposed method for risk adjustment of quality indicators makes it possible to perform a more objective comparison of neonatal outcome criteria between different hospitals or regions.

Ovary transcriptome profiling via artificial intelligence reveals a transcriptomic fingerprint predicting egg quality in striped bass, Morone saxatilis.

PubMed

Chapman, Robert W; Reading, Benjamin J; Sullivan, Craig V

2014-01-01

Inherited gene transcripts deposited in oocytes direct early embryonic development in all vertebrates, but transcript profiles indicative of embryo developmental competence have not previously been identified. We employed artificial intelligence to model profiles of maternal ovary gene expression and their relationship to egg quality, evaluated as production of viable mid-blastula stage embryos, in the striped bass (Morone saxatilis), a farmed species with serious egg quality problems. In models developed using artificial neural networks (ANNs) and supervised machine learning, collective changes in the expression of a limited suite of genes (233) representing <2% of the queried ovary transcriptome explained >90% of the eventual variance in embryo survival. Egg quality related to minor changes in gene expression (<0.2-fold), with most individual transcripts making a small contribution (<1%) to the overall prediction of egg quality. These findings indicate that the predictive power of the transcriptome as regards egg quality resides not in levels of individual genes, but rather in the collective, coordinated expression of a suite of transcripts constituting a transcriptomic "fingerprint". Correlation analyses of the corresponding candidate genes indicated that dysfunction of the ubiquitin-26S proteasome, COP9 signalosome, and subsequent control of the cell cycle engenders embryonic developmental incompetence. The affected gene networks are centrally involved in regulation of early development in all vertebrates, including humans. By assessing collective levels of the relevant ovarian transcripts via ANNs we were able, for the first time in any vertebrate, to accurately predict the subsequent embryo developmental potential of eggs from individual females. Our results show that the transcriptomic fingerprint evidencing developmental dysfunction is highly predictive of, and therefore likely to regulate, egg quality, a biologically complex trait crucial to reproductive fitness.

Ovary Transcriptome Profiling via Artificial Intelligence Reveals a Transcriptomic Fingerprint Predicting Egg Quality in Striped Bass, Morone saxatilis

PubMed Central

2014-01-01

Inherited gene transcripts deposited in oocytes direct early embryonic development in all vertebrates, but transcript profiles indicative of embryo developmental competence have not previously been identified. We employed artificial intelligence to model profiles of maternal ovary gene expression and their relationship to egg quality, evaluated as production of viable mid-blastula stage embryos, in the striped bass (Morone saxatilis), a farmed species with serious egg quality problems. In models developed using artificial neural networks (ANNs) and supervised machine learning, collective changes in the expression of a limited suite of genes (233) representing <2% of the queried ovary transcriptome explained >90% of the eventual variance in embryo survival. Egg quality related to minor changes in gene expression (<0.2-fold), with most individual transcripts making a small contribution (<1%) to the overall prediction of egg quality. These findings indicate that the predictive power of the transcriptome as regards egg quality resides not in levels of individual genes, but rather in the collective, coordinated expression of a suite of transcripts constituting a transcriptomic “fingerprint”. Correlation analyses of the corresponding candidate genes indicated that dysfunction of the ubiquitin-26S proteasome, COP9 signalosome, and subsequent control of the cell cycle engenders embryonic developmental incompetence. The affected gene networks are centrally involved in regulation of early development in all vertebrates, including humans. By assessing collective levels of the relevant ovarian transcripts via ANNs we were able, for the first time in any vertebrate, to accurately predict the subsequent embryo developmental potential of eggs from individual females. Our results show that the transcriptomic fingerprint evidencing developmental dysfunction is highly predictive of, and therefore likely to regulate, egg quality, a biologically complex trait crucial to reproductive fitness. PMID:24820964

Measuring the quality of child health care at first-level facilities.

PubMed

Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre

2005-08-01

Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

Creation of a synthetic indicator of quality of care as a clinical management standard in primary care.

PubMed

Coma, Ermengol; Ferran, Manel; Méndez, Leonardo; Iglesias, Begoña; Fina, Francesc; Medina, Manuel

2013-12-01

The development of electronic medical records has allowed the creation of new quality indicators in healthcare. Among them, synthetic indicators facilitate global interpretation of results and comparisons between professionals. A healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) was constructed to serve as a synthetic indicator to measure the quality of care provided by primary care professionals in Catalonia (Spain). The project phases were to establish the reference population; select health problems to be included; define, select and deliberate about subindicators; and construct and publish the EQA. Construction of the EQA involved 107 healthcare professionals, and 91 health problems were included. In addition, 133 experts were consulted, who proposed a total of 339 indicators. After systematic paired comparison, 61 indicators were selected to create the synthetic indicator. The EQA is now calculated on a monthly basis for more than 8000 healthcare professionals using an automated process that extracts data from electronic medical records; results are published on a follow-up website. Along with the use of the online EQA results tool, there has been an ongoing improvement in most of the quality of care indicators. Creation of the EQA has proven to be useful for the measurement of the quality of care of primary care services. Also an improvement trend over 5 years is shown across most of the measured indicators. The online version of this article (doi:10.1186/2193-1801-2-51) contains supplementary material, which is available to authorized users.

Performance Indicators: Theory and Practice. Coombe Lodge Report Volume 20, Number 1.

ERIC Educational Resources Information Center

Theodossin, Ernest; Thomson, Craig

1987-01-01

Two papers on performance indicators are presented: (1) "Quality Control in Education: The Use of Performance Indicators," by Ernest Theodossin, and (2) "Developing and Using a Performance Indicator Instrument," by Theodossin and Craig Thomson. The first paper looks at the relationship between colleges and the manufacturing…

Stem-quality changes on young, mixed upland hardwoods after crop-tree release

Treesearch

David L. Sonderman; David L. Sonderman

1987-01-01

Relative change of several types of stem defects was studied over an 8-year period to determine the effects of crop-tree thinning on the development of tree quality. Special interest was given to changes in relative quality associated with defect indicators of crop trees compared to trees in unthinned plots. The relative quality classes of the crop trees went from...

Analysis of Lexical Quality and Its Relation to Writing Quality for 4th Grade, Primary School Students in Chile

ERIC Educational Resources Information Center

Gómez Vera, Gabriela; Sotomayor, Carmen; Bedwell, Percy; Domínguez, Ana María; Jéldrez, Elvira

2016-01-01

Few studies have addressed vocabulary quality in developing writing skill in Spanish. Even less addressed it within the Chilean educational system. The specific objective of this study was to characterize, using a comprehensive set of indicators, the quality of the vocabulary produced by Chilean 4th grade students. Based on a national writing…

Using quality indicators in anaesthesia: feeding back data to improve care.

PubMed

Benn, J; Arnold, G; Wei, I; Riley, C; Aleva, F

2012-07-01

After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. Anaesthesia poses certain challenges in the identification of valid outcome indicators sensitive to variations in anaesthetic care. Metrics collected during the immediate post-anaesthetic recovery period, such as patient temperature, patient-reported quality of recovery, and pain and nausea, provide potentially useful information for the anaesthetist, yet this information is not routinely fed back. Reviews of the effects of feeding back performance data to healthcare providers suggest that this may result in small to moderate positive effects upon outcomes and professional practice, with stronger effects where feedback is integrated within a broader quality improvement strategy. The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.

Characterizing Coastal Ecosystem Service Trade-offs with Future Urban Development in a Tropical City

NASA Astrophysics Data System (ADS)

Richards, Daniel R.; Friess, Daniel A.

2017-11-01

With rapid urbanization in the coastal zone and increasing habitat losses, it is imperative to understand how urban development affects coastal biodiversity and ecosystem service provision. Furthermore, it is important to understand how habitat fragments can best be incorporated into broader land use planning and coastal management, in order to maximize the environmental benefits they provide. In this study, we characterized the trade-offs between (a) urban development and individual mangrove environmental indicators (habitat quality and ecosystem services), and (b) between different environmental indicators in the tropical nation of Singapore. A range of biological, biophysical, and cultural indicators, including carbon, charcoal production, support for offshore fisheries, recreation, and habitat quality for a threatened species were quantified using field-based, remote sensing, and expert survey methods. The shape of the trade-off Pareto frontiers was analyzed to assess the sensitivity of environmental indicators for development. When traded off individually with urban development, four out of five environmental indicators were insensitive to development, meaning that relatively minor degradation of the indicator occurred while development was below a certain threshold, although indicator loss accelerated once this threshold was reached. Most of the pairwise relationships between the five environmental indicators were synergistic; only carbon storage and charcoal production, and charcoal production and recreational accessibility showed trade-offs. Trade-off analysis and land use optimization using Pareto frontiers could be a useful decision-support tool for understanding how changes in land use and coastal management will impact the ability of ecosystems to provide environmental benefits.

Characterizing Coastal Ecosystem Service Trade-offs with Future Urban Development in a Tropical City.

PubMed

Richards, Daniel R; Friess, Daniel A

2017-11-01

With rapid urbanization in the coastal zone and increasing habitat losses, it is imperative to understand how urban development affects coastal biodiversity and ecosystem service provision. Furthermore, it is important to understand how habitat fragments can best be incorporated into broader land use planning and coastal management, in order to maximize the environmental benefits they provide. In this study, we characterized the trade-offs between (a) urban development and individual mangrove environmental indicators (habitat quality and ecosystem services), and (b) between different environmental indicators in the tropical nation of Singapore. A range of biological, biophysical, and cultural indicators, including carbon, charcoal production, support for offshore fisheries, recreation, and habitat quality for a threatened species were quantified using field-based, remote sensing, and expert survey methods. The shape of the trade-off Pareto frontiers was analyzed to assess the sensitivity of environmental indicators for development. When traded off individually with urban development, four out of five environmental indicators were insensitive to development, meaning that relatively minor degradation of the indicator occurred while development was below a certain threshold, although indicator loss accelerated once this threshold was reached. Most of the pairwise relationships between the five environmental indicators were synergistic; only carbon storage and charcoal production, and charcoal production and recreational accessibility showed trade-offs. Trade-off analysis and land use optimization using Pareto frontiers could be a useful decision-support tool for understanding how changes in land use and coastal management will impact the ability of ecosystems to provide environmental benefits.

A novel, fuzzy-based air quality index (FAQI) for air quality assessment

NASA Astrophysics Data System (ADS)

Sowlat, Mohammad Hossein; Gharibi, Hamed; Yunesian, Masud; Tayefeh Mahmoudi, Maryam; Lotfi, Saeedeh

2011-04-01

The ever increasing level of air pollution in most areas of the world has led to development of a variety of air quality indices for estimation of health effects of air pollution, though the indices have their own limitations such as high levels of subjectivity. Present study, therefore, aimed at developing a novel, fuzzy-based air quality index (FAQI ) to handle such limitations. The index developed by present study is based on fuzzy logic that is considered as one of the most common computational methods of artificial intelligence. In addition to criteria air pollutants (i.e. CO, SO 2, PM 10, O 3, NO 2), benzene, toluene, ethylbenzene, xylene, and 1,3-butadiene were also taken into account in the index proposed, because of their considerable health effects. Different weighting factors were then assigned to each pollutant according to its priority. Trapezoidal membership functions were employed for classifications and the final index consisted of 72 inference rules. To assess the performance of the index, a case study was carried out employing air quality data at five different sampling stations in Tehran, Iran, from January 2008 to December 2009, results of which were then compared to the results obtained from USEPA air quality index (AQI). According to the results from present study, fuzzy-based air quality index is a comprehensive tool for classification of air quality and tends to produce accurate results. Therefore, it can be considered useful, reliable, and suitable for consideration by local authorities in air quality assessment and management schemes. Fuzzy-based air quality index (FAQI).

Using fish communities to assess streams in Romania: Initial development of an index of biotic integrity

USGS Publications Warehouse

Angermeier, P.L.; Davideanu, G.

2004-01-01

Multimetric biotic indices increasingly are used to complement physicochemical data in assessments of stream quality. We initiated development of multimetric indices, based on fish communities, to assess biotic integrity of streams in two physiographic regions of central Romania. Unlike previous efforts to develop such indices for European streams, our metrics and scoring criteria were selected largely on the basis of empirical relations in the regions of interest. We categorised 54 fish species with respect to ten natural-history attributes, then used this information to compute 32 candidate metrics of five types (taxonomic, tolerance, abundance, reproductive, and feeding) for each of 35 sites. We assessed the utility of candidate metrics for detecting anthropogenic impact based on three criteria: (a) range of values taken, (b) relation to a site-quality index (SQI), which incorporated information on hydrologic alteration, channel alteration, land-use intensity, and water chemistry, and (c) metric redundancy. We chose seven metrics from each region to include in preliminary multimetric indices (PMIs). Both PMIs included taxonomic, tolerance, and feeding metrics, but only two metrics were common to both PMIs. Although we could not validate our PMIs, their strong association with the SQI in each region suggests that such indices would be valuable tools for assessing stream quality and could provide more comprehensive assessments than the traditional approaches based solely on water chemistry.

Quality indicators for initial licensure and discipline in nursing laws in South Korea and North Carolina.

PubMed

Kim, K K; Kjervik, D K; Foster, B

2014-03-01

The Korean regulatory framework of nursing licensure reflects that of the USA, but its content differs in some of the powers related to quality assurance. This article compares regulatory quality indicators and describes core standards in nursing regulations that are related to both initial licensure and discipline for three groups: the National Council of State Boards of Nursing, the North Carolina and the South of Korea. A descriptive, comparative law design is used to examine the differences and similarities in the quality indicators and core standards found in three documents: the National Council of State Boards of Nursing Model Act, the North Carolina Nursing Practice Act and the Korean Medical Service Act for registered nurses. The findings indicate that ten quality indicators and two standards appear in study objects. Although most of the quality indicators are common to all documents, some differences are found in terms of the scope of criminal background checks and the range of grounds for disciplinary action. These findings cannot be generalized in the USA because although the North Carolina nursing act was selected as an example of US nursing laws, nursing laws differ somewhat across states. This comparative study shows a clear opportunity to develop indicators that acknowledge the important areas of competence and good moral character and how they can improve patient safety in Korea. This study provides recommendations for Korean nursing legislative redesign and pointers for other jurisdictions to consider. © 2013 International Council of Nurses.

Eating frequency is inversely associated with BMI, waist circumference and the proportion of body fat in Korean adults when diet quality is high, but not when it is low: analysis of the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV).

PubMed

Kim, Sunmi; Yang, Jeong Hee; Park, Gyeong-Hun

2018-04-01

The role of eating frequency (EF) in obesity development has been debated, and few studies have investigated Asian populations. Diet quality might affect the association between EF and obesity. Therefore, we investigated the association between EF and obesity indicators in a representative sample of Korean adults with consideration to diet quality. This cross-sectional study used data of 6951 participants aged 19-93 years (male 49·8 %, female 50·2 %) from the Fourth Korean National Health and Nutrition Examination Survey. EF was assessed using a questionnaire, and diet quality was defined as mean adequacy ratio (MAR). To explore the association between EF and obesity indicators, we used multiple linear regression analyses with and without interaction terms between diet quality and EF. EF was inversely associated with each obesity indicator, including body fat percentage (BF%), BMI and waist circumference (WC), showing a significant linear trend (P<0·001 for BF%, WC and BMI). In addition, the association between EF and each obesity indicator was significantly altered according to diet quality (P value of the interaction term EF×diet quality=0·008 in the regression model for BF%, <0·001 for BMI and 0·043 for WC). In the stratified analyses according to diet quality, EF had a significant inverse association with BF%, WC and BMI in the high diet quality groups, but not in the low diet quality groups. This study suggests that EF is inversely associated with the obesity indicators when diet quality is high, but not when it is low in Korean adults.

Quality of care for cancer patients on home parenteral nutrition: development of key interventions and outcome indicators using a two-round Delphi approach.

PubMed

Dreesen, Mira; Foulon, Veerle; Hiele, Martin; Vanhaecht, Kris; De Pourcq, Lutgart; Pironi, Loris; Van Gossum, André; Arends, Jann; Cuerda, Cristina; Thul, Paul; Bozzetti, Frederico; Willems, Ludo

2013-05-01

Clear recommendations on how to guide patients with cancer on home parenteral nutrition (HPN) are lacking as the use of HPN in this population remains a controversial issue. Therefore, the aims of this study were to rank treatment recommendations and main outcome indicators to ensure high-quality care and to indicate differences in care concerning benign versus malignant patients. Treatment recommendations, identified from published guidelines, were used as a starting point for a two-round Delphi approach. Comments and additional interventions proposed in the first round were reevaluated in the second round. Ordinal logistic regression with SPSS 2.0 was used to identify differences in care concerning benign versus malignant patients. Twenty-seven experts from five European countries completed two Delphi rounds. After the second Delphi round, the top three most important outcome indicators were (1) quality of life (QoL), (2) incidence of hospital readmission and (3) incidence of catheter-related infections. Forty-two interventions were considered as important for quality of care (28/42 based on published guidelines; 14/42 newly suggested by Delphi panel). The topics 'Liver disease' and 'Metabolic bone disease' were considered less important for cancer patients, together with use of infusion pumps (p = 0.004) and monitoring of vitamins and trace elements (p = 0.000). Monitoring of QoL is considered more important for cancer patients (p = 0.03). Using a two-round Delphi approach, we developed a minimal set of 42 interventions that may be used to determine quality of care in HPN patients with malignancies. This set of interventions differs from a similar set developed for benign patients.

Financial gains and risks in pay-for-performance bonus algorithms.

PubMed

Cromwell, Jerry; Drozd, Edward M; Smith, Kevin; Trisolini, Michael

2007-01-01

Considerable attention has been given to evidence-based process indicators associated with quality of care, while much less attention has been given to the structure and key parameters of the various pay-for-performance (P4P) bonus and penalty arrangements using such measures. In this article we develop a general model of quality payment arrangements and discuss the advantages and disadvantages of the key parameters. We then conduct simulation analyses of four general P4P payment algorithms by varying seven parameters, including indicator weights, indicator intercorrelation, degree of uncertainty regarding intervention effectiveness, and initial baseline rates. Bonuses averaged over several indicators appear insensitive to weighting, correlation, and the number of indicators. The bonuses are sensitive to disease manager perceptions of intervention effectiveness, facing challenging targets, and the use of actual-to-target quality levels versus rates of improvement over baseline.

Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis – a perspective from structurally- and process-oriented hygiene

PubMed Central

Hübner, Nils-Olaf; Fleßa, Steffen; Jakisch, Ralf; Assadian, Ojan; Kramer, Axel

2012-01-01

In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene. PMID:22558049

Combining natural background levels (NBLs) assessment with indicator kriging analysis to improve groundwater quality data interpretation and management.

PubMed

Ducci, Daniela; de Melo, M Teresa Condesso; Preziosi, Elisabetta; Sellerino, Mariangela; Parrone, Daniele; Ribeiro, Luis

2016-11-01

The natural background level (NBL) concept is revisited and combined with indicator kriging method to analyze the spatial distribution of groundwater quality within a groundwater body (GWB). The aim is to provide a methodology to easily identify areas with the same probability of exceeding a given threshold (which may be a groundwater quality criteria, standards, or recommended limits for selected properties and constituents). Three case studies with different hydrogeological settings and located in two countries (Portugal and Italy) are used to derive NBL using the preselection method and validate the proposed methodology illustrating its main advantages over conventional statistical water quality analysis. Indicator kriging analysis was used to create probability maps of the three potential groundwater contaminants. The results clearly indicate the areas within a groundwater body that are potentially contaminated because the concentrations exceed the drinking water standards or even the local NBL, and cannot be justified by geogenic origin. The combined methodology developed facilitates the management of groundwater quality because it allows for the spatial interpretation of NBL values. Copyright © 2016 Elsevier B.V. All rights reserved.

[Access to prenatal care and quality of care in the Family Health Strategy: infrastructure, care, and management].

PubMed

Guimarães, Wilderi Sidney Gonçalves; Parente, Rosana Cristina Pereira; Guimarães, Thayanne Louzada Ferreira; Garnelo, Luiza

2018-05-10

This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

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.

Geospatial Water Quality Analysis of Dilla Town, Gadeo Zone, Ethiopia - A Case Study

NASA Astrophysics Data System (ADS)

Pakhale, G. K.; Wakeyo, T. B.

2015-12-01

Dilla is a socio-economically important town in Ethiopia, established on the international highway joining capital cities of Ethiopia and Kenya. It serves as an administrative center of the Gedeo Zone in SNNPR region of Ethiopia accommodating around 65000 inhabitants and also as an important trade centre for coffee. Due to the recent developments and urbanization in town and surrounding area, waste and sewage discharge has been raised significantly into the water resources. Also frequent rainfall in the region worsens the problem of water quality. In this view, present study aims to analyze water quality profile of Dilla town using 12 physico-chemical parameters. 15 Sampling stations are identified amongst the open wells, bore wells and from surface water, which are being extensively used for drinking and other domestic purposes. Spectrophotometer is used to analyze data and Gaussian process regression is used to interpolate the same in GIS environment to represent spatial distribution of parameters. Based on observed and desirable values of parameters, water quality index (WQI); an indicator of weighted estimate of the quantities of various parameters ranging from 1 to 100, is developed in GIS. Higher value of WQI indicates better while low value indicates poor water quality. This geospatial analysis is carried out before and after rainfall to understand temporal variation with reference to rainfall which facilitates in identifying the potential zones of drinking water. WQI indicated that 8 out of 15 locations come under acceptable category indicating the suitability of water for human use, however remaining locations are unfit. For example: the water sample at main_campus_ustream_1 (site name) site has very low WQI after rainfall, making it unfit for human usage. This suggests undertaking of certain measures in town to enhance the water quality. These results are useful for town authorities to take corrective measures and ameliorate the water quality for human use.

A Review of Self-Regulated Strategy Development for Writing for Students with EBD

ERIC Educational Resources Information Center

Sreckovic, Melissa A.; Common, Eric A.; Knowles, Meagan M.; Lane, Kathleen Lynne

2014-01-01

In this systematic review, we evaluated the evidence base of self-regulated strategy development (SRSD; Harris & Graham, 1992) for writing with students with and at risk for emotional or behavioral disorders (EBD). First, we evaluated the quality of studies identified (n 5 13) by applying the quality indicators for single case (Horner et al.,…

[Risk-adjusted assessment: late-onset infection in neonates].

PubMed

Gmyrek, Dieter; Koch, Rainer; Vogtmann, Christoph; Kaiser, Annette; Friedrich, Annette

2011-01-01

The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal database of 41,055 newborns of the Saxonian quality surveillance from 1998 to 2004 was analysed. Based on 18 possible risk factors, a logistic regression model was used to develop a specific risk predictor for the quality indicator "late-onset infection". The developed risk predictor for the incidence of late-onset infection could be described by 4 of the 18 analysed risk factors, namely gestational age, admission from home, hypoxic ischemic encephalopathy and B-streptococcal infection. The AUC(ROC) value of this quality indicator was 83.3%, which demonstrates its reliability. The hospital ranking based on the adjusted risk assessment was very different from hospital rankings before this adjustment. The average correction of ranking position was 4.96 for 35 clinics. The application of the risk adjustment method proposed here allows for a more objective comparison of the incidence of the quality indicator "late onset infection" among different hospitals. Copyright © 2011. Published by Elsevier GmbH.

Quality of life in patients with Parkinson's disease: development of a questionnaire.

PubMed Central

de Boer, A G; Wijker, W; Speelman, J D; de Haes, J C

1996-01-01

OBJECTIVES--To develop and test a questionnaire for measuring quality of life in patients with Parkinson's disease. METHODS--An item pool was developed based on the experience of patients with Parkinson's disease and of neurologists; medical literature on the problems of patients with Parkinson's disease; and other quality of life questionnaires. To reduce the item pool, 13 patients identified items that were a problem to them and rated their importance. Items which were most often chosen and rated most important were included in the Parkinson's disease quality of life questionnaire (PDQL). The PDQL consists of 37 items. To evaluate the discriminant validity of the PDQL three groups of severity of disease were compared. To test for convergent validity, the scores of the PDQL were tested for correlation with standard indices of quality of life. RESULTS--The PDQL was filled out by 384 patients with Parkinson's disease. It consisted of four subscales: parkinsonian symptoms, systemic symptoms, emotional functioning, and social functioning. The internal-consistency reliability coefficients of the PDQL subscales were high (0.80-0.87). Patients with higher disease severity had significantly lower quality of life on all PDQL subscales (P < 0.05). Almost all PDQL subscales correlated highly (P < 0.001) with the corresponding scales of the standard quality of life indices. CONCLUSION--The PDQL is a relevant, reliable, and valid measure of the quality of life of patients with Parkinson's disease. Images PMID:8676165

Comprehensive approach to smart urban development based on Big Data application

NASA Astrophysics Data System (ADS)

Kurcheeva, G. I.; Klochkov, G. A.

2018-05-01

Despite a certain technological backwardness of the Russian economy, the authors believe that the transition to the «smart city» is possible if one can solve such problems: providing large-scale investment, training and retraining specialists in the field of ICT, increasing innovation managers and consumers, increasing ICT participation in the work of governments, organizations and people, creating the appropriate conditions for the development of the information society. Accordingly, when developing models, it is planned to consider the relationship between quality of life and the existing system of indicators on trends of «smart cities». Monitoring of indicators of quality of life, mutually related indicators of technological development can help us develop the process model. When selecting directions for the main components of the «smart city», let us introduce the evaluation criteria that significantly affect the quality of the values of life. The development of «smart cities» should consider the international experience of the use of breakthrough innovative technology. Research scientists of various countries show a variety of approaches to identifying the main business processes in models of the «smart city». Having the international experience, it is necessary to improve business processes in the construction of a process model «smart city», adapting the model to the characteristics of the national environment.

School Quality and the Development of Cognitive Skills between Age Four and Six

PubMed Central

Borghans, Lex; Golsteyn, Bart H. H.; Zölitz, Ulf

2015-01-01

This paper studies the extent to which young children develop their cognitive ability in high and low quality schools. We use a representative panel data set containing cognitive test scores of 4-6 year olds in Dutch schools. School quality is measured by the school’s average achievement test score at age 12. Our results indicate that children in high-quality schools develop their skills substantially faster than those in low-quality schools. The results remain robust to the inclusion of initial ability, parental background, and neighborhood controls. Moreover, using proximity to higher-achieving schools as an instrument for school choice corroborates the results. The robustness of the results points toward a causal interpretation, although it is not possible to erase all doubt about unobserved confounding factors. PMID:26182123

Measuring Performance Excellence: Key Performance Indicators for Institutions Accepted into the Academic Quality Improvement Program (AQIP)

ERIC Educational Resources Information Center

Ballard, Paul J.

2013-01-01

Given growing interest in accountability and outcomes, the North Central Association's Higher Learning Commission developed a new path for accreditation, the Academic Quality Improvement Program (AQIP). The goal is to infuse continuous improvement and quality in the culture of higher education, and to blend traditional accreditation with the…

The Relationship between Quality of Pre-School Child Care Institutions and Teachers' Teaching Approach

ERIC Educational Resources Information Center

Õun, Tiia; Tuul, Maire; Tera, Signe; Sagen, Kelli; Mägi, Helena

2018-01-01

Various factors of the quality of preschool child care institutions influence the development of children and their future success in school. The activities of preschool child care institutions in Estonia are based on the national curriculum. Several indicators of structural quality have been determined on the national level. The aim of the…

Environmental Quality, the Third Annual Report of the Council on Environmental Quality.

ERIC Educational Resources Information Center

Council on Environmental Quality, Washington, DC.

The state of the environment and efforts to improve it are reported upon in this Third Annual Report of the Council on Environmental Quality. Broad in scope, the report covers federal and state activities during the past year, the development of environmental indices, and legal implications of the National Environmental Policy Act. The chapter on…

THE USE OF HYPERSPECTRAL REMOTE SENSING FOR THE DEVELOPMENT OF OPTICAL WATER QUALITY INDICATORS IN THE OHIO RIVER BASIN

EPA Science Inventory

Hyperspectral remote sensing for the assessment of inland water quality can be used in enhancing the capabilities of resource managers to monitor water bodies in a timely and cost-effective manner. The key factor in assessing the accuracy of water quality assessments based on re...

Quality Development in Higher Education to Meet the Future Needs of Arkansas. Report of the Quality Higher Education Study Committee.

ERIC Educational Resources Information Center

Arkansas State Dept. of Higher Education, Little Rock.

A report of the Quality Higher Education Study Committee on state-supported institutions in Arkansas is presented, including 43 recommendations. Attention is directed to: economic characteristics in the state (business indicators, population and growth, personal and family income); social characteristics in the state (education levels, illiteracy,…

Oak Seedlings: Quality Improved Available Now Genetically Improved Available Soon

Treesearch

S.E. Schlarbaum; Paul P. Kormanik; T. Tibbs; L.R. Barber

1997-01-01

Technology for obtaining natural oak regeneration on low quality upland sites, e.g. site indices of 60-65 or less, was developed in the Central Statesregion and has been successfully applied throughout the eastern United States (Sanderand Graney 1993, Clark 1993, Sander 1972). Modification of this technology for use on high quality mesic sites, productive coves and...

Guidance on Data Quality Assessment for Life Cycle Inventory ...

EPA Pesticide Factsheets

Data quality within Life Cycle Assessment (LCA) is a significant issue for the future support and development of LCA as a decision support tool and its wider adoption within industry. In response to current data quality standards such as the ISO 14000 series, various entities within the LCA community have developed different methodologies to address and communicate the data quality of Life Cycle Inventory (LCI) data. Despite advances in this field, the LCA community is still plagued by the lack of reproducible data quality results and documentation. To address these issues, US EPA has created this guidance in order to further support reproducible life cycle inventory data quality results and to inform users of the proper application of the US EPA supported data quality system. The work for this report was begun in December 2014 and completed as of April 2016.The updated data quality system includes a novel approach to the pedigree matrix by addressing data quality at the flow and the process level. Flow level indicators address source reliability, temporal correlation, geographic correlation, technological correlation and data sampling methods. The process level indicators address the level of review the unit process has undergone and its completeness. This guidance is designed to be updatable as part of the LCA Research Center’s continuing commitment to data quality advancements. Life cycle assessment is increasingly being used as a tool to identify areas of

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

PubMed

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

[Evaluating the activity of the Italian Mental Health Services inpatient and residential facilities: the PRISM (Process Indicator System for Mental health) indicators].

PubMed

Picardi, Angelo; Tarolla, Emanuele; de Girolamo, Giovanni; Gigantesco, Antonella; Neri, Giovanni; Rossi, Elisabetta; Biondi, Massimo

2014-01-01

This article describes the activities of a project aimed at developing a system of process and process/outcome indicators suitable to monitor over time the quality of psychiatric care of Italian inpatient and residential psychiatric facilities. This system, named PRISM (Process Indicator System for Mental health), was developed by means of a standardized evaluation made by a panel of experts and a consecutive pilot study in 17 inpatient and 13 residential psychiatric facilities. A total of 28 indicators were selected from a set of 251 candidate indicators developed by the most relevant and qualified Italian and international authorities. These indicators are derived by data from medical records and information about characteristics of facilities, and they cover processes of care, operational equipment of facilities, staff training and working, relationships with external agencies, and sentinel events. The procedure followed for the development of the indicator system was reliable and innovative. The data collected from the pilot study suggested a favourable benefit-cost ratio between the workload associated with regular use of the indicators into the context of daily clinical activities and the advantages related to the information gathered through regular use of the indicators. CONCLUSIONS.:The PRISM system provides additional information about the healthcare processes with respect to the information gathered via routine information systems, and it might prove useful for both continuous quality improvement programs and health services research.

Expert opinions and scientific evidence for colonoscopy key performance indicators.

PubMed

Rees, Colin J; Bevan, Roisin; Zimmermann-Fraedrich, Katharina; Rutter, Matthew D; Rex, Douglas; Dekker, Evelien; Ponchon, Thierry; Bretthauer, Michael; Regula, Jaroslaw; Saunders, Brian; Hassan, Cesare; Bourke, Michael J; Rösch, Thomas

2016-12-01

Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards. 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 Care in Performance-Based Financing: How It Is Incorporated in 32 Programs Across 28 Countries

PubMed Central

Gergen, Jessica; Josephson, Erik; Coe, Martha; Ski, Samantha; Madhavan, Supriya; Bauhoff, Sebastian

2017-01-01

ABSTRACT Objective: To describe how quality of care is incorporated into performance-based financing (PBF) programs, what quality indicators are being used, and how these indicators are measured and verified. Methods: An exploratory scoping methodology was used to characterize the full range of quality components in 32 PBF programs, initiated between 2008 and 2015 in 28 low- and middle-income countries, totaling 68 quality tools and 8,490 quality indicators. The programs were identified through a review of the peer-reviewed and gray literature as well as through expert consultation with key donor representatives. Findings: Most of the PBF programs were implemented in sub-Saharan Africa and most were funded primarily by the World Bank. On average, PBF quality tools contained 125 indicators predominately assessing maternal, newborn, and child health and facility management and infrastructure. Indicators were primarily measured via checklists (78%, or 6,656 of 8,490 indicators), which largely (over 90%) measured structural aspects of quality, such as equipment, beds, and infrastructure. Of the most common indicators across checklists, 74% measured structural aspects and 24% measured processes of clinical care. The quality portion of the payment formulas were in the form of bonuses (59%), penalties (27%), or both (hybrid) (14%). The median percentage (of a performance payment) allocated to health facilities was 60%, ranging from 10% to 100%, while the median percentage allocated to health care providers was 55%, ranging from 20% to 80%. Nearly all of the programs included in the analysis (91%, n=29) verified quality scores quarterly (every 3 months), typically by regional government teams. Conclusion: PBF is a potentially appealing instrument to address shortfalls in quality of care by linking verified performance measurement with strategic incentives and could ultimately help meet policy priorities at the country and global levels, including the ambitious Sustainable Development Goals. The substantial variation and complexity in how PBF programs incorporate quality of care considerations suggests a need to further examine whether differences in design are associated with differential program impacts. PMID:28298338

Quality of Care in Performance-Based Financing: How It Is Incorporated in 32 Programs Across 28 Countries.

PubMed

Gergen, Jessica; Josephson, Erik; Coe, Martha; Ski, Samantha; Madhavan, Supriya; Bauhoff, Sebastian

2017-03-24

To describe how quality of care is incorporated into performance-based financing (PBF) programs, what quality indicators are being used, and how these indicators are measured and verified. An exploratory scoping methodology was used to characterize the full range of quality components in 32 PBF programs, initiated between 2008 and 2015 in 28 low- and middle-income countries, totaling 68 quality tools and 8,490 quality indicators. The programs were identified through a review of the peer-reviewed and gray literature as well as through expert consultation with key donor representatives. Most of the PBF programs were implemented in sub-Saharan Africa and most were funded primarily by the World Bank. On average, PBF quality tools contained 125 indicators predominately assessing maternal, newborn, and child health and facility management and infrastructure. Indicators were primarily measured via checklists (78%, or 6,656 of 8,490 indicators), which largely (over 90%) measured structural aspects of quality, such as equipment, beds, and infrastructure. Of the most common indicators across checklists, 74% measured structural aspects and 24% measured processes of clinical care. The quality portion of the payment formulas were in the form of bonuses (59%), penalties (27%), or both (hybrid) (14%). The median percentage (of a performance payment) allocated to health facilities was 60%, ranging from 10% to 100%, while the median percentage allocated to health care providers was 55%, ranging from 20% to 80%. Nearly all of the programs included in the analysis (91%, n=29) verified quality scores quarterly (every 3 months), typically by regional government teams. PBF is a potentially appealing instrument to address shortfalls in quality of care by linking verified performance measurement with strategic incentives and could ultimately help meet policy priorities at the country and global levels, including the ambitious Sustainable Development Goals. The substantial variation and complexity in how PBF programs incorporate quality of care considerations suggests a need to further examine whether differences in design are associated with differential program impacts. © Gergen et al.

Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico

PubMed Central

2012-01-01

Background Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. Methods We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. Results We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose ≤130 mg/dl). Conclusions EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC. PMID:22672471

Water quality in shallow alluvial aquifers, Upper Colorado River Basin, Colorado, 1997

USGS Publications Warehouse

Apodaca, L.E.; Bails, J.B.; Smith, C.M.

2002-01-01

Shallow ground water in areas of increasing urban development within the Upper Colorado River Basin was sampled for inorganic and organic constituents to characterize water-quality conditions and to identify potential anthropogenic effects resulting from development. In 1997, 25 shallow monitoring wells were installed and sampled in five areas of urban development in Eagle, Grand, Gunnison, and Summit Counties, Colorado. The results of this study indicate that the shallow ground water in the study area is suitable for most uses. Nonparametric statistical methods showed that constituents and parameters measured in the shallow wells were often significantly different between the five developing urban areas. Radon concentrations exceeded the proposed USEPA maximum contaminant level at all sites. The presence of nutrients, pesticides, and volatile organic compounds indicate anthropogenic activities are affecting the shallow ground-water quality in the study area. Nitrate as N concentrations greater than 2.0 mg/L were observed in ground water recharged between the 1980s and 1990s. Low concentrations of methylene blue active substances were detected at a few sites. Total coliform bacteria were detected at ten sites; however, E. coli was not detected. Continued monitoring is needed to assess the effects of increasing urban development on the shallow ground-water quality in the study area.

Preliminary Water-Table Map and Water-Quality Data for Part of the Matanuska-Susitna Valley, Alaska, 2005

USGS Publications Warehouse

Moran, Edward H.; Solin, Gary L.

2006-01-01

The Matanuska-Susitna Valley is in the northeastern part of the Cook Inlet Basin, Alaska, an area experiencing rapid population growth and development proximal to many lakes. Here water commonly flows between lakes and ground water, indicating interrelation between water quantity and quality. Thus concerns exist that poorer quality ground water may degrade local lake ecosystems. This concern has led to water-quality sampling in cooperation with the Alaska Department of Environmental Conservation and the Matanuska-Susitna Borough. A map showing the estimated altitude of the water table illustrates potential ground-water flow directions and areas where ground- and surface-water exchanges and interactions might occur. Water quality measured in selected wells and lakes indicates some differences between ground water and surface water. 'The temporal and spatial scarcity of ground-water-level and water-quality data limits the analysis of flow direction and water quality. Regionally, the water-table map indicates that ground water in the eastern and southern parts of the study area flows southerly. In the northcentral area, ground water flows predominately westerly then southerly. Although ground and surface water in most areas of the Matanuska-Susitna Valley are interconnected, they are chemically different. Analyses of the few water-quality samples collected in the area indicate that dissolved nitrite plus nitrate and orthophosphorus concentrations are higher in ground water than in surface water.'

Quality improvement in neonatal care - a new paradigm for developing countries.

PubMed

Chawla, Deepak; Suresh, Gautham K

2014-12-01

Infrastructure for facility-based neonatal care has rapidly grown in India over last few years. Experience from developed countries indicates that different health facilities have varying clinical outcomes despite accounting for differences in illness severity of admitted neonates and random variation. Variation in quality of care provided at different neonatal units may account for variable clinical outcomes. Monitoring quality of care, comparing outcomes across different centers and conducting collaborative quality improvement projects can improve outcome of neonates in health facilities. Top priority should be given to establishing quality monitoring and improvement procedures at special care neonatal units and neonatal intensive care units of the country. This article presents an overview of methods of quality improvement. Literature reports of successful collaborative quality improvement projects in neonatal health are also reviewed.

UK key performance indicators and quality assurance standards for colonoscopy.

PubMed

Rees, Colin J; Thomas Gibson, Siwan; Rutter, Matt D; Baragwanath, Phil; Pullan, Rupert; Feeney, Mark; Haslam, Neil

2016-12-01

Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for. 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/.

Development and implementation of an audit tool for quality control of parenteral nutrition.

PubMed

García-Rodicio, Sonsoles; Abajo, Celia; Godoy, Mercedes; Catalá, Miguel Angel

2009-01-01

The aim of this article is to describe the development of a quality control methodology applied to patients receiving parenteral nutrition (PN) and to present the results obtained over the past 10 years. Development of the audit tool: In 1995, a total of 13 PN quality criteria and their standards were defined based on literature and past experiences. They were applied during 5 different 6-month audits carried out in subsequent years. According to the results of each audit, the criteria with lower validity were eliminated, while others were optimized and new criteria were introduced to complete the monitoring of other areas not previously examined. Currently, the quality control process includes 22 quality criteria and their standards that examine the following 4 different areas: (1) indication and duration of PN; (2) nutrition assessment, adequacy of the nutrition support, and monitoring; (3) metabolic and infectious complications; and (4) global efficacy of the nutrition support regimen. The authors describe the current definition of each criterion and present the results obtained in the 5 audits performed. In the past year, 9 of the 22 criteria reached the predefined standards. The areas detected for further improvements were: indication for PN, nutrition assessment, and management of catheter infections. The definition of quality criteria and their standards is an efficient method of providing a qualitative and quantitative analysis of the clinical care of patients receiving PN. It detects areas for improvement and assists in developing a methodology to work efficiently.

Quality indicators for hip fracture patients: a scoping review protocol

PubMed Central

Pitzul, Kristen B; Munce, Sarah E P; Perrier, Laure; Beaupre, Lauren; Morin, Suzanne N; McGlasson, Rhona; Jaglal, Susan B

2014-01-01

Introduction Hip fractures are a significant cause of morbidity and mortality and care of hip fracture patients places a heavy burden on healthcare systems due to prolonged recovery time. Measuring quality of care delivered to hip fracture patients is important to help target efforts to improve care for patients and efficiency of the health system. The purpose of this study is to synthesise the evidence surrounding quality of care indicators for patients who have sustained a hip fracture. Using a scoping review methodology, the research question that will be addressed is: “What patient, institutional, and system-level indicators are currently in use or proposed for measuring quality of care across the continuum for individuals following a hip fracture?”. Methods and analysis We will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The synthesis will be limited to quality of care indicators for individuals who suffered low trauma hip fracture. All English peer-reviewed studies published from the year 2000-most recent will be included. Literature search strategies will be developed using medical subject headings and text words related to hip fracture quality indicators and the search will be peer-reviewed. Numerous electronic databases will be searched. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. Abstracted data will include study characteristics and indicator definitions. Dissemination To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required. The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Knowledge translation activities will occur throughout the review with dissemination of the project goals and findings to local, national, and international stakeholders. PMID:25335964

Quality indicators for hip fracture patients: a scoping review protocol.

PubMed

Pitzul, Kristen B; Munce, Sarah E P; Perrier, Laure; Beaupre, Lauren; Morin, Suzanne N; McGlasson, Rhona; Jaglal, Susan B

2014-10-21

Hip fractures are a significant cause of morbidity and mortality and care of hip fracture patients places a heavy burden on healthcare systems due to prolonged recovery time. Measuring quality of care delivered to hip fracture patients is important to help target efforts to improve care for patients and efficiency of the health system. The purpose of this study is to synthesise the evidence surrounding quality of care indicators for patients who have sustained a hip fracture. Using a scoping review methodology, the research question that will be addressed is: "What patient, institutional, and system-level indicators are currently in use or proposed for measuring quality of care across the continuum for individuals following a hip fracture?". We will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The synthesis will be limited to quality of care indicators for individuals who suffered low trauma hip fracture. All English peer-reviewed studies published from the year 2000-most recent will be included. Literature search strategies will be developed using medical subject headings and text words related to hip fracture quality indicators and the search will be peer-reviewed. Numerous electronic databases will be searched. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. Abstracted data will include study characteristics and indicator definitions. To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required. The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Knowledge translation activities will occur throughout the review with dissemination of the project goals and findings to local, national, and international stakeholders. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Testing the Value of Information of Climate Change Indicators that use Earth Observations

NASA Astrophysics Data System (ADS)

Kenney, M. A.

2012-12-01

Indicators are usually thought of as measurements or calculations that represent important features of the status, trend, or performance of a system of interest (e.g. the economy, agriculture, air quality). They are often used for the most practical of reasons - one cannot measure everything important about systems of interest, so there is a practical need to identify major features that can be reported periodically and used to guide both research and decisions (National Research Council (NRC). 2000. Ecological Indicators for the Nation. National Academy Press. Washington, DC). The use of indicators to track the status and trends of many features of environmental or economic performance, quality of life, and a host of other social concerns is embedded in the fabric of our everyday lives. Businesses, governments, and consumers regularly use the common economic indices - e.g. the unemployment index or consumer price index - as guides for decision-making on investments and hiring. There is an analogous demand for indicators of environmental conditions and performance - everything from agricultural yields to air and water quality to weather and climate - that are currently less publicly visible than the common economic indicators, but that can have critically important uses in such areas as natural resource management, improvement of environmental quality, emergency planning, and infrastructure development. A number of these environmental indicators, be it physical or ecological, use a range of data sources including earth observations. Despite the extensive development and use of indicators, there is little testing of these indicators to assure that they indeed provide the assumed positive information benefit. This is particularly concerning because if these indicators are systematically misunderstood by the intended audience or a sub-group of that audience, such individuals could make decisions that are consistent with their incorrect understanding of the indicator. Such a result would mean that the indicator has a negative value of information. Granted the value of information depends on the intended audience(s), with some groups being able to understand and want more technically sophisticated and detailed information presented as an indicator. However, if the goal of an indicator is to provide information to a wide range of groups, it is essential to assure that these groups have a correct understanding of the indicator, its assumptions, and the ability to use the indicator (as presented or modified) for decision-making contexts. In this talk, I will present the preliminary results of a study that is testing the value of information of a range of climate change indicators, and I will focus on indicators that use earth observations. Such results contribute to a richer understanding of the value of information of indicators, and can shape the development of both individual indicators and systems of indicators, such as the development of the indicator system for the U.S. Global Change Research Program, National Climate Assessment.

Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?

PubMed

Sidorenkov, Grigory; Voorham, Jaco; de Zeeuw, Dick; Haaijer-Ruskamp, Flora M; Denig, Petra

2013-01-01

Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes. A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT) database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure- and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR) with 95% confidence intervals. Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94). Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93). Treatment intensification with glucose-lowering but not with lipid-, blood pressure- and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89). Treatment quality indicators measuring lipid- and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient outcomes. These results question whether all treatment indicators are valid measures to judge quality of health care and its economics.

Application of soil quality indices to assess the status of agricultural soils irrigated with treated wastewaters

NASA Astrophysics Data System (ADS)

Morugán-Coronado, A.; Arcenegui, V.; García-Orenes, F.; Mataix-Solera, J.; Mataix-Beneyto, J.

2012-12-01

The supply of water is limited in some parts of the Mediterranean region, such as southeastern Spain. The use of treated wastewater for the irrigation of agricultural soils is an alternative to using better-quality water, especially in semi-arid regions. On the other hand, this practice can modify some soil properties, change their relationships, the equilibrium reached and influence soil quality. In this work two soil quality indices were used to evaluate the effects of irrigation with treated wastewater in soils. The indices were developed studying different soil properties in undisturbed soils in SE Spain, and the relationships between soil parameters were established using multiple linear regressions. This study was carried out in three areas of Alicante Province (SE Spain) irrigated with wastewater, including four study sites. The results showed slight changes in some soil properties as a consequence of irrigation with wastewater, the obtained levels not being dangerous for agricultural soils, and in some cases they could be considered as positive from an agronomical point of view. In one of the study sites, and as a consequence of the low quality wastewater used, a relevant increase in soil organic matter content was observed, as well as modifications in most of the soil properties. The application of soil quality indices indicated that all the soils of study sites are in a state of disequilibrium regarding the relationships between properties independent of the type of water used. However, there were no relevant differences in the soil quality indices between soils irrigated with wastewater with respect to their control sites for all except one of the sites, which corresponds to the site where low quality wastewater was used.

Selecting indicators for patient safety at the health system level in OECD countries.

PubMed

McLoughlin, Vivienne; Millar, John; Mattke, Soeren; Franca, Margarida; Jonsson, Pia Maria; Somekh, David; Bates, David

2006-09-01

Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

Quality of anaesthesia for Caesarean sections: a cross-sectional study of a university hospital in a low-income country.

PubMed

Eriksson, Jesper; Baker, Tim; Jörnvall, Henrik; Irestedt, Lars; Mulungu, Moses; Larsson, Emma

2015-10-01

To evaluate the quality of anaesthesia for Caesarean sections at Muhimbili National Hospital, Dar es Salaam, Tanzania. We developed an instrument consisting of 40 quality indicators using an expert group process based on the existing literature. Using the instrument, we observed 50 Caesarean sections. Twenty-eight of the indicators were structural indicators, such as essential drugs, oxygen supply and anaesthetic equipment. Twelve were process indicators such as evaluation of airway, blood pressure assessment or insertion of an intravenous line. The median patient age was 28.5 years. A total of 75% (range 61-82%) of the structural indicators were present in the operating theatres, and 55% (range 33-83%) of the process indicators were performed. The neonates' median Apgar score was 9 (range 3-10). Seven babies required ventilation, four babies were stillborn, and all others were alive at follow-up 2 days after partus. All mothers were alive 2 days post-surgery. The low process score suggests that quality improvement initiatives should focus on the processes of anaesthesia for Caesarean sections rather than new drugs and equipment. © 2015 John Wiley & Sons Ltd.

Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

PubMed

Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

2017-12-01

Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in-person facilitated discussions with experts. The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC. The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms. © 2017 Milbank Memorial Fund.

Prioritizing Information for Quality Improvement Using Resident Assessment Instrument Data: Experiences in One Canadian Province

PubMed Central

Sales, Anne; O'Rourke, Hannah M.; Draper, Kellie; Teare, Gary F.; Maxwell, Colleen

2011-01-01

Purpose: To elicit priority rankings of indicators of quality of care among providers and decision-makers in continuing care in Alberta, Canada. Methods: We used modified nominal group technique to elicit priorities and criteria for prioritization among the quality indicators and resident/client assessment protocols developed by the interRAI consortium for use in long-term care and home care. Results: The top-ranked items from the long-term care assessment data were pressure ulcers, pain and incontinence. The top-ranked items from the home care data were pain, falls and proportion of clients at high risk for residential placement. Participants considered a variety of issues in deciding how to rank the indicators. Implications: This work reflects the beginning of a process to better understand how providers and policy makers can work together to assess priorities for quality improvement within continuing care. PMID:22294992

[Advances in the use of instrumental measurement of colour in the development, production and quality control of drugs, medicinal preparations and pharmaceutical auxiliary substances I ].

PubMed

Subert, Jan; Cižmárik, Jozef

2013-04-01

Colour is one of the important indices of the quality of drugs, medicinal preparations and pharmaceutical auxiliary substances. The paper summarizes the development and use of instrumental measurement of colour in pharmacy in recent ten years focusing on the drugs of synthetic origin and pharmaceutical auxiliary substances including their control.

The Professional Development Plan of a Health Care Workforce as a Qualitative Indicator of the Health Care System's Well-Being

ERIC Educational Resources Information Center

Saiti, Anna; Mylona, Vasiliki

2015-01-01

The quality of a health care system is heavily dependent on a capable and skillful health care workforce so as to guarantee the delivery of quality health care services to its user groups. Hence, only through continuous training and development can the health care workforce follow rapid scientific progress while equitably balancing investment…

Development of innovative computer software to facilitate the setup and computation of water quality index.

PubMed

Nabizadeh, Ramin; Valadi Amin, Maryam; Alimohammadi, Mahmood; Naddafi, Kazem; Mahvi, Amir Hossein; Yousefzadeh, Samira

2013-04-26

Developing a water quality index which is used to convert the water quality dataset into a single number is the most important task of most water quality monitoring programmes. As the water quality index setup is based on different local obstacles, it is not feasible to introduce a definite water quality index to reveal the water quality level. In this study, an innovative software application, the Iranian Water Quality Index Software (IWQIS), is presented in order to facilitate calculation of a water quality index based on dynamic weight factors, which will help users to compute the water quality index in cases where some parameters are missing from the datasets. A dataset containing 735 water samples of drinking water quality in different parts of the country was used to show the performance of this software using different criteria parameters. The software proved to be an efficient tool to facilitate the setup of water quality indices based on flexible use of variables and water quality databases.

Quality Indicators in Laboratory Medicine: from theory to practice. Preliminary data from the IFCC Working Group Project "Laboratory Errors and Patient Safety".

PubMed

Sciacovelli, Laura; O'Kane, Maurice; Skaik, Younis Abdelwahab; Caciagli, Patrizio; Pellegrini, Cristina; Da Rin, Giorgio; Ivanov, Agnes; Ghys, Timothy; Plebani, Mario

2011-05-01

The adoption of Quality Indicators (QIs) has prompted the development of tools to measure and evaluate the quality and effectiveness of laboratory testing, first in the hospital setting and subsequently in ambulatory and other care settings. While Laboratory Medicine has an important role in the delivery of high-quality care, no consensus exists as yet on the use of QIs focussing on all steps of the laboratory total testing process (TTP), and further research in this area is required. In order to reduce errors in laboratory testing, the IFCC Working Group on "Laboratory Errors and Patient Safety" (WG-LEPS) developed a series of Quality Indicators, specifically designed for clinical laboratories. In the first phase of the project, specific QIs for key processes of the TTP were identified, including all the pre-, intra- and post-analytic steps. The overall aim of the project is to create a common reporting system for clinical laboratories based on standardized data collection, and to define state-of-the-art and Quality Specifications (QSs) for each QI independent of: a) the size of organization and type of activities; b) the complexity of processes undertaken; and c) different degree of knowledge and ability of the staff. The aim of the present paper is to report the results collected from participating laboratories from February 2008 to December 2009 and to identify preliminary QSs. The results demonstrate that a Model of Quality Indicators managed as an External Quality Assurance Program can serve as a tool to monitor and control the pre-, intra- and post-analytical activities. It might also allow clinical laboratories to identify risks that lead to errors resulting in patient harm: identification and design of practices that eliminate medical errors; the sharing of information and education of clinical and laboratory teams on practices that reduce or prevent errors; the monitoring and evaluation of improvement activities.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study

PubMed Central

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K.; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Background: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. Methods: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Results: Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Interpretation: Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments. PMID:27730103

Top management leadership style and quality of care in nursing homes.

PubMed

Castle, Nicholas G; Decker, Frederic H

2011-10-01

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

The Impacts of Spatiotemporal Landscape Changes on Water Quality in Shenzhen, China

PubMed Central

Liu, Zhenhuan; Yang, Haiyan

2018-01-01

The urban landscape in China has changed rapidly over the past four decades, which has led to various environmental consequences, such as water quality degradation at the regional scale. To improve water restoration strategies and policies, this study assessed the relationship between water quality and landscape change in Shenzhen, China, using panel regression analysis. The results show that decreases in natural and semi-natural landscape compositions have had significant negative effects on water quality. Landscape composition and configuration changes accounted for 39–58% of the variation in regional water quality degradation. Additionally, landscape fragmentation indices, such as patch density (PD) and the number of patches (NP), are important indicators of the drivers of water quality degradation. PD accounted for 2.03–5.44% of the variability in water quality, while NP accounted for −1.63% to −4.98% of the variability. These results indicate that reducing landscape fragmentation and enhancing natural landscape composition at the watershed scale are vital to improving regional water quality. The study findings suggest that urban landscape optimization is a promising strategy for mitigating urban water quality degradation, and the results can be used in policy making for the sustainable development of the hydrological environment in rapidly urbanizing areas. PMID:29786672

The Impacts of Spatiotemporal Landscape Changes on Water Quality in Shenzhen, China.

PubMed

Liu, Zhenhuan; Yang, Haiyan

2018-05-22

The urban landscape in China has changed rapidly over the past four decades, which has led to various environmental consequences, such as water quality degradation at the regional scale. To improve water restoration strategies and policies, this study assessed the relationship between water quality and landscape change in Shenzhen, China, using panel regression analysis. The results show that decreases in natural and semi-natural landscape compositions have had significant negative effects on water quality. Landscape composition and configuration changes accounted for 39⁻58% of the variation in regional water quality degradation. Additionally, landscape fragmentation indices, such as patch density (PD) and the number of patches (NP), are important indicators of the drivers of water quality degradation. PD accounted for 2.03⁻5.44% of the variability in water quality, while NP accounted for -1.63% to -4.98% of the variability. These results indicate that reducing landscape fragmentation and enhancing natural landscape composition at the watershed scale are vital to improving regional water quality. The study findings suggest that urban landscape optimization is a promising strategy for mitigating urban water quality degradation, and the results can be used in policy making for the sustainable development of the hydrological environment in rapidly urbanizing areas.

Air quality in California forests: current efforts to initiate biomonitoring with lichens.

Treesearch

Sarah Jovan

2002-01-01

The primary objective of the Forest Health Monitoring indicator project is to develop models that use the composition of epiphytic lichen communities to detect and monitor air quality in forests. The designs of existing air quality monitoring networks in California do not provide adequate representation of rural areas to assess impacts to forests. This article is...

Improving the Quality of School Facilities through Building Performance Assessment: Educational Reform and School Building Quality in Sao Paulo, Brazil

ERIC Educational Resources Information Center

Ornstein, Sheila Walbe; Moreira, Nanci Saraiva; Ono, Rosaria; Limongi Franca, Ana J. G.; Nogueira, Roselene A. M. F.

2009-01-01

Purpose: The paper describes the purpose of and strategies for conducting post-occupancy evaluations (POEs) as a method for assessing school building performance. Set within the larger context of global efforts to develop and apply common indicators of school building quality, the authors describe research conducted within the newest generation of…

Effects of land use on surface-water quality in the East Everglades, Dade County, Florida

USGS Publications Warehouse

Waller, Bradley G.

1982-01-01

Water-quality characteristics were determined at five developed areas in the East Everglades, Dade County, Florida, during the 1978 wet season (June through October). These areas are designated as: Coopertown; Chekika Hammock State Park; residential area; rock-plowed tomato field; and Cracker Jack Slough agricultural area. Data from the developed areas were compared with data from four baseline sites in undeveloped areas to determine the effects of land use on the surface-water quality. The rock-plowed tomato field was the only area where surface-water quality was affected. Water quality at this field is affected by agricultural activities and chemical applications as indicated by increased concentrations of orthophosphate, organic nitrogen, organic carbon, copper, manganese, mercury, and potassium. The remaining four areas of land use had water-quality characteristics typical of baseline sites in nearby Northeast Shark River Slough or Taylor Slough. Chemical analyses of soil indicated chlorinated-hydrocarbon insecticide residues at Coopertown and the two agricultural areas, Cracker Jack Slough and the rock-plowed tomato field. Trace elements in concentrations greater than base level occurred at both agricultural areas (manganese), Chekika Hammock State Park (manganese), and at Coopertown (lead and zinc). (USGS)

How do stakeholder groups vary in a Delphi technique about primary mental health care and what factors influence their ratings?

PubMed

Campbell, S M; Shield, T; Rogers, A; Gask, L

2004-12-01

While mental health is a core part of primary care, there are few validated quality measures and little relevant internationally published research. Consensus panel methods are a useful means of developing quality measures where evidence is sparse and/or opinions are diverse. However, little is known about the dynamics of consensus techniques and the factors that influence the judgements and ratings of panels and individual panelists. (1) To describe differences in panel ratings on the quality of primary mental health care services by patient, carer, professional and managerial panels within a Delphi procedure; and (2) to explore why different panels and panelists rate quality indicators of primary mental health care differently. Two round postal Delphi technique and exploratory semi-structured interviews. 115 panelists across 11 panels. Eleven panelists were subsequently interviewed. 87 of 334 indicators (26%) were rated face valid by all 11 panels. There was little disagreement within panel ratings but significant differences between panels. The GP panel rated the least number of indicators valid (n = 138, 41%) and carers the most (n = 304, 91%). The way in which panelists interpreted and conceptualised the indicators and their definition of quality of mental health care affected the way in which participants made their ratings. Stakeholders in primary mental health care have diverse views of quality of care and these differences translate into how they rate quality indicators. Exploratory interviews suggest that ratings are influenced by past experience, expectations, definitions of quality of care, and perceived power relationships between stakeholders.

[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.

Development of a Standard Set of Software Indicators for Aeronautical Systems Center.

DTIC Science & Technology

1992-09-01

29:12). The composite models listed include COCOMO and the Software Productivity, Quality, and Reliability Model ( SPQR ) (29:12). The SPQR model was...determine the values of the 68 input parameters. Source provides no specifics. Indicator Name SPQR (SW Productivity, Qual, Reliability) Indicator Class

Development and validation of hospital information system-generated indicators of the appropriateness of oral anticoagulant prescriptions in hospitalised adults: the PACHA study protocol.

PubMed

Petit-Monéger, Aurélie; Thiessard, Frantz; Jouhet, Vianney; Noize, Pernelle; Berdaï, Driss; Kret, Marion; Sitta, Rémi; Salmi, Louis-Rachid; Saillour-Glénisson, Florence

2017-08-31

The appropriateness of oral anticoagulant prescriptions is a major challenge to improve quality and safety of care. As indicators of the appropriateness of oral anticoagulant prescriptions are lacking, the aim of the study is to develop and validate a panel of such indicators, in hospitalised adults, from the hospital information system of two university hospitals in France. The study will be carried out in four steps: (1) a literature review to identify indicators of the appropriateness of oral anticoagulant prescriptions and their conditions of appropriateness; (2) a Delphi consensus method to assess the potential utility and operational implementation of the selected indicators; (3) techniques of medical data search to implement indicators from the hospital information system and; (4) a cross-sectional study to assess the ability of indicators to detect inappropriate oral anticoagulant prescriptions, performance of medical data search techniques for tracking or retrieving information and the ability of tools to be transferred into other institutions. The fourth step will include up to 80 patient hospital stays for each indicator, depending on the prevalence of inappropriate prescriptions estimated in interim analyses. This work addresses the current lack of quality indicators of the appropriateness of oral anticoagulant prescriptions. We aim to develop and validate such indicators for integrating them into hospital clinical practice, as part of a structured approach to improve quality and safety of care. As each hospital information system is different, we will propose tools transferable to other healthcare institutions to allow an automated construction of these indicators. The PACHA study protocol was approved by institutional review boards and ethics committees (CPP Sud-Ouest et Outre Mer III-DC 2016/119; CPP Ile-de-France II-CDW_2016_0014). Clinical Trial.gov registration: NCT02898090. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development and validation of hospital information system-generated indicators of the appropriateness of oral anticoagulant prescriptions in hospitalised adults: the PACHA study protocol

PubMed Central

Petit-Monéger, Aurélie; Thiessard, Frantz; Jouhet, Vianney; Noize, Pernelle; Berdaï, Driss; Kret, Marion; Sitta, Rémi; Salmi, Louis-Rachid; Saillour-Glénisson, Florence

2017-01-01

Introduction The appropriateness of oral anticoagulant prescriptions is a major challenge to improve quality and safety of care. As indicators of the appropriateness of oral anticoagulant prescriptions are lacking, the aim of the study is to develop and validate a panel of such indicators, in hospitalised adults, from the hospital information system of two university hospitals in France. Methods and analysis The study will be carried out in four steps: (1) a literature review to identify indicators of the appropriateness of oral anticoagulant prescriptions and their conditions of appropriateness; (2) a Delphi consensus method to assess the potential utility and operational implementation of the selected indicators; (3) techniques of medical data search to implement indicators from the hospital information system and; (4) a cross-sectional study to assess the ability of indicators to detect inappropriate oral anticoagulant prescriptions, performance of medical data search techniques for tracking or retrieving information and the ability of tools to be transferred into other institutions. The fourth step will include up to 80 patient hospital stays for each indicator, depending on the prevalence of inappropriate prescriptions estimated in interim analyses. Ethics and dissemination This work addresses the current lack of quality indicators of the appropriateness of oral anticoagulant prescriptions. We aim to develop and validate such indicators for integrating them into hospital clinical practice, as part of a structured approach to improve quality and safety of care. As each hospital information system is different, we will propose tools transferable to other healthcare institutions to allow an automated construction of these indicators. The PACHA study protocol was approved by institutional review boards and ethics committees (CPP Sud-Ouest et Outre Mer III—DC 2016/119; CPP Ile-de-France II—CDW_2016_0014). Registration details Clinical Trial.gov registration: NCT02898090. PMID:28860229

Applying a Continuous Quality Improvement Model To Assess Institutional Effectiveness.

ERIC Educational Resources Information Center

Roberts, Keith

This handbook outlines techniques and processes for improving institutional effectiveness and ensuring continuous quality improvement, based on strategic planning activities at Wisconsin's Milwaukee Area Technical College (MATC). First, institutional effectiveness is defined and 17 core indicators of effectiveness developed by the Wisconsin…

A cross-national study to objectively evaluate the quality of diverse simulation approaches for undergraduate nursing students.

PubMed

Kable, Ashley K; Levett-Jones, Tracy L; Arthur, Carol; Reid-Searl, Kerry; Humphreys, Melanie; Morris, Sara; Walsh, Pauline; Witton, Nicola J

2018-01-01

The aim of this paper is to report the results of a cross-national study that evaluated a range of simulation sessions using an observation schedule developed from evidence-based quality indicators. Observational data were collected from 17 simulation sessions conducted for undergraduate nursing students at three universities in Australia and the United Kingdom. The observation schedule contained 27 questions that rated simulation quality. Data were collected by direct observation and from video recordings of the simulation sessions. Results indicated that the highest quality scores were for provision of learning objectives prior to the simulation session (90%) and debriefing (72%). Student preparatiosn and orientation (67%) and perceived realism and fidelity (67%) were scored lower than other components of the simulation sessions. This observational study proved to be an effective strategy to identify areas of strength and those needing further development to improve simulation sessions. Copyright © 2017 Elsevier Ltd. All rights reserved.

A new plan quality index for nasopharyngeal cancer SIB IMRT.

PubMed

Jin, X; Yi, J; Zhou, Y; Yan, H; Han, C; Xie, C

2014-02-01

A new plan quality index integrating dosimetric and radiobiological indices was proposed to facilitate the evaluation and comparison of simultaneous integrated boost (SIB) intensity modulated radiotherapy (IMRT) plans for nasopharyngeal cancer (NPC) patients. Ten NPC patients treated by SIB-IMRT were enrolled in the study. Custom software was developed to read dose-volume histogram (DVH) curves from the treatment planning system (TPS). A plan filtering matrix was introduced to filter plans that fail to satisfy treatment protocol. Target plan quality indices and organ at risk (OAR) plan quality indices were calculated for qualified plans. A unique composite plan quality index (CPQI) was proposed based on the relative weight of these indices to evaluate and compare competing plans. Plan ranking results were compared with detailed statistical analysis, radiation oncology quality system (ROQS) scoring results and physician's evaluation results to verify the accuracy of this new plan quality index. The average CPQI values for plans with OAR priority of low, normal, high, and PTV only were 0.22 ± 0.08, 0.49 ± 0.077, 0.71 ± 0.062, and -0.21 ± 0.16, respectively. There were significant differences among these plan quality indices (One-way ANOVA test, p < 0.01). This was consistent with statistical analysis, ROQS results and physician's ranking results in which 90% OAR high plans were selected. Plan filtering matrix was able to speed up the plan evaluation process. The new matrix plan quality index CPQI showed good consistence with physician ranking results. It is a promising index for NPC SIB-IMRT plan evaluation. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

The last 50years have seen substantial changes in the landscape of laboratory medicine: its role in modern medicine is in evolution and the quality of laboratory services is changing. The need to control and improve quality in clinical laboratories has grown hand in hand with the growth in technological developments leading to an impressive reduction of analytical errors over time. An essential cause of this impressive improvement has been the introduction and monitoring of quality indicators (QIs) such as the analytical performance specifications (in particular bias and imprecision) based on well-established goals. The evolving landscape of quality and errors in clinical laboratories moved first from analytical errors to all errors performed within the laboratory walls, subsequently to errors in laboratory medicine (including errors in test requesting and result interpretation), and finally, to a focus on errors more frequently associated with adverse events (laboratory-associated errors). After decades in which clinical laboratories have focused on monitoring and improving internal indicators of analytical quality, efficiency and productivity, it is time to shift toward indicators of total quality, clinical effectiveness and patient outcomes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Systematic review of studies of staffing and quality in nursing homes.

PubMed

Bostick, Jane E; Rantz, Marilyn J; Flesner, Marcia K; Riggs, C Jo

2006-07-01

To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.

Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

PubMed

Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

2017-02-01

Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

Towards the Application of Fuzzy Logic for Developing a Novel Indoor Air Quality Index (FIAQI).

PubMed

Javid, Allahbakhsh; Hamedian, Amir Abbas; Gharibi, Hamed; Sowlat, Mohammad Hossein

2016-02-01

In the past few decades, Indoor Air Pollution (IAP) has become a primary concern to the point. It is increasingly believed to be of equal or greater importance to human health compared to ambient air. However, due to the lack of comprehensive indices for the integrated assessment of indoor air quality (IAQ), we aimed to develop a novel, Fuzzy-Based Indoor Air Quality Index (FIAQI) to bridge the existing gap in this area. We based our index on fuzzy logic, which enables us to overcome the limitations of traditional methods applied to develop environmental quality indices. Fifteen parameters, including the criteria air pollutants, volatile organic compounds, and bioaerosols were included in the FIAQI due mainly to their significant health effects. Weighting factors were assigned to the parameters based on the medical evidence available in the literature on their health effects. The final FIAQI consisted of 108 rules. In order to demonstrate the performance of the index, data were intentionally generated to cover a variety of quality levels. In addition, a sensitivity analysis was conducted to assess the validity of the index. The FIAQI tends to be a comprehensive tool to classify IAQ and produce accurate results. It seems useful and reliable to be considered by authorities to assess IAQ environments.

Towards the Application of Fuzzy Logic for Developing a Novel Indoor Air Quality Index (FIAQI)

PubMed Central

JAVID, Allahbakhsh; HAMEDIAN, Amir Abbas; GHARIBI, Hamed; SOWLAT, Mohammad Hossein

2016-01-01

Background: In the past few decades, Indoor Air Pollution (IAP) has become a primary concern to the point. It is increasingly believed to be of equal or greater importance to human health compared to ambient air. However, due to the lack of comprehensive indices for the integrated assessment of indoor air quality (IAQ), we aimed to develop a novel, Fuzzy-Based Indoor Air Quality Index (FIAQI) to bridge the existing gap in this area. Methods: We based our index on fuzzy logic, which enables us to overcome the limitations of traditional methods applied to develop environmental quality indices. Fifteen parameters, including the criteria air pollutants, volatile organic compounds, and bioaerosols were included in the FIAQI due mainly to their significant health effects. Weighting factors were assigned to the parameters based on the medical evidence available in the literature on their health effects. The final FIAQI consisted of 108 rules. In order to demonstrate the performance of the index, data were intentionally generated to cover a variety of quality levels. In addition, a sensitivity analysis was conducted to assess the validity of the index. Results: The FIAQI tends to be a comprehensive tool to classify IAQ and produce accurate results. Conclusion: It seems useful and reliable to be considered by authorities to assess IAQ environments. PMID:27114985

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.

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

Efroymson, Rebecca Ann; Dale, Virginia H; Kline, Keith L

Indicators of the environmental sustainability of biofuel production, distribution, and use should be selected, measured, and interpreted with respect to the context in which they are used. These indicators include measures of soil quality, water quality and quantity, greenhouse-gas emissions, biodiversity, air quality, and vegetation productivity. Contextual considerations include the purpose for the sustainability analysis, the particular biofuel production and distribution system (including supply chain, management aspects, and system viability), policy conditions, stakeholder values, location, temporal influences, spatial scale, baselines, and reference scenarios. Recommendations presented in this paper include formulating the problem for particular analyses, selecting appropriate context-specific indicators ofmore » environmental sustainability, and developing indicators that can reflect multiple environmental properties at low cost within a defined context. In addition, contextual considerations such as technical objectives, varying values and perspectives of stakeholder groups, and availability and reliability of data need to be understood and considered. Sustainability indicators for biofuels are most useful if adequate historical data are available, information can be collected at appropriate spatial and temporal scales, organizations are committed to use indicator information in the decision-making process, and indicators can effectively guide behavior toward more sustainable practices.« less

Quality indicators and specifications for strategic and support processes in laboratory medicine.

PubMed

Ricós, Carmen; Biosca, Carme; Ibarz, Mercè; Minchinela, Joana; Llopis, Maantonia; Perich, Carmen; Alsina, Jesus; Alvarez, Virtudes; Doménech, Vicenta; Pastor, Rosa Ma; Sansalvador, Mireia; Isern, Gloria Trujillo; Navarro, Conrad Vilanova

2008-01-01

This work is the second part of a study regarding indicators and quality specifications for the non-analytical processes in laboratory medicine. Five primary care and five hospital laboratories agreed on the indicators for two strategic processes (quality planning and project development) and various support processes (client relationships, instrument and infrastructure maintenance, safety and risk prevention, purchases and storage, personnel training). In the majority of cases, the median values recorded over 1 year is considered to be the state-of-the-art in our setting and proposed as the quality specification for the indicators stated. Values have been stratified according to primary care and hospital laboratory for referred tests and group of personnel for training. In some cases, the specifications have been set equal to zero events, such as serious incidents in the infrastructure maintenance process and number of work accidents in the safety and risk prevention process. In light of this study, an effort is needed to optimize decisions regarding corrective actions and to move from a subjective individual criterion to systematic and comparative management. This preliminary study provides a comprehensive vision of a subject that could motivate further research and advances in the quality of laboratory services.

Rocky-shore communities as indicators of water quality: a case study in the Northwestern Mediterranean.

PubMed

Pinedo, Susana; García, María; Satta, Maria Paola; de Torres, Mariona; Ballesteros, Enric

2007-01-01

The collection of 152 samples from the upper sublittoral zone along the rocky coasts of Catalonia (Northwestern Mediterranean) was carried out in 1999 in order to test the suitability of littoral communities to be used as indicators of water quality in the frame of the European Water Framework Directive. Detrended correspondence analysis were performed to distinguish between different communities and to relate communities composition to water quality. Samples collected in reference sites were included in the analysis. Mediterranean rocky shore communities situated in the upper sublittoral zone can be used as indicators of the water quality: there is a gradient from high to bad status that comprises from dense Cystoseira mediterranea forests to green algae dominated communities. The geographical patterns in the distribution of these communities show that the best areas are situated in the Northern coast, where tourism is the main economic resource of the area, and the worst area is situated close to the metropolitan zone of Barcelona with high population and industrial development. Thus, Mediterranean sublittoral rocky shore communities are useful indicators of water quality and multivariate analysis are a suitable statistical tool for the assessment of the ecological status.

Logistic and linear regression model documentation for statistical relations between continuous real-time and discrete water-quality constituents in the Kansas River, Kansas, July 2012 through June 2015

USGS Publications Warehouse

Foster, Guy M.; Graham, Jennifer L.

2016-04-06

The Kansas River is a primary source of drinking water for about 800,000 people in northeastern Kansas. Source-water supplies are treated by a combination of chemical and physical processes to remove contaminants before distribution. Advanced notification of changing water-quality conditions and cyanobacteria and associated toxin and taste-and-odor compounds provides drinking-water treatment facilities time to develop and implement adequate treatment strategies. The U.S. Geological Survey (USGS), in cooperation with the Kansas Water Office (funded in part through the Kansas State Water Plan Fund), and the City of Lawrence, the City of Topeka, the City of Olathe, and Johnson County Water One, began a study in July 2012 to develop statistical models at two Kansas River sites located upstream from drinking-water intakes. Continuous water-quality monitors have been operated and discrete-water quality samples have been collected on the Kansas River at Wamego (USGS site number 06887500) and De Soto (USGS site number 06892350) since July 2012. Continuous and discrete water-quality data collected during July 2012 through June 2015 were used to develop statistical models for constituents of interest at the Wamego and De Soto sites. Logistic models to continuously estimate the probability of occurrence above selected thresholds were developed for cyanobacteria, microcystin, and geosmin. Linear regression models to continuously estimate constituent concentrations were developed for major ions, dissolved solids, alkalinity, nutrients (nitrogen and phosphorus species), suspended sediment, indicator bacteria (Escherichia coli, fecal coliform, and enterococci), and actinomycetes bacteria. These models will be used to provide real-time estimates of the probability that cyanobacteria and associated compounds exceed thresholds and of the concentrations of other water-quality constituents in the Kansas River. The models documented in this report are useful for characterizing changes in water-quality conditions through time, characterizing potentially harmful cyanobacterial events, and indicating changes in water-quality conditions that may affect drinking-water treatment processes.

Linking quality indicators to clinical trials: an automated approach

PubMed Central

Coiera, Enrico; Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B.

2017-01-01

Abstract Objective Quality improvement of health care requires robust measurable indicators to track performance. However identifying which indicators are supported by strong clinical evidence, typically from clinical trials, is often laborious. This study tests a novel method for automatically linking indicators to clinical trial registrations. Design A set of 522 quality of care indicators for 22 common conditions drawn from the CareTrack study were automatically mapped to outcome measures reported in 13 971 trials from ClinicalTrials.gov. Intervention Text mining methods extracted phrases mentioning indicators and outcome phrases, and these were compared using the Levenshtein edit distance ratio to measure similarity. Main Outcome Measure Number of care indicators that mapped to outcome measures in clinical trials. Results While only 13% of the 522 CareTrack indicators were thought to have Level I or II evidence behind them, 353 (68%) could be directly linked to randomized controlled trials. Within these 522, 50 of 70 (71%) Level I and II evidence-based indicators, and 268 of 370 (72%) Level V (consensus-based) indicators could be linked to evidence. Of the indicators known to have evidence behind them, only 5.7% (4 of 70) were mentioned in the trial reports but were missed by our method. Conclusions We automatically linked indicators to clinical trial registrations with high precision. Whilst the majority of quality indicators studied could be directly linked to research evidence, a small portion could not and these require closer scrutiny. It is feasible to support the process of indicator development using automated methods to identify research evidence. PMID:28651340

USING COMPUTER MODELS TO DETERMINE THE EFFECT OF STORAGE ON WATER QUALITY

EPA Science Inventory

Studies have indicated that water quality is degraded as a result of long residence times in storage tanks, highlighting the importance of tank design, location, and operation. Computer models, developed to explain some of the mixing and distrribution issues associated with tank...

Quality of Life: An Exploratory Study.

ERIC Educational Resources Information Center

Lankhorst, Gustaaf J.

1989-01-01

A 12-item list of human abilities/activities was developed to measure quality of life of 9 rheumatoid arthritis adults from 2 aspects: "present condition" and "relative importance" of each item. Pilot testing indicated that importance and present condition represent different aspects. Differences between self-assessments and physicians'…

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…

Measuring quality in maternal-newborn care: developing a clinical dashboard.

PubMed

Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

2013-01-01

Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.

An Indicator Approach to Assessing Benefits of Carbon Sequestration and Other Ecosystem Services

NASA Astrophysics Data System (ADS)

Dale, V. H.; Kline, K. L.; Parish, E. S.

2017-12-01

While geoengineering offers one approach to carbon management, another tactic is providing land owners and managers with incentives to more efficiently and consistently increase carbon stocks and storage in soils and above ground. Growing bioenergy crops entails such an option. Landscape design can help identify where different strategies best fit into the larger framework of resource management to achieve desired stakeholder objectives. Our research goal is to develop means to assess management options and identify those that offer the highest degree of sustainability as measured by the provision to society of specific economic, environmental and social services with the least costs. Oak Ridge National Laboratory (ORNL) has worked with the US Department of Energy to develop an approach for assessing progress toward better management to improve sustainability. This approach involves six steps with decisions made at each step. First the scope of the assessment is established based on the particular context and options. Next indicators that pertain to the objective are selected and prioritized. Then, baselines and targets are determined for each indicator. Fourth, indicator values are measured, collected, and evaluated. Once the values are in hand, trends and tradeoffs in the indicator set are analyzed. The final step seeks to define and deploy good practices for the activity. ORNL's proposed checklist of environmental and socioeconomic indicators includes greenhouse gases and soil quality (including carbon) and emphasizes that changes in carbon stocks must be viewed in terms of their effects on other indicators, such as those for water quality and quantity, biodiversity, air quality, and productivity as well as on socioeconomic costs and benefits. The framework developed to select and evaluate indicators and assess progress toward sustainability goals is being encapsulated into a visualization tool. Visualization will inform stakeholders about potential effects of decisions, allowing them to make choices that can have better outcomes than might have occurred otherwise. The concept of continual improvement forms the core of developing more sustainable development pathways, including those that will lead to carbon-negative systems.

Development and application of a soil organic matter-based soil quality index in mineralized terrane of the Western US

Treesearch

S. W. Blecker; L. L. Stillings; M. C. Amacher; J. A. Ippolito; N. M. DeCrappeo

2012-01-01

Soil quality indices provide a means of distilling large amounts of data into a single metric that evaluates the soil's ability to carry out key ecosystem functions. Primarily developed in agroecosytems, then forested ecosystems, an index using the relation between soil organic matter and other key soil properties in more semi-arid systems of the Western US...

Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties.

PubMed

Peter, W F; van der Wees, P J; Hendriks, E J M; de Bie, R A; Verhoef, J; de Jong, Z; van Bodegom-Vos, L; Hilberdink, W K H A; Vliet Vlieland, T P M

2013-12-01

The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups. Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89. The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined. Copyright © 2012 John Wiley & Sons, Ltd.

Return on investment in healthcare leadership development programs.

PubMed

Jeyaraman, Maya M; Qadar, Sheikh Muhammad Zeeshan; Wierzbowski, Aleksandra; Farshidfar, Farnaz; Lys, Justin; Dickson, Graham; Grimes, Kelly; Phillips, Leah A; Mitchell, Jonathan I; Van Aerde, John; Johnson, Dave; Krupka, Frank; Zarychanski, Ryan; Abou-Setta, Ahmed M

2018-02-05

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed

Ludt, Sabine; Campbell, Stephen M; Petek, Davorina; Rochon, Justine; Szecsenyi, Joachim; van Lieshout, Jan; Wensing, Michel; Ose, Dominik

2013-03-09

Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed Central

2013-01-01

Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482

[Quality in rehabilitation].

PubMed

Jäckel, W H

2010-12-01

Particularly in the context of introduction of quality assurance programmes 15 years ago, "quality" became a central issue for rehabilitation, and its importance is bound to grow in the years to come. After giving a general definition of quality, this article deals more closely with 3 aspects of quality: quality development, quality assurance, and data on quality. Quality development in rehabilitation centres demands an atmosphere that supports change, encourages creativity, courage, transparency and involvement, and reduces fear. The creation of such an atmosphere is, in particular, the responsibility of a centre's management. Routine interviews regarding patient as well as employee satisfaction, and the use of strategic planning and management systems have proven successful instruments in the practice of quality development. Compared with other sectors of the health system, quality assurance in rehabilitation is marked by its comprehensive approach, intense patient orientation, scientific underpinning, and nationwide implementation. Regarding the benefits of these programmes for the health system at large, however, no clear scientific proof is available yet. Data gained from quality assurance programmes on the whole show a high amount of patient satisfaction, good quality of structures and processes as well as an improvement of the patients' health status. Between centres, however, there are marked differences of quality in a number of cases, and long-term effectiveness could be improved in some indications. Finally, suggestions are offered concerning further development of quality in rehabilitation as well as of the quality assurance programmes. © Georg Thieme Verlag KG Stuttgart · New York.

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries

PubMed Central

2015-01-01

Background Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. Objective To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Design Multicenter, multilevel cross-sectional study. Setting and Participants Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. Intervention None. Measures Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Results and Limitations Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. Conclusions There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems. PMID:26588842

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.

PubMed

Sunol, Rosa; Wagner, Cordula; Arah, Onyebuchi A; Kristensen, Solvejg; Pfaff, Holger; Klazinga, Niek; Thompson, Caroline A; Wang, Aolin; DerSarkissian, Maral; Bartels, Paul; Michel, Philippe; Groene, Oliver

2015-01-01

Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Multicenter, multilevel cross-sectional study. Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. None. Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

PubMed

Thatte, Nandita; Choi, Yoonjoung

2015-04-01

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be explored to better understand the relationship between HR management and FP service quality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Development of a set of process and structure indicators for palliative care: the Europall project

PubMed Central

2012-01-01

Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs. PMID:23122255

[Points of view: the role of quality measurement from the Federal Joint Committee's perspective].

PubMed

Klakow-Franck, Regina

2014-01-01

The Federal Joint Committee (G-BA) is a central decision-making body that issues binding directives to ensure the quality of both inpatient and outpatient health care services within the German Statutory Health Insurance system. Quality measurement on the basis of quality indicators has proceeded furthest in the field of external quality assurance (QA) of inpatient services. Originally designed for quality development in a "protected environment" through learning from better practices, it has been faced with new expectations since competitive elements have been introduced into the health care system. The economisation of medicine is de facto the driving force of the development of QA measures. In terms of health policy, the 2013 coalition agreement includes "a renaissance of the concept of quality competition". In particular, this is meant to strengthen the decision-making options of insured persons by creating more transparency into the quality of not only inpatient but also outpatient care and, if necessary, to support the possibility of selective agreements with individual health insurance funds. The campaign planned to improve the quality of hospitals also provides for a quality-oriented advancement of hospital planning and funding; and the Federal Joint Committee, supported by the new Institute for Quality Assurance and Transparency in the Healthcare System in accordance with Section 137a of Book V of the Social Code (SGB V) in the GKV-FQWG version will be assigned new tasks within this context, too. On the whole, the measures already agreed upon in the Act to Improve the Financial Structure and Quality of the Statutory Health Insurance System (GKV-FQWG) and—as far as can now be anticipated—the proceedings of the working group set up between the German government and the German federal states indicate that there is a high need to improve the methods and tools of external quality assurance available, starting with questions about the validity of the quality indicators used and their relevance to patient care. Special issues and tasks require the development of new methods and tools. The need for paying more attention to the patient perspective will pose a particular challenge to future quality measurement. Additional information about the QA documentation of health care providers and the basis of social data that should be used preferentially can be gained from patient surveys. Despite the high political expectations (for example, concerning the development of online charts comparing the quality of inpatient care delivery), the Federal Joint Committee should not overlook the necessity of embedding quality measurement and public reporting into a comprehensive quality framework which can be used to promote continuous quality improvement through a structured feedback of the results to health care providers. In addition, we need a consistent patient orientation and a systematic evaluation of the QA measures employed. By networking more closely with evidence-based medicine and health services research, quality assurance may give rise to a systematic quality research from which genuine quality and care objectives can be derived and which, as an integral part of a "learning care", supports a patient-oriented advancement of care structures. Copyright © 2014. Published by Elsevier GmbH.

Liposomal Drug Product Development and Quality: Current US Experience and Perspective.

PubMed

Kapoor, Mamta; Lee, Sau L; Tyner, Katherine M

2017-05-01

Research in the area of liposomes has grown substantially in the past few decades. Liposomes are lipid bilayer structures that can incorporate drug substances to modify the drug's pharmacokinetic profile thereby improving drug delivery. The agency has received over 400 liposomal drug product submissions (excluding combination therapies), and there are currently eight approved liposomal drug products on the US market. In order to identify the pain points in development and manufacturing of liposomal drug products, a retrospective analysis was performed from a quality perspective on submissions for new and generic liposomal drug products. General analysis on liposomal drug product submissions was also performed. Results indicated that 96% of the submissions were Investigational New Drug (IND) applications, 3% were New Drug Applications (NDAs), and the remaining 1% was Abbreviated New Drug Applications (ANDAs). Doxorubicin hydrochloride was the most commonly used drug substance incorporated into the liposomes (31%). The majority of the liposomal products were administered via intravenous route (84%) with cancer (various types) being the most common indication (63%). From a quality perspective, major challenges during the development of liposomal drug products included identification and (appropriate) characterization of critical quality attributes of liposomal drug products and suitable control strategies during product development. By focusing on these areas, a faster and more efficient development of liposomal drug products may be achieved. Additionally, in this way, the drug review process for such products can be streamlined.

The development of education indicators for measuring quality in the English-speaking Caribbean: how far have we come?

PubMed

Bowe, Anica G

2015-02-01

Education evaluation has become increasingly important in the English-speaking Caribbean. This has been in response to assessing the progress of four regional initiatives aimed at improving the equity, efficiency, and quality of education. Both special interest groups and local evaluators have been responsible for assessing the progress of education and providing an overall synthesis and summary of what is taking place in the English-speaking Caribbean. This study employed content analysis to examine the indicators used in these education evaluation studies since the declaration of the Caribbean Plan of Action 2000-2015 to determine these indicators' appropriateness to the Caribbean context in measuring education progress. Findings demonstrate that the English-speaking Caribbean has made strides in operationalizing quality input, process, and output indicators; however quality outcome indicators beyond test scores are yet to be realized in a systematic manner. This study also compared the types of collaborative partnerships in conducting evaluation studies used by special interest groups and local evaluators and pinpointed the one that appears most suitable for special interest groups in this region. Copyright © 2014 Elsevier Ltd. All rights reserved.

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

PubMed

Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie

2016-03-01

A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow. Copyright © 2016. Published by Elsevier Ireland Ltd.

a Web Api and Web Application Development for Dissemination of Air Quality Information

NASA Astrophysics Data System (ADS)

Şahin, K.; Işıkdağ, U.

2017-11-01

Various studies have been carried out since 2005 under the leadership of Ministry of Environment and Urbanism of Turkey, in order to observe the quality of air in Turkey, to develop new policies and to develop a sustainable air quality management strategy. For this reason, a national air quality monitoring network has been developed providing air quality indices. By this network, the quality of the air has been continuously monitored and an important information system has been constructed in order to take precautions for preventing a dangerous situation. The biggest handicap in the network is the data access problem for instant and time series data acquisition and processing because of its proprietary structure. Currently, there is no service offered by the current air quality monitoring system for exchanging information with third party applications. Within the context of this work, a web service has been developed to enable location based querying of the current/past air quality data in Turkey. This web service is equipped with up-todate and widely preferred technologies. In other words, an architecture is chosen in which applications can easily integrate. In the second phase of the study, a web-based application was developed to test the developed web service and this testing application can perform location based acquisition of air-quality data. This makes it possible to easily carry out operations such as screening and examination of the area in the given time-frame which cannot be done with the national monitoring network.

A research review of quality assessment for software

NASA Technical Reports Server (NTRS)

1991-01-01

Measures were recommended to assess the quality of software submitted to the AdaNet program. The quality factors that are important to software reuse are explored and methods of evaluating those factors are discussed. Quality factors important to software reuse are: correctness, reliability, verifiability, understandability, modifiability, and certifiability. Certifiability is included because the documentation of many factors about a software component such as its efficiency, portability, and development history, constitute a class for factors important to some users, not important at all to other, and impossible for AdaNet to distinguish between a priori. The quality factors may be assessed in different ways. There are a few quantitative measures which have been shown to indicate software quality. However, it is believed that there exists many factors that indicate quality and have not been empirically validated due to their subjective nature. These subjective factors are characterized by the way in which they support the software engineering principles of abstraction, information hiding, modularity, localization, confirmability, uniformity, and completeness.

A MARINE RECREATIONAL WATER QUALITY CRITERION CONSISTENT WITH INDICATOR CONCEPTS AND RISK ANALYSIS

EPA Science Inventory

An overivew is provided of water quality criteria developed for marine recreational waters by EPA in 1979. The crierion used is the strength of the association with the rates of the important symptoms, such as those that correlate best with swimming in wastewater-polluted waters....

Subjective Quality of Life Measures for Evaluating Medical Intervention.

ERIC Educational Resources Information Center

McCauley, Clark; Bremer, Barbara A.

1991-01-01

Evidence indicates that subjective quality-of-life scales developed by N. M. Bradburn (1969) and by A. Campbell, P. Converse, and W. Rodgers (1976) can be as sensitive as physiological measures in distinguishing among medical treatment groups. These scales can complement more objective measures of patient status. (SLD)

Assessing Question Quality Using NLP

ERIC Educational Resources Information Center

Kopp, Kristopher J.; Johnson, Amy M.; Crossley, Scott A.; McNamara, Danielle S.

2017-01-01

An NLP algorithm was developed to assess question quality to inform feedback on questions generated by students within iSTART (an intelligent tutoring system that teaches reading strategies). A corpus of 4575 questions was coded using a four-level taxonomy. NLP indices were calculated for each question and machine learning was used to predict…

Exploring Factors That Influence Quality Literature Circles

ERIC Educational Resources Information Center

Young, Chase; Mohr, Kathleen A. J.

2018-01-01

Research indicates that literature circles are an authentic means for literacy development that students typically enjoy. To better understand the potential value and to add to the research base regarding literature circles, this study, involving 17 fourth graders, explores factors that may influence the quality of literature discussions,…

Abstracting ICU Nursing Care Quality Data From the Electronic Health Record.

PubMed

Seaman, Jennifer B; Evans, Anna C; Sciulli, Andrea M; Barnato, Amber E; Sereika, Susan M; Happ, Mary Beth

2017-09-01

The electronic health record is a potentially rich source of data for clinical research in the intensive care unit setting. We describe the iterative, multi-step process used to develop and test a data abstraction tool, used for collection of nursing care quality indicators from the electronic health record, for a pragmatic trial. We computed Cohen's kappa coefficient (κ) to assess interrater agreement or reliability of data abstracted using preliminary and finalized tools. In assessing the reliability of study data ( n = 1,440 cases) using the finalized tool, 108 randomly selected cases (10% of first half sample; 5% of last half sample) were independently abstracted by a second rater. We demonstrated mean κ values ranging from 0.61 to 0.99 for all indicators. Nursing care quality data can be accurately and reliably abstracted from the electronic health records of intensive care unit patients using a well-developed data collection tool and detailed training.

Coal resources of New Mexico

USGS Publications Warehouse

Read, Charles Brian; Duffner, R.T.; Wood, G.H.; Zapp, A.D.

1950-01-01

A study of water quality degradation due to brine contamination was made in an area of about 1,700 sq mi in east-central Oklahoma. The study area coincides in part with the outcrop of the Vamoosa-Ada aquifer of Pennsylvanian age. Water samples collected from 180 wells completed in the Vamoosa-Ada aquifer and at 167 sites from streams draining the Vamoosa-Ada aquifer show scattered occurrences of water quality degradation by brine. Degradation of water quality by brine is indicated where: (1) chloride concentration is > or = to 400 mg/L; (2) bromide concentration is > or = 2 mg/L; (3) the ratio of sodium plus chloride to dissolved solids is > or = 0.64. Ratios of secondary importance that also indicate water quality degradation by brine in the area are: (1) a ratio of lithium to bromide < or = 0.01, when the chloride concentration is > or = 400 mg/L; (2) a sodium/chloride ratio of about 0.46; (3) a sodium/bromide ratio of about 92; and (4) a bromide/chloride ratio of about 0.0048. Values for bromide, lithium, strontium, dissolved solids, calcium, magnesium, sodium, chloride, and sulfate concentrations were subjected to analysis of variance based on use of the index values in partition data sets. The analysis of variance showed the significance of the indexes for all constituents except sulfate. The two most reliable brine indicators are chloride and bromide. Statistically, chloride is a slightly more reliable index than bromide. The developed indexes can be used to indicate water quality degradation by brine. Accuracy is improved if both indexes are used. When geophysical logs from 133 pairs of oil and gas wells were analyzed, data from 5 pairs of wells indicated a possible rise in the interface between fresh water and salt water in the Vamoosa-Ada aquifer. Therefore , any rise of the interface is local rather than regional. The criteria developed in this study indicate that brine has degraded water quality at 63 sites on streams draining the Vamoosa-Ada aquifer, at 15 water wells completed in the Vamoosa-Ada aquifer, and at 5 oil and gas wells penetrating the Vamoosa-Ada aquifer. (Author 's abstract)

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

PubMed

Carinci, F; Van Gool, K; Mainz, J; Veillard, J; Pichora, E C; Januel, J M; Arispe, I; Kim, S M; Klazinga, N S

2015-04-01

To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. International group of countries participating to OECD projects. Members of the OECD HCQI expert group. A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Animals as indicators of ecosystem responses to air emissions

USGS Publications Warehouse

Newman, James R.; Schreiber, R. Kent

1984-01-01

With existing and proposed air-quality regulations, ecological disasters resulting from air emissions such as those observed at Copperhill, Tennessee, and Sudbury, Ontario, are unlikely. Current air-quality standards, however, may not protect ecosystems from subacute and chronic exposure to air emissions. The encouragement of the use of coal for energy production and the development of the fossil-fuel industries, including oil shales, tar sands, and coal liquification, point to an increase and spread of fossil-fuel emissions and the potential to influence a number of natural ecosystems. This paper reviews the reported responses of ecosystems to air-borne pollutants and discusses the use of animals as indicators of ecosystem responses to these pollutants. Animal species and populations can act as important indicators of biotic and abiotic responses of aquatic and terrestrial ecosystems. These responses can indicate long-term trends in ecosystem health and productivity, chemical cycling, genetics, and regulation. For short-term trends, fish and wildlife also serve as monitors of changes in community structure, signaling food-web contamination, as well as providing a measure of ecosystem vitality. Information is presented to show not only the importance of animals as indicators of ecosystem responses to air-quality degradation, but also their value as air-pollution indices, that is, as air-quality-related values (AQRV), required in current air-pollution regulation.

University Students' Giftedness Diagnosis and Development

ERIC Educational Resources Information Center

Narikbaeva, Lora M.

2016-01-01

This article deals with the problem of students' giftedness development. Students' test results (n = 851) for "IQ level" and "creativity level" indicators demonstrated the need to improve the quality of work in reference to students' professional giftedness development at the university. Designed complex of pedagogical…

Grain quality inspection system

NASA Technical Reports Server (NTRS)

Flood, C. A., Jr.; Singletow, D. P.; James, S. N.

1979-01-01

A review of grain quality indicators and measurement methods was conducted in order to assess the feasibility of using remote sensing technology to develop a continuous monitoring system for use during grain transfer operations. Most detection methods were found to be too slow or too expensive to be incorporated into the normal inspection procedure of a grain elevator on a continuous basis. Two indicators, moisture content and broken corn and foreign material, show potential for automation and are of an economic value. A microprocessor based system which utilizes commercially available electronic moisture meter was developed and tested. A method for automating BCFM measurement is described. A complete system description is presented along with performance test results.

Reservoir-development impacts on surface-water quantity and quality in the Yampa River basin, Colorado and Wyoming

USGS Publications Warehouse

Adams, D. Briane; Bauer, Daniel P.; Dale, Robert H.; Steele, Timothy Doak

1983-01-01

Development of coal resources and associated economy is accelerating in the Yampa River basin in northwestern Colorado and south-central Wyoming. Increased use of the water resources of the area will have a direct impact on their quantity and quality. As part of 18 surface-water projects, 35 reservoirs have been proposed with a combined total storage of 2.18 million acre-feet, 41% greater than the mean annual outflow from the basin. Three computer models were used to demonstrate methods of evaluating future impacts of reservoir development in the Yampa River basin. Four different reservoir configurations were used to simulate the effects of different degrees of proposed reservoir development. A multireservoir-flow model included both within-basin and transmountain diversions. Simulations indicated that in many cases diversion amounts would not be available for either type of diversion. A corresponding frequency analysis of reservoir storage levels indicated that most reservoirs would be operating with small percentages of total capacities and generally with less than 20% of conservation-pool volumes. Simulations using a dissolved-solids model indicated that extensive reservoir development could increase average annual concentrations at most locations. Simulations using a single-reservoir model indicated no significant occurrence of water-temperature stratification in most reservoirs due to limited reservoir storage. (USGS)

Relating landscape characteristics to non-point source pollution in mine waste-located watersheds using geospatial techniques.

PubMed

Xiao, Huaguo; Ji, Wei

2007-01-01

Landscape characteristics of a watershed are important variables that influence surface water quality. Understanding the relationship between these variables and surface water quality is critical in predicting pollution potential and developing watershed management practices to eliminate or reduce pollution risk. To understand the impacts of landscape characteristics on water quality in mine waste-located watersheds, we conducted a case study in the Tri-State Mining District which is located in the conjunction of three states (Missouri, Kansas and Oklahoma). Severe heavy metal pollution exists in that area resulting from historical mining activities. We characterized land use/land cover over the last three decades by classifying historical multi-temporal Landsat imagery. Landscape metrics such as proportion, edge density and contagion were calculated based on the classified imagery. In-stream water quality data over three decades were collected, including lead, zinc, iron, cadmium, aluminum and conductivity which were used as key water quality indicators. Statistical analyses were performed to quantify the relationship between landscape metrics and surface water quality. Results showed that landscape characteristics in mine waste-located watersheds could account for as much as 77% of the variation of water quality indicators. A single landscape metric alone, such as proportion of mine waste area, could be used to predict surface water quality; but its predicting power is limited, usually accounting for less than 60% of the variance of water quality indicators.

Use of comparative performance indicators in rehabilitation.

PubMed

Zidarov, Diana; Poissant, Lise; Sicotte, Claude

The development of performance indicators that enable benchmarking between organizations is an important mechanism for accountability, organizational learning, and performance improvement. In the province of Quebec (Canada), 21 rehabilitation organizations developed a common set of performance indicators through interorganizational collaboration. The aims of this study were to describe the rehabilitation organizations' use of a common set of performance indicators and to identify the factors influencing such use. A qualitative survey was performed. Individual semistructured interviews were conducted with executives (n = 18) working at 16 rehabilitation organizations using a common set of performance indicators. A thematic analysis of the factors of use was performed according to the Consolidated Framework for Implementation Research. The use of performance indicators was categorized as purposeful, political, or passive. Our results showed that all organizations used the common set of performance indicators. Four factors were identified as important to all the rehabilitation organizations to explain their interest in comparative performance indicators: the need to develop their own performance indicators, the compatibility of performance information with organizational needs, complexity/simplicity of performance information, and the support offered by their common association. Sixty-three percent of rehabilitation organizations made purposeful or political use of performance indicators. Three main factors contributed to typify those organizations from the others: the perceived quality of the performance indicators, the leadership of decision makers, and the resources available. Our results showed that use of performance indicators can support the initiation of projects for improving the quality of care. Key recommendations are proposed to decision makers that may enhance performance indicators' use.

Study on Quality Indicator System of Rhythmic Gymnasts in Analytic Hierarchy Process

NASA Astrophysics Data System (ADS)

Luo, Lin

2017-08-01

The rhythmic gymnastics (RG) is a sport item with the direct aim of winning as well as a good ornamental value. The scientific selection by the rhythmic gymnasts is necessary for the success, and also the beginning for the scientific training of the gymnasts in their special training stage. According to RG characteristics and the physical characteristics of the gymnasts, also in combination with the investigations & interviews to the coaches who have years of training experience in RG, the experts & scholars on RG study & teaching in universities, and by referring to relevant documents, this paper established the quality indicator system in analytic hierarchy process (AHP). We summarized and selected several indicators obviously influencing the RG training and divided them into the three types of factors: physical factors, flexibility & strength factors, and speed & dexterity factors, according to which 12 specific indicators, their weights and comprehensive evaluation coefficients. Based on these indicators, we established the quality indicator system of the gymnasts, and developed corresponding software system, providing scientific theoretical basis & practical application basis for the selection & evaluation of the gymnasts.

Development and validation of the Chinese version of dry eye related quality of life scale.

PubMed

Zheng, Bang; Liu, Xiao-Jing; Sun, Yue-Qian Fiona; Su, Jia-Zeng; Zhao, Yang; Xie, Zheng; Yu, Guang-Yan

2017-07-17

To develop the Chinese version of quality of life scale for dry eye patients based on the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire and to assess the reliability and validity of the developed scale. The original IDEEL was adapted cross-culturally to Chinese language and further developed following standard procedures. A total of 100 Chinese patients diagnosed with dry eye syndrome were included to investigate the psychometric properties of the Chinese version of scale. Psychometric tests included internal consistency (Cronbach's ɑ coefficients), construct validity (exploratory factor analysis), and known-groups validity (the analysis of variance). The Chinese version of Dry Eye Related Quality of Life (CDERQOL) Scale contains 45 items classified into 5 domains. Good to excellent internal consistency reliability was demonstrated for all 5 domains (Cronbach's ɑ coefficients range from 0.716 to 0.913). Construct validity assessment indicated a consistent factorial structure of the CDERQOL scale with hypothesized construct, with the exception of "Dry Eye Symptom-Bother" domain. All domain scores were detected with significant difference across three severity groups of dry eye patients (P < 0.05) except for "Satisfaction with Treatment" domain, indicating good known-groups validity. The results indicated that the CDERQOL scale is a reliable and valid instrument for patients with dry eye syndrome among Chinese population, and could be used as a supplementary diagnostic and treatment-effectiveness measure.

The use of aquatic macrophytes in monitoring and in assessment of biological integrity

USGS Publications Warehouse

Stewart, P.M.; Scribailo, R.W.; Simon, T.P.; Gerhardt, A.

1999-01-01

Aquatic plant species, populations, and communities should be used as indicators of the aquatic environment, allowing detection of ecosystem response to different stressors. Plant tissues bioaccumulate and concentrate toxin levels higher than what is present in the sediments; and this appears to be related to organic matter content, acidification, and buffering capacity. The majority of toxicity studies, most of these with heavy metals, have been done with several Lemna species and Vallisneria americana. Organic chemicals reviewed include pesticides and herbicides, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and other industrial contaminants. The use of aquatic plant communities as bioindicators of environmental quality was evaluated for specific characteristics and indices that may assess biological integrity. Indices such as the floristic quality index (FQI) and coefficient of conservatism (C) are pioneering efforts to describe the quality of natural areas and protect native biodiversity. Our case study in the Grand Calumet Lagoons found that 'least-impacted' sites had the greatest aquatic plant species richness, highest FQI and C values, and highest relative abundance. Lastly, we introduce the concepts necessary for the development of a plant index of biotic integrity. Development of reference conditions is essential to understanding aquatic plant community structure, function, individual health, condition, and abundance. Information on guild development and tolerance definition are also integral to the development of a multi-metric index.

Postimpoundment survey of water-quality characteristics of Raystown Lake, Huntingdon and Bedford Counties, Pennsylvania

USGS Publications Warehouse

Williams, Donald R.

1978-01-01

Water-quality data, collected from May 1974 to September 1976 at thirteen sites within Raystown Lake and in the inflow and outflow channels, define the water-quality characteristics of the lake water and the effects of impoundment on the quality of the lake outflow. Depth-profile measurements show Raystown Lake to be dimictic. Thermal stratification is well developed during the summer. Generally high concentrations of dissolved oxygen throughout the hypolimnion during thermal stratification, low phytoplankton concentrations, and small diel fluctuations of dissolved oxygen, pH, and specific conductance indicate that the lake is low in nutrients, or oligotrophic. Algal assays of surface samples indicate that orthophosphate was a growth-limiting nutrient. The diatoms (Chrysophyta) were the dominant phytoplankton group found through-out the study period. The lake waters contained very low populations of zooplankton. Fecal coliform and fecal streptococcus densities measured throughout the lake indicated no potentially dangerous areas of water-contact recreation. The most apparent effect that the impoundment had on water quality was the removal of nutrients, particularly orthophosphate, through phytoplankton uptake and sediment deposition.

Landing flying qualities evaluation criteria for augmented aircraft

NASA Technical Reports Server (NTRS)

Radford, R. C.; Smith, R.; Bailey, R.

1980-01-01

The criteria evaluated were: Calspan Neal-Smith; Onstott (Northrop Time Domain); McDonnell-Douglas Equivalent System Approach; R. H. Smith Criterion. Each criterion was applied to the same set of longitudinal approach and landing flying qualities data. A revised version of the Neal-Smith criterion which is applicable to the landing task was developed and tested against other landing flying qualities data. Results indicated that both the revised Neal-Smith criterion and the Equivalent System Approach are good discriminators of pitch landing flying qualities; Neal-Smith has particular merit as a design guide, while the Equivalent System Approach is well suited for development of appropriate military specification requirements applicable to highly augmented aircraft.

Development of innovative computer software to facilitate the setup and computation of water quality index

PubMed Central

2013-01-01

Background Developing a water quality index which is used to convert the water quality dataset into a single number is the most important task of most water quality monitoring programmes. As the water quality index setup is based on different local obstacles, it is not feasible to introduce a definite water quality index to reveal the water quality level. Findings In this study, an innovative software application, the Iranian Water Quality Index Software (IWQIS), is presented in order to facilitate calculation of a water quality index based on dynamic weight factors, which will help users to compute the water quality index in cases where some parameters are missing from the datasets. Conclusion A dataset containing 735 water samples of drinking water quality in different parts of the country was used to show the performance of this software using different criteria parameters. The software proved to be an efficient tool to facilitate the setup of water quality indices based on flexible use of variables and water quality databases. PMID:24499556

Forecasting relative impacts of land use on anadromous fish habitat to guide conservation planning.

PubMed

Lohse, Kathleen A; Newburn, David A; Opperman, Jeff J; Merenlender, Adina M

2008-03-01

Land use change can adversely affect water quality and freshwater ecosystems, yet our ability to predict how systems will respond to different land uses, particularly rural-residential development, is limited by data availability and our understanding of biophysical thresholds. In this study, we use spatially explicit parcel-level data to examine the influence of land use (including urban, rural-residential, and vineyard) on salmon spawning substrate quality in tributaries of the Russian River in California. We develop a land use change model to forecast the probability of losses in high-quality spawning habitat and recommend priority areas for incentive-based land conservation efforts. Ordinal logistic regression results indicate that all three land use types were negatively associated with spawning substrate quality, with urban development having the largest marginal impact. For two reasons, however, forecasted rural-residential and vineyard development have much larger influences on decreasing spawning substrate quality relative to urban development. First, the land use change model estimates 10 times greater land use conversion to both rural-residential and vineyard compared to urban. Second, forecasted urban development is concentrated in the most developed watersheds, which already have poor spawning substrate quality, such that the marginal response to future urban development is less significant. To meet the goals of protecting salmonid spawning habitat and optimizing investments in salmon recovery, we suggest investing in watersheds where future rural-residential development and vineyards threaten high-quality fish habitat, rather than the most developed watersheds, where land values are higher.

The governance of quality management in dutch health care: new developments and strategic challenges.

PubMed

Maarse, J A M; Ruwaard, D; Spreeuwenberg, C

2013-01-01

This article gives a brief sketch of quality management in Dutch health care. Our focus is upon the governance of guideline development and quality measurement. Governance is conceptualized as the structure and process of steering of quality management. The governance structure of guideline development in the Netherlands can be conceptualized as a network without central coordination. Much depends upon the self-initiative of stakeholders. A similar picture can be found in quality measurement. Special attention is given to the development of care standards for chronic disease. Care standards have a broader scope than guidelines and take an explicit patient perspective. They not only contain evidence-based and up-to-date guidelines for the care pathway but also contain standards for self-management. Furthermore, they comprise a set of indicators for measuring the quality of care of the entire pathway covered by the standard. The final part of the article discusses the mission, tasks and strategic challenges of the newly established National Health Care Institute (Zorginstituut Nederland), which is scheduled to be operative in 2013.

[Cross-sectoral quality assurance in ambulatory care].

PubMed

Albrecht, Martin; Loos, Stefan; Otten, Marcus

2013-01-01

Overcoming rigid sectoral segmentation in healthcare has also become a health policy target in quality assurance. With the Act to Enhance Competition in Statutory Health Insurance (GKV-WSG) coming into effect, quality assurance measures are to be designed in a cross-sectoral fashion for in- and outpatient sectors equally. An independent institution is currently mandated to develop specific quality indicators for eleven indications. For three of these operating tests have already been commissioned by the Federal Joint Committee. This article depicts the major results of a feasibility study, including a compliance cost estimate, for the aforementioned indications of cross-sectoral quality assurance (cQA). In conclusion, a number of both practical and conceptual basic challenges are still to be resolved prior to the full implementation of cQA, such as a sufficient specification to activate documentation requirements and an inspection system capable of separating actual quality problems from documentary deficits. So far, a comprehensive cost-utility analysis of cQA has not been provided, in particular with comparison to existing QA systems. In order to optimise cost and utility of cQA an evidence-based approach is required for both the extension of cQA areas and for QA provisions. Copyright © 2013. Published by Elsevier GmbH.

Biometric parameters of the bream (Abramis brama) as indicators for long-term changes in fish health and environmental quality--data from the German ESB.

PubMed

Teubner, Diana; Paulus, Martin; Veith, Michael; Klein, Roland

2015-02-01

Piscifaunal health depends upon the state and quality of the aquatic environment. Variations in physical condition of fish may therefore be attributed to changes in environmental quality. Based on time series of up to 20 years of biometric data of bream from multiple sampling sites of the German environmental specimen bank (ESB), this study assessed whether changes in biometric parameters are able to indicate long-term alterations in fish health and environmental quality. Evaluated biometric parameters of fish health comprised length and weight of individuals of a defined age class, the condition factor, lipid content and hepatosomatic index (HSI). Although there are negative trends of the HSI, the overall development of health parameters can be interpreted as positive. This seems to suggest that health parameters conclusively mirror the long-term improvement of water quality in the selected rivers. However, the applicability of the condition factor as well as lipid content as indicators for fish health remained subject to restrictions. Altogether, the results from the ESB confirmed the high value of biometric parameters for monitoring of long-term changes in state and quality of aquatic ecosystems.

What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges.

PubMed

Meier, Frederick A; Badrick, Tony C; Sikaris, Kenneth A

2018-02-17

For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal risk assessment, rather than competing with economic value, enhances it.

Open Space between Residential Buildings as a Factor of Sustainable Development - Case Studies in Brno (Czech Republic) and Vienna (Austria)

NASA Astrophysics Data System (ADS)

Kilnarová, Pavla; Wittmann, Maxmilian

2017-12-01

The characteristics of open spaces between residential buildings have, as authors suppose, an impact on the sustainable development of urban areas. Spatial arrangement and accessibility of these spaces, the type and height of surrounding buildings, the quantity and character of greenery, and many more characteristics influence the quality of environment, and the quality of life of local residents. These and further characteristics of the open spaces between residential buildings influence the ecological stability of the area, its hygienic qualities, the intensity and way of using by various social groups, and also the prices of real estates. These qualities indicate the environmental, social and economic sustainability of the urban area. The proposed research methodology assessed specific indicators of sustainability within a range from 0 to 10 points. 5 points correspond to the general standard in the area, 0 points indicate degradation, and 10 points indicate the highest contribution to sustainable development. Observation methods, questionnaire survey, statistical analyses, and methods of measurement were used to determine the values of the given indicators. The paper analyses the impact of the open spaces between residential buildings on sustainability via the case studies performed in the Central European cities of Brno, Czech Republic and Vienna, Austria. Two forms of residential urban structures in the City of Brno in the Czech Republic were selected for the analysis: the closed courtyards in the urban block from the 19th century and the open spaces in the housing estates constructed under socialism in the 20th century. The question is, if the different forms of spaces between residential buildings influence the sustainability of urban area and satisfaction of inhabitants in different ways. A complementary case study in Vienna indicates that inhabitants of a housing estate in Vienna, as well as inhabitants of housing estates in Brno, highly appreciate the meaning of large green open spaces between buildings. The paper presents results of basic research. The results indicate that the sustainability of open housing estate forms is higher than the authors expected.

Indicator methods to evaluate the hygienic performance of industrial scale operating Biowaste Composting Plants.

PubMed

Martens, Jürgen

2005-01-01

The hygienic performance of biowaste composting plants to ensure the quality of compost is of high importance. Existing compost quality assurance systems reflect this importance through intensive testing of hygienic parameters. In many countries, compost quality assurance systems are under construction and it is necessary to check and to optimize the methods to state the hygienic performance of composting plants. A set of indicator methods to evaluate the hygienic performance of normal operating biowaste composting plants was developed. The indicator methods were developed by investigating temperature measurements from indirect process tests from 23 composting plants belonging to 11 design types of the Hygiene Design Type Testing System of the German Compost Quality Association (BGK e.V.). The presented indicator methods are the grade of hygienization, the basic curve shape, and the hygienic risk area. The temperature courses of single plants are not distributed normally, but they were grouped by cluster analysis in normal distributed subgroups. That was a precondition to develop the mentioned indicator methods. For each plant the grade of hygienization was calculated through transformation into the standard normal distribution. It shows the part in percent of the entire data set which meet the legal temperature requirements. The hygienization grade differs widely within the design types and falls below 50% for about one fourth of the plants. The subgroups are divided visually into basic curve shapes which stand for different process courses. For each plant the composition of the entire data set out of the various basic curve shapes can be used as an indicator for the basic process conditions. Some basic curve shapes indicate abnormal process courses which can be emended through process optimization. A hygienic risk area concept using the 90% range of variation of the normal temperature courses was introduced. Comparing the design type range of variation with the legal temperature defaults showed hygienic risk areas over the temperature courses which could be minimized through process optimization. The hygienic risk area of four design types shows a suboptimal hygienic performance.

Complexity in action: Untangling latent relationships between land quality, economic structures and socio-spatial patterns in Italy.

PubMed

Salvati, Luca; Tombolini, Ilaria; Gemmiti, Roberta; Carlucci, Margherita; Bajocco, Sofia; Perini, Luigi; Ferrara, Agostino; Colantoni, Andrea

2017-01-01

Land quality, a key economic capital supporting local development, is affected by biophysical and anthropogenic factors. Taken as a relevant attribute of economic systems, land quality has shaped the territorial organization of any given region influencing localization of agriculture, industry and settlements. In regions with long-established human-landscape interactions, such as the Mediterranean basin, land quality has determined social disparities and polarization in the use of land, reflecting the action of geographical gradients based on elevation and population density. The present study investigates latent relationships within a large set of indicators profiling local communities and land quality on a fine-grained resolution scale in Italy with the aim to assess the potential impact of land quality on the regional socioeconomic structure. The importance of land quality gradients in the socioeconomic configuration of urban and rural regions was verified analyzing the distribution of 149 socioeconomic and environmental indicators organized in 5 themes and 17 research dimensions. Agriculture, income, education and labour market variables discriminate areas with high land quality from areas with low land quality. While differential land quality in peri-urban areas may reflect conflicts between competing actors, moderate (or low) quality of land in rural districts is associated with depopulation, land abandonment, subsidence agriculture, unemployment and low educational levels. We conclude that the socioeconomic profile of local communities has been influenced by land quality in a different way along urban-rural gradients. Policies integrating environmental and socioeconomic measures are required to consider land quality as a pivotal target for sustainable development. Regional planning will benefit from an in-depth understanding of place-specific relationships between local communities and the environment.

Complexity in action: Untangling latent relationships between land quality, economic structures and socio-spatial patterns in Italy

PubMed Central

Salvati, Luca; Tombolini, Ilaria; Gemmiti, Roberta; Carlucci, Margherita; Bajocco, Sofia; Perini, Luigi; Ferrara, Agostino

2017-01-01

Land quality, a key economic capital supporting local development, is affected by biophysical and anthropogenic factors. Taken as a relevant attribute of economic systems, land quality has shaped the territorial organization of any given region influencing localization of agriculture, industry and settlements. In regions with long-established human-landscape interactions, such as the Mediterranean basin, land quality has determined social disparities and polarization in the use of land, reflecting the action of geographical gradients based on elevation and population density. The present study investigates latent relationships within a large set of indicators profiling local communities and land quality on a fine-grained resolution scale in Italy with the aim to assess the potential impact of land quality on the regional socioeconomic structure. The importance of land quality gradients in the socioeconomic configuration of urban and rural regions was verified analyzing the distribution of 149 socioeconomic and environmental indicators organized in 5 themes and 17 research dimensions. Agriculture, income, education and labour market variables discriminate areas with high land quality from areas with low land quality. While differential land quality in peri-urban areas may reflect conflicts between competing actors, moderate (or low) quality of land in rural districts is associated with depopulation, land abandonment, subsidence agriculture, unemployment and low educational levels. We conclude that the socioeconomic profile of local communities has been influenced by land quality in a different way along urban-rural gradients. Policies integrating environmental and socioeconomic measures are required to consider land quality as a pivotal target for sustainable development. Regional planning will benefit from an in-depth understanding of place-specific relationships between local communities and the environment. PMID:28574984

A comparison of two types of neural network for weld quality prediction in small scale resistance spot welding

NASA Astrophysics Data System (ADS)

Wan, Xiaodong; Wang, Yuanxun; Zhao, Dawei; Huang, YongAn

2017-09-01

Our study aims at developing an effective quality monitoring system in small scale resistance spot welding of titanium alloy. The measured electrical signals were interpreted in combination with the nugget development. Features were extracted from the dynamic resistance and electrode voltage curve. A higher welding current generally indicated a lower overall dynamic resistance level. A larger electrode voltage peak and higher change rate of electrode voltage could be detected under a smaller electrode force or higher welding current condition. Variation of the extracted features and weld quality was found more sensitive to the change of welding current than electrode force. Different neural network model were proposed for weld quality prediction. The back propagation neural network was more proper in failure load estimation. The probabilistic neural network model was more appropriate to be applied in quality level classification. A real-time and on-line weld quality monitoring system may be developed by taking advantages of both methods.

[Quality criteria in medicine: which limits?].

PubMed

Minvielle, E

2006-06-01

This article aims to develop a critical appraisal of the criteria's development in medicine. The COMPAQH (Coordination for Measuring Performance and Assuring Quality in Hospitals) project (Ministry of Health/ High Authority of Health/ National Institute of Medical Research) helps to support this analysis. This project based on the test of 42 Quality indicators (QI) gives findings not only about the manner to build criteria, but also to interpret and diffuse results among physicians and hospital managers. Criteria must be elaborated in a pragmatic way. They must be in compliance with practice guidelines supported by scientific evidences. The associated risk is to create and develop a normative medicine. Collaboration with professional societies may be useful in preventing this risk.

A mapping review of international guidance on the management and care of amyotrophic lateral sclerosis (ALS).

PubMed

Janssens, Astrid I W A; Ruytings, Marijke; Al-Chalabi, Ammar; Chio, Adriano; Hardiman, Orla; Mcdermott, Christopher J; Meyer, Thomas; Mora, Gabriele; Van Damme, Philip; Van Den Berg, Leonard H; Vanhaecht, Kris; Winkler, Andrea S; Sermeus, Walter

2016-01-01

Management of ALS is suboptimal. Consequently, quality improvement interventions are needed to improve ALS care. An evidence-based insight into how patients should be managed is essential when developing quality improvement interventions. Therefore, this study aimed to map, categorize and summarize international guidance on the management and care of ALS and to identify gaps in this guidance by means of a mapping review. Literature was searched for clinical practice guidelines, quality indicators and evidence-based clinical summaries. A content analysis and meta-synthesis of the included literature was performed. Interventions and outcomes used in the management and care of ALS were identified and categorized. Furthermore, the amount of guidance underpinning these interventions and outcomes was analysed. Six clinical practice guidelines, one set of quality indicators and three evidence-based clinical summaries were identified. The results demonstrated that certain domains in ALS care, mainly disease-specific domains such as breathing and swallowing, are extensively addressed in the literature whereas other subjects, such as care coordination, receive little attention. In conclusion, this mapping review provides a scientific basis for targeting and developing the clinical content of a quality improvement intervention for the management of ALS.

Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.

PubMed

Suija, Kadri; Kivisto, Katrin; Sarria-Santamera, Antonio; Kokko, Simo; Liseckiene, Ida; Bredehorst, Maren; Jaruseviciene, Lina; Papp, Renata; Oona, Marje; Kalda, Ruth

2015-02-01

The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records. Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators. Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

[GeSIDA quality care indicators associated with mortality and hospital admission for the care of persons infected by HIV/AIDS].

PubMed

Delgado-Mejía, Elena; Frontera-Juan, Guillem; Murillas-Angoiti, Javier; Campins-Roselló, Antoni Abdon; Gil-Alonso, Leire; Peñaranda-Vera, María; Ribas Del Blanco, María Angels; Martín-Pena, María Luisa; Riera-Jaume, Melchor

2017-02-01

In 2010, the AIDS Study Group (Grupo de Estudio del SIDA [GESIDA]) developed 66 quality care indicators. The aim of this study is to determine which of these indicators are associated with mortality and hospital admission, and to perform a preliminary assessment of a prediction rule for mortality and hospital admission in patients on treatment and follow-up. A retrospective cohort study was conducted in the Hospital Universitario Son Espases (Palma de Mallorca, Spain). Eligible participants were patients with human immunodeficiency syndrome≥18 years old who began follow-up in the Infectious Disease Section between 1 January 2000 and 31 December 2012. A descriptive analysis was performed to evaluate anthropometric variables, and a logistic regression analysis to assess the association between GESIDA indicators and mortality/admission. The mortality probability model was built using logistic regression. A total of 1,944 adults were eligible (median age: 37 years old, 78.8% male). In the multivariate analysis, the quality of care indicators associated with mortality in the follow-up patient group were the items 7, 16 and 20, and in the group of patients on treatment were 7, 16, 20, 35, and 38. The quality of care indicators associated with hospital admissions in the follow-up patients group were the same as those in the mortality analysis, plus number 31. In the treatment group the associated quality of care indicators were items 7, 16, 20, 35, 38, and 40. Some GeSIDA quality of care indicators were associated with mortality and/or hospital admissions. These indicators are associated with delayed diagnosis, regular monitoring, prevention of infections, and control of comorbidities. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Quality of care indicators for the structure and organization of inpatient rehabilitation care of children with traumatic brain injury.

PubMed

Zumsteg, Jennifer M; Ennis, Stephanie K; Jaffe, Kenneth M; Mangione-Smith, Rita; MacKenzie, Ellen J; Rivara, Frederick P

2012-03-01

To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care. Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities. Inpatient rehabilitation units in the United States. A sample of rehabilitation programs identified using data from the National Association of Children's Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all age units. Not applicable. Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI. Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least 1 child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and more than 75% of therapists with pediatric training. There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Two approaches to estimating the effect of parenting on the development of executive function in early childhood.

PubMed

Blair, Clancy; Raver, C Cybele; Berry, Daniel J

2014-02-01

In the current article, we contrast 2 analytical approaches to estimate the relation of parenting to executive function development in a sample of 1,292 children assessed longitudinally between the ages of 36 and 60 months of age. Children were administered a newly developed and validated battery of 6 executive function tasks tapping inhibitory control, working memory, and attention shifting. Residualized change analysis indicated that higher quality parenting as indicated by higher scores on widely used measures of parenting at both earlier and later time points predicted more positive gain in executive function at 60 months. Latent change score models in which parenting and executive function over time were held to standards of longitudinal measurement invariance provided additional evidence of the association between change in parenting quality and change in executive function. In these models, cross-lagged paths indicated that in addition to parenting predicting change in executive function, executive function bidirectionally predicted change in parenting quality. Results were robust with the addition of covariates, including child sex, race, maternal education, and household income-to-need. Strengths and drawbacks of the 2 analytic approaches are discussed, and the findings are considered in light of emerging methodological innovations for testing the extent to which executive function is malleable and open to the influence of experience.

Increase in competitiveness of housing-and-communal services

NASA Astrophysics Data System (ADS)

Skripnik, Oksana

2017-10-01

The problems, interfering effective activity of housing-and-communal complex are considered in the article. Some factors of the increase in competitiveness and the importance of transactional expenses are revealed. The assessment of competitiveness of the organizations of the sphere of housing-and-communal services is considered as the set of the following basic elements organizational and administrative, marketing, financial, production, indicators of quality, indicators of development, labor indicators interconnected with processes of the organization. The author proves that the increase in competitiveness is possible by carrying out organizational and administrative, innovative, technological, economic transformations, increasing quality of services, reducing costs for production and realization of services, providing new services.

Environmental toxicology and risk assessment: Standardization of biomarkers for endocrine disruption and environmental assessment: Eighth volume. Special technical publication 1364

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

Henshel, D.S.; Black, M.C.; Harrass, M.C.

1999-07-01

This conference was held April 20--22, 1998 in Atlanta, Georgia. The purpose of this conference was to provide a multidisciplinary forum for exchange of state-of-the-art information on biological markers in toxicology and risk assessment, including endocrine disrupter screening assays. Attention is focused on the following: aquatic toxicology; behavioral toxicology; biochemical indicators; developmental indicators; endocrine indicators; biodegradation and fate of chemicals; quality assurance and quality control within laboratory and field studies; risk assessment and communication, and harmonization of standards development. Individual papers have been processed separately for inclusion in the appropriate data bases.

Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals.

PubMed

Marchant, Tanya; Bryce, Jennifer; Victora, Cesar; Moran, Allisyn C; Claeson, Mariam; Requejo, Jennifer; Amouzou, Agbessi; Walker, Neff; Boerma, Ties; Grove, John

2016-06-01

An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition.  Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need.  We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health.  Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.

Application of fuzzy set theory for integral assessment of agricultural products quality

NASA Astrophysics Data System (ADS)

Derkanosova, N. M.; Ponomareva, I. N.; Shurshikova, G. V.; Vasilenko, O. A.

2018-05-01

The methodology of integrated assessment of quality and safety of agricultural products, approbated by the example of indicators of wheat grain in relation to the provision of consumer properties of bakery products, was developed. Determination of the level of quality of the raw ingredients will allow direct using of agricultural raw materials for food production, taking into account ongoing technology, types of products, and, respectively, rational use of resource potential of the agricultural sector. The mathematical tool of the proposed method is a fuzzy set theory. The fuzzy classifier to evaluate the properties of the grain is formed. The set of six indicators normalized by the national standard is determined; values are ordered and represented by linguistic variables with a trapeziform membership function; the rules for calculation of membership functions are presented. Specific criteria values for individual indicators in shaping the quality of the finished products are considered. For one of the samples of wheat grain values of membership; functions of the linguistic variable "level" for all indicators and the linguistic variable "level of quality" were calculated. It is established that the studied sample of grain obtains the 2 (average) level of quality. Accordingly, it can be recommended for the production of bakery products with higher requirements for the structural-mechanical properties bakery and puff pastry products hearth bread and flour confectionery products of the group of hard dough cookies and crackers

Determination of colonoscopy indication from administrative claims data.

PubMed

Ko, Cynthia W; Dominitz, Jason A; Neradilek, Moni; Polissar, Nayak; Green, Pam; Kreuter, William; Baldwin, Laura-Mae

2014-04-01

Colonoscopy outcomes, such as polyp detection or complication rates, may differ by procedure indication. To develop methods to classify colonoscopy indications from administrative data, facilitating study of colonoscopy quality and outcomes. We linked 14,844 colonoscopy reports from the Clinical Outcomes Research Initiative, a national repository of endoscopic reports, to the corresponding Medicare Carrier and Outpatient File claims. Colonoscopy indication was determined from the procedure reports. We developed algorithms using classification and regression trees and linear discriminant analysis (LDA) to classify colonoscopy indication. Predictor variables included ICD-9CM and CPT/HCPCS codes present on the colonoscopy claim or in the 12 months prior, patient demographics, and site of colonoscopy service. Algorithms were developed on a training set of 7515 procedures, then validated using a test set of 7329 procedures. Sensitivity was lowest for identifying average-risk screening colonoscopies, varying between 55% and 86% for the different algorithms, but specificity for this indication was consistently over 95%. Sensitivity for diagnostic colonoscopy varied between 77% and 89%, with specificity between 55% and 87%. Algorithms with classification and regression trees with 7 variables or LDA with 10 variables had similar overall accuracy, and generally lower accuracy than the algorithm using LDA with 30 variables. Algorithms using Medicare claims data have moderate sensitivity and specificity for colonoscopy indication, and will be useful for studying colonoscopy quality in this population. Further validation may be needed before use in alternative populations.

Home on the Big River: Great River Habitat Quality Indices

EPA Science Inventory

EPA’s Environmental Monitoring and Assessment Program sampled the Upper Mississippi, Missouri and Ohio Rivers from 2004 through 2006 as part of an integrated assessment of ecological condition. We developed fish habitat indices by dividing the components of habitat into four ca...

Use of quality measures for Medicaid behavioral health services by state agencies: implications for health care reform.

PubMed

Seibert, Julie; Fields, Suzanne; Fullerton, Catherine Anne; Mark, Tami L; Malkani, Sabrina; Walsh, Christine; Ehrlich, Emily; Imshaug, Melina; Tabrizi, Maryam

2015-06-01

The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. Data were collected by reviewing online documents related to Medicaid managed care contracts for behavioral health, quality strategies, quality improvement plans, quality and performance indicators data, annual outcomes reports, performance measure specification manuals, legislative reports, and Medicaid waiver requests for proposals. Information was publicly available for 29 states. Most states relied on process measures, along with some structure and outcome measures. Although all states reported on at least one process measure of behavioral health quality, 52% of states did not use any outcomes measures and 48% of states had no structure measures. A majority of the states (69%) used behavioral health measures from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set, and all but one state in the sample (97%) used consumer experience-of-care surveys. Many states supplemented these data with locally developed behavioral health indicators that rely on administrative and nonadministrative data. State Medicaid agencies are using nationally recognized as well as local measures to assess quality of behavioral health care. Findings indicate a need for additional nationally endorsed measures in the area of substance use disorders and treatment outcomes.

Ultrasound for assessing disease activity in IBD patients: a systematic review of activity scores.

PubMed

Bots, S; Nylund, K; Löwenberg, M; Gecse, K; Gilja, O H; D'Haens, G

2018-04-19

Ultrasound (US) indices for assessing disease activity in IBD patients have never been critically reviewed. We aimed to systematically review the quality and reliability of available ultrasound (US) indices compared with reference standards for grading disease activity in IBD patients. Pubmed, Embase and Medline were searched from 1990 until June 2017. Relevant publications were identified through full text review after initial screening by 2 investigators. Data on methodology and index characteristics were collected. Study quality was assessed with a modified version of the Quadas-2 tool for risk of bias assessment. Of 20 studies with an US index, 11 studies met the inclusion criteria. Out of these 11 studies, 7 and 4 studied CD and UC activity indices, respectively. Parameters that were used in these indices included bowel wall thickness (BWT), Doppler signal (DS), wall layer stratification (WLS), compressibility, peristalsis, haustrations, fatty wrapping, contrast enhancement (CE) and strain pattern. Study quality was graded high in 5 studies, moderate in 3 studies and low in 3 studies. Ileocolonoscopy was used as the reference standard in 9 studies. In 1 study a combined index of ileocolonoscopy and barium contrast radiography and in 1 study histology was used as the reference standard. Only 5 studies used an established endoscopic index for comparison with US. Several US indices for assessing disease activity in IBD are available; however the methodology for development was suboptimal in most studies. For the development of future indices stringent methodological design is required.

Impact of temperature and relative humidity on the near infrared spectroscopy measurements of cotton fiber micronaire

USDA-ARS?s Scientific Manuscript database

A key cotton fiber property is micronaire, the indirect indicator of the fiber’s maturity (cell wall development or thickening) and fineness (linear density or size). Micronaire can impact the fiber’s quality, textile processing efficiency, and fabric dye consistency. As a key quality property, fi...

Social Integration, Work-Family Conflict and Facilitation, and Job and Marital Quality

ERIC Educational Resources Information Center

Voydanoff, Patricia

2005-01-01

This paper examines relationships between 2 dimensions of social integration (community participation and affective community resources) and job and marital quality. Data from the 1995 National Survey of Midlife Development in the United States (n= 1,816) indicate that the level of community participation is unrelated or negatively related to job…

Quality of Life in South Africa--The First Ten Years of Democracy

ERIC Educational Resources Information Center

Moller, Valerie

2007-01-01

South Africa celebrated ten years of democracy in 2004. This special issue of "Social Indicators Research" ("SIR") reviews developments that have impacted on the quality of life of ordinary South Africans during the transition period. The issue updates an earlier volume of "SIR" (Volume 41) published in 1997 and as a…

Monitoring Urban Quality of Life: The Porto Experience

ERIC Educational Resources Information Center

Santos, Luis Delfim; Martins, Isabel

2007-01-01

This paper describes the monitoring system of the urban quality of life developed by the Porto City Council, a new tool being used to support urban planning and management. The two components of this system--a quantitative approach based on statistical indicators and a qualitative analysis based on the citizens' perceptions of the conditions of…

Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming.

PubMed

Maillot, Matthieu; Ferguson, Elaine L; Drewnowski, Adam; Darmon, Nicole

2008-06-01

Nutrient profiling ranks foods based on their nutrient content. They may help identify foods with a good nutritional quality for their price. This hypothesis was tested using diet modeling with linear programming. Analyses were undertaken using food intake data from the nationally representative French INCA (enquête Individuelle et Nationale sur les Consommations Alimentaires) survey and its associated food composition and price database. For each food, a nutrient profile score was defined as the ratio between the previously published nutrient density score (NDS) and the limited nutrient score (LIM); a nutritional quality for price indicator was developed and calculated from the relationship between its NDS:LIM and energy cost (in euro/100 kcal). We developed linear programming models to design diets that fulfilled increasing levels of nutritional constraints at a minimal cost. The median NDS:LIM values of foods selected in modeled diets increased as the levels of nutritional constraints increased (P = 0.005). In addition, the proportion of foods with a good nutritional quality for price indicator was higher (P < 0.0001) among foods selected (81%) than among foods not selected (39%) in modeled diets. This agreement between the linear programming and the nutrient profiling approaches indicates that nutrient profiling can help identify foods of good nutritional quality for their price. Linear programming is a useful tool for testing nutrient profiling systems and validating the concept of nutrient profiling.

[Pay for performance in dental care: A systematic narrative review of quality P4P models in dental care].

PubMed

Chenot, Regine

2017-11-01

Pay for performance (P4P) links reimbursement to the achievement of quality objectives. Experiences with P4P instruments and studies on their effects are available for the inpatient sector. A systematic narrative review brings together findings concerning the use and the effects of P4P, especially in dental care. A systematic literature search in PubMed and the Cochrane Library for reimbursement models using quality indicators provided 77 publications. Inclusion criteria were: year of publication not older than 2007, dental sector, models of quality-oriented remuneration, quality of care, quality indicators. 27 publications met the inclusion criteria and were evaluated with regard to the instruments and effects of P4P. The database search was supplemented by a free search on the Internet as well as a search in indicator databases and portals. The results of the included studies were extracted and summarized narratively. 27 studies were included in the review. Performance-oriented remuneration is an instrument of quality competition. In principle, P4P is embedded in an existing remuneration system, i.e., it does not occur in isolation. In the United States, England and Scandinavia, models are currently being tested for quality-oriented remuneration in dental care, based on quality indicators. The studies identified by the literature search are very heterogeneous and do not yield comparable endpoints. Difficulties are seen in the reproducibility of the quality of dental care with regard to certain characteristics which still have to be defined as quality-promoting properties. Risk selection cannot be ruled out, which may have an impact on structural quality (access to care, coordination). There were no long-term effects of P4P on the quality of care. In the short and medium term, adverse effects on the participants' motivation as well as shifting effects towards the private sector are described. A prerequisite for the functioning of P4P is the definition of clear targets and measuring parameters. Furthermore, evidence-based quality indicators have to be developed that validly depict quality differences. It is yet unknown whether P4P will have long-term effects or whether the quality of dental care will increase. Copyright © 2017. Published by Elsevier GmbH.

Information security system quality assessment through the intelligent tools

NASA Astrophysics Data System (ADS)

Trapeznikov, E. V.

2018-04-01

The technology development has shown the automated system information security comprehensive analysis necessity. The subject area analysis indicates the study relevance. The research objective is to develop the information security system quality assessment methodology based on the intelligent tools. The basis of the methodology is the information security assessment model in the information system through the neural network. The paper presents the security assessment model, its algorithm. The methodology practical implementation results in the form of the software flow diagram are represented. The practical significance of the model being developed is noted in conclusions.

Early warning of changing drinking water quality by trend analysis.

PubMed

Tomperi, Jani; Juuso, Esko; Leiviskä, Kauko

2016-06-01

Monitoring and control of water treatment plants play an essential role in ensuring high quality drinking water and avoiding health-related problems or economic losses. The most common quality variables, which can be used also for assessing the efficiency of the water treatment process, are turbidity and residual levels of coagulation and disinfection chemicals. In the present study, the trend indices are developed from scaled measurements to detect warning signs of changes in the quality variables of drinking water and some operating condition variables that strongly affect water quality. The scaling is based on monotonically increasing nonlinear functions, which are generated with generalized norms and moments. Triangular episodes are classified with the trend index and its derivative. Deviation indices are used to assess the severity of situations. The study shows the potential of the described trend analysis as a predictive monitoring tool, as it provides an advantage over the traditional manual inspection of variables by detecting changes in water quality and giving early warnings.

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.

Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.

PubMed

Farida, Helmia; Rondags, Angelique; Gasem, M Hussein; Leong, Katharina; Adityana, A; van den Broek, Peterhans J; Keuter, Monique; Natsch, Stephanie

2015-04-01

To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia. Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting. Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting. © 2014 John Wiley & Sons Ltd.

Practical application of the benchmarking technique to increase reliability and efficiency of power installations and main heat-mechanic equipment of thermal power plants

NASA Astrophysics Data System (ADS)

Rimov, A. A.; Chukanova, T. I.; Trofimov, Yu. V.

2016-12-01

Data on the comparative analysis variants of the quality of power installations (benchmarking) applied in the power industry is systematized. It is shown that the most efficient variant of implementation of the benchmarking technique is the analysis of statistical distributions of the indicators in the composed homogenous group of the uniform power installations. The benchmarking technique aimed at revealing the available reserves on improvement of the reliability and heat efficiency indicators of the power installations of the thermal power plants is developed in the furtherance of this approach. The technique provides a possibility of reliable comparison of the quality of the power installations in their homogenous group limited by the number and adoption of the adequate decision on improving some or other technical characteristics of this power installation. The technique provides structuring of the list of the comparison indicators and internal factors affecting them represented according to the requirements of the sectoral standards and taking into account the price formation characteristics in the Russian power industry. The mentioned structuring ensures traceability of the reasons of deviation of the internal influencing factors from the specified values. The starting point for further detail analysis of the delay of the certain power installation indicators from the best practice expressed in the specific money equivalent is positioning of this power installation on distribution of the key indicator being a convolution of the comparison indicators. The distribution of the key indicator is simulated by the Monte-Carlo method after receiving the actual distributions of the comparison indicators: specific lost profit due to the short supply of electric energy and short delivery of power, specific cost of losses due to the nonoptimal expenditures for repairs, and specific cost of excess fuel equivalent consumption. The quality loss indicators are developed facilitating the analysis of the benchmarking results permitting to represent the quality loss of this power installation in the form of the difference between the actual value of the key indicator or comparison indicator and the best quartile of the existing distribution. The uncertainty of the obtained values of the quality loss indicators was evaluated by transforming the standard uncertainties of the input values into the expanded uncertainties of the output values with the confidence level of 95%. The efficiency of the technique is demonstrated in terms of benchmarking of the main thermal and mechanical equipment of the extraction power-generating units T-250 and power installations of the thermal power plants with the main steam pressure 130 atm.

Population quality and sustainable development in Indonesia: notes on a framework for the discussion of policy issues.

PubMed

Hayes, A C

1990-12-01

A simple and far reaching framework is needed to indicate the interdisciplinary connections between issues of population, environment, society, and development. Policy makers must understand the holistic nature of these issues when they formulate programs and official proclamations. High population quality and sustainable development are the goals they are trying to achieve and only by drawing from various disciplines is this goal going to be achieved. State guidelines are the context in which issues from these different areas are discussed. Quality of life and sustainable development is a national objective and is a reflection of lifestyles and values of the people. The government knows that it must work in conjunction with its people in order to complete policy goals.

Studies on kinetics of water quality factors to establish water transparency model in Neijiang River, China.

PubMed

Li, Ronghui; Pan, Wei; Guo, Jinchuan; Pang, Yong; Wu, Jianqiang; Li, Yiping; Pan, Baozhu; Ji, Yong; Ding, Ling

2014-05-01

The basis for submerged plant restoration in surface water is to research the complicated dynamic mechanism of water transparency. In this paper, through the impact factor analysis of water transparency, the suspended sediment, dissolved organic matter, algae were determined as three main impactfactors for water transparency of Neijiang River in Eastern China. And the multiple regression equation of water transparency and sediment concentration, permanganate index, chlorophyll-a concentration was developed. Considering the complicated transport and transformation of suspended sediment, dissolved organic matter and algae, numerical model of them were developed respectively for simulating the dynamic process. Water transparency numerical model was finally developed by coupling the sediment, water quality, and algae model. These results showed that suspended sediment was a key factor influencing water transparency of Neijiang River, the influence of water quality indicated by chemical oxygen demand and algal concentration indicated by chlorophyll a were indeterminate when their concentrations were lower, the influence was more obvious when high concentrations are available, such three factors showed direct influence on water transparency.

Understanding and managing experiential aspects of soundscapes at Muir woods national monument.

PubMed

Pilcher, Ericka J; Newman, Peter; Manning, Robert E

2009-03-01

Research has found that human-caused noise can detract from the quality of the visitor experience in national parks and related areas. Moreover, impacts to the visitor experience can be managed by formulating indicators and standards of quality as suggested in park and outdoor recreation management frameworks, such as Visitor Experience and Resource Protection (VERP), as developed by the U.S. National Park Service. The research reported in this article supports the formulation of indicators and standards of quality for human-caused noise at Muir Woods National Monument, California. Phase I identified potential indicators of quality for the soundscape of Muir Woods. A visitor "listening exercise" was conducted, where respondents identified natural and human-caused sounds heard in the park and rated the degree to which each sound was "pleasing" or "annoying." Certain visitor-caused sounds such as groups talking were heard by most respondents and were rated as annoying, suggesting that these sounds may be a good indicator of quality. Loud groups were heard by few people but were rated as highly annoying, whereas wind and water were heard by most visitors and were rated as highly pleasing. Phase II measured standards of quality for visitor-caused noise. Visitors were presented with a series of 30-second audio clips representing increasing amounts of visitor-caused sound in the park. Respondents were asked to rate the acceptability of each audio clip on a survey. Findings suggest a threshold at which visitor-caused sound is judged to be unacceptable, and is therefore considered as noise. A parallel program of sound monitoring in the park found that current levels of visitor-caused sound sometimes violate this threshold. Study findings provide an empirical basis to help formulate noise-related indicators and standards of quality in parks and related areas.

Quality indicators for hip fracture care, a systematic review.

PubMed

Voeten, S C; Krijnen, P; Voeten, D M; Hegeman, J H; Wouters, M W J M; Schipper, I B

2018-05-17

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

PubMed

Jenkins, Kathy J; Koch Kupiec, Jennifer; Owens, Pamela L; Romano, Patrick S; Geppert, Jeffrey J; Gauvreau, Kimberlee

2016-05-20

The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Environmental Kuznets Curve Hypothesis: A Perspective of Sustainable Development in Indonesia

NASA Astrophysics Data System (ADS)

Nuansa, Citrasmara Galuh; Widodo, Wahyu

2018-02-01

Sustainable development with three main pillars, namely environmental, economic, and social, is the concept of country's development to achieve inclusive economic growth, good environmental quality, and improvement of people's welfare. However, the dominance of economic factors cause various environmental problem. This phenomenon occurs in most of developing countries, including in Indonesia. The relationship between economic activity and environmental quality has been widely discussed and empirically tested by scholars. This descriptive research analysed the hypothesis called Environmental Kuznets Curve (EKC) from a perspective of sustainable development in Indonesia. EKC hypothesis illustrates the relationship between economic growth and environmental degradation forming an inverted U-curve, indicating that at the beginning of development, environmental quality will decrease along with increasing economic growth, and then reached a certain point the environmental quality will gradually improve. In this paper will be discussed how the relationship between environmental quality and economic growth in Indonesia was investigated. The preliminary results show that most of the empirical studies use the conventional approach, in which the CO2 emission used as the proxy of environmental degradation. The existence of inverted U-curve is also inconclusive. Therefore, the extension research on the relationship between economic growth and environmental quality in Indonesia using the EKC hypothesis is required.

Water quality.

USGS Publications Warehouse

Steele, T.D.; Stefan, H.G.

1979-01-01

Significant contributions in the broad area of water quality over the quadrennium 1975-78 are highlighted. This summare is concerned primarily with physical and chemical aspects of water quality. The diversity of subject areas within the topic heading and the large volume of published research results necessitated the selection of representative contributions. Over 400 references are cited which are believed to be indicative of general trends in research and of the more important developments during this period.- from Authors

Timing of High-Quality Child Care and Cognitive, Language, and Preacademic Development

PubMed Central

Li, Weilin; Farkas, George; Duncan, Greg J.; Burchinal, Margaret R.; Vandell, Deborah Lowe

2014-01-01

The effects of high- versus low-quality child care during 2 developmental periods (infant–toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-quality care in both the infant–toddler and preschool periods, somewhat lower among children who experienced high-quality child care during only 1 of these periods, and lowest among children who experienced low-quality care during both periods. Irrespective of the care received during infancy–toddlerhood, high-quality preschool care was related to better language and preacademic outcomes at the end of the preschool period; high-quality infant–toddler care, irrespective of preschool care, was related to better memory skills at the end of the preschool period. PMID:23127299

A novel quality assurance method in a university teaching paediatric radiology department.

PubMed

Gallet, J M; Reed, M H; Hlady, J

2000-08-01

Primary diagnostic equipment in a paediatric radiology department must perform at optimal levels at all times. The Children's Hospital Radiology Department in Winnipeg, Canada, has developed an impartial means of reporting radiographic image quality. The main objectives of this study programme were two-fold. First, to monitor diagnostic X-ray equipment performance, and second, to improve the resultant image quality as a means of implementing the fundamental concepts of continuous quality improvement. Reading radiologists completed a quality assurance (QA) card when they identified a radiographic image quality problem. The cards were subsequently collected by the clinical instructor who then informed, in confidence, the radiographers of the written comments or concerns. QA cards have been conspicuously installed in the paediatric radiology reading room since the middle of 1993. Since its inception, equipment malfunction has been monitored and indicators for improving image quality developed. This component of the QA programme has shown itself to be a successful means of communicating with radiographers in maintaining superior image quality.

[Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation].

PubMed

Giraldes, Maria do Rosário

2008-01-01

To proceed to the evaluation of the efficiency and quality in the NHS, based in methodologies of evaluation of management, indicators of benchmarking and indicators of process and outcome. The 1980 and 1990 decades have seen the proliferation of all forms of process indicators as a way to control health services. It is not a coincidence that the increase in managed care has been accompanied by an explosion of process indicators, as it has happened in the health system of the USA. More recently the attention has turned away from measures of performance, which measure the process (what has been done) to those which measure outcomes (what was the result). Quality indicators have been developed in Europe, first to be used in hospitals, but also to be used in primary health care. Conceptually the justification for the introduction of process indicators comes from the principle that their use will reinforce a modification in the quality of the proceedings, which will give origin to better outcomes as well at population level, as resource saving. Outcome indicators compared with process indicators in health care shows that process indicators have the advantage of being more sensitive than outcome indicators to differences in the quality. Optimizing health care quality has the objective of establishing a quantitative relationship between the quality of the health services and cost-effectiveness. To identify quality indicators and benchmarking and to implement plans to measure the quality of health care. In a study made in a group of senior GP, in the UK, with the objective of determining which process indicators better reflect the quality of the services in primary health care services a Delphi method was used. Only seven indicators were chosen by 75% of the respondents: the percentage of eligible patients receiving cervical screening; the percentage of generic prescribing; the percentage of eligible patients receiving childhood immunization; the percentage of eligible patients receiving influenza vaccinations; ability to see GP within 48 hours; percentage prescribing antibacterial drugs; primary care management (diabetes and asthma). The main characteristics of health indicators are: acceptability--The acceptability of the data collected using a measure will depend upon the extent to which the findings are acceptable to both those being assessed and those undertaking the assessment; feasibility--information about the quality of services is often driven by data availability rather than by epidemiological and clinical considerations. Quality measurement cannot be achieved without accurate and consistent information systems; reliability--indicators should be used to compare organisations/practitioners with similar organisations/practitioners; sensitivity to change--quality measures must be capable of detecting changes in quality of care in order to discriminate between and within subjects; validity--there has been little methodological scrutiny of the validity of consensus methods. Outcome indicators are not good performance indicators in health care. Which causes the variation in outcomes between deliverers of primary health care services are the observed differences due to differences in users, due to age, sex, co-morbidity, severity and socio-economic situation. The Medical Outcomes Study, published in 1989, has brought, for the first time, subjective indicators, based in the evaluation of users, as an important outcome indicator. Clinical indicators are those that are more associated with the outcomes. A few studies exist of the effects of management indicators in outcomes. Several indicators, however, reflect norms related with the local of work. The use of a Composite Indicator presents advantages. In England it has been used a Composite Indicator of process indicators in 302 organizations of primary health care, in 2001-2002. This study has used a mathematical model to select the best indicators which allow the evaluation of performance. It has concluded that the use of a Composite Indicator is of easy construction, interpretation, and acceptable and that has validity. Giraldes (2007) has done an evaluation of health centres in a perspective of management and quality of deliver using a Composite Indicator of Efficiency and Quality. It includes the efficiency indicators concerned with the main activities of the health centre, preventive activities, curative activities and drugs, by main pharmaco therapeutic groups, and auxiliary means of diagnosis (analysis, X Ray, ecographies and CAT by user, weighted according to the relevance of the expenditure in total expenditure). The Composite Quality Indicator includes 12 performance and 5 outcome indicators. From the 10 best health centres in an efficiency and quality perspective 3 are from the Porto Sub-Region (Negrelos, Rebordosa and Paredes) and 2 from the Braga Sub-Region (Vila Verde and Vila Nova de Famalicão I), Leiria (Pedrogão Grande and Batalha), and Vila Real (Mesão Frio and Sabrosa), while 1 belongs to the Aveiro Sub-Region (Sever do Vouga). The more efficient health centres are from the Aveiro Sub-Region, followed by Braga, Porto, and Lisboa. Sub-Regions with very similar values. Giraldes (2007) has made an evaluation of the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc.) and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered; process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of cesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care. Those indicators have been aggregated, by a mean. The Composite Indicator of Efficiency and Quality is the mean of the Composite Indicator of Efficiency and the Composite Indicator of Quality, having this one been converted in inverse base.

Applying ethological and health indicators to practical animal welfare assessment.

PubMed

Wemelsfelder, F; Mullan, S

2014-04-01

There is a growing effort worldwide to develop objective indicators for animal welfare assessment, which provide information on an animal's quality of life, are scientifically trustworthy, and can readily be used in practice by professionals. Animals are sentient beings capable of positive and negative emotion, and so these indicators should be sensitive not only to their physical health, but also to their experience of the conditions in which they live. This paper provides an outline of ethological research aimed at developing practical welfare assessment protocols. The first section focuses on the development and validation of welfare indicators generally, in terms of their relevance to animal well-being, their interobserver reliability, and the confidence with which the prevalence of described features can be estimated. Challenges in this work include accounting for the ways in which welfare measures may fluctuate over time, and identifying measures suited to monitoring positive welfare states. The second section focuses more specifically on qualitative welfare indicators, which assess the 'whole animal' and describe the expressive qualities of its demeanour (e.g. anxious, content). Such indicators must be validated in the same way as other health and behaviour indicators, with the added challenge of finding appropriate methods of measurement. The potential contribution of qualitative indicators, however, is to disclose an emotional richness in animals that helps to interpret information provided by other indicators, thus enhancing the validity of welfare assessment protocols. In conclusion, the paper emphasises the importance of integrating such different perspectives, showing that new knowledge of animals and new ways of relating to animals are both needed for the successful development of practical welfare assessment tools.

If you can't measure it- you can't change it - a longitudinal study on improving quality of care in hospitals and health centers in rural Kenya.

PubMed

Marx, Michael; Nitschke, Christine; Nafula, Maureen; Nangami, Mabel; Brodowski, Marc; Marx, Irmgard; Prytherch, Helen; Kandie, Charles; Omogi, Irene; Paul-Fariborz, Friederike; Szecsenyi, Joachim

2018-04-05

The Kenyan Ministry of Health- Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end an integrated quality management system based on validated indicators derived from the Kenya Quality Model for Health (KQMH) was developed and adapted to the area of Reproductive and Maternal and Neonatal Health, implemented and analysed. An integrated quality management (QM) approach was developed based on European Practice Assessment (EPA) modified to the Kenyan context. It relies on a multi-perspective, multifaceted and repeated indicator based assessment, covering the 6 World Health Organization (WHO) building blocks. The adaptation process made use of a ten step modified RAND/UCLA appropriateness Method. To measure the 303 structure, process, outcome indicators five data collection tools were developed: surveys for patients and staff, a self-assessment, facilitator assessment, a manager interview guide. The assessment process was supported by a specially developed software (VISOTOOL®) that allows detailed feedback to facility staff, benchmarking and facilitates improvement plans. A longitudinal study design was used with 10 facilities (6 hospitals; 4 Health centers) selected out of 36 applications. Data was summarized using means and standard deviations (SDs). Categorical data was presented as frequency counts and percentages. A baseline assessment (T1) was carried out, a reassessment (T2) after 1.5 years. Results from the first and second assessment after a relatively short period of 1.5 years of improvement activities are striking, in particular in the domain 'Quality and Safety' (20.02%; p < 0.0001) with the dimensions: use of clinical guidelines (34,18%; p < 0.0336); Infection control (23,61%; p < 0.0001). Marked improvements were found in the domains 'Clinical Care' (10.08%; p = 0.0108), 'Management' (13.10%: p < 0.0001), 'Interface In/out-patients' (13.87%; p = 0.0246), and in total (14.64%; p < 0.0001). Exemplarily drilling down the domain 'clinical care' significant improvements were observed in the dimensions 'Antenatal care' (26.84%; p = 0.0059) and 'Survivors of gender-based violence' (11.20%; p = 0.0092). The least marked changes or even a -not significant- decline of some was found in the dimensions 'delivery' and 'postnatal care'. This comprehensive quality improvement approach breathes life into the process of collecting data for indicators and creates ownership among users and providers of health services. It offers a reflection on the relevance of evidence-based quality improvement for health system strengthening and has the potential to lay a solid ground for further certification and accreditation.

Evaluation of global water quality - the potential of a data- and model-driven analysis

NASA Astrophysics Data System (ADS)

Bärlund, Ilona; Flörke, Martina; Alcamo, Joseph; Völker, Jeanette; Malsy, Marcus; Kaus, Andrew; Reder, Klara; Büttner, Olaf; Katterfeld, Christiane; Dietrich, Désirée; Borchardt, Dietrich

2016-04-01

The ongoing socio-economic development presents a new challenge for water quality worldwide, especially in developing and emerging countries. It is estimated that due to population growth and the extension of water supply networks, the amount of waste water will rise sharply. This can lead to an increased risk of surface water quality degradation, if the wastewater is not sufficiently treated. This development has impacts on ecosystems and human health, as well as food security. The United Nations Member States have adopted targets for sustainable development. They include, inter alia, sustainable protection of water quality and sustainable use of water resources. To achieve these goals, appropriate monitoring strategies and the development of indicators for water quality are required. Within the pre-study for a 'World Water Quality Assessment' (WWQA) led by United Nations Environment Programme (UNEP), a methodology for assessing water quality, taking into account the above-mentioned objectives has been developed. The novelty of this methodology is the linked model- and data-driven approach. The focus is on parameters reflecting the key water quality issues, such as increased waste water pollution, salinization or eutrophication. The results from the pre-study show, for example, that already about one seventh of all watercourses in Latin America, Africa and Asia show high organic pollution. This is of central importance for inland fisheries and associated food security. In addition, it could be demonstrated that global water quality databases have large gaps. These must be closed in the future in order to obtain an overall picture of global water quality and to target measures more efficiently. The aim of this presentation is to introduce the methodology developed within the WWQA pre-study and to show selected examples of application in Latin America, Africa and Asia.

Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres.

PubMed

Katsarava, Zaza; Gouveia, Raquel Gil; Jensen, Rigmor; Gaul, Charly; Schramm, Sara; Schoppe, Anja; Steiner, Timothy J

2015-01-01

Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages.

A novel approach in water quality assessment based on fuzzy logic.

PubMed

Gharibi, Hamed; Mahvi, Amir Hossein; Nabizadeh, Ramin; Arabalibeik, Hossein; Yunesian, Masud; Sowlat, Mohammad Hossein

2012-12-15

The present work aimed at developing a novel water quality index based on fuzzy logic, that is, a comprehensive artificial intelligence (AI) approach to the development of environmental indices for routine assessment of surface water quality, particularly for human drinking purposes. Twenty parameters were included based on their critical importance for the overall water quality and their potential impact on human health. To assess the performance of the proposed index under actual conditions, a case study was conducted at Mamloo dam, Iran, employing water quality data of four sampling stations in the water basin of the dam from 2006 to 2009. Results of this study indicated that the general quality of water in all the sampling stations over all the years of the study period is fairly low (yearly averages are usually in the range of 45-55). According to the results of ANOVA test, water quality did not significantly change over time in any of the sampling stations (P > 0.05). In addition, comparison of the outputs of the fuzzy-based proposed index proposed with those of the NSF water quality index (the WQI) and Canadian Water Quality Index (CWQI) showed similar results and were sensitive to changes in the level of water quality parameters. However, the index proposed by the present study produced a more stringent outputs compared to the WQI and CWQI. Results of the sensitivity analysis suggested that the index is robust against the changes in the rules. In conclusion, the proposed index seems to produce accurate and reliable results and can therefore be used as a comprehensive tool for water quality assessment, especially for the analysis of human drinking water. Copyright © 2012 Elsevier Ltd. All rights reserved.

Emerging importance of geographical indications and designations of origin - authenticating geo-authentic botanicals and implications for phytotherapy.

PubMed

Brinckmann, J A

2013-11-01

Pharmacopoeial monographs providing specifications for composition, identity, purity, quality, and strength of a botanical are developed based on analysis of presumably authenticated botanical reference materials. The specimens should represent the quality traditionally specified for the intended use, which may require different standards for medicinal versus food use. Development of quality standards monographs may occur through collaboration between a sponsor company or industry association and a pharmacopoeial expert committee. The sponsor may base proposed standards and methods on their own preferred botanical supply which may, or may not, be geo-authentic and/or correspond to qualities defined in traditional medicine formularies and pharmacopoeias. Geo-authentic botanicals are those with specific germplasm, cultivated or collected in their traditional production regions, of a specified biological age at maturity, with specific production techniques and processing methods. Consequences of developing new monographs that specify characteristics of an 'introduced' cultivated species or of a material obtained from one unique origin could lead to exclusion of geo-authentic herbs and may have therapeutic implications for clinical practice. In this review, specifications of selected medicinal plants with either a geo-authentic or geographical indication designation are discussed and compared against official pharmacopoeial standards for same genus and species regardless of origin. Copyright © 2012 John Wiley & Sons, Ltd.

Developing a Dynamic SPARROW Water Quality Decision Support System Using NASA Remotely-Sensed Products

NASA Astrophysics Data System (ADS)

Al-Hamdan, M. Z.; Smith, R. A.; Hoos, A.; Schwarz, G. E.; Alexander, R. B.; Crosson, W. L.; Srikishen, J.; Estes, M., Jr.; Cruise, J.; Al-Hamdan, A.; Ellenburg, W. L., II; Flores, A.; Sanford, W. E.; Zell, W.; Reitz, M.; Miller, M. P.; Journey, C. A.; Befus, K. M.; Swann, R.; Herder, T.; Sherwood, E.; Leverone, J.; Shelton, M.; Smith, E. T.; Anastasiou, C. J.; Seachrist, J.; Hughes, A.; Graves, D.

2017-12-01

The USGS Spatially Referenced Regression on Watershed Attributes (SPARROW) surface water quality modeling system has been widely used for long term, steady state water quality analysis. However, users have increasingly requested a dynamic version of SPARROW that can provide seasonal estimates of nutrients and suspended sediment to receiving waters. The goal of this NASA-funded project is to develop a dynamic decision support system to enhance the southeast SPARROW water quality model and finer-scale dynamic models for selected coastal watersheds through the use of remotely-sensed data and other NASA Land Information System (LIS) products. The spatial and temporal scale of satellite remote sensing products and LIS modeling data make these sources ideal for the purposes of development and operation of the dynamic SPARROW model. Remote sensing products including MODIS vegetation indices, SMAP surface soil moisture, and OMI atmospheric chemistry along with LIS-derived evapotranspiration (ET) and soil temperature and moisture products will be included in model development and operation. MODIS data will also be used to map annual land cover/land use in the study areas and in conjunction with Landsat and Sentinel to identify disturbed areas that might be sources of sediment and increased phosphorus loading through exposure of the bare soil. These data and others constitute the independent variables in a regression analysis whose dependent variables are the water quality constituents total nitrogen, total phosphorus, and suspended sediment. Remotely-sensed variables such as vegetation indices and ET can be proxies for nutrient uptake by vegetation; MODIS Leaf Area Index can indicate sources of phosphorus from vegetation; soil moisture and temperature are known to control rates of denitrification; and bare soil areas serve as sources of enhanced nutrient and sediment production. The enhanced SPARROW dynamic models will provide improved tools for end users to manage water quality in near real time and for the formulation of future scenarios to inform strategic planning. Time-varying SPARROW outputs will aid water managers in decision making regarding allocation of resources in protecting aquatic habitats, planning for harmful algal blooms, and restoration of degraded habitats, stream segments, or lakes.

Measuring Value Added in Higher Education: A Proposed Methodology for Developing a Performance Indicator Based on the Economic Value Added to Graduates

ERIC Educational Resources Information Center

Rodgers, Timothy

2007-01-01

The 2003 UK higher education White Paper suggested that the sector needed to re-examine the potential of the value added concept. This paper describes a possible methodology for developing a performance indicator based on the economic value added to graduates. The paper examines how an entry-quality-adjusted measure of a graduate's…

Toward an Understanding of the Environmental and Public Health Impacts of Unconventional Natural Gas Development: A Categorical Assessment of the Peer-Reviewed Scientific Literature, 2009-2015.

PubMed

Hays, Jake; Shonkoff, Seth B C

2016-01-01

The body of science evaluating the potential impacts of unconventional natural gas development (UNGD) has grown significantly in recent years, although many data gaps remain. Still, a broad empirical understanding of the impacts is beginning to emerge amidst a swell of research. The present categorical assessment provides an overview of the peer-reviewed scientific literature from 2009-2015 as it relates to the potential impacts of UNGD on public health, water quality, and air quality. We have categorized all available original research during this time period in an attempt to understand the weight and direction of the scientific literature. Our results indicate that at least 685 papers have been published in peer-reviewed scientific journals that are relevant to assessing the impacts of UNGD. 84% of public health studies contain findings that indicate public health hazards, elevated risks, or adverse health outcomes; 69% of water quality studies contain findings that indicate potential, positive association, or actual incidence of water contamination; and 87% of air quality studies contain findings that indicate elevated air pollutant emissions and/or atmospheric concentrations. This paper demonstrates that the weight of the findings in the scientific literature indicates hazards and elevated risks to human health as well as possible adverse health outcomes associated with UNGD. There are limitations to this type of assessment and it is only intended to provide a snapshot of the scientific knowledge based on the available literature. However, this work can be used to identify themes that lie in or across studies, to prioritize future research, and to provide an empirical foundation for policy decisions.

Dairy intensification in developing countries: effects of market quality on farm-level feeding and breeding practices.

PubMed

Duncan, A J; Teufel, N; Mekonnen, K; Singh, V K; Bitew, A; Gebremedhin, B

2013-12-01

Smallholder dairy production represents a promising income generating activity for poor farmers in the developing world. Because of the perishable nature of milk, marketing arrangements for collection, distribution and sale are important for enhanced livelihoods in the smallholder dairy sector. In this study we examined the relationship between market quality and basic feeding and breeding practices at farm level. We define market quality as the attractiveness and reliability of procurement channels and associated input supply arrangements. We took as our study countries, India with its well-developed smallholder dairy sector, and Ethiopia where the smallholder dairy industry has remained relatively undeveloped despite decades of development effort. We conducted village surveys among producer groups in 90 villages across three States in India and two Regions in Ethiopia. Producer groups were stratified according to three levels of market quality - high, medium and low. Data showed that diet composition was relatively similar in India and Ethiopia with crop residues forming the major share of the diet. Concentrate feeding tended to be more prominent in high market quality sites. Herd composition changed with market quality with more dairy (exotic) cross-bred animals in high market quality sites in both India and Ethiopia. Cross-bred animals were generally more prominent in India than Ethiopia. Herd performance within breed did not change a great deal along the market quality gradient. Parameters such as calving interval and milk yield were relatively insensitive to market quality. Insemination of cross-bred cows was predominantly by artificial insemination (AI) in India and accounted for around half of cross-bred cow inseminations in Ethiopia. Data on perceptions of change over the last decade indicated that per herd and per cow productivity are both increasing in high market quality sites with a more mixed picture in medium and low-quality sites. Similarly dairy-derived income is on the increase in high market quality sites. This is accompanied by a strong increase in stall feeding at the expense of grazing. The study indicates that the first constraint to intensification of dairy production in Ethiopia is the genetic quality of the herd. There is less scope for improved AI provision in India since the cross-bred herd is mainly serviced by AI already. However, as for Ethiopia, there is considerable scope for closing yield gaps in India through improved feed use and supply. Results strongly show that well-developed markets with good procurement arrangements are key for sustainable dairy intensification.

Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

PubMed

Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

2018-02-01

Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review. Overall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized. Howard I , Cameron P , Wallis L , Castren M , Lindstrom V . Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43-52.

Investigation of environmental indices from the Earth Resources Technology Satellite. [environmental trends in land use water quality, and air quality in Pennsylvania

NASA Technical Reports Server (NTRS)

Greeley, R. S. (Principal Investigator); Ward, E. A.; Elliott, J. C.; Friedman, E. J.; Riley, E. L.; Stryker, S.

1974-01-01

The author has identified the following significant results. Land use change, water quality, and air quality indices have been calculated from analysis of ERTS-1 multispectral scanning imagery and computer compatible tapes. Specifications have been developed and discussed for an ERTS-1 environmental monitoring system which help to serve the information needs of environmental managers at the Federal, state, regional, and local level. General conclusions of the investigation are that ERTS-1 data is very useful in land use mapping and updating to 10-15 categories, and can provide an overall measure of air and water turbidity; however, more and better ground truth and possibly additional spacecraft sensors will be required if specific air and water pollutants are to be quantified from satellite data.

Rapid integrated water quality evaluation of Mahisagar river using benthic macroinvertebrates.

PubMed

Bhadrecha, M H; Khatri, Nitasha; Tyagi, Sanjiv

2016-04-01

The water quality of Mahisagar river, near Galteshwar in Kheda district of Gujarat, India, was assessed through a rapid integrated technique by physicochemical parameters as well as benthic macroinvertebrates. Physicochemical parameters retrieved were pH, color, conductivity, total solids, total suspended solids, total dissolved solids, chlorides, total hardness, calcium hardness, magnesium hardness, alkalinity, turbidity, ammoniacal nitrogen, chemical oxygen demand, biochemical oxygen demand, dissolved oxygen, sulfates, and nitrates. The biological indices calculated were BMWP (Bio Monitoring Working Party) score or saprobic score and sequential comparison index or diversity score. In total, 37 families were encountered along the studied river stretch. The findings indicate that the water quality of Mahisagar river at sampled locations is “slightly polluted.” Moreover, the results of physicochemical analysis are also in consonance with the biological water quality criteria developed by Central Pollution Control Board.

The soil indicator of forest health in the Forest Inventory and Analysis Program

Treesearch

Michael C. Amacher; Charles H. Perry

2010-01-01

Montreal Process Criteria and Indicators (MPCI) were established to monitor forest conditions and trends to promote sustainable forest management. The Soil Indicator of forest health was developed and implemented within the USFS Forest Inventory and Analysis (FIA) program to assess condition and trends in forest soil quality in U.S. forests regardless of ownership. The...

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

PubMed

Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

2017-01-01

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

[Management systems of the quality of health care in Quebec hospitals].

PubMed

François, P

2001-03-31

The aim of this study was to take stock of the development of quality management systems in the Quebec health care services. The study relied on semi-guided interviews and on a documentary analysis. It concerned the structure and the activity of quality management in 4 Montreal university hospitals as well as on outside organizations dealing with quality of care. Quality management of the health care services is dealt with by council on health care accreditation and regional health and social services agencies. In hospitals, the quality of services is managed by structures created by the administration council and the top management: the piloting committee, the head of quality assurance, the executive committees and the multidisciplinary team or self-evaluation of the hospital, and development of plans for improvement. Other activities are management of complaints, users satisfaction evaluation and follow-up of indicators. This system of quality management of services is currently expanding. This change of paradigm leads to accepting the view of services users and to change quality management methods. Those methods have evolved from normative approach to a continuous quality improvement approach.

Genome-wide identification of multifunctional laccase gene family in cotton (Gossypium spp.); expression and biochemical analysis during fiber development

PubMed Central

Balasubramanian, Vimal Kumar; Rai, Krishan Mohan; Thu, Sandi Win; Hii, Mei Mei; Mendu, Venugopal

2016-01-01

The single-celled cotton fibers, produced from seed coat epidermal cells are the largest natural source of textile fibers. The economic value of cotton fiber lies in its length and quality. The multifunctional laccase enzymes play important roles in cell elongation, lignification and pigmentation in plants and could play crucial role in cotton fiber quality. Genome-wide analysis of cultivated allotetraploid (G. hirsutum) and its progenitor diploid (G. arboreum and G. raimondii) cotton species identified 84, 44 and 46 laccase genes, respectively. Analysis of chromosomal location, phylogeny, conserved domain and physical properties showed highly conserved nature of laccases across three cotton species. Gene expression, enzymatic activity and biochemical analysis of developing cotton fibers was performed using G. arboreum species. Of the total 44, 40 laccases showed expression during different stages of fiber development. The higher enzymatic activity of laccases correlated with higher lignin content at 25 DPA (Days Post Anthesis). Further, analysis of cotton fiber phenolic compounds showed an overall decrease at 25 DPA indicating possible incorporation of these substrates into lignin polymer during secondary cell wall biosynthesis. Overall data indicate significant roles of laccases in cotton fiber development, and presents an excellent opportunity for manipulation of fiber development and quality. PMID:27679939

Natural language processing in an intelligent writing strategy tutoring system.

PubMed

McNamara, Danielle S; Crossley, Scott A; Roscoe, Rod

2013-06-01

The Writing Pal is an intelligent tutoring system that provides writing strategy training. A large part of its artificial intelligence resides in the natural language processing algorithms to assess essay quality and guide feedback to students. Because writing is often highly nuanced and subjective, the development of these algorithms must consider a broad array of linguistic, rhetorical, and contextual features. This study assesses the potential for computational indices to predict human ratings of essay quality. Past studies have demonstrated that linguistic indices related to lexical diversity, word frequency, and syntactic complexity are significant predictors of human judgments of essay quality but that indices of cohesion are not. The present study extends prior work by including a larger data sample and an expanded set of indices to assess new lexical, syntactic, cohesion, rhetorical, and reading ease indices. Three models were assessed. The model reported by McNamara, Crossley, and McCarthy (Written Communication 27:57-86, 2010) including three indices of lexical diversity, word frequency, and syntactic complexity accounted for only 6% of the variance in the larger data set. A regression model including the full set of indices examined in prior studies of writing predicted 38% of the variance in human scores of essay quality with 91% adjacent accuracy (i.e., within 1 point). A regression model that also included new indices related to rhetoric and cohesion predicted 44% of the variance with 94% adjacent accuracy. The new indices increased accuracy but, more importantly, afford the means to provide more meaningful feedback in the context of a writing tutoring system.

A systematic review of diet quality indices in relation to obesity.

PubMed

Asghari, Golaleh; Mirmiran, Parvin; Yuzbashian, Emad; Azizi, Fereidoun

2017-04-01

Tools, called 'diet/dietary quality indices', evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

Evaluation of biologic occupational risk control practices: quality indicators development and validation.

PubMed

Takahashi, Renata Ferreira; Gryschek, Anna Luíza F P L; Izumi Nichiata, Lúcia Yasuko; Lacerda, Rúbia Aparecida; Ciosak, Suely Itsuko; Gir, Elucir; Padoveze, Maria Clara

2010-05-01

There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists' assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. The developed indicators were considered validated, and the method used for construction and validation proved to be effective. Copyright (c) 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

County-level cumulative environmental quality associated with cancer incidence.

PubMed

Jagai, Jyotsna S; Messer, Lynne C; Rappazzo, Kristen M; Gray, Christine L; Grabich, Shannon C; Lobdell, Danelle T

2017-08-01

Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains. The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with domain-specific indices and analyses were stratified by rural/urban status. Comparing the highest quintile/poorest environmental quality with the lowest quintile/best environmental quality for overall EQI, all-site county-level cancer incidence rate was positively associated with poor environmental quality overall (IRD, 38.55; 95% CI, 29.57-47.53) and for male (IRD, 32.60; 95% CI, 16.28-48.91) and female (IRD, 30.34; 95% CI, 20.47-40.21) subjects, indicating a potential increase in cancer incidence with decreasing environmental quality. Rural/urban stratified models demonstrated positive associations comparing the highest with the lowest quintiles for all strata, except the thinly populated/rural stratum and in the metropolitan/urbanized stratum. Prostate and breast cancer demonstrated the strongest positive associations with poor environmental quality. We observed strong positive associations between the EQI and all-site cancer incidence rates, and associations differed by rural/urban status and environmental domain. Research focusing on single environmental exposures in cancer development may not address the broader environmental context in which cancers develop, and future research should address cumulative environmental exposures. Cancer 2017;123:2901-8. © 2017 American Cancer Society. © 2017 American Cancer Society.

Global access to safe water: accounting for water quality and the resulting impact on MDG progress.

PubMed

Onda, Kyle; LoBuglio, Joe; Bartram, Jamie

2012-03-01

Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as "improved" or "unimproved" as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF "Rapid Assessment of Drinking Water Quality". A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator "use of an improved source" suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety.

[Family physicians attitude towards quality indicator program].

PubMed

Shani, Michal; Nakar, Sasson; Azuri, Yossi

2012-10-01

Quality indicator programs for primary care are implanted throughout the world improving quality in health care. In this study, we have assessed family physicians attitudes towards the quality indicators program in Israel. Questionnaires were distributed to family physicians in various continuing educational programs. The questionnaire addressed demographics, whether the physician dealt with quality indicators, time devoted by the physician to quality indicators, pressure placed on the physician related to quality indicators, and the working environment. A total of 140 questionnaires were distributed and 91 (65%) were completed. The average physician age was 49 years (range 33-65 years]; the average working experience as a family physician was 17.8 years (range 0.5-42); 58 physicians were family medicine specialist (65.9%). Quality indicators were part of the routine work of 94% of the physicians; 72% of the physicians noted the importance of quality indicators; 84% of the physicians noted that quality indicators demand better team work; 76% of the physicians noted that quality indicators have reduced their professional independence. Pressure to deal with quality indicators was noted by 72% of the family physicians. Pressure to deal with quality indicators was related to reduced loyalty to their employer (P = 0.001), reducing their interest to practice family medicine (p < 0.001), and increasing their burnout at work (p = 0.001). It is important that policy makers find the way to leverage the advantages of quality indicator programs, without creating a heavy burden on the work of family physicians.

FROM DATA TO INFORMATION: DEVELOPMENT OF INTEGRATIVE HABITAT INDICES FOR GREAT RIVER ECOSYSTEMS

EPA Science Inventory

This research will look at ways to combine data from the EMAP-GRE 2004 and 2005 sampling seasons of the Missouri, Upper Mississippi, and Ohio Rivers into habitat indices that can be used to compare erosion potential, storm runoff retention ability, riparian habitat quality, and h...

Social Indicators, Policy Analysis and Simulation.

ERIC Educational Resources Information Center

Little, Dennis

1972-01-01

A secondary-level simulation designed to demonstrate the impact of policy, values, and technological and societal developments upon the quality of life within a hypothetical state is described. See related document ED 064 865 for availability of the actual game. By simulating the evaluation of policies in terms of social indicators, STAPOL (State…

Measuring the Quality of Schools = Mesurer la Qualite des Establissements Scolaires.

ERIC Educational Resources Information Center

Organisation for Economic Cooperation and Development, Paris (France). Centre for Educational Research and Innovation.

As part of the Organisation for Economic Cooperation and Development project on international educational indicators, four networks were formed to represent different domains. This collection contains background papers that were prepared to deal with some of the fundamental questions about process indicators examined by Network "C," the…

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

PubMed

Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.

Internet Service Cognition and Use, and Their Promotion of Quality of Life in Taiwan

ERIC Educational Resources Information Center

Liang, Te-Hsin

2011-01-01

The "e-Taiwan Program" implemented by Taiwan government is aimed at showing the e-advantage in people's life and bring about essential benefits. This research follows the e-Life indicators of the Quality of Life measurement system developed by "e-Taiwan Program", which including four major dimensions of e-Daily Life,…

Full-Day Kindergarten: A Look across the States. 50-State Review

ERIC Educational Resources Information Center

Parker, Emily; Diffey, Louisa; Atchison, Bruce

2016-01-01

Research indicates that a high-quality, full-day kindergarten experience is a crucial component to setting students up for ongoing academic success, yet vast differences exist in the quality of kindergarten programs and how they are funded across the states. As states continue to develop strong pre-kindergarten (pre-K) programs, many are also…

Gender Differences in Mathematics Achievement in Jordan: A Differential Item Functioning Analysis of the 2015 TIMSS

ERIC Educational Resources Information Center

Innabi, Hanan; Dodeen, Hamzeh

2018-01-01

This study is within the framework of the United Nations sustainable development goals related to equitable quality education. The total score on the 2015 Trends in International Mathematics and Science Study that indicated eighth-grade girls in Jordan significantly outperformed boys is hiding many details related to the quality of mathematics…

Thinking Critically about Data Displays

ERIC Educational Resources Information Center

Duesbery, Luke; Braun-Monegan, Jenelle; Liu, Kimy; McCoy, Jan

2017-01-01

The quality of a data display can have an impact on the interpretation of those data. A survey of the literature indicates that data displays can vary in quality of accuracy, clarity, and efficacy. In this study we develop and apply an evaluative rubric to graphs in a sample of six education journals: three research and three practitioner. Results…

The Quality-of-Life (QOL) Research Movement: Past, Present, and Future

ERIC Educational Resources Information Center

Sirgy, M. Joseph; Michalos, Alex C.; Ferriss, Abbott L.; Easterlin, Richard A.; Pavot, William; Patrick, Donald

2006-01-01

The purpose of this paper is to trace the history of the social indicators or quality-of-life (QOL) research movement up to today, forecast future developments, and pave the way for future growth. Broadly speaking, we tried to review historical antecedents from the point of view of different disciplines, with specialists in each discipline…

Homework Works If Homework Quality Is High: Using Multilevel Modeling to Predict the Development of Achievement in Mathematics

ERIC Educational Resources Information Center

Dettmers, Swantje; Trautwein, Ulrich; Ludtke, Oliver; Kunter, Mareike; Baumert, Jurgen

2010-01-01

The present study examined the associations of 2 indicators of homework quality (homework selection and homework challenge) with homework motivation, homework behavior, and mathematics achievement. Multilevel modeling was used to analyze longitudinal data from a representative national sample of 3,483 students in Grades 9 and 10; homework effects…

Hackneyed, Acned, or Just Plain Good: Perceiving Quality in Young Adult Fiction.

ERIC Educational Resources Information Center

Agee, Hugh

A rating scale was developed by Stephen Dunning for evaluating adolescent literature objectively. The distinguishing features of the scale's five categories are designed to produce a numerical score between 5 and 25 (each category a 1-to-5 ranking for poor/excellent quality), indicating the relative worth of a specific literary work. The first…

Translating Oral Health-Related Quality of Life Measures: Are There Alternative Methodologies?

ERIC Educational Resources Information Center

Brondani, Mario; He, Sarah

2013-01-01

Translating existing sociodental indicators to another language involves a rigorous methodology, which can be costly. Free-of-charge online translator tools are available, but have not been evaluated in the context of research involving quality of life measures. To explore the value of using online translator tools to develop oral health-related…

Ground-water hydrology and water quality of Irwin Basin at Fort Irwin National Training Center, California

USGS Publications Warehouse

Densmore, Jill N.; Londquist, Clark J.

1997-01-01

Geohydrologic data were collected from Irwin Basin at Fort Irwin National Training Center in the Mojave Desert of southern California by the U.S. Geological Survey during 199296 to deter mine the quantity and quality of ground water available in this basin. In addition to data collected from existing wells and test holes, 17 monitoring sites were constructed in Irwin Basin to provide data on subsurface geology, ground-water levels, and ground-water quality. Eleven of these sites were multiple-well monitoring sites that were constructed to provide depth-dependent geohydrologic data in the aquifer system. The aquifer system of Irwin Basin, defined on the basis of hydrologic data collected from wells in Irwin Basin, consists of an upper and a lower aquifer. A 1994 water-table contour map shows that a cone of depression beneath Irwin Basin well field has developed as a result of ground-water development. Water-quality samples collected from Irwin Basin wells to determine potential sources of ground-water degradation indicate that water in three areas in the basin contains high nitrate and dissolved-solids concentrations. The stable isotopes of oxygen and hydrogen indicate that present-day precipitation is not a major source of recharge in this basin. Tritium and carbon-14 data indicate that most of the basin was recharged before 1953 and that this water may be more than 14,000 years old.

Hydraulic and water-quality data collection for the investigation of Great Lakes tributaries for Asian carp spawning and egg-transport suitability

USGS Publications Warehouse

Murphy, Elizabeth A.; Jackson, P. Ryan

2013-01-01

While hydraulic data from all four rivers indicated settling of eggs is possible in some locations, all four rivers also exhibited sufficient temperatures, water-quality characteristics, turbulence, and transport times outside of settling zones for successful suspension and development of Asian carp eggs to the hatching stage before the threat of settlement. These observed data indicate that these four Great Lakes tributaries have sufficient hydraulic and water-quality characteristics to support successful spawning and recruitment of Asian carps. The data indicate that with the right temperature and flow conditions, river reaches as short as 25 km may allow Asian carp eggs sufficient time to develop to hatching. Additionally, examining the relation between critical shear velocity and mean velocity, egg settling appears to take place at mean velocities in the range of 15–25 centimeters per second, a much lower value than is generally cited in the literature. A first-order estimate of the minimum transport velocity for Asian carp eggs in a river can be obtained by using mean flow depth and river substrate data, and curves were constructed to show this relation. These findings would expand the number of possible tributaries suitable for Asian carp spawning and contribute to the understanding of how hydraulic and water-quality information can be used to screen additional rivers in the future.

The impact of urbanization on CO2 emissions in China: an empirical study using 1980-2014 provincial data.

PubMed

Wang, Shijin; Li, Cunfang

2018-01-01

Towns and cities are not only the focus of attention for their consumption of energy and resources; they are also scrutinized closely for their emissions of greenhouse gases. China's urbanization level now exceeds 50%, but there is still much disparity compared with the level of urbanization in developed countries. This study selects China's urban population and carbon emissions data for the years 1980-2014 and discusses the timing and cause effect of urbanization and the corresponding carbon emissions using the Granger causality test and an error correction model (ECM) then uses STIRPAT models to extract six indicators to measure the quality of urbanization, namely, the level of urbanization, area of built-up regions, added value of tertiary industries, disposable income per capita, green areas per capita, and energy intensity. These six indicators represent population agglomeration, the expansion of urban areas, industrial agglomeration, quality of life improvements, ecological conservation, and technological improvements, respectively. The study divides 29 provinces in China into three groups based on the quality of urbanization and analyzes the impacts of the six indicators of urbanization quality on carbon emissions. The findings show that the impacts of different factors on carbon emissions vary substantially among the provinces. Finally, the study uses the findings to give suggestions on how to develop low-carbon urbanization.

Identification of sensitive indicators to assess the interrelationship between soil quality, management practices and human health

NASA Astrophysics Data System (ADS)

Zornoza, R.; Acosta, J. A.; Bastida, F.; Domínguez, S. G.; Toledo, D. M.; Faz, A.

2014-09-01

Soil quality (SQ) assessment has been a challenging issue since soils present high variability in properties and functions. This paper aims to increase understanding of SQ through review of SQ assessments in different scenarios providing evidence about the interrelationship between SQ, land use and human health. There is a general consensus that there is a need to develop methods to assess and monitor SQ for assuring sustainable land use with no prejudicial effects on human health. This review points out the importance of adopting indicators of different nature (physical, chemical and biological) to achieve a holistic image of SQ. Most authors use single indicators to assess SQ and its relationship with land uses, being the most used indicators soil organic carbon and pH. The use of nitrogen and nutrients content has resulted sensitive for agricultural and forest systems, together with physical properties such as texture, bulk density, available water and aggregate stability. These physical indicators have also been widely used to assess SQ after land use changes. The use of biological indicators is less generalized, being microbial biomass and enzyme activities the most selected indicators. Although most authors assess SQ using independent indicators, it is preferable to combine some of them into models to create a soil quality index (SQI), since it provides integrated information about soil processes and functioning. The majority of revised articles used the same methodology to establish a SQI, based on scoring and weighting of different soil indicators, selected by multivariate analyses. The use of multiple linear regressions has been successfully used under forest land use. Urban soil quality has been poorly assessed, with lack of adoption of SQIs. In addition, SQ assessments were human health indicators or exposure pathways are incorporated are practically inexistent. Thus, new efforts should be carried out to establish new methodologies not only to assess soil quality in terms of sustainability, productivity and ecosystems quality, but also human health. Additionally, new challenges arise with the use and integration into SQIs of stable isotopic, genomic, proteomic and spectroscopy data.

Identification of sensitive indicators to assess the interrelationship between soil quality, management practices and human health

NASA Astrophysics Data System (ADS)

Zornoza, R.; Acosta, J. A.; Bastida, F.; Domínguez, S. G.; Toledo, D. M.; Faz, A.

2015-02-01

Soil quality (SQ) assessment has long been a challenging issue, since soils present high variability in properties and functions. This paper aims to increase the understanding of SQ through the review of SQ assessments in different scenarios providing evidence about the interrelationship between SQ, land use and human health. There is a general consensus that there is a need to develop methods to assess and monitor SQ for assuring sustainable land use with no prejudicial effects on human health. This review points out the importance of adopting indicators of different nature (physical, chemical and biological) to achieve a holistic image of SQ. Most authors use single indicators to assess SQ and its relationship with land uses - soil organic carbon and pH being the most used indicators. The use of nitrogen and nutrient content has resulted sensitive for agricultural and forest systems, together with physical properties such as texture, bulk density, available water and aggregate stability. These physical indicators have also been widely used to assess SQ after land use changes. The use of biological indicators is less generalized, with microbial biomass and enzyme activities being the most selected indicators. Although most authors assess SQ using independent indicators, it is preferable to combine some of them into models to create a soil quality index (SQI), since it provides integrated information about soil processes and functioning. The majority of revised articles used the same methodology to establish an SQI, based on scoring and weighting of different soil indicators, selected by means of multivariate analyses. The use of multiple linear regressions has been successfully used for forest land use. Urban soil quality has been poorly assessed, with a lack of adoption of SQIs. In addition, SQ assessments where human health indicators or exposure pathways are incorporated are practically inexistent. Thus, further efforts should be carried out to establish new methodologies to assess soil quality not only in terms of sustainability, productivity and ecosystem quality but also human health. Additionally, new challenges arise with the use and integration of stable isotopic, genomic, proteomic and spectroscopic data into SQIs.

[Evaluating the rehabilitation process by means of peer review: examination of the methods used and findings of the 2000/2001 data collection in the somatic indications].

PubMed

Farin, E; Carl, C; Lichtenberg, S; Jäckel, W H; Maier-Riehle, B; Rütten-Köppel, E

2003-12-01

This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

PubMed

Kwast, B E

1998-12-01

As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

Responses of physical, chemical, and biological indicators of water quality to a gradient of agricultural land use in the Yakima River Basin, Washington

USGS Publications Warehouse

Cuffney, T.F.; Meador, M.R.; Porter, S.D.; Gurtz, M.E.

2000-01-01

The condition of 25 stream sites in the Yakima River Basin, Washington, were assessed by the U.S. Geological Survey's National Water-Quality Assessment Program. Multimetric condition indices were developed and used to rank sites on the basis of physical, chemical, and biological characteristics. These indices showed that sites in the Cascades and Eastern Cascades ecoregions were largely unimpaired. In contrast, all but two sites in the Columbia Basin ecoregion were impaired, some severely. Agriculture (nutrients and pesticides) was the primary factor associated with impairment and all impaired sites were characterized by multiple indicators of impairment. All indices of biological condition (fish, invertebrates, and algae) declined as agricultural intensity increased. The response exhibited by invertebrates and algae suggested a threshold response with conditions declining precipitously at relatively low levels of agricultural intensity and little response at moderate to high levels of agricultural intensity. This pattern of response suggests that the success of mitigation will vary depending upon where on the response curve the mitigation is undertaken. Because the form of the community condition response is critical to effective water-quality management, the National Water-Quality Assessment Program is conducting studies to examine the response of biota to gradients of land-use intensity and the relevance of these responses to water-quality management. These land-use gradient pilot studies will be conducted in several urban areas starting in 1999.

Doctors or technicians: assessing quality of medical education

PubMed Central

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products. PMID:23745059

Doctors or technicians: assessing quality of medical education.

PubMed

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products.

Performance Measures in Neurosurgical Patient Care: Differing Applications of Patient Safety Indicators.

PubMed

Moghavem, Nuriel; McDonald, Kathryn; Ratliff, John K; Hernandez-Boussard, Tina

2016-04-01

Patient Safety Indicators (PSIs) are administratively coded identifiers of potentially preventable adverse events. These indicators are used for multiple purposes, including benchmarking and quality improvement efforts. Baseline PSI evaluation in high-risk surgeries is fundamental to both purposes. Determine PSI rates and their impact on other outcomes in patients undergoing cranial neurosurgery compared with other surgeries. The Agency for Healthcare Research and Quality (AHRQ) PSI software was used to flag adverse events and determine risk-adjusted rates (RAR). Regression models were built to assess the association between PSIs and important patient outcomes. We identified cranial neurosurgeries based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in California, Florida, New York, Arkansas, and Mississippi State Inpatient Databases, AHRQ, 2010-2011. PSI development, 30-day all-cause readmission, length of stay, hospital costs, and inpatient mortality. A total of 48,424 neurosurgical patients were identified. Procedure indication was strongly associated with PSI development. The neurosurgical population had significantly higher RAR of most PSIs evaluated compared with other surgical patients. Development of a PSI was strongly associated with increased length of stay and hospital cost and, in certain PSIs, increased inpatient mortality and 30-day readmission. In this population-based study, certain accountability measures proposed for use as value-based payment modifiers show higher RAR in neurosurgery patients compared with other surgical patients and were subsequently associated with poor outcomes. Our results indicate that for quality improvement efforts, the current AHRQ risk-adjustment models should be viewed in clinically meaningful stratified subgroups: for profiling and pay-for-performance applications, additional factors should be included in the risk-adjustment models. Further evaluation of PSIs in additional high-risk surgeries is needed to better inform the use of these metrics.

Development of a regional bio-optical model for water quality assessment in the US Virgin Islands

NASA Astrophysics Data System (ADS)

Kerrigan, Kristi Lisa

Previous research in the US Virgin Islands (USVI) has demonstrated that land-based sources of pollution associated with watershed development and climate change are local and global factors causing coral reef degradation. A good indicator that can be used to assess stress on these environments is the water quality. Conventional assessment methods based on in situ measurements are timely and costly. Satellite remote sensing techniques offer better spatial coverage and temporal resolution to accurately characterize the dynamic nature of water quality parameters by applying bio-optical models. Chlorophyll-a, suspended sediments (TSM), and colored-dissolved organic matter are color-producing agents (CPAs) that define the water quality and can be measured remotely. However, the interference of multiple optically active constituents that characterize the water column as well as reflectance from the bottom poses a challenge in shallow coastal environments in USVI. In this study, field and laboratory based data were collected from sites on St. Thomas and St. John to characterize the CPAs and bottom reflectance of substrates. Results indicate that the optical properties of these waters are a function of multiple CPAs with chlorophyll-a values ranging from 0.10 to 2.35 microg/L and TSM values from 8.97 to 15.7 mg/L. These data were combined with in situ hyperspectral radiometric and Landsat OLI satellite data to develop a regionally tiered model that can predict CPA concentrations using traditional band ratio and multivariate approaches. Band ratio models for the hyperspectral dataset (R2 = 0.35; RMSE = 0.10 microg/L) and Landsat OLI dataset (R2 = 0.35; RMSE = 0.12 microg/L) indicated promising accuracy. However, a stronger model was developed using a multivariate, partial least squares regression to identify wavelengths that are more sensitive to chlorophyll-a (R2 = 0.62, RMSE = 0.08 microg/L) and TSM (R2 = 0.55). This approach takes advantage of the full spectrum of hyperspectral data, thus providing a more robust predictive model. Models developed in this study will significantly improve near-real time and long-term water quality monitoring in USVI and will provide insight to factors contributing to coral reef decline.

How Clean is your Local Air? Here's an app for that

NASA Astrophysics Data System (ADS)

Maskey, M.; Yang, E.; Christopher, S. A.; Keiser, K.; Nair, U. S.; Graves, S. J.

2011-12-01

Air quality is a vital element of our environment. Accurate and localized air quality information is critical for characterizing environmental impacts at the local and regional levels. Advances in location-aware handheld devices and air quality modeling have enabled a group of UAHuntsville scientists to develop a mobile app, LocalAQI, that informs users of current conditions and forecasts of up to twenty-four hours, of air quality indices. The air quality index is based on Community Multiscale Air Quality Modeling System (CMAQ). UAHuntsville scientists have used satellite remote sensing products as inputs to CMAQ, resulting in forecast guidance for particulate matter air quality. The CMAQ output is processed to compute a standardized air quality index. Currently, the air quality index is available for the eastern half of the United States. LocalAQI consists of two main views: air quality index view and map view. The air quality index view displays current air quality for the zip code of a location of interest. Air quality index value is translated into a color-coded advisory system. In addition, users are able to cycle through available hourly forecasts for a location. This location-aware app defaults to the current air quality of user's location. The map view displays color-coded air quality information for the eastern US with an ability to animate through the available forecasts. The app is developed using a cross-platform native application development tool, appcelerator; hence LocalAQI is available for iOS and Android-based phones and pads.

Study on an Air Quality Evaluation Model for Beijing City Under Haze-Fog Pollution Based on New Ambient Air Quality Standards

PubMed Central

Li, Li; Liu, Dong-Jun

2014-01-01

Since 2012, China has been facing haze-fog weather conditions, and haze-fog pollution and PM2.5 have become hot topics. It is very necessary to evaluate and analyze the ecological status of the air environment of China, which is of great significance for environmental protection measures. In this study the current situation of haze-fog pollution in China was analyzed first, and the new Ambient Air Quality Standards were introduced. For the issue of air quality evaluation, a comprehensive evaluation model based on an entropy weighting method and nearest neighbor method was developed. The entropy weighting method was used to determine the weights of indicators, and the nearest neighbor method was utilized to evaluate the air quality levels. Then the comprehensive evaluation model was applied into the practical evaluation problems of air quality in Beijing to analyze the haze-fog pollution. Two simulation experiments were implemented in this study. One experiment included the indicator of PM2.5 and was carried out based on the new Ambient Air Quality Standards (GB 3095-2012); the other experiment excluded PM2.5 and was carried out based on the old Ambient Air Quality Standards (GB 3095-1996). Their results were compared, and the simulation results showed that PM2.5 was an important indicator for air quality and the evaluation results of the new Air Quality Standards were more scientific than the old ones. The haze-fog pollution situation in Beijing City was also analyzed based on these results, and the corresponding management measures were suggested. PMID:25170682

Influence of land use on water quality in a tropical landscape: a multi-scale analysis

PubMed Central

Yackulic, Charles B.; Lim, Yili; Arce-Nazario, Javier A.

2015-01-01

There is a pressing need to understand the consequences of human activities, such as land transformations, on watershed ecosystem services. This is a challenging task because different indicators of water quality and yield are expected to vary in their responsiveness to large versus local-scale heterogeneity in land use and land cover (LUC). Here we rely on water quality data collected between 1977 and 2000 from dozens of gauge stations in Puerto Rico together with precipitation data and land cover maps to (1) quantify impacts of spatial heterogeneity in LUC on several water quality indicators; (2) determine the spatial scale at which this heterogeneity influences water quality; and (3) examine how antecedent precipitation modulates these impacts. Our models explained 30–58% of observed variance in water quality metrics. Temporal variation in antecedent precipitation and changes in LUC between measurements periods rather than spatial variation in LUC accounted for the majority of variation in water quality. Urbanization and pasture development generally degraded water quality while agriculture and secondary forest re-growth had mixed impacts. The spatial scale over which LUC influenced water quality differed across indicators. Turbidity and dissolved oxygen (DO) responded to LUC in large-scale watersheds, in-stream nitrogen concentrations to LUC in riparian buffers of large watersheds, and fecal matter content and in-stream phosphorus concentration to LUC at the sub-watershed scale. Stream discharge modulated impacts of LUC on water quality for most of the metrics. Our findings highlight the importance of considering multiple spatial scales for understanding the impacts of human activities on watershed ecosystem services. PMID:26146455

Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery

PubMed Central

Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson

2016-01-01

Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040

Application and partial validation of a habitat model for moose in the Lake Superior region

USGS Publications Warehouse

Allen, A.W.; Terrell, J.W.; Mangus, W.L.; Lindquist, E.L.

1991-01-01

A modified version of the dormant-season portion of a Habitat Suitability Index (HSI) model developed for assessing moose (Alces alces) habitat in the Lake Superior Region was incorporated in a Geographic Information System (GIS) for 490 km2 of Minnesota's Superior National Forest. Moose locations (n=235) were plotted during aerial surveys conducted in December 1988 and January 1990-1991. Dormant-season forage and cover quality for 1,000-m, 500-m, and 200-m radii plots around random points and moose locations were compared using U.S. Forest Service stand examination data. Cover quality indices were lower than forage quality indices within all plots. The median value for the average cover quality index was greater (P=0.003) within 200-m plots around cow moose locations than for plots around random points for the most severe winter of the study. The proportion of highest-quality winter cover, such as mixed stands dominated by mid-age class white spruce (Picea glauca) and balsam fir (Abies balsanea), was greater within 500-m and 200-m plots around cow moose than within similar plots around random points during the two most severe winters. These results indicate that suboptimum ratings of winter habitat quality used in the GIS for dormant-season forage >100 m from cover, as suggested in the original HSI model, are reasonable. Integrating the habitat model with forest stand data using a GIS permitted analysis of moose habitat within a relatively large geographic area. Simulation of habitat quality indicated a potential shortage of late-winter cover in the study area. The effects of forest management actions on moose habitat quality can be simulated without collecting additional data.

Environmental Quality Index - Overview Report | Science ...

EPA Pesticide Factsheets

A better estimate of overall environmental quality is needed to improve our understanding of the relationship between environmental conditions and humanhealth. Described in this report is the effort to construct an environmental quality index representing multiple domains of the ambient environment, includingair, water, land, built and sociodemographic for all counties in the U.S. for the time period including the years 2000-2005. The EQI was created for two mainpurposes: a.) as an indicator of ambient conditions/exposure in environmental health modeling and b.) as a covariate to adjust for ambient conditions inenvironmental models. However, as detailed in the discussion of this report, the EQI can be adapted and used for other objectives. The EQI was developedin four parts: domain identification; data source identification and review; variable construction; and data reduction. Each of these four areas represents achapter in the report where detailed information is provided on the development of the EQI. The methods applied provide a reproducible approach thatcapitalizes almost exclusively on publically-available data sources.This report is written as an overview to the companion technical document. A better estimate of overall environmental quality is needed to improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) was developed for all counties in the U.S. using indicators from the

Two approaches to improving mental health care: positivist/quantitative versus skill-based/qualitative.

PubMed

Luchins, Daniel

2012-01-01

The quality improvement model currently used in medicine and mental health was adopted from industry, where it developed out of early 20th-century efforts to apply a positivist/quantitative agenda to improving manufacturing. This article questions the application of this model to mental health care. It argues that (1) developing "operational definitions" for something as value-laden as "quality" risks conflating two realms, what we measure with what we value; (2) when measurements that are tied to individuals are aggregated to establish benchmarks and goals, unwarranted mathematical assumptions are made; (3) choosing clinical outcomes is problematic; (4) there is little relationship between process measures and clinical outcomes; and (5) since changes in quality indices do not relate to improved clinical care, management's reliance on such indices provides an illusory sense of control. An alternative model is the older, skill-based/qualitative approach to knowing, which relies on "implicit/ expert" knowledge. These two approaches offer a series of contrasts: quality versus excellence, competence versus expertise, management versus leadership, extrinsic versus intrinsic rewards. The article concludes that we need not totally dispense with the current quality improvement model, but rather should balance quantitative efforts with the older qualitative approach in a mixed methods model.

Two Approaches to Estimating the Effect of Parenting on the Development of Executive Function in Early Childhood

PubMed Central

Blair, Clancy; Raver, C. Cybele; Berry, Daniel J.

2015-01-01

In the current article, we contrast 2 analytical approaches to estimate the relation of parenting to executive function development in a sample of 1,292 children assessed longitudinally between the ages of 36 and 60 months of age. Children were administered a newly developed and validated battery of 6 executive function tasks tapping inhibitory control, working memory, and attention shifting. Residualized change analysis indicated that higher quality parenting as indicated by higher scores on widely used measures of parenting at both earlier and later time points predicted more positive gain in executive function at 60 months. Latent change score models in which parenting and executive function over time were held to standards of longitudinal measurement invariance provided additional evidence of the association between change in parenting quality and change in executive function. In these models, cross-lagged paths indicated that in addition to parenting predicting change in executive function, executive function bidirectionally predicted change in parenting quality. Results were robust with the addition of covariates, including child sex, race, maternal education, and household income-to-need. Strengths and drawbacks of the 2 analytic approaches are discussed, and the findings are considered in light of emerging methodological innovations for testing the extent to which executive function is malleable and open to the influence of experience. PMID:23834294

Fostering High-Quality Teaching with an Enriched Curriculum and Professional Development Support: The Head Start REDI Program

PubMed Central

Domitrovich, Celene E.; Gest, Scott D.; Gill, Sukhdeep; Bierman, Karen L.; Welsh, Janet; Jones, Damon

2017-01-01

This randomized controlled trial tested whether teaching quality in Head Start classrooms could be improved with the addition of evidence-based curriculum components targeting emergent language/literacy and social-emotional development and the provision of associated professional development support. Participants were lead and assistant teachers in 44 Head Start classrooms. Teachers received 4 days of workshop training along with weekly in-class support from a mentor teacher. End-of-year observations indicated that, compared to the control group, intervention teachers talked with children more frequently and in more cognitively complex ways, established a more positive classroom climate, and used more preventive behavior management strategies. Results supported the conclusion that enriched curriculum components and professional development support can produce improvements in multiple domains of teaching quality. PMID:29081534

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.

Urban stream syndrome in a small, lightly developed watershed: a statistical analysis of water chemistry parameters, land use patterns, and natural sources.

PubMed

Halstead, Judith A; Kliman, Sabrina; Berheide, Catherine White; Chaucer, Alexander; Cock-Esteb, Alicea

2014-06-01

The relationships among land use patterns, geology, soil, and major solute concentrations in stream water for eight tributaries of the Kayaderosseras Creek watershed in Saratoga County, NY, were investigated using Pearson correlation coefficients and multivariate regression analysis. Sub-watersheds corresponding to each sampling site were delineated, and land use patterns were determined for each of the eight sub-watersheds using GIS. Four land use categories (urban development, agriculture, forests, and wetlands) constituted more than 99 % of the land in the sub-watersheds. Eleven water chemistry parameters were highly and positively correlated with each other and urban development. Multivariate regression models indicated urban development was the most powerful predictor for the same eleven parameters (conductivity, TN, TP, NO[Formula: see text], Cl(-), HCO(-)3, SO9(2-)4, Na(+), K(+), Ca(2+), and Mg(2+)). Adjusted R(2) values, ranging from 19 to 91 %, indicated that these models explained an average of 64 % of the variance in these 11 parameters across the samples and 70 % when Mg(2+) was omitted. The more common R (2), ranging from 29 to 92 %, averaged 68 % for these 11 parameters and 72 % when Mg(2+) was omitted. Water quality improved most with forest coverage in stream watersheds. The strong associations between water quality variables and urban development indicated an urban source for these 11 water quality parameters at all eight sampling sites was likely, suggesting that urban stream syndrome can be detected even on a relatively small scale in a lightly developed area. Possible urban sources of Ca(2+) and HCO(-)3 are suggested.

A process for developing standards to promote quality in general practice.

PubMed

Khoury, Julie; Krejany, Catherine J; Versteeg, Roald W; Lodewyckx, Michaela A; Pike, Simone R; Civil, Michael S; Jiwa, Moyez

2018-06-02

Since 1991, the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.

Standardizing Quality Assessment of Fused Remotely Sensed Images

NASA Astrophysics Data System (ADS)

Pohl, C.; Moellmann, J.; Fries, K.

2017-09-01

The multitude of available operational remote sensing satellites led to the development of many image fusion techniques to provide high spatial, spectral and temporal resolution images. The comparison of different techniques is necessary to obtain an optimized image for the different applications of remote sensing. There are two approaches in assessing image quality: 1. Quantitatively by visual interpretation and 2. Quantitatively using image quality indices. However an objective comparison is difficult due to the fact that a visual assessment is always subject and a quantitative assessment is done by different criteria. Depending on the criteria and indices the result varies. Therefore it is necessary to standardize both processes (qualitative and quantitative assessment) in order to allow an objective image fusion quality evaluation. Various studies have been conducted at the University of Osnabrueck (UOS) to establish a standardized process to objectively compare fused image quality. First established image fusion quality assessment protocols, i.e. Quality with No Reference (QNR) and Khan's protocol, were compared on varies fusion experiments. Second the process of visual quality assessment was structured and standardized with the aim to provide an evaluation protocol. This manuscript reports on the results of the comparison and provides recommendations for future research.

Evaluating the Relationship between Productivity and Quality in Emergency Departments

PubMed Central

Bastian, Nathaniel D.; Riordan, John P.

2017-01-01

Background In the United States, emergency departments (EDs) are constantly pressured to improve operational efficiency and quality in order to gain financial benefits and maintain a positive reputation. Objectives The first objective is to evaluate how efficiently EDs transform their input resources into quality outputs. The second objective is to investigate the relationship between the efficiency and quality performance of EDs and the factors affecting this relationship. Methods Using two data sources, we develop a data envelopment analysis (DEA) model to evaluate the relative efficiency of EDs. Based on the DEA result, we performed multinomial logistic regression to investigate the relationship between ED efficiency and quality performance. Results The DEA results indicated that the main source of inefficiencies was working hours of technicians. The multinomial logistic regression result indicated that the number of electrocardiograms and X-ray procedures conducted in the ED and the length of stay were significantly associated with the trade-offs between relative efficiency and quality. Structural ED characteristics did not influence the relationship between efficiency and quality. Conclusions Depending on the structural and operational characteristics of EDs, different factors can affect the relationship between efficiency and quality. PMID:29065673

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

PubMed

van Doorn-Klomberg, Arna L; Braspenning, Jozé C C; Wolters, René J; Bouma, Margriet; Wensing, Michel

2014-11-04

Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). A comparative observational study with two cohorts was performed. We included 138 Dutch family practices that participated in the national accreditation program for primary care. A first cohort of 69 practices was measured at start and completion of a 3-year accreditation program. A second cohort of 69 practices was included and measured simultaneously with the final measurement of the first cohort. In separate multilevel regression analyses, we compared both within-group changes in the first cohort and between-groups differences at follow-up (first cohort) and start (second cohort). Outcome measures consisted of 24 systematically developed indicators of quality of care in targeted chronic diseases. In the within-group comparison, we found improvements on 6 indicators related to diabetes (feet examination, cholesterol measurement, lipid lowering medication prescription) and COPD (spirometry performance, stop smoking advice). In the between-groups comparison we found that first cohort practices performed better on 4 indicators related to diabetes (cholesterol outcome) and CVD (blood pressure outcome, smoke status registration, glucose measurement). Improvements of the quality of primary care for patients with chronic diseases were found, but few could be attributed to the accreditation program. Further development of accreditation is needed to enhance its effectiveness on chronic disease management.

Service quality in community pharmacy: an exploration of determinants.

PubMed

White, Lesley; Klinner, Christiane

2012-01-01

Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs' understanding of service quality and its determinants. This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality. Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants' perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers. From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management. The study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Environmental Indicator Principium with Case References to Agricultural Soil, Water, and Air Quality and Model-Derived Indicators.

PubMed

Zhang, T Q; Zheng, Z M; Lal, R; Lin, Z Q; Sharpley, A N; Shober, A L; Smith, D; Tan, C S; Van Cappellen, P

2018-03-01

Environmental indicators are powerful tools for tracking environmental changes, measuring environmental performance, and informing policymakers. Many diverse environmental indicators, including agricultural environmental indicators, are currently in use or being developed. This special collection of technical papers expands on the peer-reviewed literature on environmental indicators and their application to important current issues in the following areas: (i) model-derived indicators to indicate phosphorus losses from arable land to surface runoff and subsurface drainage, (ii) glutathione-ascorbate cycle-related antioxidants as early-warning bioindicators of polybrominated diphenyl ether toxicity in mangroves, and (iii) assessing the effectiveness of using organic matrix biobeds to limit herbicide dissipation from agricultural fields, thereby controlling on-farm point-source pollution. This introductory review also provides an overview of environmental indicators, mainly for agriculture, with examples related to the quality of the agricultural soil-water-air continuum and the application of model-derived indicators. Current knowledge gaps and future lines of investigation are also discussed. It appears that environmental indicators, particularly those for agriculture, work efficiently at the field, catchment, and local scales and serve as valuable metrics of system functioning and response; however, these indicators need to be refined or further developed to comprehensively meet community expectations in terms of providing a consistent picture of relevant issues and/or allowing comparisons to be made nationally or internationally. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit.

PubMed

van Bommel, Annelotte C M; Spronk, Pauline E R; Vrancken Peeters, Marie-Jeanne T F D; Jager, Agnes; Lobbes, Marc; Maduro, John H; Mureau, Marc A M; Schreuder, Kay; Smorenburg, Carolien H; Verloop, Janneke; Westenend, Pieter J; Wouters, Michel W J M; Siesling, Sabine; Tjan-Heijnen, Vivianne C G; van Dalen, Thijs

2017-03-01

In 2011, the NABON Breast Cancer Audit (NBCA) was instituted as a nation-wide audit to address quality of breast cancer care and guideline adherence in the Netherlands. The development of the NBCA and the results of 4 years of auditing are described. Clinical and pathological characteristics of patients diagnosed with invasive breast cancer or in situ carcinoma (DCIS) and information regarding diagnosis and treatment are collected in all hospitals (n = 92) in the Netherlands. Thirty-two quality indicators measuring care structure, processes and outcomes were evaluated over time and compared between hospitals. The NBCA contains data of 56,927 patients (7,649 DCIS and 49,073 invasive cancers). Patients being discussed in pre- and post-operative multidisciplinary team meetings improved (2011: 83% and 91%; 2014: 98% and 99%, respectively) over the years. Tumour margin positivity rates after breast-conserving surgery for invasive cancer requiring re-operation were consistently low (∼5%). Other indicators, for example, the use of an MRI-scan prior to surgery or immediate breast reconstruction following mastectomy showed considerable hospital variation. Results shown an overall high quality of breast cancer care in all hospitals in the Netherlands. For most quality indicators improvement was seen over time, while some indicators showed yet unexplained variation. J. Surg. Oncol. 2017;115:243-249. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Mathematical model for prediction of efficiency indicators of educational activity in high school

NASA Astrophysics Data System (ADS)

Tikhonova, O. M.; Kushnikov, V. A.; Fominykh, D. S.; Rezchikov, A. F.; Ivashchenko, V. A.; Bogomolov, A. S.; Filimonyuk, L. Yu; Dolinina, O. N.; Kushnikov, O. V.; Shulga, T. E.; Tverdokhlebov, V. A.

2018-05-01

The quality of high school is a current problem all over the world. The paper presents the system dedicated to predicting the accreditation indicators of technical universities based on J. Forrester mechanism of system dynamics. The mathematical model is developed for prediction of efficiency indicators of the educational activity and is based on the apparatus of nonlinear differential equations.

Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study.

PubMed

Bernardo, Miquel; de Dios, Consuelo; Pérez, Víctor; Ignacio, Emilio; Serrano, Manuel; Vieta, Eduard; Mira, José Joaquín; Guilabert, Mercedes; Roca, Miquel

To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

Using High Resolution Commercial Satellite Imagery to Quantify Spatial Features of Urban Areas and their Relationship to Quality of Life Indicators in Accra, Ghana

NASA Astrophysics Data System (ADS)

Sandborn, A.; Engstrom, R.; Yu, Q.

2014-12-01

Mapping urban areas via satellite imagery is an important task for detecting and anticipating land cover and land use change at multiple scales. As developing countries experience substantial urban growth and expansion, remotely sensed based estimates of population and quality of life indicators can provide timely and spatially explicit information to researchers and planners working to determine how cities are changing. In this study, we use commercial high spatial resolution satellite imagery in combination with fine resolution census data to determine the ability of using remotely sensed data to reveal the spatial patterns of quality of life in Accra, Ghana. Traditionally, spectral characteristics are used on a per-pixel basis to determine land cover; however, in this study, we test a new methodology that quantifies spatial characteristics using a variety of spatial features observed in the imagery to determine the properties of an urban area. The spatial characteristics used in this study include histograms of oriented gradients, PanTex, Fourier transform, and line support regions. These spatial features focus on extracting structural and textural patterns of built-up areas, such as homogeneous building orientations and straight line indices. Information derived from aggregating the descriptive statistics of the spatial features at both the fine-resolution census unit and the larger neighborhood level are then compared to census derived quality of life indicators including information about housing, education, and population estimates. Preliminary results indicate that there are correlations between straight line indices and census data including available electricity and literacy rates. Results from this study will be used to determine if this methodology provides a new and improved way to measure a city structure in developing cities and differentiate between residential and commercial land use zones, as well as formal versus informal housing areas.

The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

PubMed

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S

2015-01-01

A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs.

Effects of agricultural management on productivity, soil quality and climate change mitigation - evaluations within the EU Project (FP 7) CATCH-C

NASA Astrophysics Data System (ADS)

Spiegel, Heide; Schlatter, Norman; Haslmayr, Hans-Peter; Baumgarten, Andreas; ten Berge, Hein

2014-05-01

Soils are the main basis for the production of food and feed. Furthermore, the production of biomass for energy and material use is becoming increasingly important. Goals for an optimal management of agricultural soils are, on the one hand, the maintenance or improvement of soil quality and, on the other hand, high productivity and climate change mitigation (reduction of GHG emissions and C sequestration). Thus, the EU project CATCH-C aims to evaluate current management practices concerning these three goals based on indicators derived from long-term field experiments of the project partners and from literature data. A maximum of 72 indicators for productivity, soil quality and the potential for carbon storage in the soil and the reduction of greenhouse gas emissions were selected by the project partners. As indicators for productivity, crop yields are determined in almost all field trials. The content of soil organic carbon (SOC) is an indicator for chemical, physical and biological soil quality and was analysed in the topsoil in all field trials. Less data exist for SOC contents in the subsoil. An important physical soil quality indicator is the bulk density, however, it is not determined in all field trials of the project partners. Therefore, information on SOC stocks, with relevance to carbon storage and climate change mitigation, is not available in all field experiments. Other physical indicators, such as penetration resistance, runoff coefficient and soil losses are evaluated. Essential biological indicators are microbial biomass and the number and weight of earthworms, which have been tested in several field trials. The evaluation of all these indicators will help to select "best management practices" and to address trade-offs and synergies for all indicators under consideration of major European farm type zones. CATCH-C is funded within the 7th Framework Programme for Research, Technological Development and Demonstration, Theme 2 - Biotechnologies, Agriculture & Food. (Grant Agreement N° 289782).

The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

PubMed Central

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

2015-01-01

Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs. PMID:25875252

Teaching Guide for "The Environmental Data Book: A Guide to Statistics on the Environment and Development."

ERIC Educational Resources Information Center

Sheram, Katherine

This teaching guide accompanies "The Environmental Data Book," published by the World Bank. Environmental and development statistics are presented for discussion and analysis. Indicators of environmental quality and economic development are defined with accompanying charts and maps. Activities accompany each lesson, along with a worksheet at the…

[(Dis)satisfaction with the municipal infrastructure. How do senior citizens evaluate their living conditions?].

PubMed

Piorkowsky, M-B

2010-04-01

In order to evaluate the perceived living conditions, i.e., satisfaction with the scope and quality of municipal infrastructure, from a senior citizen's perspective, a questionnaire, differentiating six areas and 39 sub-areas and the corresponding testing scales for satisfaction with the quality of life, was developed analogous to the grading system used in the German school system. This questionnaire is suitable for evaluative city walks and comparative analyses of the municipal infrastructure to gain indications of the quality and to identify or shape future infrastructure actions. In 2007/2008, the questionnaire was used by the local senior citizen's representatives in the federal states of Germany. The data obtained were condensed into indices of citizen satisfaction and factor analysis was performed. As a result, the 39 sub-areas could be reduced to 11 independent dimensions, which disclose general patterns of perceiving and evaluating the quality of municipal life.

Training quality job interviews with adults with developmental disabilities.

PubMed

Mozingo, D; Ackley, G B; Bailey, J S

1994-01-01

Supported work models of vocational integration have increased the employability of individuals with developmental disabilities. Interview questions most frequently used and corresponding responses considered most beneficial to job applicants were derived from an empirical analysis of the "hiring community" and served as a basis for the development of the verbal job interview skills training package evaluated in this research. Dependent measures were objective, behavioral indices of the quality of job interview responses. One-to-one training by a direct training staff, job coach, and a trained behavior analyst resulted in improved responding by all subjects as indicated in a multiple baseline design across interview questions. Improved quality in responding to questions generalized to variations in interview questions, to a novel interviewer, and in an in vivo interview situation. Finally, global measures of social validity support the value of the quality-of-response training.

Urban environment and well-being: cross-cultural studies on Perceived Residential Environment Quality Indicators (PREQIs).

PubMed

Bonaiuto, Marino; Fornara, Ferdinando; Alves, Susana; Ferreira, Ines; Mao, Yanhui; Moffat, Eva; Piccinin, Gloria; Rahimi, Leila

2015-09-01

Architectural and environmental psychology literature has shown the importance of urban design in provoking stress feelings or enhancing well-being and quality of life. The aim of this contribution is to show the main results of a set of cross-cultural survey studies concerning the perceived quality of urban features at the neighbourhood level. A questionnaire was used including the extended or the short version of the 11 scales measuring Perceived Residential Environment Quality Indicators (PREQIs), which cover architectural, social, functional, and contextual aspects. Both versions of PREQIs showed a similar factorial structure and a good (or at least acceptable) reliability across different geographical contexts, even though some differences emerged in those countries that are more distant from the Western linguistic and cultural milieu. The development of tools like PREQIs should increase a "user-centred" vision on urban issues.

USEPA Environmental Quality Index (EQI) and Associated Domain Indices by County for the United States

EPA Pesticide Factsheets

This map service displays the results data from the EPA's Environmental Quality Index. The US Environmental Protection Agency's (EPA) National Health and Environmental Effects Research Laboratory (NHEERL) in the Environmental Public Health Division (EPHD) is currently engaged in research aimed at developing a measure that estimates overall environmental quality at the county level for the United States. This work is being conducted as an effort to learn more about how various environmental factors simultaneously contribute to health disparities in low-income and minority populations, and to better estimate the total environmental and social context to which humans are exposed. This dataset contains the finalized Environmental Quality Index (EQI), and an index for each of the associated domains (air, water, land, built environment, and sociodemographic environment). Indices are at the county level for all counties in the United States.

Hospital quality of care: does information technology matter? The relationship between information technology adoption and quality of care.

PubMed

Menachemi, Nir; Chukmaitov, Askar; Saunders, Charles; Brooks, Robert G

2008-01-01

Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption. To explore the relationship between IT adoption and quality of care in acute-care hospitals. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality. Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy. Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.

Some Equalities Are More Equal Than Others: Quality Equality Emerges Later Than Numerical Equality.

PubMed

Sheskin, Mark; Nadal, Amber; Croom, Adam; Mayer, Tanya; Nissel, Jenny; Bloom, Paul

2016-09-01

By age 6, children typically share an equal number of resources between themselves and others. However, fairness involves not merely that each person receive an equal number of resources ("numerical equality") but also that each person receive equal quality resources ("quality equality"). In Study 1, children (N = 87, 3-10 years) typically split four resources "two each" by age 6, but typically monopolized the better two resources until age 10. In Study 2, a new group of 6- to 8-year-olds (N = 32) allocated resources to third parties according to quality equality, indicating that children in this age group understand that fairness requires both types of equality. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

[Managing a health research institute: towards research excellence through continuous improvement].

PubMed

Olmedo, Carmen; Buño, Ismael; Plá, Rosa; Lomba, Irene; Bardinet, Thierry; Bañares, Rafael

2015-01-01

Health research institutes are a strategic commitment considered the ideal environment to develop excellence in translational research. Achieving quality research requires not only a powerful scientific and research structure but also the quality and integrity of management systems that support it. The essential instruments in our institution were solid strategic planning integrated into and consistent with the system of quality management, systematic evaluation through periodic indicators, measurement of key user satisfaction and internal audits, and implementation of an innovative information management tool. The implemented management tools have provided a strategic thrust to our institute while ensuring a level of quality and efficiency in the development and management of research that allows progress towards excellence in biomedical research. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Quantifying Error in Survey Measures of School and Classroom Environments

ERIC Educational Resources Information Center

Schweig, Jonathan David

2014-01-01

Developing indicators that reflect important aspects of school and classroom environments has become central in a nationwide effort to develop comprehensive programs that measure teacher quality and effectiveness. Formulating teacher evaluation policy necessitates accurate and reliable methods for measuring these environmental variables. This…

[Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program].

PubMed

Pérez-Cuevas, Ricardo; Jasso Gutiérrez, Luis; Doubova, Svetlana; Flores Hernández, Sergio; Mantilla Trollé, Clara; González Guerra, Eduardo; Muñoz Hernández, Onofre

Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

The professional perspective on patient involvement in the development of quality indicators: a qualitative analysis using the example of chronic heart failure in the German health care setting.

PubMed

Pohontsch, Nadine Janis; Herzberg, Heidrun; Joos, Stefanie; Welti, Felix; Scherer, Martin; Blozik, Eva

2015-01-01

There is an international consensus that quality indicators (QIs) of health care ought to represent patient-relevant aspects. Therefore, patient involvement in the development process is essential. However, there is no methodological gold standard for involving patients in QI development. The aim of this study is to explore experts' views on the representation of patient-relevant aspects in the QI development process using the QIs developed in the context of the German National Disease Management Guideline for Heart Failure as an example. Semi-structured, open telephone interviews were conducted with 15 German experts (patient representatives, physicians, researchers, and methodologists involved in guideline development or quality assessment). Interview themes were the relevance of the exemplary set of QIs for patients, as well as the legitimacy of, competence of, and collaboration with the patient representative who participated in the development process. Interviews were fully transcribed and content analyzed. Deductive categories derived from the research questions were supplemented by inductively formed categories during the review of the interview material. The qualitative analysis suggests a discrepancy between the guidelines' QIs and those relevant to patients from an expert's point of view, such as physician-patient communication and quality of counseling. Experts reported only minor communication and cooperation problems while working together in the guideline/QI development team. Concerns existed, for example, regarding the recruitment of patient representatives for diseases without self-help organizations, the financing of patient representation, and the training of patient representatives. Only few potential strategies for improving the process of patient involvement were mentioned. Integrating the patients' perspectives through the recruitment of a patient representative to participate in the development team was well established and broadly accepted. However, experts stated that the finally selected QIs represent only a small part of the patient-relevant aspects of medical care. According to the experts' perceptions, the current processes provide a very limited scope for integrating the patients' perspectives in a more extensive way. Supplementing the set of "conventional" QIs with additional, separately developed, "patient-side" QIs might help to include patient priorities in quality measurement.

Brand Name, Store Image, and Country-of-Origin: The Effects on Consumers' Perception of Quality and Price.

ERIC Educational Resources Information Center

King, Margaret C. A.

1993-01-01

A review of literature indicated that, with regard to brand labels, consumers' perception of price, but not of quality, was affected. Consumers expected to pay more for goods bought in a higher status store and rated imported goods as being more expensive than domestically produced goods. Products from developing countries received lower quality…

Laboratory Evaluations of the Enterococcus qPCR Method for Recreational Water Quality Testing: Method Performance and Sources of Uncertainty in Quantitative Measurements

EPA Science Inventory

The BEACH Act of 2000 directed the U.S. EPA to establish more expeditious methods for the detection of pathogen indicators in coastal waters, as well as new water quality criteria based on these methods. Progress has been made in developing a quantitative PCR (qPCR) method for en...