Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed Central

Mengo, Doris M.; Mohamud, Abdikher D.; Ochieng, Susan M.; Milgo, Sammy K.; Sexton, Connie J.; Moyo, Sikhulile; Luman, Elizabeth T.

2014-01-01

Background Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Methods Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. Results All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Conclusion Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories. PMID:29043193

How to Begin a Quality Improvement Project.

PubMed

Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

2016-05-06

Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. Copyright © 2016 by the American Society of Nephrology.

How to Begin a Quality Improvement Project

PubMed Central

Harel, Ziv; McQuillan, Rory; Weizman, Adam V.; Thomas, Alison; Chertow, Glenn M.; Nesrallah, Gihad; Bell, Chaim M.; Chan, Christopher T.

2016-01-01

Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. PMID:27016497

Researchers' Roles in Patient Safety Improvement.

PubMed

Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

2016-03-01

In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

Creating a national culture of quality: the Tanzania experience.

PubMed

Mwidunda, Patrick E; Eliakimu, Eliudi

2015-07-01

Although quality improvement has been a priority for Tanzania's health sector since the 1970s, few effective quality improvement initiatives were implemented, due to limited expertise, political commitment and resources. More recently, as the HIV epidemic gained momentum within the country, an influx of funding and of international organizations with quality improvement expertise accelerated the implementation of quality improvement projects, as well as efforts to institutionalize quality improvement at the national level. The support of US President's Emergency Plan for AIDS Relief (PEPFAR) and other donors, and the increasing numbers of HIV-implementing partners focused on quality management, and quality improvement strategies catalysed the development of HIV-specific quality improvement initiatives first, and then of national quality improvement frameworks. The diversity of quality improvement approaches championed by various donors and partners also presented important challenges to harmonization and institutionalization of quality improvement programmes.

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

PubMed

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

2015-07-01

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

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

ERIC Educational Resources Information Center

Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

2010-01-01

Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

Quality Improvement on the Acute Inpatient Psychiatry Unit Using the Model for Improvement

PubMed Central

Singh, Kuldeep; Sanderson, Joshua; Galarneau, David; Keister, Thomas; Hickman, Dean

2013-01-01

Background A need exists for constant evaluation and modification of processes within healthcare systems to achieve quality improvement. One common approach is the Model for Improvement that can be used to clearly define aims, measures, and changes that are then implemented through a plan-do-study-act (PDSA) cycle. This approach is a commonly used method for improving quality in a wide range of fields. The Model for Improvement allows for a systematic process that can be revised at set time intervals to achieve a desired result. Methods We used the Model for Improvement in an acute psychiatry unit (APU) to improve the screening incidence of abnormal involuntary movements in eligible patients—those starting or continuing on standing neuroleptics—with the Abnormal Involuntary Movement Scale (AIMS). Results After 8 weeks of using the Model for Improvement, both of the participating inpatient services in the APU showed substantial overall improvement in screening for abnormal involuntary movements using the AIMS. Conclusion Crucial aspects of a successful quality improvement initiative based on the Model for Improvement are well-defined goals, process measures, and structured PDSA cycles. Success also requires communication, organization, and participation of the entire team. PMID:24052768

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

PubMed

Singh, Kuldeep; Sanderson, Joshua; Galarneau, David; Keister, Thomas; Hickman, Dean

2013-01-01

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

Empirical Study on the Sustainability of China's Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery.

PubMed

Zhang, Ming; Duan, Fang; Mao, Zisen

2018-02-05

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces' potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China's grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield.

Empirical Study on the Sustainability of China’s Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery

PubMed Central

Zhang, Ming; Duan, Fang; Mao, Zisen

2018-01-01

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces’ potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China’s grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield. PMID:29401727

Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review

PubMed Central

Prince, Lisa K.; Little, Dustin J.; Schexneider, Katherine I.

2017-01-01

The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice–based learning and systems–based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty–specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty–specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology–specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds—specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved nephrology clinical care within the institution and introduced new educational and assessment tools to the training program. All have been opportunities for quality improvement scholarship. The curriculum prepares fellows to apply quality improvement principals in independent clinical practice—while showing milestone advancement and divisional compliance with Clinical Learning Environment Review requirements. PMID:28174318

Unpacking the black box of improvement

PubMed Central

Ramaswamy, Rohit; Reed, Julie; Livesley, Nigel; Boguslavsky, Victor; Garcia-Elorrio, Ezequiel; Sax, Sylvia; Houleymata, Diarra; Kimble, Leighann; Parry, Gareth

2018-01-01

Abstract During the Salzburg Global Seminar Session 565—‘Better Health Care: How do we learn about improvement?’, participants discussed the need to unpack the ‘black box’ of improvement. The ‘black box’ refers to the fact that when quality improvement interventions are described or evaluated, there is a tendency to assume a simple, linear path between the intervention and the outcomes it yields. It is also assumed that it is enough to evaluate the results without understanding the process of by which the improvement took place. However, quality improvement interventions are complex, nonlinear and evolve in response to local settings. To accurately assess the effectiveness of quality improvement and disseminate the learning, there must be a greater understanding of the complexity of quality improvement work. To remain consistent with the language used in Salzburg, we refer to this as ‘unpacking the black box’ of improvement. To illustrate the complexity of improvement, this article introduces four quality improvement case studies. In unpacking the black box, we present and demonstrate how Cynefin framework from complexity theory can be used to categorize and evaluate quality improvement interventions. Many quality improvement projects are implemented in complex contexts, necessitating an approach defined as ‘probe-sense-respond’. In this approach, teams experiment, learn and adapt their changes to their local setting. Quality improvement professionals intuitively use the probe-sense-respond approach in their work but document and evaluate their projects using language for ‘simple’ or ‘complicated’ contexts, rather than the ‘complex’ contexts in which they work. As a result, evaluations tend to ask ‘How can we attribute outcomes to the intervention?’, rather than ‘What were the adaptations that took place?’. By unpacking the black box of improvement, improvers can more accurately document and describe their interventions, allowing evaluators to ask the right questions and more adequately evaluate quality improvement interventions. PMID:29462325

The Improvement Cycle: Analyzing Our Experience

NASA Technical Reports Server (NTRS)

Pajerski, Rose; Waligora, Sharon

1996-01-01

NASA's Software Engineering Laboratory (SEL), one of the earliest pioneers in the areas of software process improvement and measurement, has had a significant impact on the software business at NASA Goddard. At the heart of the SEL's improvement program is a belief that software products can be improved by optimizing the software engineering process used to develop them and a long-term improvement strategy that facilitates small incremental improvements that accumulate into significant gains. As a result of its efforts, the SEL has incrementally reduced development costs by 60%, decreased error rates by 85%, and reduced cycle time by 25%. In this paper, we analyze the SEL's experiences on three major improvement initiatives to better understand the cyclic nature of the improvement process and to understand why some improvements take much longer than others.

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement organization activities. 423... and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers, practitioners, and...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

Improvements to rural intersections to improve motorist compliance.

DOT National Transportation Integrated Search

2014-10-01

The Texas Department of Transportation (TxDOT) has placed improving safety as one of its top objectives. : Improving safety in rural intersections is a means to improve roadway safety especially in rural districts such : as the districts in West Texa...

Do quality improvement systems improve health library services? A systematic review.

PubMed

Gray, Hannah; Sutton, Gary; Treadway, Victoria

2012-09-01

A turbulent financial and political climate requires health libraries to be more accountable than ever. Quality improvement systems are widely considered a 'good thing to do', but do they produce useful outcomes that can demonstrate value? To undertake a systematic review to identify which aspects of health libraries are being measured for quality, what tools are being used and what outcomes are reported following utilisation of quality improvement systems. Many health libraries utilise quality improvement systems without translating the data into service improvements. Included studies demonstrate that quality improvement systems produce valuable outcomes including a positive impact on strategic planning, promotion, new and improved services and staff development. No impact of quality improvement systems on library users or patients is reported in the literature. The literature in this area is sparse and requires updating. We recommend further primary research is conducted in health libraries focusing upon the outcomes of utilising quality improvement systems. An exploration of quality improvement systems in other library sectors may also provide valuable insight for health libraries. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

PubMed

OʼRourke, Hannah M; Fraser, Kimberly D

2016-01-01

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

Enzyme replacement therapy improves joint motion and outcome of the 12-min walk test in a mucopolysaccharidosis type VI patient previously treated with bone marrow transplantation.

PubMed

Sohn, Young Bae; Park, Sung Won; Kim, Se-Hwa; Cho, Sung-Yoon; Ji, Sun-Tae; Kwon, Eun Kyung; Han, Sun Ju; Oh, Se Jung; Park, Yong Jae; Ko, Ah-Ra; Paik, Kyung-Hoon; Lee, Jeehun; Lee, Dong Hwan; Jin, Dong-Kyu

2012-05-01

Mucopolysaccharidosis type VI (MPS VI; Maroteaux-Lamy syndrome, OMIM #253200) is a rare disorder involving multiple organs and manifested particularly by severe skeletal abnormalities. Bone marrow transplantation (BMT) improves cardiopulmonary function and facial features, but has limited success in ameliorating skeletal abnormalities and short stature. Here, we report the outcome of enzyme replacement therapy (ERT) with recombinant human arylsulfatase-B (ASB, Naglazyme, BioMarin, Novato, CA) in an MPS VI patient who received BMT 10 years prior to ERT induction. Administration of weekly Naglazyme for 18 months was effective in improving range of motion in several joints [shoulders (improvement of flexion (Right/Left): 40°/55°; improvement of extension 30°/40°; improvement of abduction 10°/10°), elbows (improvement of flexion 25°/25°; improvement of extension 10°/15°), hips (improvement of flexion 25°/10°), and knees (improvement of flexion 45°/40°; improvement of extension 50°/60°)]. Improvement in the outcome of the 12-min walk test (70% increase) and 3-min stair-climbing test (29% increase) was also noted after ERT. Because ERT improved clinical features in an MPS VI patient who had undergone prior BMT, the role of ERT post successful BMT in MPS VI needs further investigation. Copyright © 2012 Wiley Periodicals, Inc.

National quality improvement policies and strategies in European healthcare systems.

PubMed

Spencer, E; Walshe, K

2009-02-01

This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.

Evolution and outcomes of a quality improvement program.

PubMed

Thor, Johan; Herrlin, Bo; Wittlöv, Karin; Øvretveit, John; Brommels, Mats

2010-01-01

The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it. The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations. Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees. Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied. This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.

Lightning Arrestor Connectors Production Readiness

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

Marten, Steve; Linder, Kim; Emmons, Jim

2008-10-20

The Lightning Arrestor Connector (LAC), part “M”, presented opportunities to improve the processes used to fabricate LACs. The A## LACs were the first production LACs produced at the KCP, after the product was transferred from Pinnellas. The new LAC relied on the lessons learned from the A## LACs; however, additional improvements were needed to meet the required budget, yield, and schedule requirements. Improvement projects completed since 2001 include Hermetic Connector Sealing Improvement, Contact Assembly molding Improvement, development of a second vendor for LAC shells, general process improvement, tooling improvement, reduction of the LAC production cycle time, and documention of themore » LAC granule fabrication process. This report summarizes the accomplishments achieved in improving the LAC Production Readiness.« less

Improving the simple, complicated and complex realities of community-acquired pneumonia.

PubMed

Liu, S K; Homa, K; Butterly, J R; Kirkland, K B; Batalden, P B

2009-04-01

This paper first describes efforts to improve the care for patients hospitalised with community-acquired pneumonia and the associated changes in quality measures at a rural academic medical centre. The results of the improvement interventions and the associated clinical realities, expected outcomes, measures, improvement interventions and improvement aims are then re-examined using the Glouberman and Zimmerman typology of healthcare problems--simple, complicated and complex. The typology is then used to explore the future design and assessment of improvement interventions, which may allow better matching with the types of problem healthcare providers and organisations are confronted with. Matching improvement interventions with problem category has the possibility of improving the success of improvement efforts and the reliability of care while at the same time preserving needed provider autonomy and judgement to adapt care for more complex problems.

24 CFR 1715.25 - Misleading sales practices.

Code of Federal Regulations, 2010 CFR

2010-04-01

... meaning.) (a) Proposed improvements. References to proposed improvements of any land unless it is clearly indicated that (1) the improvements are only proposed or (2) what the completion date is for the proposed improvement. (b) Off-premises representations. Representing scenes or proposed improvements other than those...

12 CFR 541.16 - Improved residential real estate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Improved residential real estate. 541.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

12 CFR 541.16 - Improved residential real estate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Improved residential real estate. 541.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

12 CFR 141.16 - Improved residential real estate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Improved residential real estate. 141.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

12 CFR 141.16 - Improved residential real estate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Improved residential real estate. 141.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

12 CFR 141.16 - Improved residential real estate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Improved residential real estate. 141.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

The Relationship of Engagement in Improvement Practices to Outcome Measures in Large-Scale Quality Improvement Initiatives.

PubMed

Foster, Gregory L; Kenward, Kevin; Hines, Stephen; Joshi, Maulik S

Hospital engagement networks (HENs) are part of the largest health care improvement initiative ever undertaken. This article explores whether engagement in improvement activities within a HEN affected quality measures. Data were drawn from 1174 acute care hospitals. A composite quality score was created from 10 targeted topic area measures multiplied by the number of qualifying topics. Scores improved from 5.4 (SD = 6.8) at baseline to 4.6 (5.9) at remeasurement; P < .0001. Hospitals with higher baseline scores demonstrated greater improvement ( P < .0001) than hospitals with lower baseline scores. Hospitals with larger Medicaid populations ( P = .023) and micropolitan ( P = .034) hospitals tended to have greater improvement, whereas hospitals in the West ( P = .0009) did not improve as much as hospitals in other regions. After adjusting for hospital characteristics, hospitals with improvement champions ( P = .008), a higher level of engagement with their state association ( P = .001), and more leadership involvement ( P = .005) in HEN demonstrated greater improvement.

Experimental study on durability improvement of fly ash concrete with durability improving admixture.

PubMed

Quan, Hong-zhu; Kasami, Hideo

2014-01-01

In order to improve the durability of fly ash concrete, a series of experimental studies are carried out, where durability improving admixture is used to reduce drying shrinkage and improve freezing-thawing resistance. The effects of durability improving admixture, air content, water-binder ratio, and fly ash replacement ratio on the performance of fly ash concrete are discussed in this paper. The results show that by using durability improving admixture in nonair-entraining fly ash concrete, the compressive strength of fly ash concrete can be improved by 10%-20%, and the drying shrinkage is reduced by 60%. Carbonation resistance of concrete is roughly proportional to water-cement ratio regardless of water-binder ratio and fly ash replacement ratio. For the specimens cured in air for 2 weeks, the freezing-thawing resistance is improved. In addition, by making use of durability improving admixture, it is easier to control the air content and make fly ash concrete into nonair-entraining one. The quality of fly ash concrete is thereby optimized.

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

PubMed Central

Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill

2012-01-01

Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681

Making it easy to do the right thing in healthcare: Advancing improvement science education through accredited pan European higher education modules.

PubMed

MacRae, Rhoda; Rooney, Kevin D; Taylor, Alan; Ritters, Katrina; Sansoni, Julita; Lillo Crespo, Manuel; Skela-Savič, Brigita; O'Donnell, Barbara

2016-07-01

Numerous international policy drivers espouse the need to improve healthcare. The application of Improvement Science has the potential to restore the balance of healthcare and transform it to a more person-centred and quality improvement focussed system. However there is currently no accredited Improvement Science education offered routinely to healthcare students. This means that there are a huge number of healthcare professionals who do not have the conceptual or experiential skills to apply Improvement Science in everyday practise. This article describes how seven European Higher Education Institutions (HEIs) worked together to develop four evidence informed accredited inter-professional Improvement Science modules for under and postgraduate healthcare students. It outlines the way in which a Policy Delphi, a narrative literature review, a review of the competency and capability requirements for healthcare professionals to practise Improvement Science, and a mapping of current Improvement Science education informed the content of the modules. A contemporary consensus definition of Healthcare Improvement Science was developed. The four Improvement Science modules that have been designed are outlined. A framework to evaluate the impact modules have in practise has been developed and piloted. The authors argue that there is a clear need to advance healthcare Improvement Science education through incorporating evidence based accredited modules into healthcare professional education. They suggest that if Improvement Science education, that incorporates work based learning, becomes a staple part of the curricula in inter-professional education then it has real promise to improve the delivery, quality and design of healthcare. Copyright © 2016 Elsevier Ltd. All rights reserved.

The business case for quality improvement: oral anticoagulation for atrial fibrillation.

PubMed

Rose, Adam J; Berlowitz, Dan R; Ash, Arlene S; Ozonoff, Al; Hylek, Elaine M; Goldhaber-Fiebert, Jeremy D

2011-07-01

The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation. Our population consisted of 67 077 Veterans Health Administration patients anticoagulated for atrial fibrillation between October 1, 2006, and September 30, 2008. We simulated the number of adverse events and their associated costs and utilities, both before and after various degrees of improvement in percent time in therapeutic range (TTR). The simulation had a 2-year time horizon, and costs were calculated from the perspective of the payer. In the base-case analysis, improving TTR by 5% prevented 1114 adverse events, including 662 deaths; it gained 863 quality-adjusted life-years and saved $15.9 million compared with the status quo, not accounting for the cost of the quality improvement program. Improving TTR by 10% prevented 2087 events, gained 1606 quality-adjusted life-years, and saved $29.7 million. In sensitivity analyses, costs were most sensitive to the estimated risk of stroke and the expected stroke reduction from improved TTR. Utilities were most sensitive to the estimated risk of death and the expected mortality benefit from improved TTR. A quality improvement program to improve anticoagulation control probably would be cost-saving for the payer, even if it were only modestly effective in improving control and even without considering the value of improved health. This study demonstrates how to make a business case for a quality improvement initiative.

Beyond the Rhetoric: A Framework for Evaluating Improvements to the Student Experience

ERIC Educational Resources Information Center

Baird, Jeanette; Gordon, George

2009-01-01

A framework is described to assist institutions in evaluating the extent to which activities described as "quality improvements" or "quality enhancements" are likely to directly improve the student experience. The framework classifies ways of improving the student experience into "coaching improvements",…

12 CFR 541.16 - Improved residential real estate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Improved residential real estate. 541.16 Section... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

12 CFR 541.16 - Improved residential real estate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Improved residential real estate. 541.16 Section... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

ERIC Educational Resources Information Center

Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

2009-01-01

Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

32 CFR 644.485 - Sale of buildings and other improvements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Sale of buildings and other improvements. 644.485... PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Buildings and Other Improvements (without the Related Land) § 644.485 Sale of buildings and other improvements. Buildings and other improvements made...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... projects, develop and implement an information technology system explicitly designed to improve patient... program that shows measurable improvement in indicators for which there is evidence that it will improve... learning throughout the hospital. (3) The hospital must take actions aimed at performance improvement and...

43 CFR 4120.3-8 - Range improvement fund.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., improvement and protection, fish and wildlife habitat improvement or protection, soil and water resource... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Range improvement fund. 4120.3-8 Section... Grazing Management § 4120.3-8 Range improvement fund. (a) In addition to range developments accomplished...

25 CFR 256.12 - Who administers the Housing Improvement Program?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Who administers the Housing Improvement Program? 256.12 Section 256.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.12 Who administers the Housing Improvement Program? The Housing Improvement Program is...

25 CFR 256.12 - Who administers the Housing Improvement Program?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Who administers the Housing Improvement Program? 256.12 Section 256.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.12 Who administers the Housing Improvement Program? The Housing Improvement Program is...

25 CFR 256.12 - Who administers the Housing Improvement Program?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Who administers the Housing Improvement Program? 256.12 Section 256.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.12 Who administers the Housing Improvement Program? The Housing Improvement Program is...

25 CFR 256.12 - Who administers the Housing Improvement Program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Who administers the Housing Improvement Program? 256.12 Section 256.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.12 Who administers the Housing Improvement Program? The Housing Improvement Program is...

25 CFR 256.12 - Who administers the Housing Improvement Program?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Who administers the Housing Improvement Program? 256.12 Section 256.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.12 Who administers the Housing Improvement Program? The Housing Improvement Program is...

Making process improvement 'stick'.

PubMed

Studer, Quint

2014-06-01

To sustain gains from a process improvement initiative, healthcare organizations should: Explain to staff why a process improvement initiative is needed. Encourage leaders within the organization to champion the process improvement, and tie their evaluations to its outcomes. Ensure that both leaders and employees have the skills to help sustain the sought-after process improvements.

42 CFR 438.240 - Quality assessment and performance improvement program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement... Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and performance improvement program. (a) General rules. (1) The State must require, through its contracts, that each MCO and...

34 CFR 200.41 - School improvement plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false School improvement plan. 200.41 Section 200.41... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.41 School improvement plan. (a)(1) Not later than three months after an LEA has identified a school for improvement...

Improved actions and asymptotic scaling in lattice Yang-Mills theory

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

Langfeld, Kurt

2007-11-01

Improved actions in SU(2) and SU(3) lattice gauge theories are investigated with an emphasis on asymptotic scaling. A new scheme for tadpole improvement is proposed. The standard but heuristic tadpole improvement emerges from a mean field approximation from the new approach. Scaling is investigated by means of the large distance static quark potential. Both the generic and the new tadpole scheme yield significant improvements on asymptotic scaling when compared with loop improved actions. A study of the rotational symmetry breaking terms, however, reveals that only the new improvement scheme efficiently eliminates the leading irrelevant term from the action.

Quality improvement and emerging global health priorities

PubMed Central

Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

2018-01-01

Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

Healthcare quality measurement in orthopaedic surgery: current state of the art.

PubMed

Auerbach, Andrew

2009-10-01

Improving quality of care in arthroplasty is of increasing importance to payors, hospitals, surgeons, and patients. Efforts to compel improvement have traditionally focused measurement and reporting of data describing structural factors, care processes (or 'quality measures'), and clinical outcomes. Reporting structural measures (eg, surgical case volume) has been used with varying degrees of success. Care process measures, exemplified by initiatives such as the Surgical Care Improvement Project measures, are chosen based on the strength of randomized trial evidence linking the process to improved outcomes. However, evidence linking improved performance on Surgical Care Improvement Project measures with improved outcomes is limited. Outcome measures in surgery are of increasing importance as an approach to compel care improvement with prominent examples represented by the National Surgical Quality Improvement Project. Although outcomes-focused approaches are often costly, when linked to active benchmarking and collaborative activities, they may improve care broadly. Moreover, implementation of computerized data systems collecting information formerly collected on paper only will facilitate benchmarking. In the end, care will only be improved if these data are used to define methods for innovating care systems that deliver better outcomes at lower or equivalent costs.

Target recognition of ladar range images using slice image: comparison of four improved algorithms

NASA Astrophysics Data System (ADS)

Xia, Wenze; Han, Shaokun; Cao, Jingya; Wang, Liang; Zhai, Yu; Cheng, Yang

2017-07-01

Compared with traditional 3-D shape data, ladar range images possess properties of strong noise, shape degeneracy, and sparsity, which make feature extraction and representation difficult. The slice image is an effective feature descriptor to resolve this problem. We propose four improved algorithms on target recognition of ladar range images using slice image. In order to improve resolution invariance of the slice image, mean value detection instead of maximum value detection is applied in these four improved algorithms. In order to improve rotation invariance of the slice image, three new improved feature descriptors-which are feature slice image, slice-Zernike moments, and slice-Fourier moments-are applied to the last three improved algorithms, respectively. Backpropagation neural networks are used as feature classifiers in the last two improved algorithms. The performance of these four improved recognition systems is analyzed comprehensively in the aspects of the three invariances, recognition rate, and execution time. The final experiment results show that the improvements for these four algorithms reach the desired effect, the three invariances of feature descriptors are not directly related to the final recognition performance of recognition systems, and these four improved recognition systems have different performances under different conditions.

Can formal collaborative methodologies improve quality in primary health care in New Zealand? Insights from the EQUIPPED Auckland Collaborative.

PubMed

Palmer, Celia; Bycroft, Janine; Healey, Kate; Field, Adrian; Ghafel, Mazin

2012-12-01

Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to improve the management of long-term conditions in New Zealand, with support from the Ministry of Health. To improve clinical outcomes, facilitate planned care and promote quality improvement within participating practices in Auckland. Implementation of the Collaborative followed the improvement model / Institute for Healthcare Improvement methodology. Three topic areas were selected: system redesign, cardio-vascular disease/diabetes, and self-management support. An expert advisory group and the Improvement Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 practice teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted. Improvements were recorded in cardiovascular disease risk assessment, practice-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found improvements in coordination and teamwork, knowledge of practice populations and understanding of managing long-term conditions. The Collaborative process delivered some real improvements in the systems of care for people with long-term conditions and a change in culture among participating practices. The findings suggest that by strengthening facilitation processes, improving access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant improvements in practice. Other organisations should consider this approach when investigating quality improvement programmes.

Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity?

PubMed

Daubs, Michael D; Lenke, Lawrence G; Bridwell, Keith H; Kim, Yongjung J; Hung, Man; Cheh, Gene; Koester, Linda A

2013-03-15

Retrospective study with prospectively collected outcomes data. Determine the significance of coronal balance on spinal deformity surgery outcomes. Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear. Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone. Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092). Sagittal balance improvement is the strongest predictor of improved outcomes in patients with combined coronal and sagittal imbalance. In patients with coronal imbalance alone, improvement in coronal balance was not a factor for predicting improved functional outcomes.

Improving the Simplified Acquisition of Base Engineering Requirements (SABER) Delivery Order Award Process: Results of a Process Improvement Plan

DTIC Science & Technology

1991-09-01

putting all tasks directed towsrds achieving an outcome in aequence. The tasks can be viewed as steps in the process (39:2.3). Using this...improvement opportunity is investigated. A plan is developed, root causes are identified, and solutions are tested and implemented. The process is... solutions , check for actual improvement, and integrate the successful improvements into the process. ?UP 7. Check Improvement Performance. Finally, the

Software Defined GPS API: Development and Implementation of GPS Correlator Architectures Using MATLAB with Focus on SDR Implementations

DTIC Science & Technology

2014-05-18

intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques...with the intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved...intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques to

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

PubMed

Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A

2018-03-01

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Relationships between evidence-based practice, quality improvement and clinical error experience of nurses in Korean hospitals.

PubMed

Hwang, Jee-In; Park, Hyeoun-Ae

2015-07-01

This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based practice (EBP) and quality improvement (QI), and the relationships between evidence-based practice, quality improvement and clinical errors. Understanding the factors affecting evidence-based practice and quality improvement activities and their relationships with clinical errors is important for designing strategies to promote evidence-based practice, quality improvement and patient safety. A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based practice Questionnaire and quality improvement scale developed in this study. Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based practice scores whereas age and job position were associated with quality improvement scores. There were positive, moderate correlations between evidence-based practice and quality improvement scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality improvement skills scores than those who had. The findings indicated the necessity of educational support regarding evidence-based practice and quality improvement for younger staff nurses who have no master degrees. Enhancing quality improvement skills may reduce clinical errors. Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based practice and quality improvement. © 2013 John Wiley & Sons Ltd.

Reference Manual on Making School Climate Improvements. School Climate Improvement Resource Package, 2017

ERIC Educational Resources Information Center

Yoder, N.; Darling-Churchill, K.; Colombi, G. D.; Ruddy, S.; Neiman, S.; Chagnon, E.; Mayo, R.

2017-01-01

This reference manual identifies five overarching sets of activities for improving school climate, with the goal of improving student outcomes (e.g., achievement, attendance, behaviors, and skills). These sets of activities help to initiate, implement, and sustain school climate improvements. For each activity set, the manual presents a clear…

25 CFR 117.29 - Sale of improvements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Sale of improvements. 117.29 Section 117.29 Indians... Sale of improvements. The superintendent may approve the sale of improvements on restricted Indian... written request that the sale be made and a statement that the improvements can no longer be used by him...

25 CFR 117.29 - Sale of improvements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Sale of improvements. 117.29 Section 117.29 Indians... Sale of improvements. The superintendent may approve the sale of improvements on restricted Indian... written request that the sale be made and a statement that the improvements can no longer be used by him...

How effective are tree improvement programs in the 50 states?

Treesearch

Christopher D. Risbrudt; Stephen E. McDonald

1986-01-01

All 50 states were surveyed to determine the extent of their activities in producing genetically improved trees for timber production. Describes the funds expended, the species being improved, and the use of State and Private Forestry funds provided for genetic improvement. Projects future timber volumes attributable to genetic improvement, and estimates benefit cost...

34 CFR 637.3 - What regulations apply to the Minority Science and Engineering Improvement Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Engineering Improvement Program? 637.3 Section 637.3 Education Regulations of the Offices of the Department of... ENGINEERING IMPROVEMENT PROGRAM General § 637.3 What regulations apply to the Minority Science and Engineering Improvement Program? The following regulations apply to the Minority Science and Engineering Improvement...

34 CFR 637.3 - What regulations apply to the Minority Science and Engineering Improvement Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Engineering Improvement Program? 637.3 Section 637.3 Education Regulations of the Offices of the Department of... ENGINEERING IMPROVEMENT PROGRAM General § 637.3 What regulations apply to the Minority Science and Engineering Improvement Program? The following regulations apply to the Minority Science and Engineering Improvement...

34 CFR 637.3 - What regulations apply to the Minority Science and Engineering Improvement Program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Engineering Improvement Program? 637.3 Section 637.3 Education Regulations of the Offices of the Department of... ENGINEERING IMPROVEMENT PROGRAM General § 637.3 What regulations apply to the Minority Science and Engineering Improvement Program? The following regulations apply to the Minority Science and Engineering Improvement...

34 CFR 637.3 - What regulations apply to the Minority Science and Engineering Improvement Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Engineering Improvement Program? 637.3 Section 637.3 Education Regulations of the Offices of the Department of... ENGINEERING IMPROVEMENT PROGRAM General § 637.3 What regulations apply to the Minority Science and Engineering Improvement Program? The following regulations apply to the Minority Science and Engineering Improvement...

34 CFR 637.3 - What regulations apply to the Minority Science and Engineering Improvement Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Engineering Improvement Program? 637.3 Section 637.3 Education Regulations of the Offices of the Department of... ENGINEERING IMPROVEMENT PROGRAM General § 637.3 What regulations apply to the Minority Science and Engineering Improvement Program? The following regulations apply to the Minority Science and Engineering Improvement...

Improving Teaching and Teachers: A "Generative Dance"?

ERIC Educational Resources Information Center

Lampert, Magdalene

2012-01-01

Working on teaching as a collective practice--understanding it, specifying it, and improving it--is crucially important and too often ignored. But setting up a choice between improving teaching and improving teachers is problematic for several reasons. To begin with, it seems that the very methods Hiebert and Morris outline for improving teaching…

Highly porous ceramic oxide aerogels having improved flexibility

NASA Technical Reports Server (NTRS)

Guo, Haiquan (Inventor); Meador, Mary Ann B. (Inventor); Nguyen, Baochau N. (Inventor)

2012-01-01

Ceramic oxide aerogels having improved flexibility are disclosed. Preferred embodiments exhibit high modulus and other strength properties despite their improved flexibility. The gels may be polymer cross-linked via organic polymer chains to further improve strength properties, without substantially detracting from the improved flexibility. Methods of making such aerogels are also disclosed.

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

PubMed

Millar, Ross

2013-01-01

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

Experimental Study on Durability Improvement of Fly Ash Concrete with Durability Improving Admixture

PubMed Central

Quan, Hong-zhu; Kasami, Hideo

2014-01-01

In order to improve the durability of fly ash concrete, a series of experimental studies are carried out, where durability improving admixture is used to reduce drying shrinkage and improve freezing-thawing resistance. The effects of durability improving admixture, air content, water-binder ratio, and fly ash replacement ratio on the performance of fly ash concrete are discussed in this paper. The results show that by using durability improving admixture in nonair-entraining fly ash concrete, the compressive strength of fly ash concrete can be improved by 10%–20%, and the drying shrinkage is reduced by 60%. Carbonation resistance of concrete is roughly proportional to water-cement ratio regardless of water-binder ratio and fly ash replacement ratio. For the specimens cured in air for 2 weeks, the freezing-thawing resistance is improved. In addition, by making use of durability improving admixture, it is easier to control the air content and make fly ash concrete into nonair-entraining one. The quality of fly ash concrete is thereby optimized. PMID:25013870

An improvement project within urological care.

PubMed

Khatami, Annelie; Rosengren, Kristina

2015-01-01

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

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

PubMed Central

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-01-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

PubMed

Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

2016-04-01

Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, p<0.001), but did not differ in post-I period. Dysphagia screening improved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. 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/

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

PubMed

Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

Balancing measures or a balanced accounting of improvement impact: a qualitative analysis of individual and focus group interviews with improvement experts in Scotland.

PubMed

Toma, Madalina; Dreischulte, Tobias; Gray, Nicola M; Campbell, Diane; Guthrie, Bruce

2018-07-01

As quality improvement (QI) programmes have become progressively larger scale, the risks of implementation having unintended consequences are increasingly recognised. More routine use of balancing measures to monitor unintended consequences has been proposed to evaluate overall effectiveness, but in practice published improvement interventions hardly ever report identification or measurement of consequences other than intended goals of improvement. We conducted 15 semistructured interviews and two focus groups with 24 improvement experts to explore the current understanding of balancing measures in QI and inform a more balanced accounting of the overall impact of improvement interventions. Data were analysed iteratively using the framework approach. Participants described the consequences of improvement in terms of desirability/undesirability and the extent to which they were expected/unexpected when planning improvement. Four types of consequences were defined: expected desirable consequences ( goals ); expected undesirable consequences ( trade-offs ); unexpected undesirable consequences ( unpleasant surprises ); and unexpected desirable consequences ( pleasant surprises ). Unexpected consequences were considered important but rarely measured in existing programmes, and an improvement pause to take stock after implementation would allow these to be more actively identified and managed. A balanced accounting of all consequences of improvement interventions can facilitate staff engagement and reduce resistance to change, but has to be offset against the cost of additional data collection. Improvement measurement is usually focused on measuring intended goals , with minimal use of balancing measures which when used, typically monitor trade-offs expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any pleasant or unpleasant surprises. © 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.

Results of a Regional Effort to Improve Warfarin Management.

PubMed

Rose, Adam J; Park, Angela; Gillespie, Christopher; Van Deusen Lukas, Carol; Ozonoff, Al; Petrakis, Beth Ann; Reisman, Joel I; Borzecki, Ann M; Benedict, Ashley J; Lukesh, William N; Schmoke, Timothy J; Jones, Ellen A; Morreale, Anthony P; Ourth, Heather L; Schlosser, James E; Mayo-Smith, Michael F; Allen, Arthur L; Witt, Daniel M; Helfrich, Christian D; McCullough, Megan B

2017-05-01

Improved anticoagulation control with warfarin reduces adverse events and represents a target for quality improvement. No previous study has described an effort to improve anticoagulation control across a health system. To describe the results of an effort to improve anticoagulation control in the New England region of the Veterans Health Administration (VA). Our intervention encompassed 8 VA sites managing warfarin for more than 5000 patients in New England (Veterans Integrated Service Network 1 [VISN 1]). We provided sites with a system to measure processes of care, along with targeted audit and feedback. We focused on processes of care associated with site-level anticoagulation control, including prompt follow-up after out-of-range international normalized ratio (INR) values, minimizing loss to follow-up, and use of guideline-concordant INR target ranges. We used a difference-in-differences (DID) model to examine changes in anticoagulation control, measured as percentage time in therapeutic range (TTR), as well as process measures and compared VISN 1 sites with 116 VA sites located outside VISN 1. VISN 1 sites improved on TTR, our main indicator of quality, from 66.4% to 69.2%, whereas sites outside VISN 1 improved from 65.9% to 66.4% (DID 2.3%, P < 0.001). Improvement in TTR correlated strongly with the extent of improvement on process-of-care measures, which varied widely across VISN 1 sites. A regional quality improvement initiative, using performance measurement with audit and feedback, improved TTR by 2.3% more than control sites, which is a clinically important difference. Improving relevant processes of care can improve outcomes for patients receiving warfarin.

Facial expression recognition based on improved local ternary pattern and stacked auto-encoder

NASA Astrophysics Data System (ADS)

Wu, Yao; Qiu, Weigen

2017-08-01

In order to enhance the robustness of facial expression recognition, we propose a method of facial expression recognition based on improved Local Ternary Pattern (LTP) combined with Stacked Auto-Encoder (SAE). This method uses the improved LTP extraction feature, and then uses the improved depth belief network as the detector and classifier to extract the LTP feature. The combination of LTP and improved deep belief network is realized in facial expression recognition. The recognition rate on CK+ databases has improved significantly.

Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation).

PubMed

Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter

2012-07-01

Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

Applications of process improvement techniques to improve workflow in abdominal imaging.

PubMed

Tamm, Eric Peter

2016-03-01

Major changes in the management and funding of healthcare are underway that will markedly change the way radiology studies will be reimbursed. The result will be the need to deliver radiology services in a highly efficient manner while maintaining quality. The science of process improvement provides a practical approach to improve the processes utilized in radiology. This article will address in a step-by-step manner how to implement process improvement techniques to improve workflow in abdominal imaging.

Changing the cytology laboratory information system to improve cytology performance.

PubMed

Renshaw, Andrew A; Birdsong, George G

2014-02-01

A central tenet in the Patient Protection and Affordable Care Act is the increased use of information technology to improve patient care. However, areas for improvement in cytology are not well defined. Improvements in information technology could improve quality assessment in gynecologic cytology, but the cytology community must identify and ask for changes in information technology that can improve the care of patients. Cancer (Cancer Cytopathol) 2014;122:87-91. © 2013 American Cancer Society. © 2013 American Cancer Society.

Enhancing causal interpretations of quality improvement interventions

PubMed Central

Cable, G

2001-01-01

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments. Key Words: causal interpretations; quality improvement; interrupted time series design; implementation fidelity PMID:11533426

42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... performance improvement program. (3) The RNHCI must set priorities for performance improvement, considering... assessment and performance improvement program addresses identified priorities in the RNHCI and are...

Module 1--Shared Leadership. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Module 4--Effective Teaching. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Module 2--Learning Culture. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

ERIC Educational Resources Information Center

Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

2015-01-01

As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

ERIC Educational Resources Information Center

Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

2010-01-01

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

Teaching Evaluation: A Critical Measure for Improving the Quality of Education

ERIC Educational Resources Information Center

Ji, Zhou

2009-01-01

In the coming period, the main task for China's higher education system is to improve the quality of education, and the key to improving the quality of education is to improve the quality of teaching. Teaching evaluations are a critical measure for improving the quality of teaching. The work of evaluating teaching at institutions of higher…

School Climate Improvement Action Guide for Working with Students. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps to engage students in the school climate improvement process. Key action steps are provided for the following strategies: (1) Participate in planning for school climate improvements; (2) Engage stakeholders in…

School Climate Improvement Action Guide for Working with Families. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines how family members--including guardians of students--can support school climate improvements. Key action steps are provided for the following strategies: (1) Participate in planning for school climate improvements; (2) Engage…

EUV process improvement with novel litho track hardware

NASA Astrophysics Data System (ADS)

Stokes, Harold; Harumoto, Masahiko; Tanaka, Yuji; Kaneyama, Koji; Pieczulewski, Charles; Asai, Masaya

2017-03-01

Currently, there are many developments in the field of EUV lithography that are helping to move it towards increased HVM feasibility. Targeted improvements in hardware design for advanced lithography are of interest to our group specifically for metrics such as CD uniformity, LWR, and defect density. Of course, our work is focused on EUV process steps that are specifically affected by litho track performance, and consequently, can be improved by litho track design improvement and optimization. In this study we are building on our experience to provide continual improvement for LWR, CDU, and Defects as applied to a standard EUV process by employing novel hardware solutions on our SOKUDO DUO coat develop track system. Although it is preferable to achieve such improvements post-etch process we feel, as many do, that improvements after patterning are a precursor to improvements after etching. We hereby present our work utilizing the SOKUDO DUO coat develop track system with an ASML NXE:3300 in the IMEC (Leuven, Belgium) cleanroom environment to improve aggressive dense L/S patterns.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

PubMed

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Improving Service Delivery in a County Health Department WIC Clinic: An Application of Statistical Process Control Techniques

PubMed Central

Boe, Debra Thingstad; Parsons, Helen

2009-01-01

Local public health agencies are challenged to continually improve service delivery, yet they frequently operate with constrained resources. Quality improvement methods and techniques such as statistical process control are commonly used in other industries, and they have recently been proposed as a means of improving service delivery and performance in public health settings. We analyzed a quality improvement project undertaken at a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic to reduce waiting times and improve client satisfaction with a walk-in nutrition education service. We used statistical process control techniques to evaluate initial process performance, implement an intervention, and assess process improvements. We found that implementation of these techniques significantly reduced waiting time and improved clients' satisfaction with the WIC service. PMID:19608964

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

PubMed

Palmersheim, T M

1999-12-01

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

Health-related quality of life in randomized controlled trials of lorcaserin for obesity management: what mediates improvement?

PubMed

Kolotkin, R L; Crosby, R D; Wang, Z

2017-12-01

Lorcaserin, plus diet and exercise, has demonstrated significant weight loss and improved cardiometabolic parameters vs. placebo in patients with overweight/obesity in three randomized, placebo-controlled trials. We examined whether lorcaserin is also associated with greater improvements in health-related quality of life (HRQOL) and whether these improvements are wholly attributable to weight loss. Pooled data from Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM), Behavioral Modification and Lorcaserin Second Study for Obesity Management (BLOSSOM) and BLOOM-Diabetes Mellitus (BLOOM-DM) trials were analysed (n = 5624). HRQOL was assessed at baseline and 52 weeks using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. Multiple mediation analyses were conducted to evaluate the mechanisms underlying improved HRQOL. Greater HRQOL improvements were observed at 52 weeks in lorcaserin vs. placebo (P < 0.0001). A greater percentage of lorcaserin patients (54.1%) experienced meaningful improvements in IWQOL-Lite total score than placebo patients (48.2%) (P < 0.001). Body mass index (BMI) reduction was the primary driver of improved HRQOL (P < 0.0001), with depressive symptoms and total cholesterol also playing a role (P < 0.05). Improved HRQOL varied by gender, age, race and presence of diabetes and other comorbidities. Lorcaserin treatment significantly improves HRQOL compared with placebo. Although BMI reduction accounts for the majority of these improvements, improvement in depressive symptoms and total cholesterol are contributing factors. © 2017 World Obesity Federation.

Adapting improvements to context: when, why and how?

PubMed Central

Ovretveit, John; Dolan-Branton, Lisa; Marx, Michael; Reid, Amy; Reed, Julie; Agins, Bruce

2018-01-01

Abstract There is evidence that practitioners applying quality improvements often adapt the improvement method or the change they are implementing, either unknowingly, or intentionally to fit their service or situation. This has been observed especially in programs seeking to spread or ‘scale up’ an improvement change to other services. Sometimes their adaptations result in improved outcomes, sometimes they do not, and sometimes they do not have data make this assessment or to describe the adaptation. The purpose of this paper is to summarize key points about adaptation and context discussed at the Salzburg Global Seminar in order to help improvers judge when and how to adapt an improvement change. It aims also to encourage more research into such adaptations to develop our understanding of the when, why and how of effective adaptation and to provide more research informed guidance to improvers. The paper gives examples to illustrate key issues in adaptation and to consider more systematic and purposeful adaptation of improvements so as to increase the chances of achieving improvements in different settings for different participants. We describe methods for assessing whether adaptation is necessary or likely to reduce the effectiveness of an improvement intervention, which adaptations might be required, and methods for collecting data to assess whether the adaptations are successful. We also note areas where research is most needed in order to enable more effective scale up of quality improvements changes and wider take up and use of the methods.

Integrating improvement learning into a family medicine residency curriculum.

PubMed

Pensa, Mellisa; Frew, Patty; Gelmon, Sherril B

2013-06-01

Knowledge of improvement practices is a critical skill for family medicine residents who will lead patient-centered medical homes. The Accreditation Council for Graduate Medical Education includes systems-based practice and improvement knowledge as a core competency for residency education. The objective of this report is to describe the 6-year implementation and development of our practice-based improvement curriculum in a family medicine residency. In 2006, Oregon Health and Science University Family Medicine Residency implemented an improvement curriculum that focused on clinic-based improvement and involved longitudinal didactics. Over the course of 6 years, the curriculum has been refined to include longitudinal instruction of improvement principles according to the levels of training and clinic-based didactics and experientials that are team oriented. Residents complete ambulatory improvement projects over the cycle of 12 months and present outcomes each year. Residents evaluated their knowledge, experience, confidence, and satisfaction at the end of the academic year. Ninety percent of residents designed and lead improvement projects upon graduation from residency in 2011. Resident confidence to make a change in local health care settings at the end of the curriculum was high and improved from 2009/2010 to 2010/2011. Upon graduation from the program, 100% of residents reported competence or proficiency in their ability to apply knowledge to an improvement project and present results. We describe a longitudinal, practical, developmental, and clinically based experiential improvement curriculum that has been successfully integrated into a family medicine residency program.

Model-driven approach to data collection and reporting for quality improvement

PubMed Central

Curcin, Vasa; Woodcock, Thomas; Poots, Alan J.; Majeed, Azeem; Bell, Derek

2014-01-01

Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed. PMID:24874182

CF6 Jet Engine Performance Improvement Program: High Pressure Turbine Aerodynamic Performance Improvement

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1980-01-01

The improved single shank high pressure turbine design was evaluated in component tests consisting of performance, heat transfer and mechanical tests, and in core engine tests. The instrumented core engine test verified the thermal, mechanical, and aeromechanical characteristics of the improved turbine design. An endurance test subjected the improved single shank turbine to 1000 simulated flight cycles, the equivalent of approximately 3000 hours of typical airline service. Initial back-to-back engine tests demonstrated an improvement in cruise sfc of 1.3% and a reduction in exhaust gas temperature of 10 C. An additional improvement of 0.3% in cruise sfc and 6 C in EGT is projected for long service engines.

Does Teacher Professional Development Improve Math and Science Outcomes and Is It Cost Effective?

ERIC Educational Resources Information Center

Foster, John M.; Toma, Eugenia F.; Troske, SuZanne P.

2013-01-01

Scholars and policymakers see improving teacher quality as a key way to improve student learning. While quality may be improved in a variety of ways for pre-service teachers, professional development is one of the few avenues by which quality can be improved for those teachers already in the teaching profession. But professional development, like…

Embarking on performance improvement.

PubMed

Brown, Bobbi; Falk, Leslie Hough

2014-06-01

Healthcare organizations should approach performance improvement as a program, not a project. The program should be led by a guidance team that identifies goals, prioritizes work, and removes barriers to enable clinical improvement teams and work groups to realize performance improvements. A healthcare enterprise data warehouse can provide the initial foundation for the program analytics. Evidence-based best practices can help achieve improved outcomes and reduced costs.

Improving Low-Achieving Schools: Building State Capacity to Support School Improvement through Race to the Top

ERIC Educational Resources Information Center

Childs, Joshua; Russell, Jennifer Lin

2017-01-01

Improving low-achieving schools is a critical challenge facing urban education. Recent national policy shifts have pressed states to take an expanded role in school improvement efforts. In 2009, a federal grant competition called Race to the Top (RttT) compelled states to improve their capacity to implement ambitious education reform agendas.…

Improving School Improvement: Development and Validation of the CSIS-360, a 360-Degree Feedback Assessment for School Improvement Specialists

ERIC Educational Resources Information Center

McDougall, Christie M.

2013-01-01

The purpose of the mixed methods study was to develop and validate the CSIS-360, a 360-degree feedback assessment to measure competencies of school improvement specialists from multiple perspectives. The study consisted of eight practicing school improvement specialists from a variety of settings. The specialists nominated 23 constituents to…

Reducing fatalities and severe injuries on Florida's high-speed multi-lane arterial corridors : part IV, safety improvements on multilane arterials in Florida--a before and after evaluation, final report, April 2009.

DOT National Transportation Integrated Search

2009-03-28

This study examines the safety effects of the improvements made on multi-lane arterials. The improvements were divided into two categories: 1) corridor level improvements, and 2) intersection improvements. Empirical Bayes method, which is one of the ...

Module 3--School-Family-Community Connections. School Improvement Specialist Training Materials: Performance Standards, Improving Schools, and Literature Review

ERIC Educational Resources Information Center

Appalachia Educational Laboratory at Edvantia (NJ1), 2005

2005-01-01

The School Improvement Specialist Project prepared seven modules. School improvement specialists, as defined by the Appalachia Educational Laboratory at Edvantia, are change agents who work with schools to help them improve in the following areas so as to increase student achievement. These modules are intended to provide training materials for…

Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives.

PubMed

Godfrey, Marjorie M; Andersson-Gare, Boel; Nelson, Eugene C; Nilsson, Mats; Ahlstrom, Gerd

2014-05-01

To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives. Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia. Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities. Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support. All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions. Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement. © 2013 John Wiley & Sons Ltd.

Alteration of histological gastritis after cure of Helicobacter pylori infection.

PubMed

Hojo, M; Miwa, H; Ohkusa, T; Ohkura, R; Kurosawa, A; Sato, N

2002-11-01

It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection. To clarify the histological changes after the cure of H. pylori infection through a literature survey. Fifty-one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system. Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow-up period (> 12 months), suggesting that disagreement between the studies was not totally due to sample size or follow-up period. Methodological flaws, such as patient selection, and statistical analysis based on the assumption that atrophy improves continuously and generally in all patients might be responsible for the inconsistent results. Four of 28 studies described significant improvement of intestinal metaplasia [corrected]. Activity and inflammation were improved after the cure of H. pylori infection. Atrophy did not improve generally among all patients, but improved in certain patients. Improvement of intestinal metaplasia was difficult to analyse due to methodological problems including statistical power.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education.

PubMed

Christiansen, Angela; Robson, Linda; Griffith-Evans, Christine

2010-10-01

The present study reports a descriptive survey of nursing students' experience of service improvement learning in the university and practice setting. Opportunities to develop service improvement capabilities were embedded into pre-registration programmes at a university in the Northwest of England to ensure future nurses have key skills for the workplace. A cross-sectional survey designed to capture key aspects of students' experience was completed by nursing students (n = 148) who had undertaken a service improvement project in the practice setting. Work organizations in which a service improvement project was undertaken were receptive to students' efforts. Students reported increased confidence to undertake service improvement and service improvement capabilities were perceived to be important to future career development and employment prospects. Service improvement learning in pre-registration education appears to be acceptable, effective and valued by students. Further research to identify the impact upon future professional practice and patient outcomes would enhance understanding of this developing area. Nurse Managers can play an active role in creating a service culture in which innovation and improvement can flourish to enhance patient outcomes, experience and safety. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

System characteristics of healthcare organizations conducting successful improvements.

PubMed

Olsson, Jesper; Elg, Mattias; Lindblad, Staffan

2007-01-01

In a previous study, based on a survey to all clinical department and primary care center managers in Sweden, it was concluded that the prevailing general improvement strategy is characterized by: drivers for improvement are staff needs; patients and data are not as important; improvements mainly focus on administrative routines and stress management; improvements are mainly reached, by writing guidelines, and conducting meetings; the majority of managers perceive outcomes from this strategy as successful. The purpose of current research in this paper is to investigate whether there is any other improvement strategy at play in Swedish health care. Data from the study of all Swedish managers were stratified into two populations based on an instrument predicting successful improvement. One population represented organizations with exceptionally high probability of successful imrpovement and remaining organizations represented the general improvement strategy. The paper finds that organizations with high probability for successful change differed from the comparison population at the p = 0.05 level in many of the surveyed characteristics. They put emphasis on patient focus, measuring outcomes, feedback of data, interorganizational collaboration, learning and knowledge, communication/information, culture, and development of administration and management. Thus these organizations center their attention towards behavioral changes supported by data. Organizations predicted to conduct successful improvement apply comprehensive improvement strategies as suggested in the literature. Such actions are part of the Patient Centered Task Alignment strategy and it is suggested that this concept has managerial implications as well, as it might be useful in further studies on improvement work in health care. This paper provides empirically based findings on a successful improvement strategy that can aid research-informed policy decisions on organizational improvement strategies.

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program.

PubMed

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-09-12

In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Both legs will show improvement in hop test-measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Retrospective cohort study. Level 3. Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre- and post-hop test scores were recorded as the primary outcome measure. Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. © 2016 The Author(s).

The association between sleep quality, low back pain and disability: A prospective study in routine practice.

PubMed

Kovacs, F M; Seco, J; Royuela, A; Betegon, J N; Sánchez-Herráez, S; Meli, M; Martínez Rodríguez, M E; Núñez, M; Álvarez-Galovich, L; Moyá, J; Sánchez, C; Luna, S; Borrego, P; Moix, J; Rodríguez-Pérez, V; Torres-Unda, J; Burgos-Alonso, N; Gago-Fernández, I; González-Rubio, Y; Abraira, V

2018-01-01

The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability. © 2017 European Pain Federation - EFIC®.

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program

PubMed Central

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-01-01

Background: In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Hypothesis: Both legs will show improvement in hop test–measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre– and post–hop test scores were recorded as the primary outcome measure. Results: Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Conclusion: Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Clinical Relevance: Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. PMID:27620968

Using crowdsourcing to prioritize bicycle network improvements : final report.

DOT National Transportation Integrated Search

2016-04-01

Effort to improve the bicycle route network using crowdsourced data is a powerful means : of incorporating citizens in infrastructure improvement decisions, which will improve : livability by maximizing the benefit of the bicycle infrastructure fundi...

78 FR 40488 - Availability of Draft Environmental Impact Statement for the Proposed Construction of a Highway...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-05

... operating conditions for vehicular and pedestrian traffic; Improve capacity of the local roadway network; Improve local mobility; reduce congestion; improve emergency response times; and Improve evacuation...

"Rheum to Improve": Quality Improvement in Outpatient Rheumatology.

PubMed

Chow, Shirley L; Shojania, Kaveh G

2017-09-01

The commitment to improve care processes and patient outcomes is a professional mandate for clinicians and is also seen as an operational priority for institutions. Quality improvement now figures in the accreditation of training programs, specialty examinations, and hospital scorecards. Rheumatologists have traditionally focused primarily on quality problems such as guideline adherence; however, improvement goals should also include other aspects of care that are helpful to patients and are professionally rewarding for practitioners. This review makes use of improvement projects in outlining tangible tools rheumatologists can use to resolve quality concerns in their practices.

CF6 jet engine performance improvement: High pressure turbine roundness

NASA Technical Reports Server (NTRS)

Howard, W. D.; Fasching, W. A.

1982-01-01

An improved high pressure turbine stator reducing fuel consumption in current CF6-50 turbofan engines was developed. The feasibility of the roundness and clearance response improvements was demonstrated. Application of these improvements will result in a cruise SFC reduction of 0.22 percent for new engines. For high time engines, the improved roundness and response characteristics results in an 0.5 percent reduction in cruise SFC. A basic life capability of the improved HP turbine stator in over 800 simulated flight cycles without any sign of significant distress is shown.

Facial expression recognition based on improved deep belief networks

NASA Astrophysics Data System (ADS)

Wu, Yao; Qiu, Weigen

2017-08-01

In order to improve the robustness of facial expression recognition, a method of face expression recognition based on Local Binary Pattern (LBP) combined with improved deep belief networks (DBNs) is proposed. This method uses LBP to extract the feature, and then uses the improved deep belief networks as the detector and classifier to extract the LBP feature. The combination of LBP and improved deep belief networks is realized in facial expression recognition. In the JAFFE (Japanese Female Facial Expression) database on the recognition rate has improved significantly.

JT8D-15/17 High Pressure Turbine Root Discharged Blade Performance Improvement. [engine design

NASA Technical Reports Server (NTRS)

Janus, A. S.

1981-01-01

The JT8D high pressure turbine blade and seal were modified, using a more efficient blade cooling system, improved airfoil aerodynamics, more effective control of secondary flows, and improved blade tip sealing. Engine testing was conducted to determine the effect of these improvements on performance. The modified turbine package demonstrated significant thrust specific fuel consumption and exhaust gas temperature improvements in sea level and altitude engine tests. Inspection of the improved blade and seal hardware after testing revealed no unusual wear or degradation.

Accelerating quality improvement within your organization: Applying the Model for Improvement.

PubMed

Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

2015-01-01

To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of success.

Transferring skills in quality collaboratives focused on improving patient logistics.

PubMed

Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen

2018-04-02

A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as 'important' in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Our findings seem to suggest that Quality collaboratives could benefit if more attention is paid to the transfer of 'soft skills' (e.g. change, project management and communication skills) and reflexive skills (e.g. adjusting logistics principles to specific situations and inter-project translation of experiences).

How to Sustain Change and Support Continuous Quality Improvement

PubMed Central

McQuillan, Rory; Harel, Ziv; Weizman, Adam V.; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M.; Chan, Christopher T.; Chertow, Glenn M.

2016-01-01

To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). PMID:27016498

Can proprioception really be improved by exercises?

PubMed

Ashton-Miller, J A; Wojtys, E M; Huston, L J; Fry-Welch, D

2001-05-01

There is little question that ankle disc training can improve ankle muscle motor performance in a unipedal balance task, most likely through improved strength and coordination [62] and possibly endurance. How much of the observed improvement in motor performance is due to improved ankle proprioception remains unknown. We have reviewed a number of theoretical ways in which training might improve proprioception for moderately challenging weight-bearing situations such as balancing on one leg. Although the relevant experiments have yet to be performed to test this hypothesis, any improvement would theoretically help to reduce injuries at these moderate levels of challenge. We question, however, whether these exercises can ever improve the reactive response required to prevent injury under the most challenging time-critical situations. If confirmed, this limitation needs to be acknowledged by authors and practitioners alike. Alternative protective strategies for the most challenging time-critical situations should be sought. We conclude that, despite their widespread acceptance, current exercises aimed at "improving proprioception" have not been demonstrated to achieve that goal. We have outlined theoretical scenarios by which proprioception might be improved, but these are speculative. The relevant experiments remain to be conducted. We argue that even if they were proven to improve proprioception, under the best circumstances such exercises could only prevent injury under slow to intermediate rate provocations to the joint musculoligamentous complex in question.

Improving quality of reproductive health care in Senegal through formative supervision: results from four districts.

PubMed

Suh, Siri; Moreira, Philippe; Ly, Moussa

2007-11-29

In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. The most notable improvement across regions was in infection prevention.Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

Improving quality of reproductive health care in Senegal through formative supervision: results from four districts

PubMed Central

Suh, Siri; Moreira, Philippe; Ly, Moussa

2007-01-01

Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. Methods This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. Results The most notable improvement across regions was in infection prevention. Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Conclusion Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality. PMID:18047678

Improved Critical Eigenfunction Restriction Estimates on Riemannian Surfaces with Nonpositive Curvature

NASA Astrophysics Data System (ADS)

Xi, Yakun; Zhang, Cheng

2017-03-01

We show that one can obtain improved L 4 geodesic restriction estimates for eigenfunctions on compact Riemannian surfaces with nonpositive curvature. We achieve this by adapting Sogge's strategy in (Improved critical eigenfunction estimates on manifolds of nonpositive curvature, Preprint). We first combine the improved L 2 restriction estimate of Blair and Sogge (Concerning Toponogov's Theorem and logarithmic improvement of estimates of eigenfunctions, Preprint) and the classical improved {L^∞} estimate of Bérard to obtain an improved weak-type L 4 restriction estimate. We then upgrade this weak estimate to a strong one by using the improved Lorentz space estimate of Bak and Seeger (Math Res Lett 18(4):767-781, 2011). This estimate improves the L 4 restriction estimate of Burq et al. (Duke Math J 138:445-486, 2007) and Hu (Forum Math 6:1021-1052, 2009) by a power of {(log logλ)^{-1}}. Moreover, in the case of compact hyperbolic surfaces, we obtain further improvements in terms of {(logλ)^{-1}} by applying the ideas from (Chen and Sogge, Commun Math Phys 329(3):435-459, 2014) and (Blair and Sogge, Concerning Toponogov's Theorem and logarithmic improvement of estimates of eigenfunctions, Preprint). We are able to compute various constants that appeared in (Chen and Sogge, Commun Math Phys 329(3):435-459, 2014) explicitly, by proving detailed oscillatory integral estimates and lifting calculations to the universal cover H^2.

I-25 truck safety improvements project : local evaluation report

DOT National Transportation Integrated Search

2004-12-29

The I-25 Truck Safety Improvements project (I-25 TSIP) is the result of a FY98 congressionally designated earmark to support improvements in transportation efficiency, promote safety, increase traffic flow, reduce emissions, improve traveler informat...

Perceptual experience and posttest improvements in perceptual accuracy and consistency.

PubMed

Wagman, Jeffrey B; McBride, Dawn M; Trefzger, Amanda J

2008-08-01

Two experiments investigated the relationship between perceptual experience (during practice) and posttest improvements in perceptual accuracy and consistency. Experiment 1 investigated the potential relationship between how often knowledge of results (KR) is provided during a practice session and posttest improvements in perceptual accuracy. Experiment 2 investigated the potential relationship between how often practice (PR) is provided during a practice session and posttest improvements in perceptual consistency. The results of both experiments are consistent with previous findings that perceptual accuracy improves only when practice includes KR and that perceptual consistency improves regardless of whether practice includes KR. In addition, the results showed that although there is a relationship between how often KR is provided during a practice session and posttest improvements in perceptual accuracy, there is no relationship between how often PR is provided during a practice session and posttest improvements in consistency.

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

PubMed

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-10-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. 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.

How an educational improvement project improved the summative evaluation of medical students.

PubMed

Hoffman, K G; Brown, R Margaret A; Gay, J W; Headrick, L A

2009-08-01

At the University of Missouri-Columbia School of Medicine (USA) "commitment to improving quality and safety in healthcare" is one of eight key characteristics set as goals for our graduates. As educators, commitment to continuous improvement in the educational experience has been modelled through improvement of the Medical Student Performance Evaluation (MSPE) letter (formerly the Dean's letter). This educational improvement project decreased waste, increased collaboration and developed locally useful knowledge. By applying continuous improvement principles to the construction of the MSPE the overall efficiency of the process could be enhanced, and the MSPE committee was able to spend less cognitive energy on structure and format and focus more on the content of the letters. Four MSPE cycles have been completed using a new Web-based system; after each cycle, additional enhancements were identified and implemented. This work adds to the literature, as it describes the application of continuous improvement principles to an educational system.

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives.

PubMed

Chelico, John D; Wilcox, Adam B; Vawdrey, David K; Kuperman, Gilad J

2016-01-01

Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement.

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives

PubMed Central

Chelico, John D.; Wilcox, Adam B.; Vawdrey, David K.; Kuperman, Gilad J.

2016-01-01

Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement. PMID:28269833

Applying Lean principles and Kaizen rapid improvement events in public health practice.

PubMed

Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

PubMed Central

Feasel, Jeff; Wentz, Erin; Brooks, Frederick P.; Whitton, Mary C.

2012-01-01

Background and Purpose Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. Case Description A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. Outcomes Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. Discussion Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke. PMID:22228605

Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

PubMed

Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

2009-03-01

Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

A dual change model of life satisfaction and functioning for individuals with schizophrenia

PubMed Central

Edmondson, Melissa; Pahwa, Rohini; Lee, Karen Kyeunghae; Hoe, Maanse; Brekke, John S.

2013-01-01

Despite the notion that increases in functioning should be associated with increases in life satisfaction in schizophrenia, research has often found no association between the two. Dual change models of global and domain-specific life satisfaction and functioning were examined in 145 individuals with schizophrenia receiving community-based services over 12 months. Functioning and satisfaction were measured using the Role Functioning Scale and Satisfaction with Life Scale. Data were analyzed using latent growth curve modeling. Improvement in global life satisfaction was associated with improvement in overall functioning over time. Satisfaction with living situation also improved as independent functioning improved. Work satisfaction did not improve as work functioning improved. Although social functioning improved, satisfaction with social relationships did not. The link between overall functioning and global life satisfaction provides support for a recovery-based orientation to community based psychosocial rehabilitation services. When examining sub-domains, the link between outcomes and subjective experience suggests a more complex picture than previously found. These findings are crucial to interventions and programs aimed at improving functioning and the subjective experiences of consumers recovering from mental illness. Interventions that show improvements in functional outcomes can assume that they will show concurrent improvements in global life satisfaction as well and in satisfaction with independent living. Interventions geared toward improving social functioning will need to consider the complexity of social relationships and how they affect satisfaction associated with personal relationships. Interventions geared towards improving work functioning will need to consider how the quality and level of work affect satisfaction with employment. PMID:22591780

Model-driven approach to data collection and reporting for quality improvement.

PubMed

Curcin, Vasa; Woodcock, Thomas; Poots, Alan J; Majeed, Azeem; Bell, Derek

2014-12-01

Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Improving transition of care for veterans after total joint replacement.

PubMed

Green, Uthona R; Dearmon, Valorie; Taggart, Helen

2015-01-01

Patients transitioning from hospital to home are at risk for readmission to the hospital. Readmissions are costly and occur too often. Standardized discharge education processes have shown to decrease readmissions. The purpose of this quality improvement project was to utilize evidence-based practice changes to decrease 30-day all-cause readmissions after total joint replacement. Review of literature revealed that improved discharge education can decrease unnecessary readmissions after discharge. A quality improvement project was developed including standardized total joint replacement discharge education, teach-back education methodology, and improved postdischarge telephone follow-up. The quality improvement project was initiated and outcomes were evaluated. Improving coordination of the discharge process, enhanced education for patients/caregivers, and postdischarge follow-up decreased total joint replacement readmissions.

Utilizing a Human Factors Nursing Worksystem Improvement Framework to Increase Nurses' Time at the Bedside and Enhance Safety.

PubMed

Probst, C Adam; Carter, Megan; Cadigan, Caton; Dalcour, Cortney; Cassity, Cindy; Quinn, Penny; Williams, Tiana; Montgomery, Donna Cook; Wilder, Claudia; Xiao, Yan

2017-02-01

The aim of this study is to increase nurses' time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement. Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside. A novel human factors framework was developed for worksystem improvement in 3 units at 2 facilities. Objectives included improving nurse efficiency as measured by time-and-motion studies, reducing missing medications and subsequent trips to medication rooms and improving medication safety. Worksystem improvement resulted in time savings of 16% to 32% per nurse per 12-hour shift. Requests for missing medications dropped from 3.2 to 1.3 per day. Nurse medication room trips were reduced by 30% and nurse-reported medication errors fell from a range of 1.2 to 0.8 and 6.3 to 4.0 per month. An innovative human factors framework for nursing worksystem improvement provided practical and high priority targets for interventions that significantly improved the nursing worksystem.

Quality improvement in pediatrics: past, present, and future.

PubMed

Schwartz, Stephanie P; Rehder, Kyle J

2017-01-01

Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

Improving Earth/Prediction Models to Improve Network Processing

NASA Astrophysics Data System (ADS)

Wagner, G. S.

2017-12-01

The United States Atomic Energy Detection System (USAEDS) primaryseismic network consists of a relatively small number of arrays andthree-component stations. The relatively small number of stationsin the USAEDS primary network make it both necessary and feasibleto optimize both station and network processing.Station processing improvements include detector tuning effortsthat use Receiver Operator Characteristic (ROC) curves to helpjudiciously set acceptable Type 1 (false) vs. Type 2 (miss) errorrates. Other station processing improvements include the use ofempirical/historical observations and continuous background noisemeasurements to compute time-varying, maximum likelihood probabilityof detection thresholds.The USAEDS network processing software makes extensive use of theazimuth and slowness information provided by frequency-wavenumberanalysis at array sites, and polarization analysis at three-componentsites. Most of the improvements in USAEDS network processing aredue to improvements in the models used to predict azimuth, slowness,and probability of detection. Kriged travel-time, azimuth andslowness corrections-and associated uncertainties-are computedusing a ground truth database. Improvements in station processingand the use of improved models for azimuth, slowness, and probabilityof detection have led to significant improvements in USADES networkprocessing.

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

[Sustainable process improvement with application of 'lean philosophy'].

PubMed

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

Enzymatic treatment to improve the quality of black tea extracts.

PubMed

Chandini, S K; Rao, L Jaganmohan; Gowthaman, M K; Haware, D J; Subramanian, R

2011-08-01

Enzymatic extraction was investigated to improve the quality of black tea extracts with pretreatment of pectinase and tannase independently, successively and simultaneously. Pectinase improved the extractable-solids-yield (ESY) up to 11.5%, without much of an improvement in polyphenols recovery, while tannase pre-treatment showed a significant improvement in polyphenols recovery (14.3%) along with an 11.1% improvement in ESY. Among the four treatments, tannase-alone treatment showed the maximum improvement in tea quality, with higher polyphenols-in-extracted solids. Treatments involving tannase resulted in the significant release of gallic acid, due to its hydrolytic activity, leading to greater solubility besides favourably improving TF/TR ratio. The results suggested that employing a single enzyme, tannase, for the pre-treatment of black tea is desirable. Enzymatic extraction may be preferred over enzymatic clarification as it not only displayed reduction in tea cream and turbidity but also improved the recovery of polyphenols and ESY in the extract, as well as maintaining a good balance of tea quality. Copyright © 2011 Elsevier Ltd. All rights reserved.

75 FR 27341 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference To Discuss Increasing Market and Planning Efficiency Through Improved Software May 7, 2010. Take notice that Commission... planning efficiency through improved software. [[Page 27342

Guidelines for development : Transportation Improvement Programs (TIPs) and the Iowa Statewide Transportation Improvement Program (STIP).

DOT National Transportation Integrated Search

2011-02-01

This document serves as a reference guide to local planning agencies for the development of their regional Transportation Improvement Program (TIP) and the Statewide Transportation Improvement Program (STIP). Any questions regarding content or relati...

Using TSP to Improve Performance

DTIC Science & Technology

2008-11-13

Carnegie Mellon University Using TSP to Improve Performance 46 Work - Life Balance People are your most important resource. Finding and retaining good people...is critical to long-term success. Intuit found that TSP improved work - life balance , a key factor in job satisfaction. Source: Intuit © 2008 Carnegie...Mellon University Using TSP to Improve Performance 47 Intuit TSP Survey Results Improved work - life balance with TSP is reflected in job satisfaction

Increase net worth: repair business and rental properties; improve your home.

PubMed

1998-01-01

When it comes to repairs and improvements, it pays to know the rules. On rental and business property, the repair produces more than double the value of an improvement. On your personal home, the improvement is infinitely better than the repair (the repair is useless). Thus, before you make the repair or improvement, read this article. Then, plan your fix-up for maximum tax benefit.

Improved components for engine fuel savings

NASA Technical Reports Server (NTRS)

Antl, R. J.; Mcaulay, J. E.

1980-01-01

NASA programs for developing fuel saving technology include the Engine Component Improvement Project for short term improvements in existing air engines. The Performance Improvement section is to define component technologies for improving fuel efficiency for CF6, JT9D and JT8D turbofan engines. Sixteen concepts were developed and nine were tested while four are already in use by airlines. If all sixteen concepts are successfully introduced the gain will be fuel savings of more than 6 billion gallons over the lifetime of the engines. The improvements include modifications in fans, mounts, exhaust nozzles, turbine clearance and turbine blades.

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

PubMed

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

2000-01-01

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

Improving the Service with the Servqual Method

NASA Astrophysics Data System (ADS)

Midor, Katarzyna; Kučera, Marian

2018-03-01

At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

Enhancing causal interpretations of quality improvement interventions.

PubMed

Cable, G

2001-09-01

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments.

Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation.

PubMed

Baillie, Lesley; Bromley, Barbara; Walker, Moira; Jones, Rebecca; Mhlanga, Fortune

2014-01-01

Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations. The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum. A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach. Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff. Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential. Copyright © 2013 Elsevier Ltd. All rights reserved.

Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial.

PubMed

Galovski, Tara E; Harik, Juliette M; Blain, Leah M; Elwood, Lisa; Gloth, Chelsea; Fletcher, Thomas D

2016-02-01

Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory after treatment. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy [CPT]). Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members.

PubMed

Brandrud, Aleidis Skard; Schreiner, Ada; Hjortdahl, Per; Helljesen, Gro Sævil; Nyen, Bjørnar; Nelson, Eugene C

2011-03-01

The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge. To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered. Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity. The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements. A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques.

PubMed

Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

2016-12-01

Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications.

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques

PubMed Central

Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

2016-01-01

Background: Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. Methods: In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. Results: With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Conclusion: Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications. PMID:28077898

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

PubMed Central

Boaz, Annette; Hanney, Stephen; Jones, Teresa; Soper, Bryony

2015-01-01

Objective There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance? Methods An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. Results Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. Conclusions Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate. PMID:26656023

Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned.

PubMed

Mohammadi, S Mehrdad; Mohammadi, S Farzad; Hedges, Jerris R; Zohrabi, Morteza; Ameli, Omid

2007-08-01

Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented. OBJECTIVE METHOD: During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a 'positive impact' on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects. Our quality improvement package supported rapid implementation of multiple projects. The underlying 'change structure' comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.

76 FR 46769 - Applications for New Awards; Minority Science and Engineering Improvement Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-03

... DEPARTMENT OF EDUCATION Applications for New Awards; Minority Science and Engineering Improvement... Information: Minority Science and Engineering Improvement Program (MSEIP) Notice inviting applications for new... effect long-range improvement in science and engineering education at predominantly minority institutions...

78 FR 33799 - National Poultry Improvement Plan; General Conference Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

...] National Poultry Improvement Plan; General Conference Committee Meeting AGENCY: Animal and Plant Health... General Conference Committee of the National Poultry Improvement Plan. DATES: The General Conference.... Denise L. Brinson, Acting Senior Coordinator, National Poultry Improvement Plan, VS, APHIS, 1506 Klondike...

Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

PubMed

Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

2016-07-01

Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." © The Author(s) 2015.

Planning of distributed generation in distribution network based on improved particle swarm optimization algorithm

NASA Astrophysics Data System (ADS)

Li, Jinze; Qu, Zhi; He, Xiaoyang; Jin, Xiaoming; Li, Tie; Wang, Mingkai; Han, Qiu; Gao, Ziji; Jiang, Feng

2018-02-01

Large-scale access of distributed power can improve the current environmental pressure, at the same time, increasing the complexity and uncertainty of overall distribution system. Rational planning of distributed power can effectively improve the system voltage level. To this point, the specific impact on distribution network power quality caused by the access of typical distributed power was analyzed and from the point of improving the learning factor and the inertia weight, an improved particle swarm optimization algorithm (IPSO) was proposed which could solve distributed generation planning for distribution network to improve the local and global search performance of the algorithm. Results show that the proposed method can well reduce the system network loss and improve the economic performance of system operation with distributed generation.

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

PubMed

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

2018-06-01

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

Do ergonomics improvements increase computer workers' productivity?: an intervention study in a call centre.

PubMed

Smith, Michael J; Bayehi, Antoinette Derjani

2003-01-15

This paper examines whether improving physical ergonomics working conditions affects worker productivity in a call centre with computer-intensive work. A field study was conducted at a catalogue retail service organization to explore the impact of ergonomics improvements on worker production. There were three levels of ergonomics interventions, each adding incrementally to the previous one. The first level was ergonomics training for all computer users accompanied by workstation ergonomics analysis leading to specific customized adjustments to better fit each worker (Group C). The second level added specific workstation accessories to improve the worker fit if the ergonomics analysis indicated a need for them (Group B). The third level met Group B requirements plus an improved chair (Group A). Productivity data was gathered from 72 volunteer participants who received ergonomics improvements to their workstations and 370 control subjects working in the same departments. Daily company records of production outputs for each worker were taken before ergonomics intervention (baseline) and 12 months after ergonomics intervention. Productivity improvement from baseline to 12 months post-intervention was examined across all ergonomics conditions combined, and also compared to the control group. The findings showed that worker performance increased for 50% of the ergonomics improvement participants and decreased for 50%. Overall, there was a 4.87% output increase for the ergonomics improvement group as compared to a 3.46% output decrease for the control group. The level of productivity increase varied by the type of the ergonomics improvements with Group C showing the best improvement (9.43%). Even though the average production improved, caution must be used in interpreting the findings since the ergonomics interventions were not successful for one-half of the participants.

Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

PubMed

McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian

2017-01-01

Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P < 0.001), but not technical performance; systems interventions (Lean & SOP, 2 & 3) improved nontechnical skills and technical performance (P < 0.001) but improved WHO compliance less. Combined interventions (4 & 5) improved all performance measures except WHO time-out attempts, whereas single approaches (1 & 2 & 3) improved WHO compliance less (P < 0.001) and failed to improve technical performance. Safety interventions combining teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

Evaluation of a Quality Improvement Resource for Public Health Practitioners

PubMed Central

Marcial, Laura H.; Brown, Stephen; Throop, Cynthia; Pina, Jamie

2017-01-01

Objectives: Quality improvement is a critical mechanism to manage public health agency performance and to strengthen accountability for public funds. The objective of this study was to evaluate a relatively new quality improvement resource, the Public Health Quality Improvement Exchange (PHQIX), a free online communication platform dedicated to making public health quality improvement information accessible to practitioners. Methods: We conducted an internet-based survey of registered PHQIX users (n = 536 respondents) in 2013 and key informant interviews with PHQIX frequent users (n = 21) in 2014, in the United States. We assessed use of the PHQIX website, user engagement and satisfaction, communication and knowledge exchange, use of information, and impact on quality improvement capacity and accreditation readiness. Results: Of 462 respondents, 369 (79.9%) browsed quality improvement initiatives, making it the most commonly used site feature, and respondents described PHQIX as a near-unique source for real-world quality improvement examples. Respondents were satisfied with the quality and breadth of topics and relevance to their settings (average satisfaction scores, 3.9-4.1 [where 5 was the most satisfied]). Of 407 respondents, 237 (58.2%) said that they had put into practice information learned on PHQIX, and 209 of 405 (51.6%) said that PHQIX had helped to improve quality improvement capacity. Fewer than half of respondents used the commenting function, the Community Forum, and the Ask an Expert feature. Conclusions: Findings suggest that PHQIX, particularly descriptions of the quality improvement initiatives, is a valued resource for public health practitioners. Users reported sharing information with colleagues and applying what they learned to their own work. These findings may relate to other efforts to disseminate quality improvement knowledge. PMID:28135430

Evaluation of a Quality Improvement Resource for Public Health Practitioners.

PubMed

Porterfield, Deborah S; Marcial, Laura H; Brown, Stephen; Throop, Cynthia; Pina, Jamie

Quality improvement is a critical mechanism to manage public health agency performance and to strengthen accountability for public funds. The objective of this study was to evaluate a relatively new quality improvement resource, the Public Health Quality Improvement Exchange (PHQIX), a free online communication platform dedicated to making public health quality improvement information accessible to practitioners. We conducted an internet-based survey of registered PHQIX users (n = 536 respondents) in 2013 and key informant interviews with PHQIX frequent users (n = 21) in 2014, in the United States. We assessed use of the PHQIX website, user engagement and satisfaction, communication and knowledge exchange, use of information, and impact on quality improvement capacity and accreditation readiness. Of 462 respondents, 369 (79.9%) browsed quality improvement initiatives, making it the most commonly used site feature, and respondents described PHQIX as a near-unique source for real-world quality improvement examples. Respondents were satisfied with the quality and breadth of topics and relevance to their settings (average satisfaction scores, 3.9-4.1 [where 5 was the most satisfied]). Of 407 respondents, 237 (58.2%) said that they had put into practice information learned on PHQIX, and 209 of 405 (51.6%) said that PHQIX had helped to improve quality improvement capacity. Fewer than half of respondents used the commenting function, the Community Forum, and the Ask an Expert feature. Findings suggest that PHQIX, particularly descriptions of the quality improvement initiatives, is a valued resource for public health practitioners. Users reported sharing information with colleagues and applying what they learned to their own work. These findings may relate to other efforts to disseminate quality improvement knowledge.

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

Turner, Tom; Watson, Stuart

This paper describes how the level of environmental sustainability at the Solid Waste Processing plant at Research Sites Restoration Ltd (RSRL) Harwell was measured and improved. It provides reasons to improve environmental performance in an organisation, states best practice on how improvement should be conducted, and gives first-hand experience on how changes were implemented. In this paper sustainability is defined as 'meeting the needs of the present without compromising the ability of future generations to meet their own needs'. A baseline for environmental sustainability was created, by looking at multiple attributes. From this, a matrix was created to show howmore » the baseline environmental performance compared to best practice, and a gap analysis was performed. Results from this analysis showed areas for potential systematic improvement, and actions were created. Nearly all actions were implemented within one year, and environmental sustainability improved significantly. Most improvements cost no money to implement, and the few that did had to pass criteria in a business case. Results from a company-wide survey showed that the vast majority of employees felt that environmental issues were important, and that they were willing to help improve performance. Environmental awareness training was given to everyone in the department, and individuals were given measurable improvement targets. A focus group was set up and met regularly to agree improvements and monitor results. Environmental performance was publicised regularly to highlight successes and seek further engagement and improvement. Improvement ideas were encouraged and managed in a transparent way which showed clear prioritisation and accountability. The culture of environmental improvement changed visibly and results at the end of the first year showed that electricity consumption had reduced by 12.5%, and gas consumption had reduced by 7.3%. In less than two years over UK Pound 60,000 was saved on utility bills in the Waste Processing Plant. (authors)« less

Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with Major Depressive Disorder: Systematic review and meta-analysis.

PubMed

Wagner, Stefanie; Engel, Alice; Engelmann, Jan; Herzog, David; Dreimüller, Nadine; Müller, Marianne B; Tadić, André; Lieb, Klaus

2017-11-01

Early improvement of depressive symptoms during the first two weeks of antidepressant treatment has been discussed to be a resilience signal predicting a later positive treatment outcome in patients with Major Depressive Disorder (MDD). However, the predictive value of early improvement varies between studies, and the use of different antidepressants may explain heterogeneous results. The objective of this review was to assess the predictive value of early improvement on later response and remission and to identify antidepressants with the highest chance of early improvement. We included 17 randomized controlled trials investigating early improvement in 14,779 adult patients with MDD comparing monotherapy with an antidepressant against placebo or another antidepressant drug. 62% (range: 35-85%) of patients treated with an antidepressant and 47% (range: 21-69%) with placebo were early improver, defined as a >20%/25% symptom reduction after two weeks of treatment. Early improvement predicted response and remission after 5-12 weeks of treatment with high sensitivity (85%; 95%-CI: 84.3 to 85.7) and low to moderate specificity (54%; 95%-CI: 53.1 to 54.9). Early improver had a 8.37 fold (6.97-10.05) higher likelihood to become responder and a 6.38 fold (5.07-8.02) higher likelihood to be remitter at endpoint than non-improver. The highest early improver rates were achieved in patients treated with mirtazapine or a tricyclic antidepressant. This finding of a high predictive value of early improvement on treatment outcome may be important for treatment decisions in the early course of antidepressant treatment. Further studies should test the efficacy of such early treatment decisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improved Motor-Timing: Effects of Synchronized Metro-Nome Training on Golf Shot Accuracy

PubMed Central

Sommer, Marius; Rönnqvist, Louise

2009-01-01

This study investigates the effect of synchronized metronome training (SMT) on motor timing and how this training might affect golf shot accuracy. Twenty-six experienced male golfers participated (mean age 27 years; mean golf handicap 12.6) in this study. Pre- and post-test investigations of golf shots made by three different clubs were conducted by use of a golf simulator. The golfers were randomized into two groups: a SMT group and a Control group. After the pre-test, the golfers in the SMT group completed a 4-week SMT program designed to improve their motor timing, the golfers in the Control group were merely training their golf-swings during the same time period. No differences between the two groups were found from the pre-test outcomes, either for motor timing scores or for golf shot accuracy. However, the post-test results after the 4-weeks SMT showed evident motor timing improvements. Additionally, significant improvements for golf shot accuracy were found for the SMT group and with less variability in their performance. No such improvements were found for the golfers in the Control group. As with previous studies that used a SMT program, this study’s results provide further evidence that motor timing can be improved by SMT and that such timing improvement also improves golf accuracy. Key points This study investigates the effect of synchronized metronome training (SMT) on motor timing and how this training might affect golf shot accuracy. A randomized control group design was used. The 4 week SMT intervention showed significant improvements in motor timing, golf shot accuracy, and lead to less variability. We conclude that this study’s results provide further evidence that motor timing can be improved by SMT training and that such timing improvement also improves golf accuracy. PMID:24149608

The Planning and Implementation of Test Facility Improvements

NASA Technical Reports Server (NTRS)

Oberlander, Larry

2008-01-01

As engineering programs develop, and product testing begins, ideas for process improvement soon become obvious. Engineers envision new holding and handling fixtures. Additional custom-made support equipment may be needed. Perhaps modifications to the building or modifications to facility hardware are the order of the day. This is where a flexible creative test organization is needed. We need not be content with the status quo. All of these desired test innovations can make the difficult easy and improve the work flow. At times, implementing these new ideas demands more time or specialized expertise than test team members have. Through the coordinated use of labor resources, the needed improvements can still be made and in a timely fashion that supports program schedules. This presentation provides practical advice and a method whereby test personnel can creatively develop facility improvements and manage them from start to finish. You can control just how much time you invest and what part of your concepts you will personally design. By wisely defining the requirements and presenting them to the appropriate help sources (vendors, contractors, coworkers, and support departments), you can get the help you need to bring the improvements you have conceived, into fruition. Aspects of this presentation include defining requirements for test facility improvements, choosing labor resources, writing a statement of work, determining cost and benefits, securing department approval, coordinating procurement, managing the project, and training the end users. The process of successfully implementing test facility improvements is thoroughly explained. It has been tried, proven and improved over nearly 25 years of use. Whether considering a $50 improvement or a $50 million dollar improvement, this discussion will provide helpful pointers. Examples of improvements made through this process and their illustration will be included.

Resident-Specific Morbidity Reduced Following ACS NSQIP Data-Driven Quality Program.

PubMed

Turrentine, Florence E; Hanks, John B; Tracci, Megan C; Jones, R Scott; Schirmer, Bruce D; Smith, Philip W

2018-04-16

The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement. A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention. Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12. Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated. Copyright © 2018. Published by Elsevier Inc.

Time to improvement of pain and sleep quality in clinical trials of pregabalin for the treatment of fibromyalgia.

PubMed

Arnold, Lesley M; Emir, Birol; Pauer, Lynne; Resnick, Malca; Clair, Andrew

2015-01-01

To determine the time to immediate and sustained clinical improvement in pain and sleep quality with pregabalin in patients with fibromyalgia. A post hoc analysis of four 8- to 14-week phase 2-3, placebo-controlled trials of fixed-dose pregabalin (150-600 mg/day) for fibromyalgia, comprising 12 pregabalin and four placebo treatment arms. A total of 2,747 patients with fibromyalgia, aged 18-82 years. Pain and sleep quality scores, recorded daily on 11-point numeric rating scales (NRSs), were analyzed to determine time to immediate improvement with pregabalin, defined as the first of ≥2 consecutive days when the mean NRS score was significantly lower for pregabalin vs placebo in those treatment arms with a significant improvement at endpoint, and time to sustained clinical improvement with pregabalin, defined as a ≥1-point reduction of the baseline NRS score of patient responders who had a ≥30% improvement on the pain NRS, sleep NRS, or Fibromyalgia Impact Questionnaire (FIQ) from baseline to endpoint, or who reported "much improved" or "very much improved" on the Patient Global Impression of Change (PGIC) at endpoint. Significant improvements in pain and sleep quality scores at endpoint vs placebo were seen in 8/12 and 11/12 pregabalin treatment arms, respectively (P < 0.05). In these arms, time to immediate improvements in pain or sleep occurred by day 1 or 2. Time to sustained clinical improvement occurred significantly earlier in pain, sleep, PGIC, and FIQ responders (P < 0.02) with pregabalin vs placebo. Both immediate and sustained clinical improvements in pain and sleep quality occurred faster with pregabalin vs placebo. Wiley Periodicals, Inc.

How to build up the actionable knowledge base: the role of ‘best fit’ framework synthesis for studies of improvement in healthcare

PubMed Central

Booth, Andrew; Carroll, Christopher

2015-01-01

Increasing recognition of the role and value of theory in improvement work in healthcare offers the prospect of capitalising upon, and consolidating, actionable lessons from synthesis of improvement projects and initiatives. We propose that informed use of theory can (i) provide a mechanism by which to collect and organise data from a body of improvement work, (ii) offer a framework for analysis and identification of lessons learnt and (iii) facilitate an evaluation of the feasibility, effectiveness and acceptability of improvement programmes. Improvement practitioners can benefit from using an underpinning external structure as a lens by which to examine the specific achievements of their own projects alongside comparable initiatives led by others. We demonstrate the utility of a method known as ‘best fit framework synthesis’ (BFFS) in offering a ubiquitous and versatile means by which to collect, analyse and evaluate improvement work in healthcare. First reported in 2011, BFFS represents a pragmatic, flexible approach to integrating theory with findings from practice. A deductive phase, where a review team seeks to accommodate a substantial part of the data, is followed by an inductive phase, in which the team explores data not accommodated by the framework. We explore the potential for BFFS within improvement work by drawing upon the evidence synthesis methodology literature and practical examples of improvement work reported in BMJ Quality and Safety (2011–2015). We suggest four variants of BFFS that may have particular value in synthesising a body of improvement work. We conclude that BFFS, alongside other approaches that seek to optimise the contribution of theory to improvement work, represents one important enabling mechanism by which to establish the rigour and scientific credentials of the emerging discipline of ‘improvement science’. PMID:26306609

Improved Conceptual Models Methodology (ICoMM) for Validation of Non-Observable Systems

DTIC Science & Technology

2015-12-01

distribution is unlimited IMPROVED CONCEPTUAL MODELS METHODOLOGY (ICoMM) FOR VALIDATION OF NON-OBSERVABLE SYSTEMS by Sang M. Sok December 2015...REPORT TYPE AND DATES COVERED Dissertation 4. TITLE AND SUBTITLE IMPROVED CONCEPTUAL MODELS METHODOLOGY (ICoMM) FOR VALIDATION OF NON-OBSERVABLE...importance of the CoM. The improved conceptual model methodology (ICoMM) is developed in support of improving the structure of the CoM for both face and

Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm

PubMed Central

Burton, Christopher R; Rycroft Malone, Jo; Robert, Glenn; Willson, Alan; Hopkins, Angela

2014-01-01

Introduction Little is understood about the role of quality improvement in enabling health organisations to survive and thrive in the contemporary context of financial and economic challenges. We will draw on the theoretical foundations of the ‘Resource Based View of the Firm’ (RBV) to develop insights into why health organisations engage in improvement work, how impacts are conceptualised, and ‘what works’ in delivering these impacts. Specifically, RBV theorises that the mix and use of resources across different organisations may explain differences in performance. Whether improvement work influences these resources is unclear. Methods and analysis Case study research will be conducted across health organisations participating in four approaches to improvement, including: a national improvement programme; a multiorganisational partnership around implementation; an organisational strategy for quality improvement; and a coproduction project designed to enhance the experience of a clinical service from the perspective of patients. Data will comprise in-depth interviews with key informants, observation of key events and documents; analysed within and then across cases. Adopting a realist perspective, the core tenets of RBV will be evaluated as a programme theory, focusing on the interplay between organisational conditions and behavioural or resource responses that are reported through engagement in improvement. Ethics and dissemination The study has been approved by Bangor University Ethics Committee. The investigation will not judge the relative merits of different approaches to healthcare quality improvement. Rather, we will develop unique insights into the organisational consequences, and dependencies of quality improvement, providing an opportunity to add to the explanatory potential of RBV in this and other contexts. In addition to scientific and lay reports of the study findings, research outputs will include a framework for constructing the economic impacts of quality improvement and practical guidance for health service managers that maximises the impacts of investment in quality improvement. PMID:25082421

Longitudinal Household Trends in Access to Improved Water Sources and Sanitation in Chi Linh Town, Hai Duong Province, Viet Nam and Associated Factors.

PubMed

Tuyet-Hanh, Tran Thi; Long, Tran Khanh; Van Minh, Hoang; Huong, Le Thi Thanh

2016-01-01

This study aims to characterize household trends in access to improved water sources and sanitaton in Chi Linh Town, Hai Duong Province, Vietnam, and to identify factors affecting those trends. Data were extracted from the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) database from 2004-2014, which included household access to improved water sources, household access to improved sanitation, and household demographic data. Descriptive statistical analysis and multinominal logistic regression were used. The results showed that over a 10-year period (2004-2014), the proportion of households with access to improved water and improved sanitation increased by 3.7% and 28.3%, respectively. As such, the 2015 Millennium Development Goal targets for safe drinking water and basic sanitation were met. However, 13.5% of households still had unimproved water and sanitation. People who are retired, work in trade or services, or other occupations were 1.49, 1.97, and 1.34 times more likely to have access to improved water and sanitation facilities than farming households, respectively ( p < 0.001). Households living in urban areas were 1.84 times more likely than those living in rural areas to have access to improved water sources and improved sanitation facilities (OR =1.84; 95% CI = 1.73-1.96). Non-poor households were 2.12 times more likely to have access to improved water sources and improved sanitation facilities compared to the poor group (OR = 2.12; 95% CI = 2.00-2.25). More efforts are required to increase household access to both improved water and sanitation in Chi Linh Town, focusing on the 13.5% of households currently without access. Similar to situations observed elsewhere in Vietnam and other low- and middle- income countries, there is a need to address socio-economic factors that are associated with inadequate access to improved water sources and sanitation facilities.

What Is Improvement Science? Do We Need It in Education?

ERIC Educational Resources Information Center

Lewis, Catherine

2015-01-01

The theory and tools of "improvement science" have produced performance improvements in many organizational sectors. This essay describes improvement science and explores its potential and challenges within education. Potential contributions include attention to the knowledge-building and motivational systems within schools, strategies…

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality improvement...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., psychosocial, or clinical domains (for example, quality of life indicators, depression scales, or chronic... 42 Public Health 3 2010-10-01 2010-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality improvement...

Improving Schools: Investing in Our Future

ERIC Educational Resources Information Center

McEwen, Nelly

2006-01-01

Improving Schools--Investing in Our Future provides a foundation for improving student learning and performance, and improving aspects of schooling. Chapter (1) provides information about Alberta's well--established K-12 education system. Alberta's school-aged population is becoming more diverse with growing numbers of Aboriginal and immigrant…

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

Nanopurification of semen improves AI pregnancy rates in beef cattle

USDA-ARS?s Scientific Manuscript database

Reproductive efficiency is several times more important than any other factor affecting economic efficiency in beef production. Multiple studies have been conducted to improve fertility of beef cows, but few studies have been conducted to improve fertility in sires. Also, with current improvements...

Mathematics: Program Assessment and Improvement Planning Manual.

ERIC Educational Resources Information Center

Whitman, Nancy C.; And Others

This document provides a model for assessing a school's mathematics program and planning for program improvement. A systematic process for instructional improvement focuses upon students' needs and the identification of successful instructional strategies to meet these needs. The improvement plan and the implementation of intervention strategies…

12 CFR 541.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Improved nonresidential real estate. 541.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 541.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Improved nonresidential real estate. 541.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 141.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Improved nonresidential real estate. 141.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 541.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Improved nonresidential real estate. 541.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 541.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Improved nonresidential real estate. 541.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 141.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Improved nonresidential real estate. 141.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 541.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Improved nonresidential real estate. 541.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

12 CFR 141.15 - Improved nonresidential real estate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Improved nonresidential real estate. 141.15... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 141.15 Improved nonresidential real estate. The term improved nonresidential real estate means nonresidential real estate: (a) Containing a permanent structure...

36 CFR 230.7 - Program practices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... soil erosion. (5) Soil and Water Protection and Improvement (SIP5), which includes the maintenance or improvement of water quality and soil productivity on forest land. (6) Riparian and Wetland Protection and...) Forest and Agroforest Improvement (SIP3), which includes the improvement of forest and agroforest stand...

36 CFR 222.9 - Range improvements.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Forest Service, is authorized to install and maintain structural and nonstructural range improvements... provisions of which become a part of the grazing permit(s). (2) Title to permanent structural range improvements shall rest in the United States. (3) Title to temporary structural range improvements may be...

7 CFR 4280.128 - Application and documentation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Program General Renewable Energy System and Energy Efficiency Improvement Guaranteed Loans § 4280.128... capital improvements to an existing renewable energy system) or to make energy efficiency improvements. The response to § 4280.113(a) must include a brief description of the system or improvement. This...

24 CFR 905.200 - Eligible activities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... reduction. Physical improvements to reduce the number of units that are vacant. Not included are costs for... physical improvement costs associated with: (i) Correcting violations of local building code or the Uniform...) Management improvements. Noncapital activities that are project-specific or PHA-wide improvements needed to...

7 CFR 4280.128 - Application and documentation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Program General Renewable Energy System and Energy Efficiency Improvement Guaranteed Loans § 4280.128... capital improvements to an existing renewable energy system) or to make energy efficiency improvements. The response to § 4280.113(a) must include a brief description of the system or improvement. This...

7 CFR 4280.128 - Application and documentation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Program General Renewable Energy System and Energy Efficiency Improvement Guaranteed Loans § 4280.128... capital improvements to an existing renewable energy system) or to make energy efficiency improvements. The response to § 4280.113(a) must include a brief description of the system or improvement. This...

Teacher Research as Continuous Process Improvement

ERIC Educational Resources Information Center

Ellis, Charles; Castle, Kathryn

2010-01-01

Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

Deliberate Learning in Health Care: The Effect of Importing Best Practices and Creative Problem Solving on Hospital Performance Improvement

PubMed Central

Nembhard, Ingrid M.; Cherian, Praseetha; Bradley, Elizabeth H.

2015-01-01

This article examines the effect on quality improvement of two common but distinct approaches to organizational learning: importing best practices (an externally oriented approach rooted in learning by imitating others’ best practices) and internal creative problem solving (an internally oriented approach rooted in learning by experimenting with self-generated solutions). We propose that independent and interaction effects of these approaches depend on where organizations are in their improvement journey – initial push or later phase. We examine this contingency in hospitals focused on improving treatment time for patients with heart attacks. Our results show that importing best practices helps hospitals achieve initial phase but not later phase improvement. Once hospitals enter the later phase of their efforts, however, significant improvement requires creative problem solving as well. Together, our results suggest that importing best practices delivers greater short-term improvement, but continued improvement depends on creative problem solving. PMID:24876100

Process safety improvement--quality and target zero.

PubMed

Van Scyoc, Karl

2008-11-15

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

Improved Ant Algorithms for Software Testing Cases Generation

PubMed Central

Yang, Shunkun; Xu, Jiaqi

2014-01-01

Existing ant colony optimization (ACO) for software testing cases generation is a very popular domain in software testing engineering. However, the traditional ACO has flaws, as early search pheromone is relatively scarce, search efficiency is low, search model is too simple, positive feedback mechanism is easy to porduce the phenomenon of stagnation and precocity. This paper introduces improved ACO for software testing cases generation: improved local pheromone update strategy for ant colony optimization, improved pheromone volatilization coefficient for ant colony optimization (IPVACO), and improved the global path pheromone update strategy for ant colony optimization (IGPACO). At last, we put forward a comprehensive improved ant colony optimization (ACIACO), which is based on all the above three methods. The proposed technique will be compared with random algorithm (RND) and genetic algorithm (GA) in terms of both efficiency and coverage. The results indicate that the improved method can effectively improve the search efficiency, restrain precocity, promote case coverage, and reduce the number of iterations. PMID:24883391

A residency clinic chronic condition management quality improvement project.

PubMed

Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon

2007-02-01

Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

Self-Compassion Promotes Personal Improvement From Regret Experiences via Acceptance.

PubMed

Zhang, Jia Wei; Chen, Serena

2016-02-01

Why do some people report more personal improvement from their regret experiences than others? Three studies examined whether self-compassion promotes personal improvement derived from recalled regret experiences. In Study 1, we coded anonymous regret descriptions posted on a blog website. People who spontaneously described their regret with greater self-compassion were also judged as having expressed more personal improvement. In Study 2, higher trait self-compassion predicted greater self-reported and observer-rated personal improvement derived from recalled regret experiences. In Study 3, people induced to take a self-compassionate perspective toward a recalled regret experience reported greater acceptance, forgiveness, and personal improvement. A multiple mediation analysis comparing acceptance and forgiveness showed self-compassion led to greater personal improvement, in part, through heightened acceptance. Furthermore, self-compassion's effects on personal improvement were distinct from self-esteem and were not explained by adaptive emotional responses. Overall, the results suggest that self-compassion spurs positive adjustment in the face of regrets. © 2015 by the Society for Personality and Social Psychology, Inc.

Developing Quality Improvement capacity and capability across the Children in Fife partnership.

PubMed

Morris, Craig; Alexander, Ingrid

2016-01-01

A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families. Essentially growing the confidence and capability of practitioners to deliver sustainable QI. 27 respective improvement projects were delivered, some leading to service redesign, reduced waiting times, increased uptake of health entitlements, and improved accessibility to front-line health services. 13 improvement projects spread or scaled beyond the initial site and informal QI mentoring took place with peers in respective agencies. Multiple PDSA cycles were conducted testing the most efficient and effective support mechanisms during and post training, maintaining regular contact, and utilising social media to share progress and achievements.

Enhancements to the IBM version of COSMIC/NASTRAN

NASA Technical Reports Server (NTRS)

Brown, W. Keith

1989-01-01

Major improvements were made to the IBM version of COSMIC/NASTRAN by RPK Corporation under contract to IBM Corporation. These improvements will become part of COSMIC's IBM version and will be available in the second quarter of 1989. The first improvement is the inclusion of code to take advantage of IBM's new Vector Facility (VF) on its 3090 machines. The remaining improvements are modifications that will benefit all users as a result of the extended addressing capability provided by the MVS/XA operating system. These improvements include the availability of an in-memory data base that potentially eliminates the need for I/O to the PRIxx disk files. Another improvement is the elimination of multiple load modules that have to be loaded for every link switch within NASTRAN. The last improvement allows for NASTRAN to execute above the 16 mega-byte line. This improvement allows for NASTRAN to have access to 2 giga-bytes of memory for open core and the in-memory data base.

Introducing practice-based learning and improvement ACGME core competencies into a family medicine residency curriculum.

PubMed

Coleman, Mary Thoesen; Nasraty, Soraya; Ostapchuk, Michael; Wheeler, Stephen; Looney, Stephen; Rhodes, Sandra

2003-05-01

The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

Variations in schools' commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales.

PubMed

Moore, Graham F; Littlecott, Hannah J; Fletcher, Adam; Hewitt, Gillian; Murphy, Simon

2016-02-10

Interventions to improve young people's health are most commonly delivered via schools. While young people attending the lowest socioeconomic status (SES) schools report poorer health profiles, no previous studies have examined whether there is an 'inverse care law' in school health improvement activity (i.e., whether schools in more affluent areas deliver more health improvement). Nor have other factors that may explain variations, such as leadership of health improvement activities, been examined at a population level. This paper examines variability in delivery of health improvement actions among secondary schools in Wales, and whether variability is linked to organisational commitment to health, socioeconomic status and school size. Of the 82 schools participating in the 2013/14 Health Behaviour in School-aged Children (HBSC) survey in Wales, 67 completed a questionnaire on school health improvement delivery structures and health improvement actions within their school. Correlational analyses explore associations of delivery of health improvement activity among schools in Wales with organisational commitment to health, socioeconomic context and school size. There is substantial variability among schools in organisational commitment to health, with pupil emotional health identified as a priority by 52 % of schools, and physical health by 43 %. Approximately half (49 %) report written action plans for pupil health. Based on composite measures, the quantity of school health improvement activity was greater in less affluent schools and schools reporting greater commitment to health. There was a consistent though non-significant trend toward more health improvement activity in larger schools. In multivariate analysis deprivation (OR = 1.06; 95 % CI = 1.01 to 1.12) and organisational commitment to health were significant independent predictors of the quantity of health improvement (OR = 1.60; 95 % CI = 1.15 to 2.22). There is no evidence of an 'inverse care law' in school health, with some evidence of more comprehensive, multi-level health improvement activity in more deprived schools. This large-scale, quantitative analysis supports previous smaller scale, qualitative studies/process evaluations that suggest that senior management team commitment to delivering health improvement, and formulating and reviewing progress against written action plans, are important for facilitating the delivery of comprehensive interventions.

A framework for the continual improvement of behavioral healthcare. Part II--Policy for leadership.

PubMed

Redelheim, P S; Pomeroy, L H; Batalden, P

1994-01-01

In the first part of this article, published in the November/December 1993 issue of Behavioral Healthcare Tomorrow, the authors presented a framework for understanding the process of continuous quality improvement in the behavioral healthcare setting. Four elements of continual improvement were identified: underlying knowledge, policy for leadership, tools and methods, and daily work applications. They showed how traditional professional knowledge of one's subject, discipline and values must be augmented by improvement knowledge--which quality improvement guru W. Edwards Deming calls "the system of profound knowledge." In Part II, they focus on the second element of continual improvement, the importance of organizational leadership.

Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital.

PubMed

Roberts, Renée J; Wilson, Ashley E; Quezado, Zenaide

2017-03-01

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

Continuous improvement in the Industrial and Management Systems Engineering programme at Kuwait University

NASA Astrophysics Data System (ADS)

Aldowaisan, Tariq; Allahverdi, Ali

2016-07-01

This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been applied to the results of four assessment tools and other data sources to improve performance. Important improvements include the need to reconsider two student outcomes as they were difficult to implement in courses. In addition, through benchmarking and the engagement of Alumni and Employers, key decisions were made to improve the curriculum and enhance employability.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

PubMed

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair.

PubMed

Kimura, M; Nagao, K; Tai, T; Kobayashi, H; Nakajima, K

2017-04-01

Accumulating evidence indicates that varicocele repair improves sperm quality. However, longitudinal changes in sperm parameters and predictors of improved semen characteristics after surgery have not been fully investigated. We retrospectively reviewed data from 100 men who underwent microsurgical subinguinal varicocele repair at a single centre. Follow-up semen examinations were carried out at 3, 6 and 12 months post-operatively. Logistic regression was used to identify predictors of early (3 months) and late (≥6 months) improvement in semen parameters after varicocele repair. At 3 months post-operatively, 76.1% of the patients had improved total motile sperm counts, which continued to improve significantly up to 12 months post-operatively (p = .016). When comparing changes in semen parameters between younger (<37 years) and older (≥37 years) men, post-operative improvements in sperm concentration and motility were greater among younger men. Multivariate analysis showed that younger age was associated with early (p = .043) and late (p = .010) post-operative improvement in total motile sperm count. Our findings indicate that early varicocele repair improved semen parameters after surgery. © 2016 Blackwell Verlag GmbH.

Improvement attributes in healthcare: implications for integrated care.

PubMed

Harnett, Patrick John

2018-04-16

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

Development and implementation of a quality improvement curriculum for child neurology residents: lessons learned.

PubMed

Maski, Kiran P; Loddenkemper, Tobias; An, Sookee; Allred, Elizabeth N; Urion, David K; Leviton, Alan

2014-05-01

Quality improvement is a major component of the Accreditation Council for Graduate Medical Education core competencies required of all medical trainees. Currently, neither the Neurology Residency Review Committee nor the Accreditation Council for Graduate Medical Education defines the process by which this competency should be taught and assessed. We developed a quality improvement curriculum that provides mentorship for resident quality improvement projects and is clinically relevant to pediatric neurologists. Before and after implementation of the quality improvement curriculum, a 14-item survey assessed resident comfort with quality improvement project skills and attitudes about implementation of quality improvement in clinical practice using a 5-point Likert scale. We used the Kruskal-Wallis and Fisher exact tests to evaluate pre to post changes. Residents' gained confidence in their abilities to identify measures (P = 0.02) and perform root cause analysis (P = 0.02). Overall, 73% of residents were satisfied or very satisfied with the quality improvement curriculum. Our child neurology quality improvement curriculum was well accepted by trainees. We report the details of this curriculum and its impact on residents and discuss its potential to meet the Accreditation Council for Graduate Medical Education's Next Accreditation System requirements. Published by Elsevier Inc.

Evolving Improvements to TRMM Ground Validation Rainfall Estimates

NASA Technical Reports Server (NTRS)

Robinson, M.; Kulie, M. S.; Marks, D. A.; Wolff, D. B.; Ferrier, B. S.; Amitai, E.; Silberstein, D. S.; Fisher, B. L.; Wang, J.; Einaudi, Franco (Technical Monitor)

2000-01-01

The primary function of the TRMM Ground Validation (GV) Program is to create GV rainfall products that provide basic validation of satellite-derived precipitation measurements for select primary sites. Since the successful 1997 launch of the TRMM satellite, GV rainfall estimates have demonstrated systematic improvements directly related to improved radar and rain gauge data, modified science techniques, and software revisions. Improved rainfall estimates have resulted in higher quality GV rainfall products and subsequently, much improved evaluation products for the satellite-based precipitation estimates from TRMM. This presentation will demonstrate how TRMM GV rainfall products created in a semi-automated, operational environment have evolved and improved through successive generations. Monthly rainfall maps and rainfall accumulation statistics for each primary site will be presented for each stage of GV product development. Contributions from individual product modifications involving radar reflectivity (Ze)-rain rate (R) relationship refinements, improvements in rain gauge bulk-adjustment and data quality control processes, and improved radar and gauge data will be discussed. Finally, it will be demonstrated that as GV rainfall products have improved, rainfall estimation comparisons between GV and satellite have converged, lending confidence to the satellite-derived precipitation measurements from TRMM.

Challenges of using quality improvement methods in nursing homes that "need improvement".

PubMed

Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna

2012-10-01

Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams. A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a "change champion" and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they "own" the process and are responsible for change. Results of this qualitative analysis can help allocate expert nurse time to facilities that are actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by nursing home medical directors in collaborative practice with advanced practice nurses. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Continuous Improvement through Baldridge in Education.

ERIC Educational Resources Information Center

Siri, Diane K.; Miller, Ruth

2001-01-01

Describes efforts of the Baldrige in Education Center and Quality Leadership Academy in Santa Cruz County, California, to support teacher and administrator efforts to improve student performance in selected schools through the use of continuous-improvement techniques adopted by many American corporations to improve product quality and increase…

Examining the Relationship between Employee Satisfaction and Organizational Performance in Higher Education

ERIC Educational Resources Information Center

Dusing, Roger P.

2017-01-01

Organizations, regardless of industry/sector, should consistently evaluate and improve organizational performance. Higher education institutions have come under increasing pressures to control costs while improving outcomes and would benefit from strategies that improve the performance of their employees leading to improved organizational…

75 FR 22576 - Minority Science and Engineering Improvement Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... DEPARTMENT OF EDUCATION [CFDA No. 84.120A] Minority Science and Engineering Improvement Program... the fiscal year (FY) 2009 grant slate for the Minority Science and Engineering Improvement Program... Engineering Improvement Program (MSEIP), authorized by Title III, Part E of the Higher Education Act of 1965...

The Use of Hypnosis in Improving Reading Performance.

ERIC Educational Resources Information Center

Fillmer, H. Thompson; And Others

1983-01-01

Describes a study investigating the effects of group hypnosis on the reading improvement of university students. Finds marginally significant improvement in total vocabulary and comprehension scores and greatest improvement in students with initially low reading scores. Sees group hypnosis as an efficient and economically feasible instructional…

20 CFR 220.180 - Determining continuation or cessation of disability.

Code of Federal Regulations, 2010 CFR

2010-04-01

... exceptions to medical improvement may be considered at any point in this process; (f) If medical improvement... Activity or Medical Improvement § 220.180 Determining continuation or cessation of disability. Evaluation... the annuitant's impairment(s) is not medically disabling, has there been medical improvement as...

12 CFR 541.16 - Improved residential real estate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... improved residential real estate means residential real estate containing offsite or other improvements sufficient to make the property ready for primarily residential construction, and real estate in the process of being improved by a building or buildings to be constructed or in the process of construction for...

Improving HRD Practice.

ERIC Educational Resources Information Center

Gilley, Jerry W.

This book provides human resource development (HRD) professionals with a practical approach for improving the way they practice their profession and presents a four-part framework for improving HRD practice. Each of the book's four parts is dedicated to one part of the framework: examining HRD strategy; improving perceptions of HRD; improving…

Improved Electrophoresis Cell

NASA Technical Reports Server (NTRS)

Rhodes, P. H.; Snyder, R. S.

1982-01-01

Several proposed modifications are expected to improve performance of a continous-flow electrophoresis cell. Changes would allow better control of buffer flow and would increase resolution by suppressing thermal gradients. Improved electrophoresis device would have high resolution and be easy to operate. Improvements would allow better flow control and heat dissipation.

Improving Cognitive Function in Veterans with Gulf War Illness by Improving Cerebral Vascular Function

DTIC Science & Technology

2017-10-01

AWARD NUMBER: W81XWH-16-1-0610 TITLE: Improving Cognitive Function in Veterans with Gulf War Illness by Improving Cerebral Vascular Function...From - To) 15 Sep 2016 - 14 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Improving Cognitive Function in Veterans with Gulf War Illness by...investigate a relationship between cognitive impairment in Veterans with Gulf War Illness (GWI) and reduced vasodilatory function. One of the multiple

Exercise (and Estrogen) Make Fat Cells “Fit”

PubMed Central

Vieira-Potter, Victoria J.; Zidon, Terese M.; Padilla, Jaume

2016-01-01

Adipose tissue inflammation links obesity and metabolic disease. Both exercise and estrogen improve metabolic health, enhance mitochondrial function, and have anti-inflammatory effects. We hypothesize that there is an inverse relationship between mitochondrial function and inflammation in adipose tissue and that exercise acts as an estrogen “mimetic”. Explicitly, exercise may improve adipose tissue “immunometabolism” by improving mitochondrial function and reducing inflammation. Summary Exercise improves adipose tissue metabolic health by reducing inflammation and improving mitochondrial function. PMID:25906425

Quality of life improvements among cancer patients in remission following the consumption of Agaricus blazei Murill mushroom extract.

PubMed

Ohno, Satoshi; Sumiyoshi, Yoshiteru; Hashine, Katsuyoshi; Shirato, Akitomi; Kyo, Satoru; Inoue, Masaki

2013-10-01

The aim of this preliminary clinical study was to assess if the daily intake of Agaricus blazei Murill (ABM) granulated powder (SSI Co., Ltd., Tokyo, Japan) for 6 months improved the quality of life (QOL) in cancer patients in remission. Open study. Subjects diurnally took 1 (1.8 g; N=23), 2 (3.6 g; N=22), or 3 (5.4 g; N=22) packs/day orally for 6 months. The SF-8 Health Survey questionnaire was used to evaluate the QOL. The differences between the SF-8 baseline scores at the time of entry and 6-months after ABM treatment were evaluated. The results showed a significant improvement in QOL in both physical and mental components. More specifically, QOL effects of ABM in different genders showed males improved physical components, while females improved only mental components. QOL effects in the different age groups showed that ages 65 and under improved mental components, while ages 66 and older improved physical components. Furthermore, with respect to optimal dose effects of ABM with respect to QOL improvement, two packs per day for 6 months showed improvements in both physical and mental components. This preliminary longitudinal clinical study demonstrated that daily intake of ABM appears to improve both physical and mental components based on SF-8 qualimetric analysis. Copyright © 2013 Elsevier Ltd. All rights reserved.

Improving together: better science writing through peer learning

NASA Astrophysics Data System (ADS)

Stiller-Reeve, Mathew A.; Heuzé, Céline; Ball, William T.; White, Rachel H.; Messori, Gabriele; van der Wiel, Karin; Medhaug, Iselin; Eckes, Annemarie H.; O'Callaghan, Amee; Newland, Mike J.; Williams, Sian R.; Kasoar, Matthew; Wittmeier, Hella Elisa; Kumer, Valerie

2016-07-01

Science, in our case the climate and geosciences, is increasingly interdisciplinary. Scientists must therefore communicate across disciplinary boundaries. For this communication to be successful, scientists must write clearly and concisely, yet the historically poor standard of scientific writing does not seem to be improving. Scientific writing must improve, and the key to long-term improvement lies with the early-career scientist (ECS). Many interventions exist for an ECS to improve their writing, like style guides and courses. However, momentum is often difficult to maintain after these interventions are completed. Continuity is key to improving writing. This paper introduces the ClimateSnack project, which aims to motivate ECSs to develop and continue to improve their writing and communication skills. The project adopts a peer-learning framework where ECSs voluntarily form writing groups at different institutes around the world. The group members learn, discuss, and improve their writing skills together. Several ClimateSnack writing groups have formed. This paper examines why some of the groups have flourished and others have dissolved. We identify the challenges involved in making a writing group successful and effective, notably the leadership of self-organized groups, and both individual and institutional time management. Within some of the groups, peer learning clearly offers a powerful tool to improve writing as well as bringing other benefits, including improved general communication skills and increased confidence.

An Example of an Improvable Rao-Blackwell Improvement, Inefficient Maximum Likelihood Estimator, and Unbiased Generalized Bayes Estimator.

PubMed

Galili, Tal; Meilijson, Isaac

2016-01-02

The Rao-Blackwell theorem offers a procedure for converting a crude unbiased estimator of a parameter θ into a "better" one, in fact unique and optimal if the improvement is based on a minimal sufficient statistic that is complete. In contrast, behind every minimal sufficient statistic that is not complete, there is an improvable Rao-Blackwell improvement. This is illustrated via a simple example based on the uniform distribution, in which a rather natural Rao-Blackwell improvement is uniformly improvable. Furthermore, in this example the maximum likelihood estimator is inefficient, and an unbiased generalized Bayes estimator performs exceptionally well. Counterexamples of this sort can be useful didactic tools for explaining the true nature of a methodology and possible consequences when some of the assumptions are violated. [Received December 2014. Revised September 2015.].

Improvement of GRCop-84 Through the Addition of Zirconium

NASA Technical Reports Server (NTRS)

Ellis, David L.; Lerch, Bradley A.

2012-01-01

GRCop-84 (Cu-8 at.% Cr-4 at.% Nb) has excellent strength, creep resistance, low cycle fatigue (LCF) life and stability at elevated temperatures. It suffers in comparison to many commercially available precipitation-strengthened alloys below 500 C (932 F). It was observed that the addition of Zr consistently improved the mechanical properties of Cu-based alloys especially below 500 C. In an effort to improve the low temperature properties of GRCop-84, 0.35 wt.% Zr was added to the alloy. Limited tensile, creep, and LCF testing was conducted to determine if improvements occur. The results showed some dramatic increases in the tensile and creep properties at the conditions tested with the probability of additional improvements being possible through cold working. LCF testing at room temperature did not show an improvement, but improvements might occur at elevated temperatures.

Speaking the right language: the scientific method as a framework for a continuous quality improvement program within academic medical research compliance units.

PubMed

Nolte, Kurt B; Stewart, Douglas M; O'Hair, Kevin C; Gannon, William L; Briggs, Michael S; Barron, A Marie; Pointer, Judy; Larson, Richard S

2008-10-01

The authors developed a novel continuous quality improvement (CQI) process for academic biomedical research compliance administration. A challenge in developing a quality improvement program in a nonbusiness environment is that the terminology and processes are often foreign. Rather than training staff in an existing quality improvement process, the authors opted to develop a novel process based on the scientific method--a paradigm familiar to all team members. The CQI process included our research compliance units. Unit leaders identified problems in compliance administration where a resolution would have a positive impact and which could be resolved or improved with current resources. They then generated testable hypotheses about a change to standard practice expected to improve the problem, and they developed methods and metrics to assess the impact of the change. The CQI process was managed in a "peer review" environment. The program included processes to reduce the incidence of infections in animal colonies, decrease research protocol-approval times, improve compliance and protection of animal and human research subjects, and improve research protocol quality. This novel CQI approach is well suited to the needs and the unique processes of research compliance administration. Using the scientific method as the improvement paradigm fostered acceptance of the project by unit leaders and facilitated the development of specific improvement projects. These quality initiatives will allow us to improve support for investigators while ensuring that compliance standards continue to be met. We believe that our CQI process can readily be used in other academically based offices of research.

Forecast Verification: Identification of small changes in weather forecasting skill

NASA Astrophysics Data System (ADS)

Weatherhead, E. C.; Jensen, T. L.

2017-12-01

Global and regonal weather forecasts have improved over the past seven decades most often because of small, incrmental improvements. The identificaiton and verification of forecast improvement due to proposed small changes in forecasting can be expensive and, if not carried out efficiently, can slow progress in forecasting development. This presentation will look at the skill of commonly used verification techniques and show how the ability to detect improvements can depend on the magnitude of the improvement, the number of runs used to test the improvement, the location on the Earth and the statistical techniques used. For continuous variables, such as temperture, wind and humidity, the skill of a forecast can be directly compared using a pair-wise statistical test that accommodates the natural autocorrelation and magnitude of variability. For discrete variables, such as tornado outbreaks, or icing events, the challenges is to reduce the false alarm rate while improving the rate of correctly identifying th discrete event. For both continuus and discrete verification results, proper statistical approaches can reduce the number of runs needed to identify a small improvement in forecasting skill. Verification within the Next Generation Global Prediction System is an important component to the many small decisions needed to make stat-of-the-art improvements to weather forecasting capabilities. The comparison of multiple skill scores with often conflicting results requires not only appropriate testing, but also scientific judgment to assure that the choices are appropriate not only for improvements in today's forecasting capabilities, but allow improvements that will come in the future.

Accelerating the rate of improvement in cystic fibrosis care: contributions and insights of the learning and leadership collaborative.

PubMed

Godfrey, Marjorie M; Oliver, Brant J

2014-04-01

The Learning and Leadership Collaborative (LLC) supports cystic fibrosis (CF) centres' responses to the variation in CF outcomes in the USA. Between 2002 and 2013, the Cystic Fibrosis Foundation (CFF) designed, tested and modified the LLC to guide front line staff efforts in these efforts. This paper describes the CFF LLC evolution and essential elements that have facilitated increased improvement capability of CF centres and improved CF outcomes. CF centre improvement teams across the USA have participated in 11 LLCs of 12 months' duration since 2002. Based on the Dartmouth Microsystem Improvement Curriculum, the original LLC included face to face meetings, an email listserv, conference calls and completion of between learning session task books. The LLCs evolved over time to include internet based learning, an electronic repository of improvement resources and examples, change ideas driven by evidence based clinical practice guidelines, benchmarking site visits, an applied QI measurement curriculum and team coaching. Over 90% of the CF centres in the USA have participated in the LLCs and have increased their improvement capabilities. Ten essential elements were identified as contributors to the successful LLCs: LLC national leadership and coordination, local leadership, people with CF and families involvement, registry data transparency, standardised improvement curriculum with evidence based change ideas, internet resources with reminders, team coaching, regular progress reporting and tracking, benchmarking site visits and applied improvement measurement. The LLCs have contributed to improved medical and process outcomes over the past 10 years. Ten essential elements of the LLCs may benefit improvement efforts in other chronic care populations and health systems.

Photoacoustic signals denoising of the glucose aqueous solutions using an improved wavelet threshold method

NASA Astrophysics Data System (ADS)

Ren, Zhong; Liu, Guodong; Xiong, Zhihua

2016-10-01

The photoacoustic signals denoising of glucose is one of most important steps in the quality identification of the fruit because the real-time photoacoustic singals of glucose are easily interfered by all kinds of noises. To remove the noises and some useless information, an improved wavelet threshld function were proposed. Compared with the traditional wavelet hard and soft threshold functions, the improved wavelet threshold function can overcome the pseudo-oscillation effect of the denoised photoacoustic signals due to the continuity of the improved wavelet threshold function, and the error between the denoised signals and the original signals can be decreased. To validate the feasibility of the improved wavelet threshold function denoising, the denoising simulation experiments based on MATLAB programmimg were performed. In the simulation experiments, the standard test signal was used, and three different denoising methods were used and compared with the improved wavelet threshold function. The signal-to-noise ratio (SNR) and the root-mean-square error (RMSE) values were used to evaluate the performance of the improved wavelet threshold function denoising. The experimental results demonstrate that the SNR value of the improved wavelet threshold function is largest and the RMSE value is lest, which fully verifies that the improved wavelet threshold function denoising is feasible. Finally, the improved wavelet threshold function denoising was used to remove the noises of the photoacoustic signals of the glucose solutions. The denoising effect is also very good. Therefore, the improved wavelet threshold function denoising proposed by this paper, has a potential value in the field of denoising for the photoacoustic singals.

Emotion Regulation and Substance Use Frequency in Women with Substance Dependence and Borderline Personality Disorder Receiving Dialectical Behavior Therapy

PubMed Central

Axelrod, Seth R.; Perepletchikova, Francheska; Holtzman, Kevin; Sinha, Rajita

2011-01-01

Background Dialectical Behavior Therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. Objective Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. Method Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. Conclusions This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. Significance and Future Research Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dyregulation such as BPD and substance dependence, and to further explore emotion regulation as a potential mechanism of change for clinical interventions. PMID:21091162

Improving patient satisfaction with pain management using Six Sigma tools.

PubMed

DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

2009-07-01

Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

PubMed

Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

2016-08-01

Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

Cutoff value of pharyngeal residue in prognosis prediction after neuromuscular electrical stimulation therapy for Dysphagia in subacute stroke patients.

PubMed

Park, Jeong Mee; Yong, Sang Yeol; Kim, Ji Hyun; Jung, Hong Sun; Chang, Sei Jin; Kim, Ki Young; Kim, Hee

2014-10-01

To determine the cutoff value of the pharyngeal residue for predicting reduction of aspiration, by measuring the residue of valleculae and pyriformis sinuses through videofluoroscopic swallowing studies (VFSS) after treatment with neuromuscular electrical stimulator (VitalStim) in stroke patients with dysphagia. VFSS was conducted on first-time stroke patients before and after the VitalStim therapy. The results were analyzed for comparison of the pharyngeal residue in the improved group and the non-improved group. A total of 59 patients concluded the test, in which 42 patients improved well enough to change the dietary methods while 17 did not improve sufficiently. Remnant area to total area (R/T) ratios of the valleculae before treatment in the improved group were 0.120, 0.177, and 0.101 for solid, soft, and liquid foods, respectively, whereas the ratios for the non-improved group were 0.365, 0.396, and 0.281, respectively. The ratios of the pyriformis sinuses were 0.126, 0.159, and 0.121 for the improved group and 0.315, 0.338, and 0.244 for the non-improved group. The R/T ratios of valleculae and pyriformis sinus were significantly lower in the improved group than the non-improved group in all food types before treatment. The R/T ratio cutoff values were 0.267, 0.250, and 0.185 at valleculae and 0.228, 0.218, and 0.185 at pyriformis sinuses. In dysphagia after stroke, less pharyngeal residue before treatment serves as a factor for predicting greater improvement after VitalStim treatment.

Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

PubMed

Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

2013-12-01

The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

Co-culture of channel catfish with hybrid catfish facilitates 'herd effect' to improve production performance

USDA-ARS?s Scientific Manuscript database

Herd effect is an epidemiological phenomenon, where the presence or proximity of a certain proportion of improved (superior) individuals improve the performance of less improved (normal) individuals. Channel catfish, Ictalurus puntatus is the single largest aquaculture species cultured in US. Ho...

Why Process Improvement Training Fails

ERIC Educational Resources Information Center

Lu, Dawei; Betts, Alan

2011-01-01

Purpose: The purpose of this paper is to explore the underlying reasons why providing process improvement training, by itself, may not be sufficient to achieve the desired outcome of improved processes; and to attempt a conceptual framework of management training for more effective improvement. Design/methodology/approach: Two similar units within…

How to conduct a clinical audit and quality improvement project.

PubMed

Limb, Christopher; Fowler, Alex; Gundogan, Buket; Koshy, Kiron; Agha, Riaz

2017-07-01

Audits and quality improvement projects are vital aspects of clinical governance and continual service improvement in medicine. In this article we describe the process of clinical audit and quality improvement project. Guidance is also provided on how to design an effective audit and bypass barriers encountered during the process.

A Qualitative Study to Improve the Student Learning Experience

ERIC Educational Resources Information Center

Jastania, Raid A.; Balata, Gehan F.; Abd El-Hady, Mohamed I. S.; Gouda, Ahmad; Abd El-Wahab, Mohamad; Mohamad, Abeer S.; Ibrahim, Nashwa M.; Beshr, Eman; Mahdi, Abeer Y.; Mousa, Rabab; Tag, Batool F.; Hisham, Hadeel; El-Sofiani, Ibtehal

2017-01-01

Purpose: For any educational institution, student satisfaction is an important goal. Thus, the purpose of the study is to use a structured improvement process, define--measure--analyse--improve--control (DMAIC) methodology, to improve students' satisfaction regarding their learning experience at the College of Pharmacy/Umm Al-Qura University.…

Improving Quality Higher Education in Nigeria: The Roles of Stakeholders

ERIC Educational Resources Information Center

Asiyai, Romina Ifeoma

2015-01-01

This paper discusses the roles of stakeholders in improving quality of university education in Nigeria. Internal and external stakeholders are identified and the various roles they could play in improving the quality of university education are discussed. The paper contends that continuous and holistic improvement in university education system…

42 CFR 422.153 - Use of quality improvement organization review information.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Improvement § 422.153 Use of quality improvement organization review information. CMS will acquire from... 42 Public Health 3 2012-10-01 2012-10-01 false Use of quality improvement organization review information. 422.153 Section 422.153 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

42 CFR 422.153 - Use of quality improvement organization review information.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Improvement § 422.153 Use of quality improvement organization review information. CMS will acquire from... 42 Public Health 3 2014-10-01 2014-10-01 false Use of quality improvement organization review information. 422.153 Section 422.153 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

42 CFR 422.153 - Use of quality improvement organization review information.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Improvement § 422.153 Use of quality improvement organization review information. CMS will acquire from... 42 Public Health 3 2013-10-01 2013-10-01 false Use of quality improvement organization review information. 422.153 Section 422.153 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

Supporting Parents through Parent Education. Building Community Systems for Young Children.

ERIC Educational Resources Information Center

Zepeda, Marlene; Morales, Alex

California's Proposition 10, the "Children and Families Act," has targeted three general areas for improvement in support of families and young children: improved family functioning, improved child development, and improved child health. Proposition 10 views parents as critical to the development of young children. Noting that parent…

Bi-Regional Educational Improvement Forum (Atlanta, Georgia, November 19-20, 1979).

ERIC Educational Resources Information Center

Appalachia Educational Lab., Charleston, WV.

The Bi-Regional Educational Improvement Forum in Atlanta, Georgia (November 1979) considered three areas of school improvement, including State Department of Education (SEA) delivery systems and the use of technology to improve schooling. The three forum articles concerned with delivery systems treat the transformation of policies emanating from…

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

What School Boards Can Do to Improve Teacher Competency.

ERIC Educational Resources Information Center

Karagan, Nicholas J.

The school board's role in improving teacher competency involves avoiding incompetent teachers, improving competent ones, and maintaining highly competent ones. Because teacher competence is a complex social phenomenon, affected by many different variables, boards should keep in mind that actions to improve competency may not be preferred by…

Improv(ing) the Academy: Applied Improvisation as a Strategy for Educational Development

ERIC Educational Resources Information Center

Rossing, Jonathan P.; Hoffmann-Longtin, Krista

2016-01-01

Improvisational theater training (or "improv") is a strategy employed by many business leaders and educators to cultivate creativity and collaboration amid change. Drawing on improv principles such as "Yes, And…" and "Make your scene partners look good," we explore the ways in which educational developers might apply…

23 CFR 140.914 - Credits for improvements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Reimbursement for Railroad Work § 140.914 Credits for improvements. (a) Credit shall be made to the project for additions or improvements which provide for higher quality or increased service capability of the operating... 23 Highways 1 2010-04-01 2010-04-01 false Credits for improvements. 140.914 Section 140.914...

The Developmental Evaluation of School Improvement Networks

ERIC Educational Resources Information Center

Peurach, Donald J.; Glazer, Joshua L.; Winchell Lenhoff, Sarah

2016-01-01

The national education reform agenda has rapidly expanded to include attention to continuous improvement research in education. The purpose of this analysis is to propose a new approach to "developmental evaluation" aimed at building a foundation for continuous improvement in large-scale school improvement networks, on the argument that…

77 FR 19280 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference: Increasing Real-Time and Day- Ahead Market Efficiency Through Improved Software Take notice that Commission staff will...-time and day-ahead market efficiency through improved software. A detailed agenda with the list of and...

Meeting the Challenge: Providing High-Quality School Environments through Energy Performance Contracting.

ERIC Educational Resources Information Center

Birr, David

2000-01-01

Energy performance contracting allows schools to pay for needed new energy equipment and modernization improvements with savings from reduced utility and maintenance costs. Improved energy efficiency reduces demand for burning fossil fuels, which reduces air pollution, leading to improved learning environments and budgets (through improved average…

Improving Quality in Education: Dynamic Approaches to School Improvement

ERIC Educational Resources Information Center

Creemers, Bert P. M.; Kyriakides, Leonidas

2011-01-01

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

Continuous Improvement in Education. Advancing Teaching--Improving Learning. White Paper

ERIC Educational Resources Information Center

Park, Sandra; Hironaka, Stephanie; Carver, Penny; Nordstrum, Lee

2013-01-01

In recent years, "continuous improvement" has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education. This white paper attempts…

45 CFR 158.150 - Activities that improve health care quality.

Code of Federal Regulations, 2012 CFR

2012-10-01

... designed primarily to control or contain costs; (2) The pro rata share of expenses that are for lines of... improve quality must meet the following requirements: (1) The activity must be designed to: (i) Improve... primarily designed to: (i) Improve health outcomes including increasing the likelihood of desired outcomes...

77 FR 42257 - General Conference Committee of the National Poultry Improvement Plan; Solicitation for Membership

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

...] General Conference Committee of the National Poultry Improvement Plan; Solicitation for Membership AGENCY... regional membership for the General Conference Committee of the National Poultry Improvement Plan. DATES... INFORMATION CONTACT: Dr. C. Stephen Roney, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS...

75 FR 70712 - General Conference Committee of the National Poultry Improvement Plan; Reestablishment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

...] General Conference Committee of the National Poultry Improvement Plan; Reestablishment AGENCY: Animal and... Poultry Improvement Plan (Committee) for a 2-year period. The Secretary of Agriculture has determined that.... Rhorer, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS, USDA, Suite 101, 1498 Klondike...

Leadership Capacity--A Key to Sustaining Lasting Improvement

ERIC Educational Resources Information Center

Williams, Henry S.

2009-01-01

Studies on school change indicate that schools successful in sustaining school improvement build capacity for leadership within the organization (Harris & Lambert, 2003). Reliance on the leadership of the principal alone is no longer viable if schools are to improve and sustain improvement. Leadership capacity is about creating conditions…

A Systems Approach to Rapid School Improvement

ERIC Educational Resources Information Center

McCauley, Carlas

2018-01-01

To support systemic thinking about school improvement, the Center on School Turnaround at WestEd developed a framework to assist states, districts, and schools in leading and managing rapid improvement efforts. The framework, which is presented in this article, has four domains that have proved central to rapid, significant improvement: (1)…

7 CFR 764.151 - Farm Ownership loan uses.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) Make capital improvements to a farm owned by the applicant, for construction, purchase or improvement of farm dwellings, service buildings or other facilities and improvements essential to the farming operation. In the case of leased property, the applicant must have a lease to ensure use of the improvement...

Key Strategies to Improve Schools: How to Apply Them Contextually

ERIC Educational Resources Information Center

Harris, Edward L.

2005-01-01

In recent years, school improvement initiatives have been the focus of political agendas, professional conferences, and publication topics. While a plethora of school improvement resources and techniques exist, most explanations regarding how to employ school improvement strategies in differing contexts is extremely vague at best, and non-existent…

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

76 FR 28022 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference: Increasing Real-Time and Day- Ahead Market Efficiency Through Improved Software Take notice that Commission staff will... for increasing real-time and day-ahead market efficiency through improved software. This conference...

Improving Strategies for Low-Income Family Children's Information Literacy

ERIC Educational Resources Information Center

Zhang, Haiyan; Washington, Rodney; Yin, Jianjun

2014-01-01

This article discussed the significance of improving low-income family children's information literacy, which could improve educational quality, enhance children's self-esteem, adapt children to the future competitive world market, as well as the problems in improving low-income family children's information literacy, such as no home computer and…

24 CFR 201.20 - Property improvement loan eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... jurisdiction over the fire safety requirements of health care facilities prior to making application for a loan... property improvement loan (other than a manufactured home improvement loan), the borrower shall have at... property. (2) To be eligible for a manufactured home improvement loan, the borrower shall have at least a...

Implementing and Sustaining School Improvement. The Informed Educator Series

ERIC Educational Resources Information Center

Protheroe, Nancy

2011-01-01

This "Informed Educator" examines research-proven strategies for implementing and sustaining school improvement by looking at the key elements of the process, enabling conditions for improvement, issues of school culture, and implementation. It also looks at school turnarounds and how to sustain school improvement once reforms are implemented.

Using Lean in the Flipped Classroom for At Risk Students

ERIC Educational Resources Information Center

Flumerfelt, Shannon; Green, Greg

2013-01-01

Schools are working to improve achievement through the examination of instructional practice and the use of instructional technology. This article provides informed commentary on the state of school reform and the need for continuous improvement, instructional improvement and instructional technology improvement. It also presents advocacy for the…

African goat improvement project: A feed the future initiative harnessing geneticdiversity for conservation, disease resistance, and improved productivity

USDA-ARS?s Scientific Manuscript database

AFRICAN GOAT IMPROVEMENT PROJECT: A FEED THE FUTURE INITIATIVE HARNESSING GENETIC DIVERSITY FOR CONSERVATION, DISEASE RESISTANCE, AND IMPROVED PRODUCTIVITY Food production systems in Africa depend heavily on the use of locally adapted animals. These animals are of agricultural, cultural, and econom...

34 CFR 200.25 - Schoolwide programs in general.

Code of Federal Regulations, 2012 CFR

2012-07-01

... EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED Improving... in general. (a) Purpose. (1) The purpose of a schoolwide program is to improve academic achievement... related to the State's academic standards under § 200.1. (2) The improved achievement is to result from...

Quality of Instruction Improved by Evaluation and Consultation of Instructors

ERIC Educational Resources Information Center

Rindermann, Heiner; Kohler, Jurgen; Meisenberg, Gerhard

2007-01-01

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

Do Clinical Practice Guidelines Improve Quality?

PubMed

Baldassari, Cristina M

2017-07-01

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

The theory, practice, and future of process improvement in general thoracic surgery.

PubMed

Freeman, Richard K

2014-01-01

Process improvement, in its broadest sense, is the analysis of a given set of actions with the aim of elevating quality and reducing costs. The tenets of process improvement have been applied to medicine in increasing frequency for at least the last quarter century including thoracic surgery. This review outlines the theory underlying process improvement, the currently available data sources for process improvement and possible future directions of research. Copyright © 2015 Elsevier Inc. All rights reserved.

A small business worksite wellness model for improving health behaviors.

PubMed

Merrill, Ray M

2013-08-01

To evaluate the effectiveness of a wellness program delivered by WellSteps, LLC, aimed at improving employee health behaviors in small companies that lack the resources to independently develop and manage a wellness program. Analyses are based on 618 employees from five diverse companies that completed an initial personal health assessment. Exercise and dietary behaviors significantly improved across the five companies. Significant improvements in health perception and life satisfaction also resulted and were associated with improvements in health behaviors. Three of the five companies, each with fewer than 50 employees, were most effective in influencing positive health behaviors, health perceptions, and life satisfaction. The worksite wellness program effectively improved health behaviors, health perceptions, and life satisfaction.

Potential improvements in turbofan engine fuel economy

NASA Technical Reports Server (NTRS)

Hines, R. W.; Gaffin, W. O.

1976-01-01

The method developed for initial evaluation of possible performance improvements in the NASA Aircraft Energy Efficiency Program, directed toward improving the fuel economy of turbofan engines, is outlined, and results of the evaluation of 100 candidate engine modifications are presented. The study indicates that fuel consumption improvements of as much as 5% may be possible in current JT3D, JT8D, and JT9D turbofan engines. Aerodynamic, thermodynamic, material, and structural advances are expected to yield fuel consumption improvements on the order of 10 to 15% in advanced turbofan engines, with the greatest improvement stemming from significantly higher cycle pressure ratios. Higher turbine temperature and fan bypass ratios are also expected to contribute to fuel conservation.

Signal quality improvement using cylindrical confinement for laser induced breakdown spectroscopy.

PubMed

Hou, Zongyu; Wang, Zhe; Liu, Jianmin; Ni, Weidou; Li, Zheng

2013-07-01

In our previous work, we found that there was great potential to improve the pulse-to-pulse signal repeatability using a moderate cylindrical cavity confinement. However, the improvement was achieved only with certain experimental parameters; while under other conditions, there was no improvement or even worse repeatability. In the present work, the experimental configuration was redesigned and unexpected uncertainty from the variation of the laser and cavity alignment and the laser ablated aerosols were avoided. With these two improvements, we demonstrated that the cavity can always increase the signal repeatability. In addition, image taken by ICCD verified that the confinement improved the stability of the plasma morphology as expected.

Quality improvement 101 for surgeons: Navigating the alphabet soup.

PubMed

Santore, Matthew T; Islam, Saleem

2015-12-01

It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. Copyright © 2015 Elsevier Inc. All rights reserved.

A plan for application system verification tests: The value of improved meteorological information, volume 1. [economic consequences of improved meteorological information

NASA Technical Reports Server (NTRS)

1976-01-01

The framework within which the Applications Systems Verification Tests (ASVTs) are performed and the economic consequences of improved meteorological information demonstrated is described. This framework considers the impact of improved information on decision processes, the data needs to demonstrate the economic impact of the improved information, the data availability, the methodology for determining and analyzing the collected data and demonstrating the economic impact of the improved information, and the possible methods of data collection. Three ASVTs are considered and program outlines and plans are developed for performing experiments to demonstrate the economic consequences of improved meteorological information. The ASVTs are concerned with the citrus crop in Florida, the cotton crop in Mississippi and a group of diverse crops in Oregon. The program outlines and plans include schedules, manpower estimates and funding requirements.

Understanding the conditions for improvement: research to discover which context influences affect improvement success

PubMed Central

2011-01-01

Context can be defined as all factors that are not part of a quality improvement intervention itself. More research indicates which aspects are ‘conditions for improvement’, which influence improvement success. However, little is known about which conditions are most important, whether these are different for different quality interventions or whether some become less or more important at different times in carrying out an improvement. Knowing more about these conditions could help speed up and spread improvements and develop the science. This paper proposes ways to build knowledge about the conditions needed for different changes, and to create conditional-attribution explanations to provide qualified generalisations. It describes theory-based, non-experimental research designs. It also suggests that ‘practical improvers’ can make their changes more effective by reflecting on and revising their own ‘assumption-theories’ about the conditions which will help and hinder the improvements they aim to implement. PMID:21450764

Online Education Improves Dementia Knowledge: Evidence From an International Intervention.

PubMed

Annear, Michael J

2018-03-01

Dementia education disseminated through massive open online courses (MOOCs) has the potential to improve knowledge and care provision among health professionals and lay people. The potential learning effects of a dementia MOOC were assessed using a reliable and valid measure with international volunteers ( N = 3,649) who completed the measure before and after online education. Evaluation of learning effects suggests that the MOOC significantly increased dementia knowledge by at least 17% across six cohorts. Knowledge was improved by the MOOC in three ways: it significantly improved overall understanding of dementia for diverse cohorts; it reduced knowledge disparity within occupational and lay cohorts; and it reduced knowledge disparity across occupational and lay cohorts. The capacity of a dementia MOOC to significantly improve knowledge and reach a wide audience may lead to population-level improvements in understanding about dementia. This may foster improvements in treatment and quality of care for people with dementia.

Collaborative field research and training in occupational health and ergonomics.

PubMed

Kogi, K

1998-01-01

Networking collaborative research and training in Asian developing countries includes three types of joint activities: field studies of workplace potentials for better safety and health, intensive action training for improvement of working conditions in small enterprises, and action-oriented workshops on low-cost improvements for managers, workers, and farmers. These activities were aimed at identifying workable strategies for making locally adjusted improvements in occupational health and ergonomics. Many improvements have resulted as direct outcomes. Most these improvements were multifaceted, low-cost, and practicable using local skills. Three common features of these interactive processes seem important in facilitating realistic improvements: 1) voluntary approaches building on local achievements; 2) the use of practical methods for identifying multiple improvements; and 3) participatory steps for achieving low-cost results first. The effective use of group work tools is crucial. Stepwise training packages have thus proven useful for promoting local problem-solving interventions based on voluntary initiatives.

A Novel Feed-Forward Modeling System Leads to Sustained Improvements in Attention and Academic Performance.

PubMed

McDermott, Ashley F; Rose, Maya; Norris, Troy; Gordon, Eric

2016-01-28

This study tested a novel feed-forward modeling (FFM) system as a nonpharmacological intervention for the treatment of ADHD children and the training of cognitive skills that improve academic performance. This study implemented a randomized, controlled, parallel design comparing this FFM with a nonpharmacological community care intervention. Improvements were measured on parent- and clinician-rated scales of ADHD symptomatology and on academic performance tests completed by the participant. Participants were followed for 3 months after training. Participants in the FFM training group showed significant improvements in ADHD symptomatology and academic performance, while the control group did not. Improvements from FFM were sustained 3 months later. The FFM appeared to be an effective intervention for the treatment of ADHD and improving academic performance. This FFM training intervention shows promise as a first-line treatment for ADHD while improving academic performance. © The Author(s) 2016.

The history of quality measurement in home health care.

PubMed

Rosati, Robert J

2009-02-01

Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care.

Assessing the evidence of Six Sigma and Lean in the health care industry.

PubMed

DelliFraine, Jami L; Langabeer, James R; Nembhard, Ingrid M

2010-01-01

Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. The authors conducted a comprehensive literature review to assess the empirical evidence relating SS/L to improved clinical outcomes, processes of care, and financial performance of health care organizations. The authors identified 177 articles on SS/L published in the last 10 years. However, only 34 of them reported any outcomes of the SS/L projects studied, and less than one-third of these articles included statistical analyses to test for significant changes in outcomes. This review demonstrates that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence that SS/L improve health care quality.

Continual improvement plan

NASA Technical Reports Server (NTRS)

1994-01-01

NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

Recent trends in assistive technology for mobility

PubMed Central

2012-01-01

Loss of physical mobility makes maximal participation in desired activities more difficult and in the worst case fully prevents participation. This paper surveys recent work in assistive technology to improve mobility for persons with a disability, drawing on examples observed during a tour of academic and industrial research sites in Europe. The underlying theme of this recent work is a more seamless integration of the capabilities of the user and the assistive technology. This improved integration spans diverse technologies, including powered wheelchairs, prosthetic limbs, functional electrical stimulation, and wearable exoskeletons. Improved integration is being accomplished in three ways: 1) improving the assistive technology mechanics; 2) improving the user-technology physical interface; and 3) sharing of control between the user and the technology. We provide an overview of these improvements in user-technology integration and discuss whether such improvements have the potential to be transformative for people with mobility impairments. PMID:22520500

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

PubMed

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

2014-01-01

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

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

Project ORDER: Organization for Responsibility, Dependability, Education and Reality. Evaluation Report 1974-75.

ERIC Educational Resources Information Center

North Forest Independent School District, Houston, TX.

Project ORDER is a pilot project tested in an urban middle school in Houston, Texas. The program was intended to improve the general school atmosphere; to improve students' attitudes toward the school, its program, faculty, and administration; to show significant improvement in pupil behavior; and to substantially improve teaching-learning…

Establishing and Sustaining Networked Improvement Communities: Lessons from Michigan and Minnesota. REL 2017-264

ERIC Educational Resources Information Center

Proger, Amy R.; Bhatt, Monica P.; Cirks, Victoria; Gurke, Deb

2017-01-01

There is growing interest in the ability of improvement science--the systematic study of improvement strategies to identify promising practices for addressing issues in complex systems (Improvement Science Research Network, 2016)--to spur innovation and address complex problems. In education this methodology is often implemented through…

The Minnesota Tree Improvement Cooperative

Treesearch

Andrew David

2002-01-01

As the director of the Minnesota Tree Improvement Cooperative (MTIC) based in Cloquet, Minnesota, I would like to tell you a little about our strategy for creating improved seed, and how individual nurseries or nursery associations can interact with tree improvement programs to the benefit of both parties. MTIC is approximately 15 miles west of Duluth, at the...

39 CFR 3050.42 - Proceedings to improve the quality of financial data.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Proceedings to improve the quality of financial... § 3050.42 Proceedings to improve the quality of financial data. The Commission may, on its own motion or on request of an interested party, initiate proceedings to improve the quality, accuracy, or...

76 FR 62894 - Agency Information Collection Activities: Notice of Request for Renewal of a Previously Approved...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-11

... innovative technologies that will improve safety, reduce congestion due to construction, and improve quality... project, the innovative technologies to be used and a description of how these technologies will improve safety, reduce construction congestion, and improve quality. The collected information will be used by...

Improving Mathematics Teaching as Deliberate Practice through Chinese Lesson Study

ERIC Educational Resources Information Center

Huang, Rongjin; Prince, Kyle M.; Barlow, Angela T.

2017-01-01

This study examined how a ninth grade teacher improved an Algebra I lesson through a lesson study approach. We used multiple data sources to investigate the improvement of the lesson towards student-centered mathematics instruction, perceived benefits of the teacher, and factors associated with the improvement of teaching. The lesson group…

77 FR 4299 - Agency Information Collection Activities; Proposed Collection; Comment Request; Valuing Improved...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

... Activities; Proposed Collection; Comment Request; Valuing Improved Water Quality in the Chesapeake Bay Using...: Willingness to Pay for Improved Water Quality in the Chesapeake Bay. ICR numbers: EPA ICR No. 2456.01, OMB... Economics (NCEE) is undertaking a benefits analysis of improvements in Bay water quality under the TMDLs, as...

77 FR 31006 - Agency Information Collection Activities; Proposed Collection; Comment Request; Valuing Improved...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... Activities; Proposed Collection; Comment Request; Valuing Improved Water Quality in the Chesapeake Bay Using... contacted to participate in the study. Title: Willingness to Pay for Improved Water Quality in the... benefits analysis of improvements in Bay water quality under the TMDLs, as well as of ancillary benefits...

Leadership and Context Connectivity: Merging Two Forces for Sustainable School Improvement

ERIC Educational Resources Information Center

Marishane, Nylon Ramodikoe

2016-01-01

School improvement is admittedly the main business of school leadership. However, while there is agreement on the importance of school improvement, sustaining this improvement remains a challenge. The challenge seems to lie in the disconnection between the leader and the context in which the school operates. This chapter presents contextual…

JLTV - Briefings to Industry, Ground Vehicle Power and Mobility (GVPM)

DTIC Science & Technology

2009-05-27

lithium ion battery cathodes, separators, and electrolytes. This effort shall also access the...manufacturability of the improved designs using the new materials. PAYOFF: Improved lithium ion battery power density Improved lithium ion battery energy...negative electrodes in lithium-ion batteries. PAYOFF: Better understanding of lithium - ion battery charging limitations Improved safety for

34 CFR 200.49 - SEA responsibilities for school improvement, corrective action, and restructuring.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false SEA responsibilities for school improvement, corrective... Agencies Lea and School Improvement § 200.49 SEA responsibilities for school improvement, corrective action... subject to corrective action on January 7, 2002, the SEA must ensure that the LEA for that school provides...

Improving Performance in a Nuclear Cardiology Department

ERIC Educational Resources Information Center

LaFleur, Doug; Smalley, Karolyn; Austin, John

2005-01-01

Improving performance in the medical industry is an area that is ideally suited for the tools advocated by the International Society of Performance Improvement (ISPI). This paper describes an application of the tools that have been developed by Dale Brethower and Geary Rummler, two pillars of the performance improvement industry. It allows the…

32 CFR 644.381 - Disposal of buildings and other improvements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Disposal of buildings and other improvements. 644... Temporary Basis from Another Federal Agency § 644.381 Disposal of buildings and other improvements. Where... reimburse the Army for their net salvage value, or the buildings or improvements will be disposed of in...

Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

ERIC Educational Resources Information Center

Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

2013-01-01

The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in QIS…

Can Schools Meet the Promise of Continuous Improvement?

ERIC Educational Resources Information Center

Elgart, Mark A.

2018-01-01

Continuous improvement is "an embedded behavior within the culture of a school that constantly focuses on the conditions, processes, and practices that will improve teaching and learning." The phrase has been part of the lexicon of school improvement for decades, but real progress is rare. Based on its observations of about 5,000…

Evaluating realized genetic gains from tree improvement.

Treesearch

J.B. St. Clair

1993-01-01

Tree improvement has become an essential part of the management of forest lands for wood production, and predicting yields and realized gains from forests planted with genetically-improved trees will become increasingly important. This paper discusses concepts of tree improvement and genetic gain important to growth and yield modeling, and reviews previous studies of...

76 FR 41790 - Increasing Market and Planning Efficiency Through Improved Software; Notice Establishing Date for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

... Market and Planning Efficiency Through Improved Software; Notice Establishing Date for Comments From June... real-time and day- ahead market efficiency through improved software.\\1\\ \\1\\ Notice of technical conference: increasing real-time and day-ahead market efficiency through improved software, 76 Fed. Reg. 28...

34 CFR 637.1 - What is the Minority Science and Engineering Improvement Program (MSEIP)?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false What is the Minority Science and Engineering... ENGINEERING IMPROVEMENT PROGRAM General § 637.1 What is the Minority Science and Engineering Improvement Program (MSEIP)? The Minority Science and Engineering Improvement Program (MSEIP) is designed to effect...

34 CFR 637.1 - What is the Minority Science and Engineering Improvement Program (MSEIP)?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false What is the Minority Science and Engineering... ENGINEERING IMPROVEMENT PROGRAM General § 637.1 What is the Minority Science and Engineering Improvement Program (MSEIP)? The Minority Science and Engineering Improvement Program (MSEIP) is designed to effect...

34 CFR 637.1 - What is the Minority Science and Engineering Improvement Program (MSEIP)?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false What is the Minority Science and Engineering... ENGINEERING IMPROVEMENT PROGRAM General § 637.1 What is the Minority Science and Engineering Improvement Program (MSEIP)? The Minority Science and Engineering Improvement Program (MSEIP) is designed to effect...

34 CFR 637.1 - What is the Minority Science and Engineering Improvement Program (MSEIP)?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false What is the Minority Science and Engineering... ENGINEERING IMPROVEMENT PROGRAM General § 637.1 What is the Minority Science and Engineering Improvement Program (MSEIP)? The Minority Science and Engineering Improvement Program (MSEIP) is designed to effect...

34 CFR 637.1 - What is the Minority Science and Engineering Improvement Program (MSEIP)?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false What is the Minority Science and Engineering... ENGINEERING IMPROVEMENT PROGRAM General § 637.1 What is the Minority Science and Engineering Improvement Program (MSEIP)? The Minority Science and Engineering Improvement Program (MSEIP) is designed to effect...

School Faculty as a High-Performing Learning Community: Normative Data from 132 Schools.

ERIC Educational Resources Information Center

Meehan, Merrill L.; Wiersma, William; Cowley, Kimberly S.; Craig, James R.; Orletsky, Sandra R.; Childers, Robert D.

A faculty's commitment to continuous learning and improvement is a critical dimension in defining schools as high-performing learning communities. When planning an improvement effort, a school's staff needs a conceptual framework that outlines the dimensions of school improvement. The AEL Continuous School Improvement Questionnaire (CSIQ) is a…

Sawmilling practices for hardwoods

Treesearch

John. Dramm

2013-01-01

The Sawmill Improvement Program (SIP) provides guidance to improve the bottom line of a sawmill both by recovering more lumber from a log and by using simplified procedures to produce more grade lumber. Lessons learned from SIP have led to improved yields of grade lumber through improved log manufacturing, reducing sawing variation by using thinner kerf saws and better...

Poverty and Social Developments in Peru, 1994-1997. A World Bank Country Study.

ERIC Educational Resources Information Center

World Bank, Washington, DC.

From 1994 to 1997, social welfare improved in Peru. Areas of improvement included decreased poverty and severe poverty rates, increased school attendance and literacy, and a healthier population. Most important among health improvements was reduced malnutrition among young children. Social improvements stemmed from the favorable overall economic…

77 FR 46374 - National Poultry Improvement Plan; General Conference Committee Meeting and 41st Biennial Conference

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

...] National Poultry Improvement Plan; General Conference Committee Meeting and 41st Biennial Conference AGENCY... notice of a meeting of the General Conference Committee of the National Poultry Improvement Plan (NPIP... CONTACT: Dr. C. Stephen Roney, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS, 1506...

Compressed Air System Upgrade Improves Production at an Automotive Glass Plant

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

Not Available

2003-02-01

In 2000, The Visteon automotive glass plant improved its compressed air system at its automotive glass plant in Nashville, Tennessee. This improvement allowed Visteon to save $711,000 annually, reduce annual energy consumption by 7.9 million kilowatt-hours, reduce maintenance, improve system performance, and avoid $800,000 in asbestos abatement costs.

SOURCE APPORTIONMENT OF SEATTLE PM 2.5: A COMPARISON OF IMPROVE AND ENHANCED STN DATA SETS

EPA Science Inventory

Seattle, WA, STN and IMPROVE data sets with STN temperature resolved carbon peaks were analyzed with both the PMF and Unmix receptor models. In addition, the IMPROVE trace element data was combined with the major STN species to examine the role of IMPROVE metals. To compare the ...

Strategic plans for the Hardwood Tree Improvement and Regeneration Center

Treesearch

Charles H. Michler; Keith E. Woeste

2002-01-01

The mission of the Hardwood Tree Improvement and Regeneration Center (HTIRC) at Purdue University is to advance the science of hardwood tree improvement and genomics in the central hardwood region of the United States by: developing and disseminating knowledge on improving the genetic quality of hardwood tree species; conserving fine hardwood germplasm; developing...

The Evolution of School Improvement from the Classroom Teacher's Perspective.

ERIC Educational Resources Information Center

Thompson, Marci; Mitchell, Deborah

2002-01-01

Highlights changes that have occurred since 1992 at Elm Dale Elementary School (Greenfield, Wisconsin) through the school improvement process. Describes how teachers have become involved in and developed ownership of the improvement process, and how they have learned to analyze data. Asserts that the school improvement process has changed the…

Finding Root Causes Effectively a Powerful Way to Improve Schools

ERIC Educational Resources Information Center

Hegedus, Andrew S.

2010-01-01

Most School Improvement Plans (SIPs) in education do not guide staff efforts to tackle the root causes that prevent significant performance improvement. It is unlikely student achievement will improve should these root causes remain. As a result, NCLB mandated consequences will eventually be imposed. These consequences increase pressure to address…

Development and Face Validation of Strategies for Improving Consultation Skills

ERIC Educational Resources Information Center

Lefroy, Janet; Thomas, Adam; Harrison, Chris; Williams, Stephen; O'Mahony, Fidelma; Gay, Simon; Kinston, Ruth; McKinley, R. K.

2014-01-01

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of…

Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

ERIC Educational Resources Information Center

Aluri, Rao

1993-01-01

Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

Improving University Teaching. Volume II [and] Volume III. Contributed Papers. International Conference (12th, Heidelberg, Germany, July 15-18, 1986).

ERIC Educational Resources Information Center

Maryland Univ., College Park. Univ. Coll.

Seventy-four papers from a 1986 international conference on improving university teaching are presented. Topics include: student-teacher relationships, the pulse of the academic professional, improving teaching via techology, campus-corporate linkages, institutional changes and liberal learning, improving university teaching through evaluation,…

Improving the Nuclear Reform Implementation for Success

DTIC Science & Technology

2016-09-15

IMPROVING THE NUCLEAR REFORM IMPLEMENTATION FOR SUCCESS GRADUATE RESEARCH PAPER Allen Y. Agnes...United States. AFIT-ENS-MS-16-S-023 IMPROVING THE NUCLEAR REFORM IMPLMENTATION FOR SUCCESS GRADUATE RESEARCH PAPER Presented to the...AFIT-ENS-MS-16-S-023 IMPROVING THE NUCLEAR REFORM IMPLEMENTATION FOR SUCCESS Allen Y. Agnes, BS, MS Major, USAF

Selected Activities to Improve Cardiovascular Endurance and Strength and Muscular Endurance; K-3.

ERIC Educational Resources Information Center

Schmidt, Sharon

Activities to help the young child improve his/her physical fitness are difficult to find because of insufficient research supporting the effectiveness of proposed activities. However, several activities are assumed to improve the fitness of various areas of the body while concurrently improving cardiovascular endurance by increasing the heart…

School Climate Improvement Action Guide for District Leaders. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that district leaders--including superintendents, assistant superintendents, directors of student support services, or others--can take to support school climate improvements. Key action steps are provided for…

76 FR 19976 - Proposed Information Collection; Comment Request; Survey of EDA Grant Process Improvement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

...; Comment Request; Survey of EDA Grant Process Improvement AGENCY: Economic Development Administration.... In 2010, EDA made improvements in its grant application process. The proposed short survey of five to... improvements to the grant application process and to make any necessary adjustments. EDA would like to conduct...

Innovation for maintenance technology improvements

NASA Technical Reports Server (NTRS)

Shives, T. R. (Editor); Willard, W. A. (Editor)

1982-01-01

A group of 34 submitted entries (32 papers and 2 abstracts) from the 33rd meeting of the Mechanical Failures Prevention Group whose subject was maintenance technology improvement through innovation. Areas of special emphasis included maintenance concepts, maintenance analysis systems, improved maintenance processes, innovative maintenance diagnostics and maintenance indicators, and technology improvements for power plant applications.

76 FR 71554 - Civil Penalties; Notice of Adjusted Maximum Amounts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

..., and the Flammable Fabrics Act. On August 14, 2009, the Consumer Product Safety Improvement Act of 2008... Product Safety Improvement Act of 1990 (Improvement Act), Public Law 101-608, 104 Stat. 3110 (November 16, 1990), and the Consumer Product Safety Improvement Act of 2008 (CPSIA), Public Law 110-314, 122 Stat...

43 CFR 3863.1-2 - Proof of improvements for patent.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Proof of improvements for patent. 3863.1-2... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Placer Mining Claim Patent Applications § 3863.1-2 Proof of improvements for patent. The proof of improvements must...

43 CFR 3863.1-2 - Proof of improvements for patent.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Proof of improvements for patent. 3863.1-2... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Placer Mining Claim Patent Applications § 3863.1-2 Proof of improvements for patent. The proof of improvements must...

43 CFR 3863.1-2 - Proof of improvements for patent.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Proof of improvements for patent. 3863.1-2... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Placer Mining Claim Patent Applications § 3863.1-2 Proof of improvements for patent. The proof of improvements must...

43 CFR 3863.1-2 - Proof of improvements for patent.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Proof of improvements for patent. 3863.1-2... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Placer Mining Claim Patent Applications § 3863.1-2 Proof of improvements for patent. The proof of improvements must...

The reliability of in-training assessment when performance improvement is taken into account.

PubMed

van Lohuizen, Mirjam T; Kuks, Jan B M; van Hell, Elisabeth A; Raat, A N; Stewart, Roy E; Cohen-Schotanus, Janke

2010-12-01

During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how this improvement affects the reliability of the overall judgement. In-training assessment results were obtained from 104 students on rotation at our university hospital or at one of the six affiliated hospitals. Generalisability theory was used in combination with multilevel analysis to obtain reliability coefficients and to estimate the number of assessments needed for reliable overall judgement, both including and excluding performance improvement. Students' clinical performance ratings improved significantly from a mean of 7.6 at the start to a mean of 7.8 at the end of their clerkship. When taking performance improvement into account, reliability coefficients were higher. The number of assessments needed to achieve a reliability of 0.80 or higher decreased from 17 to 11. Therefore, when studying reliability of in-training assessment, performance improvement should be considered.

Personal wellbeing in posttraumatic stress disorder (PTSD): association with PTSD symptoms during and following treatment.

PubMed

Berle, David; Hilbrink, Dominic; Russell-Williams, Clare; Kiely, Rachael; Hardaker, Laura; Garwood, Natasha; Gilchrist, Anne; Steel, Zachary

2018-03-02

It remains unclear to what extent treatment-related gains in posttraumatic stress disorder (PTSD) symptoms translate to improvements in broader domains of personal wellbeing, such as community connectedness, life achievement and security. We sought to determine whether: 1. personal wellbeing improves during the course of a treatment program and 2. changes in core symptom domains (PTSD, anxiety and depression) were associated with improvements in overall personal wellbeing. Participants (N = 124) completed the PTSD Checklist, the Depression and Anxiety Stress Scales and the Personal Wellbeing Index at the start and end of a 4-week Trauma Focused CBT residential program, as well as 3- and 9-months post-treatment. Personal wellbeing improved significantly across the 9-months of the study. Generalised estimating equations analyses indicated that (older) age and improvements in PTSD and depressive symptoms were independent predictors of personal wellbeing across time. Although personal wellbeing improved in tandem with PTSD symptoms, the magnitude of improvement was small. These findings highlight a need to better understand how improvements in personal wellbeing can be optimised following PTSD treatment.

A comparison of text and technology based training tools to improve cognitive skills in older adults.

PubMed

Power, Kevin; Kirwan, Grainne; Palmer, Marion

2011-01-01

Research has indicated that use of cognitive skills training tools can produce positive benefits with older adults. However, little research has compared the efficacy of technology-based interventions and more traditional, text-based interventions which are also available. This study aimed to investigate cognitive skills improvements experienced by 40 older adults using cognitive skills training tools. A Solomon 4 group design was employed to determine which intervention demonstrated the greatest improvement. Participants were asked to use the interventions for 5-10 minutes per day, over a period of 60 days. Pre and post-tests consisted of measures of numerical ability, self-reported memory and intelligence. Following training, older adults indicated significant improvements on numerical ability and intelligence regardless of intervention type. No improvement in selfreported memory was observed. This research provides a critical appraisal of brain training tools and can help point the way for future improvements in the area. Brain training improvements could lead to improved quality of life, and perhaps, have financial and independent living ramifications for older adults.

The clinical nurse specialist: leadership in quality improvement.

PubMed

Finkelman, Anita

2013-01-01

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

Improving the signal subtle feature extraction performance based on dual improved fractal box dimension eigenvectors

NASA Astrophysics Data System (ADS)

Chen, Xiang; Li, Jingchao; Han, Hui; Ying, Yulong

2018-05-01

Because of the limitations of the traditional fractal box-counting dimension algorithm in subtle feature extraction of radiation source signals, a dual improved generalized fractal box-counting dimension eigenvector algorithm is proposed. First, the radiation source signal was preprocessed, and a Hilbert transform was performed to obtain the instantaneous amplitude of the signal. Then, the improved fractal box-counting dimension of the signal instantaneous amplitude was extracted as the first eigenvector. At the same time, the improved fractal box-counting dimension of the signal without the Hilbert transform was extracted as the second eigenvector. Finally, the dual improved fractal box-counting dimension eigenvectors formed the multi-dimensional eigenvectors as signal subtle features, which were used for radiation source signal recognition by the grey relation algorithm. The experimental results show that, compared with the traditional fractal box-counting dimension algorithm and the single improved fractal box-counting dimension algorithm, the proposed dual improved fractal box-counting dimension algorithm can better extract the signal subtle distribution characteristics under different reconstruction phase space, and has a better recognition effect with good real-time performance.

Improving Efficiency While Improving Patient Care in a Student-Run Free Clinic.

PubMed

Lee, Jason S; Combs, Kristen; Pasarica, Magdalena

2017-01-01

Student-run free clinics (SRFCs) have the capacity to decrease health care inequity in underserved populations. These facilities can benefit from improved patient experience and outcomes. We implemented a series of quality improvement interventions with the objectives to decrease patient wait times and to increase the variety of services provided. A needs assessment was performed. Problems related to time management, communication between staff and providers, clinic resources, and methods for assessing clinic performance were identified as targets to reduce wait times and improve the variety of services provided. Seventeen interventions were designed and implemented over a 2-month period. The interventions resulted in improved efficiency for clinic operations and reduced patient wait times. The number of specialty providers, patient visits for specialty care, lifestyle education visits for disease prevention and treatment, free medications, and free laboratory investigations increased to achieve the goal of improving the availability and the variety of services provided. We demonstrated that it is feasible to implement successful quality improvement interventions in SRFCs to decrease patient wait times and to increase the variety of services provided. We believe that the changes we implemented can serve as a model for other SRFCs to improve their performance. © Copyright 2017 by the American Board of Family Medicine.

Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?

PubMed

Hagerman, Nancy S; Varughese, Anna M; Kurth, C Dean

2014-06-01

Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. Quality improvement encourages the examination of systems to create stable processes and ultimately high-value care. Quality improvement initiatives in pediatric anesthesiology have been shown to improve outcomes and the delivery of efficient and effective care at many institutions. The use of checklists, in particular, improves adherence to evidence-based care in crisis situations, decreases catheter-associated bloodstream infections, reduces blood product utilization, and improves communication during the patient handoff process. Use of this simple tool has been associated with decreased morbidity, fewer medical errors, improved provider satisfaction, and decreased mortality in nonanesthesia disciplines as well. Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.

Caring for inpatient boarders in the emergency department: improving safety and patient and staff satisfaction.

PubMed

Bornemann-Shepherd, Melanie; Le-Lazar, Jamie; Makic, Mary Beth Flynn; DeVine, Deborah; McDevitt, Kelly; Paul, Marcee

2015-01-01

Hospital capacity constraints lead to large numbers of inpatients being held for extended periods in the emergency department. This creates concerns with safety, quality of care, and dissatisfaction of patients and staff. The aim of this quality-improvement project was to improve satisfaction and processes in which nurses provided care to inpatient boarders held in the emergency department. A quality-improvement project framework that included the use of a questionnaire was used to ascertain employee and patient dissatisfaction and identify opportunities for improvement. A task force was created to develop action plans related to holding and caring for inpatients in the emergency department. A questionnaire was sent to nursing staff in spring 2012, and responses from the questionnaire identified improvements that could be implemented to improve care for inpatient boarders. Situation-background-assessment-recommendation (SBAR) communications and direct observations were also used to identify specific improvements. Post-questionnaire results indicated improved satisfaction for both staff and patients. It was recognized early that the ED inpatient area would benefit from the supervision of an inpatient director, managers, and staff. Outcomes showed that creating an inpatient unit within the emergency department had a positive effect on staff and patient satisfaction. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy.

PubMed

Wysham, Nicholas G; Mularski, Richard A; Schmidt, David M; Nord, Shirley C; Louis, Deborah L; Shuster, Elizabeth; Curtis, J Randall; Mosen, David M

2014-06-01

Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients. We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention. Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities. Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements. Copyright © 2014 Elsevier Inc. All rights reserved.

Examining quality improvement programs: the case of Minnesota hospitals.

PubMed

Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M

2008-10-01

To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. DATA COLLECTION/DATA EXTRACTION: Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings. The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.

Evaluating NASA Technology Programs in Terms of Private Sector Impacts

NASA Technical Reports Server (NTRS)

Greenberg, J. S.

1984-01-01

NASA is currently developing spacecraft technology for application to NASA scientific missions, military missions and commercial missions which are part of or form the basis of private sector business ventures. The justification of R&D programs that lead to spacecraft technology improvements encompasses the establishment of the benefits in terms of improved scientific knowledge that may result from new and/or improved NASA science missions, improved cost effectiveness of NASA and DOD missions and new or improved services that may be offered by the private sector (for example communications satellite services). It is with the latter of these areas that attention will be focused upon. In particular, it is of interest to establish the economic value of spacecraft technology improvements to private sector communications satellite business ventures. It is proposed to assess the value of spacecraft technology improvements in terms of the changes in cash flow and present value of cash flows, that may result from the use of new and/or improved spacecraft technology for specific types of private sector communications satellite missions (for example domestic point-to-point communication or direct broadcasting). To accomplish this it is necessary to place the new and/or improved technology within typical business scenarios and estimate the impacts of technical performance upon business and financial performance.

Potential Improvements to Remote Primary Productivity Estimation in the Southern California Current System

NASA Astrophysics Data System (ADS)

Jacox, M.; Edwards, C. A.; Kahru, M.; Rudnick, D. L.; Kudela, R. M.

2012-12-01

A 26-year record of depth integrated primary productivity (PP) in the Southern California Current System (SCCS) is analyzed with the goal of improving satellite net primary productivity (PP) estimates. The ratio of integrated primary productivity to surface chlorophyll correlates strongly to surface chlorophyll concentration (chl0). However, chl0 does not correlate to chlorophyll-specific productivity, and appears to be a proxy for vertical phytoplankton distribution rather than phytoplankton physiology. Modest improvements in PP model performance are achieved by tuning existing algorithms for the SCCS, particularly by empirical parameterization of photosynthetic efficiency in the Vertically Generalized Production Model. Much larger improvements are enabled by improving accuracy of subsurface chlorophyll and light profiles. In a simple vertically resolved production model, substitution of in situ surface data for remote sensing estimates offers only marginal improvements in model r2 and total log10 root mean squared difference, while inclusion of in situ chlorophyll and light profiles improves these metrics significantly. Autonomous underwater gliders, capable of measuring subsurface fluorescence on long-term, long-range deployments, significantly improve PP model fidelity in the SCCS. We suggest their use (and that of other autonomous profilers such as Argo floats) in conjunction with satellites as a way forward for improved PP estimation in coastal upwelling systems.

The potential for improving remote primary productivity estimates through subsurface chlorophyll and irradiance measurement

NASA Astrophysics Data System (ADS)

Jacox, Michael G.; Edwards, Christopher A.; Kahru, Mati; Rudnick, Daniel L.; Kudela, Raphael M.

2015-02-01

A 26-year record of depth integrated primary productivity (PP) in the Southern California Current System (SCCS) is analyzed with the goal of improving satellite net primary productivity (PP) estimates. Modest improvements in PP model performance are achieved by tuning existing algorithms for the SCCS, particularly by parameterizing carbon fixation rate in the vertically generalized production model as a function of surface chlorophyll concentration and distance from shore. Much larger improvements are enabled by improving the accuracy of subsurface chlorophyll and light profiles. In a simple vertically resolved production model for the SCCS (VRPM-SC), substitution of in situ surface data for remote sensing estimates offers only marginal improvements in model r2 (from 0.54 to 0.56) and total log10 root mean squared difference (from 0.22 to 0.21), while inclusion of in situ chlorophyll and light profiles improves these metrics to 0.77 and 0.15, respectively. Autonomous underwater gliders, capable of measuring subsurface properties on long-term, long-range deployments, significantly improve PP model fidelity in the SCCS. We suggest their use (and that of other autonomous profilers such as Argo floats) in conjunction with satellites as a way forward for large-scale improvements in PP estimation.

Interventions to improve the use of antimalarials in south-east Asia: an overview.

PubMed Central

Gomes, M.; Wayling, S.; Pang, L.

1998-01-01

There are few drugs for malaria, and those which are available for use are subject to rapid development of resistance. Curiously, little effort has been made to improve drug use in malaria-endemic countries and to assess the benefits of such improvements. Advances can be made in public understanding of the value of ingesting a full regimen of antimalarials, in order to achieve complete cure, and in improving simple technologies (blister packaging) to achieve the same result. Better efforts can be made to reduce the availability of fake or substandard drugs in the marketplace. In this article, we describe the outcome of a concerted effort to improve drug compliance and drug quality in an area of multidrug resistance for malaria. These research efforts, guided by the Task Force for Improved Use of Antimalarials, characterized the problems in drug compliance in South-East Asia, and developed interventions to improve drug use in the various countries. Interventions involved drug packaging, public information campaigns, and assessments of drug quality. Results show that blister packaging worked best to improve drug compliance and that the increased cost of packaged medication did not limit its use. Drug quality was a major problem in unregulated countries and should be improved. PMID:9763718

Interventions to improve the use of antimalarials in south-east Asia: an overview.

PubMed

Gomes, M; Wayling, S; Pang, L

1998-01-01

There are few drugs for malaria, and those which are available for use are subject to rapid development of resistance. Curiously, little effort has been made to improve drug use in malaria-endemic countries and to assess the benefits of such improvements. Advances can be made in public understanding of the value of ingesting a full regimen of antimalarials, in order to achieve complete cure, and in improving simple technologies (blister packaging) to achieve the same result. Better efforts can be made to reduce the availability of fake or substandard drugs in the marketplace. In this article, we describe the outcome of a concerted effort to improve drug compliance and drug quality in an area of multidrug resistance for malaria. These research efforts, guided by the Task Force for Improved Use of Antimalarials, characterized the problems in drug compliance in South-East Asia, and developed interventions to improve drug use in the various countries. Interventions involved drug packaging, public information campaigns, and assessments of drug quality. Results show that blister packaging worked best to improve drug compliance and that the increased cost of packaged medication did not limit its use. Drug quality was a major problem in unregulated countries and should be improved.

Improvement Research Priorities: USA Survey and Expert Consensus

PubMed Central

Stevens, Kathleen R.; Ovretveit, John

2013-01-01

The purpose of this study was to identify stakeholder views about national priorities for improvement science and build agreement for action in a national improvement and implementation research network in the USA. This was accomplished using three stages of identification and consensus. (1) Topics were identified through a multipronged environmental scan of the literature and initiatives. (2) Based on this scan, a survey was developed, and stakeholders (n = 2,777) were invited to rate the resulting 33-topic, 9-category list, via an online survey. Data from 560 respondents (20% response) were analyzed. (3) An expert panel used survey results to further refine the research priorities through a Rand Delphi process. Priorities identified were within four categories: care coordination and transitions, high-performing clinical systems and microsystems improvement approaches, implementation of evidence-based improvements and best practices, and culture of quality and safety. The priorities identified were adopted by the improvement science research network as the research agenda to guide strategy. The process and conclusions may be of value to quality improvement research funding agencies, governments, and research units seeking to concentrate their resources on improvement topics where research is capable of yielding timely and actionable answers as well as contributing to the knowledge base for improvement. PMID:24024029

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

PubMed

Kesteloot, K; Voet, N

1998-12-01

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Minimal effects of visual memory training on the auditory performance of adult cochlear implant users

PubMed Central

Oba, Sandra I.; Galvin, John J.; Fu, Qian-Jie

2014-01-01

Auditory training has been shown to significantly improve cochlear implant (CI) users’ speech and music perception. However, it is unclear whether post-training gains in performance were due to improved auditory perception or to generally improved attention, memory and/or cognitive processing. In this study, speech and music perception, as well as auditory and visual memory were assessed in ten CI users before, during, and after training with a non-auditory task. A visual digit span (VDS) task was used for training, in which subjects recalled sequences of digits presented visually. After the VDS training, VDS performance significantly improved. However, there were no significant improvements for most auditory outcome measures (auditory digit span, phoneme recognition, sentence recognition in noise, digit recognition in noise), except for small (but significant) improvements in vocal emotion recognition and melodic contour identification. Post-training gains were much smaller with the non-auditory VDS training than observed in previous auditory training studies with CI users. The results suggest that post-training gains observed in previous studies were not solely attributable to improved attention or memory, and were more likely due to improved auditory perception. The results also suggest that CI users may require targeted auditory training to improve speech and music perception. PMID:23516087

PconsFold: improved contact predictions improve protein models.

PubMed

Michel, Mirco; Hayat, Sikander; Skwark, Marcin J; Sander, Chris; Marks, Debora S; Elofsson, Arne

2014-09-01

Recently it has been shown that the quality of protein contact prediction from evolutionary information can be improved significantly if direct and indirect information is separated. Given sufficiently large protein families, the contact predictions contain sufficient information to predict the structure of many protein families. However, since the first studies contact prediction methods have improved. Here, we ask how much the final models are improved if improved contact predictions are used. In a small benchmark of 15 proteins, we show that the TM-scores of top-ranked models are improved by on average 33% using PconsFold compared with the original version of EVfold. In a larger benchmark, we find that the quality is improved with 15-30% when using PconsC in comparison with earlier contact prediction methods. Further, using Rosetta instead of CNS does not significantly improve global model accuracy, but the chemistry of models generated with Rosetta is improved. PconsFold is a fully automated pipeline for ab initio protein structure prediction based on evolutionary information. PconsFold is based on PconsC contact prediction and uses the Rosetta folding protocol. Due to its modularity, the contact prediction tool can be easily exchanged. The source code of PconsFold is available on GitHub at https://www.github.com/ElofssonLab/pcons-fold under the MIT license. PconsC is available from http://c.pcons.net/. Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press.

Computerized clinical documentation system in the pediatric intensive care unit

PubMed Central

2001-01-01

Background To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs. PMID:11604105

Characterization of an improved 1-3 piezoelectric composite by simulation and experiment.

PubMed

Zhong, Chao; Wang, Likun; Qin, Lei; Zhang, Yanjun

2017-06-16

To increase electromechanical coupling factor of 1-3 piezoelectric composite and reduce its bending deformation under external stress, an improved 1-3 piezoelectric composite is developed. In the improved structure, both epoxy resin and silicone rubber are used as polymer material. The simulation model of the improved 1-3 piezoelectric composite was established using the finite element software ANSYS. The relationship of the performance of the improved composite to the volume percentage of silicone rubber was determined by harmonic response analysis and the bending deformation under external stress was simulated by static analysis. The improved composite samples were prepared by cutting and filling methods, and the performance was tested. The feasibility of the improved structure was verified by finite element simulation and experiment. The electromechanical coupling factor of the improved composite can reach 0.67 and meanwhile the characteristic impedance can decline to 13 MRayl. The electromechanical coupling factor of the improved composite is higher than that of the composite with only epoxy resin as the polymer and the improved composite can reduce bending deformation. Comparison of simulation and experiment, the results of the experiment are in general agreement with those from the simulation. However, most experimental values were higher than the simulation results, and the abnormality of the test results was also more obvious than that of the simulation. These findings may be attributed to slight difference in the material parameters of simulation and experiment.

Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia.

PubMed

Hur, Won Sok; Kim, Joon Chul; Kim, Hyo Sin; Koh, Jun Sung; Kim, Sang Hoon; Kim, Hyun Woo; Cho, Su Yeon; Cho, Kang Jun

2016-11-01

To investigate the change in urinary urgency and predictors of urgency improvement after holmium laser enucleation of the prostate (HoLEP) in men with benign prostatic hyperplasia (BPH). We retrospectively analyzed the medical records of patients who were treated with HoLEP for BPH and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Those with prostate cancer diagnosed prior to or after HoLEP, a history of other prostatic and/or urethral surgery, moderate to severe postoperative complications, and neurogenic causes were excluded. Patients who had improved urgency with antimuscarinic medication after HoLEP were excluded. We divided the patients into 2 groups based on urgency symptoms 3 months after HoLEP: improved and unimproved urgency. Improved urgency was defined as a reduction of 2 or more points on the 5-point urinary sensation scale. Preoperative clinical and urodynamic factors as well as perioperative factors were compared between groups. In total, 139 patients were included in this study. Voiding parameters in all patients improved significantly after HoLEP. Seventy-one patients (51.1%) had improved urgency, while 68 (48.9%) did not show any improvement. A history of acute urinary retention (AUR) and postvoid residual were associated with postoperative urgency improvement in univariate analysis. In multivariate analysis, a history of AUR was an independent factor affecting urgency improvement. A preoperative history of AUR could influence the change in urgency after HoLEP surgery in patients with BPH.

Practical ways to facilitate ergonomics improvements in occupational health practice.

PubMed

Kogi, Kazutaka

2012-12-01

Recent advances in participatory programs for improving workplace conditions are discussed to examine practical ways to facilitate ergonomics improvements. Participatory training programs are gaining importance, particularly in promoting occupational health and safety in small-scale workplaces. These programs have led to many improvements that can reduce work-related risks in varied situations. Recent experiences in participatory action-oriented training programs in small workplaces and agriculture are reviewed.The emphasis of the review is on training steps, types of improvements achieved, and the use of action tools by trainers and training participants. Immediate improvements in multiple technical areas are targeted, including materials handling,workstation design, physical environment, welfare facilities, and work organization. In facilitating ergonomics improvements in each local situation, it is important to focus on (a) building on local good practices; (b) applying practical, simple improvements that apply the basic principles of ergonomics; and (c) developing action-oriented toolkits for direct use by workers and managers. This facilitation process is effective when locally designed action toolkits are used by trainers, including local good examples, action checklists, and illustrated how-to guides. Intervention studies demonstrate the effectiveness of participatory steps that use these toolkits in promoting good practices and reducing work-related risks. In facilitating ergonomics improvements in small-scale workplaces, it is important to focus on practical, low-cost improvements that build on local good practices. The use of action-oriented toolkits reflecting basic ergonomics principles is helpful.The promotion of the intercountry networking of positive experiences in participatory training is suggested.

Artifact interactions retard technological improvement: An empirical study

PubMed Central

Magee, Christopher L.

2017-01-01

Empirical research has shown performance improvement of many different technological domains occurs exponentially but with widely varying improvement rates. What causes some technologies to improve faster than others do? Previous quantitative modeling research has identified artifact interactions, where a design change in one component influences others, as an important determinant of improvement rates. The models predict that improvement rate for a domain is proportional to the inverse of the domain’s interaction parameter. However, no empirical research has previously studied and tested the dependence of improvement rates on artifact interactions. A challenge to testing the dependence is that any method for measuring interactions has to be applicable to a wide variety of technologies. Here we propose a novel patent-based method that is both technology domain-agnostic and less costly than alternative methods. We use textual content from patent sets in 27 domains to find the influence of interactions on improvement rates. Qualitative analysis identified six specific keywords that signal artifact interactions. Patent sets from each domain were then examined to determine the total count of these 6 keywords in each domain, giving an estimate of artifact interactions in each domain. It is found that improvement rates are positively correlated with the inverse of the total count of keywords with Pearson correlation coefficient of +0.56 with a p-value of 0.002. The results agree with model predictions, and provide, for the first time, empirical evidence that artifact interactions have a retarding effect on improvement rates of technological domains. PMID:28777798

Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study.

PubMed

Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Robberecht, Wim; Van Damme, Philip; Decramer, Marc; Testelmans, Dries

2015-04-15

To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG). In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month. In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores. This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality. A commentary on this article appears in this issue on page 511. © 2015 American Academy of Sleep Medicine.

Augmenting CPT to Improve Sleep Impairment in PTSD: A Randomized Clinical Trial

PubMed Central

Galovski, Tara E.; Mott, Juliette; Blain, Leah M.; Elwood, Lisa; Gloth, Chelsea; Fletcher, Thomas

2015-01-01

Objective Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory following treatment for PTSD. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy; CPT). Method Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. Results After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Conclusion Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. Public Health Significance: This study suggests that hypnosis may be a viable treatment option in a stepped-care approach for treating sleep impairment in individuals suffering from PTSD. PMID:26689303

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration

PubMed Central

Ogrinc, G; Mooney, S E; Estrada, C; Foster, T; Goldmann, D; Hall, L W; Huizinga, M M; Liu, S K; Mills, P; Neily, J; Nelson, W; Pronovost, P J; Provost, L; Rubenstein, L V; Speroff, T; Splaine, M; Thomson, R; Tomolo, A M; Watts, B

2008-01-01

As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work. This “Explanation and Elaboration” document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at http://www.squire-statement.org. PMID:18836062

Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

PubMed

Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

2018-05-25

Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

Application of process improvement principles to increase the frequency of complete airway management documentation.

PubMed

McCarty, L Kelsey; Saddawi-Konefka, Daniel; Gargan, Lauren M; Driscoll, William D; Walsh, John L; Peterfreund, Robert A

2014-12-01

Process improvement in healthcare delivery settings can be difficult, even when there is consensus among clinicians about a clinical practice or desired outcome. Airway management is a medical intervention fundamental to the delivery of anesthesia care. Like other medical interventions, a detailed description of the management methods should be documented. Despite this expectation, airway documentation is often insufficient. The authors hypothesized that formal adoption of process improvement methods could be used to increase the rate of "complete" airway management documentation. The authors defined a set of criteria as a local practice standard of "complete" airway management documentation. The authors then employed selected process improvement methodologies over 13 months in three iterative and escalating phases to increase the percentage of records with complete documentation. The criteria were applied retrospectively to determine the baseline frequency of complete records, and prospectively to measure the impact of process improvements efforts over the three phases of implementation. Immediately before the initial intervention, a retrospective review of 23,011 general anesthesia cases over 6 months showed that 13.2% of patient records included complete documentation. At the conclusion of the 13-month improvement effort, documentation improved to a completion rate of 91.6% (P<0.0001). During the subsequent 21 months, the completion rate was sustained at an average of 90.7% (SD, 0.9%) across 82,571 general anesthetic records. Systematic application of process improvement methodologies can improve airway documentation and may be similarly effective in improving other areas of anesthesia clinical practice.

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

PubMed Central

Goodman, Daisy; Ogrinc, Greg; Davies, Louise; Baker, G Ross; Barnsteiner, Jane; Foster, Tina C; Gali, Kari; Hilden, Joanne; Horwitz, Leora; Kaplan, Heather C; Leis, Jerome; Matulis, John C; Michie, Susan; Miltner, Rebecca; Neily, Julia; Nelson, William A; Niedner, Matthew; Oliver, Brant; Rutman, Lori; Thomson, Richard

2016-01-01

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org. PMID:27076505

A Mixed-Methods Research Framework for Healthcare Process Improvement.

PubMed

Bastian, Nathaniel D; Munoz, David; Ventura, Marta

2016-01-01

The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes. The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement. The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care. Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow. We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency. Published by Elsevier Inc.

Exemplar pediatric collaborative improvement networks: achieving results.

PubMed

Billett, Amy L; Colletti, Richard B; Mandel, Keith E; Miller, Marlene; Muething, Stephen E; Sharek, Paul J; Lannon, Carole M

2013-06-01

A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "perfect care," and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs. It has achieved reductions in central line-associated blood stream infections (CLABSI), increased breast-milk feeding rates at hospital discharge, and is now working to improve delivery room management. Solutions for Patient Safety (SPS) has achieved significant improvements in adverse drug events and surgical site infections across all 8 Ohio children's hospitals, with 7700 fewer children harmed and >$11.8 million in avoided costs. SPS is now expanding nationally, aiming to eliminate all events of serious harm at children's hospitals. National collaborative networks include ImproveCareNow, which aims to improve care and outcomes for children with inflammatory bowel disease. Reliable adherence to Model Care Guidelines has produced improved remission rates without using new medications and a significant increase in the proportion of Crohn disease patients not taking prednisone. Data-driven collaboratives of the Children's Hospital Association Quality Transformation Network initially focused on CLABSI in PICUs. By September 2011, they had prevented an estimated 2964 CLABSI, saving 355 lives and $103,722,423. Subsequent improvement efforts include CLABSI reductions in additional settings and populations.

Perceptual learning improves visual performance in juvenile amblyopia.

PubMed

Li, Roger W; Young, Karen G; Hoenig, Pia; Levi, Dennis M

2005-09-01

To determine whether practicing a position-discrimination task improves visual performance in children with amblyopia and to determine the mechanism(s) of improvement. Five children (age range, 7-10 years) with amblyopia practiced a positional acuity task in which they had to judge which of three pairs of lines was misaligned. Positional noise was produced by distributing the individual patches of each line segment according to a Gaussian probability function. Observers were trained at three noise levels (including 0), with each observer performing between 3000 and 4000 responses in 7 to 10 sessions. Trial-by-trial feedback was provided. Four of the five observers showed significant improvement in positional acuity. In those four observers, on average, positional acuity with no noise improved by approximately 32% and with high noise by approximately 26%. A position-averaging model was used to parse the improvement into an increase in efficiency or a decrease in equivalent input noise. Two observers showed increased efficiency (51% and 117% improvements) with no significant change in equivalent input noise across sessions. The other two observers showed both a decrease in equivalent input noise (18% and 29%) and an increase in efficiency (17% and 71%). All five observers showed substantial improvement in Snellen acuity (approximately 26%) after practice. Perceptual learning can improve visual performance in amblyopic children. The improvement can be parsed into two important factors: decreased equivalent input noise and increased efficiency. Perceptual learning techniques may add an effective new method to the armamentarium of amblyopia treatments.

Improvement of ambulatory function with multilevel soft tissue surgery in children with spastic diplegic cerebral palsy.

PubMed

Thamkunanon, Verasak

2011-08-01

Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery. Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue surgery had been observed in these study groups of patients. Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6-12 months after operation. Analyzing GMFCS change was performed by statistics. Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group (92 month old), was a trend difference in statistic (p = 0.032). Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more benefit than older children.

A multicentre randomised controlled trial of reciprocal lung cancer peer review and supported quality improvement: results from the improving lung cancer outcomes project

PubMed Central

Russell, G K; Jimenez, S; Martin, L; Stanley, R; Peake, M D; Woolhouse, I

2014-01-01

Background: Results from the National Lung Cancer Audit demonstrate unexplained variation in outcomes. Peer review with supported quality improvement has been shown to reduce variation in other areas of health care but has not been formally tested in cancer multidisciplinary teams. The aim of the current study is to assess the impact of reciprocal peer-to-peer review visits with supported quality improvement and collaborative working on lung cancer process and outcome measures. Methods: English lung cancer teams were randomised to usual care or facilitated reciprocal peer review visits followed by 12 months of supported quality improvement. The primary outcome was change in the following national audit indicators; mulitdisciplinary team discussion, histological confirmation, active treatment, surgical resection, small-cell chemotherapy and specialist nurse review. Patient experience was measured using a new lung cancer patient questionnaire in the intervention group. Results: Thirty teams (31 trusts) entered the intervention group and 29 of these submitted a total of 67 quality improvement plans. Active treatment increased in the intervention group (n=31) by 5.2% compared with 1.2% in the control group (n=48, mean difference 4.1%, 95% CI −0.1 to 8.2%, P=0.055). The remaining audit indicators improved similarly in all groups. Mean patient experience scores in the intervention group did not change significantly during the study but a significant improvement was seen in the scores for the five teams with the worst baseline scores (0.86 to 0.22, P<0.001). Conclusions: Reciprocal peer review with supported quality improvement was feasible and effective in stimulating quality improvement activity but resulted in only modest improvements in lung cancer treatment rates and patient experience. PMID:24651386

How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis.

PubMed

Levin, Frances R; Choi, C Jean; Pavlicova, Martina; Mariani, John J; Mahony, Amy; Brooks, Daniel J; Nunes, Edward V; Grabowski, John

2018-05-01

Attention-deficit hyperactivity disorder (ADHD) is overrepresented among individuals seeking treatment for substance use disorders. We previously reported that treatment with extended release mixed amphetamine salts (MAS-XR) increased abstinence, compared to placebo, among patients with co-occurring ADHD and cocaine dependence. This secondary analysis investigates the temporal relationship between ADHD improvement and cocaine abstinence in the first six weeks of the trial. The study was a three-arm, randomized, double-blinded, placebo-controlled, 14-week trial comparing MAS-XR (60 mg or 80 mg daily) versus placebo among 126 participants with ADHD and cocaine dependence. An autoregressive cross-lagged structural equation model was fit and evaluated weekly ADHD improvement (defined as ≥30% reduction in the Adult ADHD Investigator Symptom Rating Scale) and urine-confirmed abstinence over the first six weeks. The proportion of patients with each of the possible overall patterns of response was: ADHD improves before cocaine abstinence: 24%; Cocaine abstinence occurs before ADHD improvement: 12%; ADHD improvement and abstinence occur during the same week: 6%; ADHD improves but abstinence never achieved: 34%; Abstinence achieved but ADHD never improves: 6%; Neither ADHD improvement nor abstinence: 18%. A significant cross-lagged association was found; subjects with ADHD improvement at week 2 had significantly higher odds of cocaine abstinence at week 3 (p = .014). When treating co-occurring ADHD and cocaine dependence with stimulant medication, abstinence is most likely preceded by improvement in ADHD, which tends to occur early with medication treatment. Other observed temporal patterns suggest the potential complexity of the relationship between ADHD and cocaine dependence. Copyright © 2018. Published by Elsevier B.V.

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.

PubMed

Kringos, Dionne S; Sunol, Rosa; Wagner, Cordula; Mannion, Russell; Michel, Philippe; Klazinga, Niek S; Groene, Oliver

2015-07-22

It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors. We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool. We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences. Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

Improving a complex finite-difference ground water flow model through the use of an analytic element screening model

USGS Publications Warehouse

Hunt, R.J.; Anderson, M.P.; Kelson, V.A.

1998-01-01

This paper demonstrates that analytic element models have potential as powerful screening tools that can facilitate or improve calibration of more complicated finite-difference and finite-element models. We demonstrate how a two-dimensional analytic element model was used to identify errors in a complex three-dimensional finite-difference model caused by incorrect specification of boundary conditions. An improved finite-difference model was developed using boundary conditions developed from a far-field analytic element model. Calibration of a revised finite-difference model was achieved using fewer zones of hydraulic conductivity and lake bed conductance than the original finite-difference model. Calibration statistics were also improved in that simulated base-flows were much closer to measured values. The improved calibration is due mainly to improved specification of the boundary conditions made possible by first solving the far-field problem with an analytic element model.This paper demonstrates that analytic element models have potential as powerful screening tools that can facilitate or improve calibration of more complicated finite-difference and finite-element models. We demonstrate how a two-dimensional analytic element model was used to identify errors in a complex three-dimensional finite-difference model caused by incorrect specification of boundary conditions. An improved finite-difference model was developed using boundary conditions developed from a far-field analytic element model. Calibration of a revised finite-difference model was achieved using fewer zones of hydraulic conductivity and lake bed conductance than the original finite-difference model. Calibration statistics were also improved in that simulated base-flows were much closer to measured values. The improved calibration is due mainly to improved specification of the boundary conditions made possible by first solving the far-field problem with an analytic element model.

A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality.

PubMed

Blake, Matthew J; Snoep, Lian; Raniti, Monika; Schwartz, Orli; Waloszek, Joanna M; Simmons, Julian G; Murray, Greg; Blake, Laura; Landau, Elizabeth R; Dahl, Ronald E; Bootzin, Richard; McMakin, Dana L; Dudgeon, Paul; Trinder, John; Allen, Nicholas B

2017-12-01

The aim of this study was to test whether a cognitive-behavioral and mindfulness-based group sleep intervention would improve behavior problems in at-risk adolescents, and whether these improvements were specifically related to improvements in sleep. Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48, range 12.04-16.31 years) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into either a sleep improvement intervention (n = 63) or an active control "study skills" intervention (n = 60). Participants completed sleep and behavior problems questionnaires, wore an actiwatch and completed a sleep diary for five school nights, both before and after the intervention. Parallel multiple mediation models showed that postintervention improvements in social problems, attention problems, and aggressive behaviors were specifically mediated by moderate improvements in self-reported sleep quality on school nights, but were not mediated by moderate improvements in actigraphy-assessed sleep onset latency or sleep diary-measured sleep efficiency on school nights. This study provides evidence, using a methodologically rigorous design, that a cognitive-behavioral and mindfulness-based group sleep intervention improved behavior problems in at-risk adolescent by improving perceived sleep quality on school nights. These findings suggest that sleep interventions could be directed towards adolescents with behavior problems. This study was part of The SENSE Study (Sleep and Education: learning New Skills Early). URL: ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True. Copyright © 2017 Elsevier Ltd. All rights reserved.

Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives.

PubMed

Strating, Mathilde M H; Nieboer, Anna P

2013-06-01

Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. A multiple-case cross-sectional study. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems. © 2012 Blackwell Publishing Ltd.

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

PubMed Central

New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2016-01-01

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

Cutoff Value of Pharyngeal Residue in Prognosis Prediction After Neuromuscular Electrical Stimulation Therapy for Dysphagia in Subacute Stroke Patients

PubMed Central

Park, Jeong Mee; Kim, Ji Hyun; Jung, Hong Sun; Chang, Sei Jin; Kim, Ki Young; Kim, Hee

2014-01-01

Objective To determine the cutoff value of the pharyngeal residue for predicting reduction of aspiration, by measuring the residue of valleculae and pyriformis sinuses through videofluoroscopic swallowing studies (VFSS) after treatment with neuromuscular electrical stimulator (VitalStim) in stroke patients with dysphagia. Methods VFSS was conducted on first-time stroke patients before and after the VitalStim therapy. The results were analyzed for comparison of the pharyngeal residue in the improved group and the non-improved group. Results A total of 59 patients concluded the test, in which 42 patients improved well enough to change the dietary methods while 17 did not improve sufficiently. Remnant area to total area (R/T) ratios of the valleculae before treatment in the improved group were 0.120, 0.177, and 0.101 for solid, soft, and liquid foods, respectively, whereas the ratios for the non-improved group were 0.365, 0.396, and 0.281, respectively. The ratios of the pyriformis sinuses were 0.126, 0.159, and 0.121 for the improved group and 0.315, 0.338, and 0.244 for the non-improved group. The R/T ratios of valleculae and pyriformis sinus were significantly lower in the improved group than the non-improved group in all food types before treatment. The R/T ratio cutoff values were 0.267, 0.250, and 0.185 at valleculae and 0.228, 0.218, and 0.185 at pyriformis sinuses. Conclusion In dysphagia after stroke, less pharyngeal residue before treatment serves as a factor for predicting greater improvement after VitalStim treatment. PMID:25379490

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review.

PubMed

Boaz, Annette; Hanney, Stephen; Jones, Teresa; Soper, Bryony

2015-12-09

There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance? An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate. 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/

Use of cerebrospinal fluid flow rates measured by phase-contrast MR to predict outcome of ventriculoperitoneal shunting for idiopathic normal-pressure hydrocephalus.

PubMed

Dixon, Geoffrey R; Friedman, Jonathan A; Luetmer, Patrick H; Quast, Lynn M; McClelland, Robyn L; Petersen, Ronald C; Maher, Cormac O; Ebersold, Michael J

2002-06-01

To determine whether favorable clinical response and magnitude of improvement are associated with increased aqueductal cerebrospinal fluid (CSF) flow rates in patients who undergo ventriculoperitoneal shunting (VPS) for idiopathic normal-pressure hydrocephalus (NPH). Between January 1995 and June 2000, 49 patients (14 men and 35 women; mean age, 72.9 years; range, 54-88 years) underwent magnetic resonance quantification of aqueductal CSF flow followed by VPS for presumed idiopathic NPH at the Mayo Clinic, Rochester, Minn. Logistic regression models for the odds of any improvement in score as a function of aqueductal CSF flow and separate models for any improvement in gait, incontinence, cognition, and total score were constructed. Forty-two patients (86%) had improvement in gait at postoperative follow-up (mean, 10 months). Of the 32 patients with incontinence, 27 (69%) improved. Of the 36 patients with cognitive impairment, 16 (44%) improved. In univariate and fully adjusted models, increased CSF flow through the aqueduct was not significantly associated with improvement or the magnitude of improvement in gait, cognition, or incontinence. Thirty-six patients underwent high-volume lumbar puncture preoperatively, of whom 5 (14%) had no response. The aqueductal CSF flow rates of these 5 patients were significantly higher than those of the patients who improved after lumbar puncture. Postoperative complications occurred in 15 patients. The aqueductal CSF flow rates in these 15 patients were not significantly different from those of patients who experienced no complications. Among patients who underwent VPS for the treatment of NPH, measurement of CSF flow through the cerebral aqueduct did not reliably predict which patients would improve after shunting or the magnitude of improvement.

Operational Efficiency and Productivity Improvement Initiatives in a Large Cardiac Catheterization Laboratory.

PubMed

Reed, Grant W; Hantz, Scott; Cunningham, Rebecca; Krishnaswamy, Amar; Ellis, Stephen G; Khot, Umesh; Rak, Joe; Kapadia, Samir R

2018-02-26

This study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab. Operational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity. In this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative. The principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p < 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p < 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction. A systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement.

PubMed

Ovretveit, John; Mittman, Brian; Rubenstein, Lisa; Ganz, David A

2017-10-09

Purpose The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice. Design/methodology/approach This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods. Findings The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist. Research limitations/implications The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists. Practical implications If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively. Social implications More patients could benefit more quickly from more effective implementation of proven interventions. Originality/value The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis.

PubMed

Finn Davis, Katherine; Napolitano, Natalie; Li, Simon; Buffman, Hayley; Rehder, Kyle; Pinto, Matthew; Nett, Sholeen; Jarvis, J Dean; Kamat, Pradip; Sanders, Ronald C; Turner, David A; Sullivan, Janice E; Bysani, Kris; Lee, Anthony; Parker, Margaret; Adu-Darko, Michelle; Giuliano, John; Biagas, Katherine; Nadkarni, Vinay; Nishisaki, Akira

2017-10-01

To describe promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Mixed methods. Thirteen PICUs of the National Emergency Airway Registry for Children network. Remote or on-site focus groups with interdisciplinary ICU staff. Two semistructured interviews with ICU quality improvement leaders with quantitative and qualitative data-based feedbacks. Bundle implementation success (compliance) was defined as greater than or equal to 80% use for tracheal intubations for 3 consecutive months. ICUs were classified as early or late adopters. Focus group discussions concentrated on safety concerns and promoters and barriers to bundle implementation. Initial semistructured quality improvement leader interviews assessed implementation tactics and provided recommendations. Follow-up interviews assessed degree of acceptance and changes made after initial interview. Transcripts were thematically analyzed and contrasted by early versus late adopters. Median duration to achieve success was 502 days (interquartile range, 182-781). Five sites were early (median, 153 d; interquartile range, 146-267) and eight sites were late adopters (median, 783 d; interquartile range, 773-845). Focus groups identified common "promoter" themes-interdisciplinary approach, influential champions, and quality improvement bundle customization-and "barrier" themes-time constraints, competing paperwork and quality improvement activities, and poor engagement. Semistructured interviews with quality improvement leaders identified effective and ineffective tactics implemented by early and late adopters. Effective tactics included interdisciplinary quality improvement team involvement (early adopter: 5/5, 100% vs late adopter: 3/8, 38%; p = 0.08); ineffective tactics included physician-only rollouts, lack of interdisciplinary education, lack of data feedback to frontline clinicians, and misconception of bundle as research instead of quality improvement intervention. Implementation of an airway safety quality improvement bundle with high compliance takes a long time across diverse ICUs. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.

How to build up the actionable knowledge base: the role of 'best fit' framework synthesis for studies of improvement in healthcare.

PubMed

Booth, Andrew; Carroll, Christopher

2015-11-01

Increasing recognition of the role and value of theory in improvement work in healthcare offers the prospect of capitalising upon, and consolidating, actionable lessons from synthesis of improvement projects and initiatives. We propose that informed use of theory can (i) provide a mechanism by which to collect and organise data from a body of improvement work, (ii) offer a framework for analysis and identification of lessons learnt and (iii) facilitate an evaluation of the feasibility, effectiveness and acceptability of improvement programmes. Improvement practitioners can benefit from using an underpinning external structure as a lens by which to examine the specific achievements of their own projects alongside comparable initiatives led by others. We demonstrate the utility of a method known as 'best fit framework synthesis' (BFFS) in offering a ubiquitous and versatile means by which to collect, analyse and evaluate improvement work in healthcare. First reported in 2011, BFFS represents a pragmatic, flexible approach to integrating theory with findings from practice. A deductive phase, where a review team seeks to accommodate a substantial part of the data, is followed by an inductive phase, in which the team explores data not accommodated by the framework. We explore the potential for BFFS within improvement work by drawing upon the evidence synthesis methodology literature and practical examples of improvement work reported in BMJ Quality and Safety (2011-2015). We suggest four variants of BFFS that may have particular value in synthesising a body of improvement work. We conclude that BFFS, alongside other approaches that seek to optimise the contribution of theory to improvement work, represents one important enabling mechanism by which to establish the rigour and scientific credentials of the emerging discipline of 'improvement science'. 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.

Effects produced by CDU improvement of resist pattern with PEB temperature control for wiring resistance variation reduction

NASA Astrophysics Data System (ADS)

Tadokoro, Masahide; Shinozuka, Shinichi; Ogata, Kunie; Morimoto, Tamotsu

2008-03-01

Semiconductor manufacturing technology has shifted towards finer design rules, and demands for critical dimension uniformity (CDU) of resist patterns have become greater than ever. One of the methods for improving CDU of resist pattern is to control the temperature of post-exposure bake (PEB). When ArF resist is used, there is a certain relationship between critical dimension (CD) and PEB temperature. By utilizing this relationship, Resist Pattern CDU can be improved through control of within-wafer temperature distribution in the PEB process. We have already applied this method to Resist Pattern CDU improvement and have achieved these results. In this evaluation, we aim at: 1. Clarifying the relationship between the improvement in Resist Pattern CDU through PEB temperature control and the improvement in Etching Pattern CDU. 2. Verifying whether Resist Pattern CDU improvement through PEB temperature control has any effect on the reduction in wiring resistance variation. The evaluation procedure is: 1. Preparation of wafers with base film of doped Poly-Si (D-Poly). 2. Creation of two sets of samples on the base, a set of samples with good Resist Pattern CDU and a set of samples with poor Resist Pattern CDU. 3. Etching of the two sets under the same conditions. 4. Measurements of CD and wiring resistance. We used Optical CD Measurement (OCD) for measurement of resist pattern and etching pattern for the reason that OCD is minimally affected by Line Edge Roughness (LER). As a result, we found that; 1. The improvement in Resist Pattern CDU leads to the improvement in Etching Pattern CDU . 2. The improvement in Resist Pattern CDU has an effect on the reduction in wiring resistance variation. There is a cause-and-effect relationship between wiring resistance variation and transistor characteristics. From this relationship, we expect that the improvement in Resist Pattern CDU through PEB temperature control can contribute to device performance improvement.

Quality improvement in coronary care: analysis of sustainability and impact on adjacent clinical measures after a Swedish controlled, multicenter quality improvement collaborative.

PubMed

Carlhed, Rickard; Bellman, Christina; Bojestig, Mats; Bojö, Leif; Peterson, Anette; Lindahl, Bertil

2012-08-01

Quality Improvement in Coronary Care, a Swedish multicenter, controlled quality-improvement (QI) collaborative, has shown significant improvements in adherence to national guidelines for acute myocardial infarction, as well as improved clinical outcome. The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted. Multidisciplinary teams from 19 Swedish hospitals were educated in basic QI methodologies. Another 19 matched hospitals were included as blinded controls. All evaluations were made on the hospital level, and data were obtained from a national quality registry, Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sustainability indicators consisted of use of angiotensin-converting enzyme inhibitors, lipid-lowering therapy, clopidogrel, low-molecular weight heparin, and coronary angiography. Dissemination indicators were use of echocardiography, stress tests, and reperfusion therapy; time delays; and length of stay. At the reevaluation period of 6 months, the improvements at the QI intervention hospitals were sustained in all indicators but 1 (angiotensin-converting enzyme inhibitor). Between the 2 measurements, the control group improved significantly in all but 1 indicator (angiotensin-converting enzyme inhibitor). However, at the second measurement, the absolute adherence rates of the intervention hospitals were still numerically higher in all 5 indicators, and significantly so in 1 (clopidogrel). No significant changes were observed for the dissemination indicators. The combination of a systematic QI collaborative with a national, interactive quality registry might lead to substantial and sustained improvements in the quality of acute myocardial infarction care. However, to achieve disseminated improvements in adjacent clinical measures, those adjacent measures probably should be made explicit before any QI intervention. (J Am Heart Assoc. 2012;1:e000737 doi: 10.1161/JAHA.112.000737.).

Aculaser therapy: a comprehensive approach for the treatment of cerebral palsy

NASA Astrophysics Data System (ADS)

Anwar, Shahzad; Nazir Khan, Malik Muhammed; Nadeem Khan, Malik Mohammad; Munir Qazi, Faiza; Ahmed, Imtiaz; Awan, Abid Hareef

2006-10-01

A single, open and non comparative study was conducted at Anwar Shah's First C.P. & Paralysis Clinic and Research Center in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (CP) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, quadriplegia, paraplegia, monoplegia, sensory-neural deafness and speech disorders. In all 100 childern were treated and the data was gathered during a period of 18 months from December 2003 till June 2005. This article shows results of the treatment with ACULASER THERAPY in CP childern who were treated for minimum 6 weeks and more or had minimum of 10 treatment sessions and more. This paper also shows that those childern who were given a break in the treatment for 4-12 weeks did not show any reversal of the symptoms. These children were classified according to the associated Neurological Disorders. Analysis of the data showed that out of 81 children with Spasticity and Stiffness 69 showed marked improvement showing 85% improvement rate, out of 54 children with Epileptic fits there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 34 children showing 63% success rate, out of 18 children with Cortical Blindness 13 children showed improvement accounting for 72% efficacy rate, out of 45 children with Hearing Difficulties, 31 showed marked improvement accounting for 69% improvement rate, out of 100 children with Speech Disorders 67 showed improvement reflecting 67 % improvement rate, out of 46 children with Hemiplegia 32 showed improvement in movement, tone and power accounting for 69% improvement rate, out of 36 children with Quadriplegia 25 showed improvement in gross and fine motor functions showing 69% success rate and out of 18 children with Paraplegia of lower limbs 12 showed improvement in weight bearing, standing and movement accounting for 67% improvement rate .

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.

Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR.

PubMed

Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P; Duh, Mei S; Benson, Al B

2017-09-01

To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor's perspective. Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p = .03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p = .01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p = .02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients. Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.

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

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

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

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

PubMed

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

2014-12-02

Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice's commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. All five implementation capability measures independently predicted practice leaders' relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p <0.001), prior depression quality improvement activities (p <0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders' relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers.

Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm.

PubMed

Burton, Christopher R; Rycroft Malone, Jo; Robert, Glenn; Willson, Alan; Hopkins, Angela

2014-07-31

Little is understood about the role of quality improvement in enabling health organisations to survive and thrive in the contemporary context of financial and economic challenges. We will draw on the theoretical foundations of the 'Resource Based View of the Firm' (RBV) to develop insights into why health organisations engage in improvement work, how impacts are conceptualised, and 'what works' in delivering these impacts. Specifically, RBV theorises that the mix and use of resources across different organisations may explain differences in performance. Whether improvement work influences these resources is unclear. Case study research will be conducted across health organisations participating in four approaches to improvement, including: a national improvement programme; a multiorganisational partnership around implementation; an organisational strategy for quality improvement; and a coproduction project designed to enhance the experience of a clinical service from the perspective of patients. Data will comprise in-depth interviews with key informants, observation of key events and documents; analysed within and then across cases. Adopting a realist perspective, the core tenets of RBV will be evaluated as a programme theory, focusing on the interplay between organisational conditions and behavioural or resource responses that are reported through engagement in improvement. The study has been approved by Bangor University Ethics Committee. The investigation will not judge the relative merits of different approaches to healthcare quality improvement. Rather, we will develop unique insights into the organisational consequences, and dependencies of quality improvement, providing an opportunity to add to the explanatory potential of RBV in this and other contexts. In addition to scientific and lay reports of the study findings, research outputs will include a framework for constructing the economic impacts of quality improvement and practical guidance for health service managers that maximises the impacts of investment in quality improvement. 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.

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project.

PubMed

Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

2013-01-01

Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. WE DESIGNED AND IMPLEMENTED A STRUCTURED CURRICULUM IN WHICH INTERDISCIPLINARY TEAMS ACQUIRED KNOWLEDGE ON QUALITY IMPROVEMENT AND TEAMWORK, WHILE FOCUSING ON A SPECIFIC CLINICAL PROJECT: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The hospital has completed quality improvement projects in the past; however, this project was the first in which residents were actively involved. The didactic components and experiential learning were powerfully synergistic. This and similar projects can have far-reaching implications in terms of promoting patient health and improving the quality of care delivered by the healthcare systems and teaching hospitals.

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.

PubMed

Schoeppe, Stephanie; Alley, Stephanie; Van Lippevelde, Wendy; Bray, Nicola A; Williams, Susan L; Duncan, Mitch J; Vandelanotte, Corneel

2016-12-07

Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes. This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than stand-alone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

PubMed

Curtis, J Randall; Cook, Deborah J; Wall, Richard J; Angus, Derek C; Bion, Julian; Kacmarek, Robert; Kane-Gill, Sandra L; Kirchhoff, Karin T; Levy, Mitchell; Mitchell, Pamela H; Moreno, Rui; Pronovost, Peter; Puntillo, Kathleen

2006-01-01

Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit. The task force met in person twice and by conference call twice to write this document. We also conducted a literature search on "quality improvement" and "critical care or intensive care" and searched online for additional resources. DATA SYNTHESIS AND OVERVIEW: We present an overview of quality improvement in the intensive care unit setting and then describe the following steps for initiating or improving an interdisciplinary critical care quality improvement program: a) identify local motivation, support teamwork, and develop strong leadership; b) prioritize potential projects and choose the first target; c) operationalize the measures, build support for the project, and develop a business plan; d) perform an environmental scan to better understand the problem, potential barriers, opportunities, and resources for the project; e) create a data collection system that accurately measures baseline performance and future improvements; f) create a data reporting system that allows clinicians and others to understand the problem; g) introduce effective strategies to change clinician behavior. In addition, we identify four steps for evaluating and maintaining this program: a) determine whether the target is changing with periodic data collection; b) modify behavior change strategies to improve or sustain improvements; c) focus on interdisciplinary collaboration; and d) develop and sustain support from the hospital leadership. We also identify a number of online resources to complement this overview. This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.

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

PubMed

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

2000-12-01

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

Serial headache drawings by children with migraine: correlation with clinical headache status.

PubMed

Stafstrom, Carl E; Goldenholz, Shira R; Dulli, Douglas A

2005-10-01

Children's artistic self-depictions of headache provide valuable insights into their experience of pain and aid in the diagnostic differentiation of headache types. In a previous study, we compared the clinical diagnosis (gold standard) and artistic diagnosis of headaches in 226 children. In approximately 90% of cases, the drawing predicted the clinical diagnosis of migraine versus nonmigraine headache correctly. In the present study, we explored whether headache drawings correlate with clinical improvement after treatment in children with migraine headaches followed longitudinally. Children seen in the Pediatric Neurology Clinic with the chief complaint of headache were asked to draw a picture of what their headache feels like. On subsequent clinic visits, children with the clinical diagnosis of migraine were asked to draw another picture depicting their current headache. The two drawings were compared to assess whether there was improvement; this "artistic response" was then correlated with the child's clinical status (ie, whether the headaches were improved clinically). One hundred eleven children (66 girls, 45 boys) participated in the study, with a mean interval of 5.3 +/- 2.3 (standard error of the mean) months between the first and second visits. The mean age at the first visit was 11.6 +/- 3.1 years. The raters agreed that serial drawings were both improved or both not improved in 99 of the 111 cases (89%; interrater reliability kappa score of 0.767). Fifty-three children had improvements in their headaches and drawings, 3 children had an improved drawing but no clinical headache improvement, 32 children had no improvement in either their drawing or clinical headaches, and 11 children had improved headaches but no improvement in their drawing. The sensitivity of the drawings for clinical improvement was 0.83, and the specificity was 0.91. The predictive value of an improved headache drawing for an improved clinical response was 0.946. There was no correlation between specific treatment modality and artistic response. We concluded that children's headache drawings are a useful adjunct for the diagnosis of headache type and provide valuable insights into their experience of pain. The present data show that headache drawings can be used longitudinally to provide additional information about the clinical course. The technique is simple, inexpensive, and enjoyable for children and can be applied in a variety of clinical settings.

Improving America's Schools Act

NASA Technical Reports Server (NTRS)

Cradler, John; Bridgforth, Elizabeth

1995-01-01

The Improving America's Schools ACT (IASA) emphasizes coherent systemic education reform, with Goals 2000 setting common standards for IASA and the recently authorized School-to-Work Program. IASA addresses the need to raise academic achievement, increase opportunities to learn, improve professional development, increase community involvement, utilize instructional applications of technology, and improve assessment, and allow more local flexibility in the use of funds.

The Reliability of In-Training Assessment when Performance Improvement Is Taken into Account

ERIC Educational Resources Information Center

van Lohuizen, Mirjam T.; Kuks, Jan B. M.; van Hell, Elisabeth A.; Raat, A. N.; Stewart, Roy E.; Cohen-Schotanus, Janke

2010-01-01

During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how this improvement affects the reliability of the…

Continuous Quality Improvement: A Roadmap for Rural School Improvement.

ERIC Educational Resources Information Center

Kilmer, Lloyd C.

A case study documented a continuous quality improvement approach to school improvement in a rural Nebraska high school over a 2-year period. Data gathered from surveys, portfolios, pilot results, and test scores indicated that the changes during the 2-year period were not dramatic, but significant and consistent with the Total Quality literature.…

Managing Quality by Action Research--Improving Quality Service Delivery in Higher Education as a Marketing Strategy.

ERIC Educational Resources Information Center

Corbitt, Brian

1998-01-01

Describes two action research projects undertaken at an Australian university to improve quality of services to foreign students and improve the institution's image through word of mouth, or informal marketing. Each project, although small, facilitated changes or improvements to a targeted service. The role of management in empowering employees…

Quick Reference Guide: Working with Stakeholders to Identify Potential Improvement Strategies for Program Improvement (Including the SSIP)

ERIC Educational Resources Information Center

Center for IDEA Early Childhood Data Systems (DaSy), 2015

2015-01-01

This 2015 quick reference guide is designed to assist states in understanding what information needs to be available in order for stakeholders to assist in selecting potential improvement strategies that will increase capacity of Local Education Agencies (LEAs), Early Intervention Services (EIS) programs, and practitioners to improve results for…

Improving Student Science Achievement in Grades 4-6 through Hands-On Materials and Concept Verbalization.

ERIC Educational Resources Information Center

Brooks, Roger C.

This report describes a program designed to improve science achievement among students in grades 4-6 in a New Hampshire school. The areas of improvement included physical, earth, and life sciences. Analysis of the problem indicated a need for improved teaching techniques and for additional materials related to the instructional strategies. The…

See It, Be It, Write It: Using Performing Arts to Improve Writing Skills and Test Scores

ERIC Educational Resources Information Center

Blecher-Sass, Hope Sara; Moffitt, Maryellen

2010-01-01

Improve students' writing skills and boost their assessment scores while adding arts education, creativity, and fun to your writing curriculum. With this vibrant resource, improving writing skills goes hand-in-hand with improving test scores. Students learn how to use acting and visualization as prewriting activities to help them connect writing…

77 FR 43822 - Proposed Information Collection Request; Comment Request; Valuing Improved Water Quality in the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

... Request; Comment Request; Valuing Improved Water Quality in the Chesapeake Bay Using Stated Preference... efforts to improve water quality in the Chesapeake Bay. In 2009, Executive Order (E.O.) 13508 re... undertaking a benefits analysis of improvements in Bay water quality under the TMDLs, as well as of ancillary...

The role of genetics in improving forest health

Treesearch

Mary F. Mahalovich

1995-01-01

An often ignored tool to improve forest health is the application of genetics-Tree improvement programs in the Inland West utilize genetic principles to develop-seed transfer guidelines to avoid the problems associated with off-site plantings and to improve characteristics in conifers related to forest health. PC-based expert systems have been developed to aid in seed...

Improving the Academic Achievement of Third and Fourth Grade Underachievers as a Result of Improved Self-Esteem.

ERIC Educational Resources Information Center

Coakley, Barbara Fairfax

This study was designed to improve the academic achievement of 35 third- and fourth-grade underachievers through improved self-esteem. Specific goals included focusing on self-concept and learning skills reinforcement, with the ultimate goal of increasing academic performance and motivation. Large group sessions with students focused on…

Teachers' Perception of Their Principal's Leadership Style and the Effects on Student Achievement in Improving and Non-Improving Schools

ERIC Educational Resources Information Center

Hardman, Brenda Kay

2011-01-01

Teachers' perceptions of their school leaders influence student achievement in their schools. The extent of this influence is examined in this study. This quantitative study examined teachers' perceptions of the leadership style of their principals as transformational, transactional or passive-avoidant in improving and non-improving schools in…

Alternative Fuels Data Center: Natural Gas Street Sweepers Improve Air

Science.gov Websites

Quality in New York Natural Gas Street Sweepers Improve Air Quality in New York to someone by E -mail Share Alternative Fuels Data Center: Natural Gas Street Sweepers Improve Air Quality in New York on Facebook Tweet about Alternative Fuels Data Center: Natural Gas Street Sweepers Improve Air

School Improvement for Schools Facing Challenging Circumstances: A Review of Research and Practice.

ERIC Educational Resources Information Center

Potter, David; Reynolds, David; Chapman, Christopher

2002-01-01

Reviews the literature on what works in school improvement in the UK. Outlines the practices that appear to be necessary--in terms of organization, culture, leadership, and ethos--to improve the levels of effectiveness. Appended is an outline of a number of particularly effective school-improvement projects. (Contains 22 references.) (WFA)

Bringing Bourdieu to Mathematics Education: A Response to Williams and Choudry

ERIC Educational Resources Information Center

Noyes, Andrew

2016-01-01

For those engaged in educational "improvement," it is important to pause from time to time to ask the question: what is improving? If Bourdieu's thesis is correct, namely that education is a key site of social reproduction, does school improvement, and/or improvement of mathematics education, also enhance that capacity for the social…

CF6 jet engine performance improvement program. Task 1: Feasibility analysis

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1979-01-01

Technical and economic engine improvement concepts selected for subsequent development include: (1) fan improvement; (2) short core exhaust; (3) HP turbine aerodynamic improvement; (4) HP turbine roundness control; (5) HP turbine active clearance control; and (6) cabin air recirculation. The fuel savings for the selected engine modification concepts for the CF6 fleet are estimated.

Trends in shortleaf pine tree improvement

Treesearch

Robert N. Kitchens

1986-01-01

Tree improvement programs of shortleaf pine (Pinus echinata Mill.) have developed over the past 25 years to the point that virtually all demand for planting stock is met with genetically improved trees. About 22,600 acres of improved stock are planted each year. Although shortleaf has the largest geographic range of any southern pine, it is not being promoted in...

Proceedings of the 23rd Southern Forest Tree Improvement Conference

Treesearch

Robert J. Weir; Alice V. Hatcher; [Compilers

1995-01-01

The 23rd Southern Forest Tree Improvement Conference was held at the Holiday Inn SunSpree Resort in Asheville, North Carolina. The Conference was sponsored by the Southern Forest Tree Improvement Committee and hosted by the N. C. State University-Industry Cooperative Tree Improvement Program. A total of 37 presentations, three invited and 34 voluntary, were given....

Quality Improvement Efforts among Early Childhood Education Programs Participating in Iowa's Quality Rating System. REL 2017-244

ERIC Educational Resources Information Center

Hawkinson, Laura E.; Faria, Ann-Marie; Bouacha, Nora; Lee, Dong Hoon; Metzger, Ivan

2017-01-01

This report describes the quality improvement efforts of early childhood education programs participating in Iowa's Quality Rating System (QRS). It identifies supports and barriers to quality improvement and examines how quality improvement supports and activities relate to changes in program quality ratings across time. The study team developed…

What Drives Teachers to Improve? The Role of Teacher Mindset in Professional Learning

ERIC Educational Resources Information Center

Gero, Greg Philip

2013-01-01

Teacher quality has received increasing focus over the past decade, yet, by some measures, teachers rarely improve after their first few years of teaching, and not all teachers seem driven to improve. Traditional models of professional learning have emphasized the processes that teachers take part in as a facilitator of their improvement. Research…

Method of freezing living cells and tissues with improved subsequent survival

DOEpatents

Senkan, Selim M.; Hirsch, Gerald P.

1980-01-01

This invention relates to an improved method for freezing red blood cells, ther living cells, or tissues with improved subsequent survival, wherein constant-volume freezing is utilized that results in significantly improved survival compared with constant-pressure freezing; optimization is attainable through the use of different vessel geometries, cooling baths and warming baths, and sample concentrations.

Improving School Climate in an Urban Junior High School.

ERIC Educational Resources Information Center

Lawson, Robert C.

The problem of poor school climate in an eighth- and ninth-grade center was addressed by the implementation of a school climate improvement project. The following are the primary goals of this practicum: (1) improve school attendance; (2) reduce out-of-school suspensions; and (3) improve student and teacher morale. To address these goals, a…

Teaching, Rather than Teachers, as a Path toward Improving Classroom Instruction

ERIC Educational Resources Information Center

Hiebert, James; Morris, Anne K.

2012-01-01

For several historical and cultural reasons, the United States has long pursued a strategy of improving teaching by improving teachers. The rarely questioned logic underlying this choice says that by improving the right characteristics of teachers, they will teach more effectively. The authors expose the assumptions on which this logic is built,…

A System That Works: Highlights of Effective Intervention Strategies in a Quality Improvement System

ERIC Educational Resources Information Center

Sinisterra, Diana; Baker, Stephen

2010-01-01

This paper describes one approach to quality improvement efforts: the Quality Improvement System (QIS) implemented by Prime Time Palm Beach County (Prime Time) in Palm Beach County, Florida. Prime Time's QIS is recognized as one promising systemic effort to improve quality in the afterschool field (Yohalem, Granger, & Pittman, 2009). As a…

Report on the 31st Southern Forest Tree Improvement Conference (SFTIC)

Treesearch

C. Dana Nelson; Randall J Rousseau; Joshua P Adams; M. Cetin Yuceer

2012-01-01

The 31st Southern Forest Tree Improvement Conference was held 14-16 June 2011 in Biloxi, MS, USA. This marks 60 years of biennial technical conferences supported by the Southern Forest Tree Improvement Committee. The theme of the conference was tree improvement opportunities and challenges in the economy emerging around cellulosic biomass, bioproducts, and biofuels....

School Climate Improvement Action Guide for Community Partners. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines how community partners can support school climate improvements. Organizations and individuals can partner with schools in many different ways--from delivering or coordinating direct services to students and families inside or…

Proceedings: third lake states forest tree improvement conference

Treesearch

Forest Service U.S.

1958-01-01

The Third Lake States Forest Tree Improvement Conference culminated the activities of the Lake States Forest Tree Improvement Committee and offered an opportmity to report on committee work for the past biennium. It also provided an important means for the Committee to meet its major objective - the encouraging and coordinating of forest tree improvement activities in...

School Self-Evaluation for School Improvement: What Works and Why?

ERIC Educational Resources Information Center

Chapman, Christopher; Sammons, Pamela

2013-01-01

The idea that schools can impact positively on student outcomes is a crucial driver in the rise of interest in school improvement research and practice. This review focuses on school self-evaluation for school improvement. School self-evaluation can be a fundamental force in achieving school improvement and this review establishes what the key…

Examining Changes to Michigan's Early Childhood Quality Rating and Improvement System (QRIS). REL 2015-029

ERIC Educational Resources Information Center

Faria, Ann-Marie; Hawkinson, Laura E.; Greenberg, Ariela C.; Howard, Eboni C.; Brown, Leah

2015-01-01

Documenting and improving early childhood program quality is a national priority, leading to a rapid expansion of Quality Rating and Improvement Systems (QRISs). QRISs document and improve the quality of early childhood education programs and provide clear information to families about their child care choices. The current study described how…

School Climate Improvement Action Guide for Instructional Staff. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that instructional staff--including teachers, paraprofessionals, and others in the classroom who provide instruction or assistance--can take to support school climate improvements. Key action steps are provided…

School Climate Improvement Action Guide for School Leaders. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that school leaders--including principals, assistant/vice principals, and building leaders--can take to support school climate improvements. Key action steps are provided for the following strategies: (1)…

14 CFR 13.3 - Investigations (general).

Code of Federal Regulations, 2010 CFR

2010-01-01

....), the Airport and Airway Improvement Act of 1982 (49 U.S.C. 2201 et seq.), the Airport and Airway Improvement Act of 1982 (as amended, 49 U.S.C. App. 2201 et seq., Airport and Airway Safety and Capacity... Improvement Act of 1982, the Airport and Airway Improvement Act of 1982 as amended by the Airport and Airway...

Teaching the NIATx Model of Process Improvement as an Evidence-Based Process

ERIC Educational Resources Information Center

Evans, Alyson C.; Rieckmann, Traci; Fitzgerald, Maureen M.; Gustafson, David H.

2007-01-01

Process Improvement (PI) is an approach for helping organizations to identify and resolve inefficient and ineffective processes through problem solving and pilot testing change. Use of PI in improving client access, retention and outcomes in addiction treatment is on the rise through the teaching of the Network for the Improvement of Addiction…

20 CFR 220.178 - Determining medical improvement and its relationship to the annuitant's ability to do work.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Determining medical improvement and its... Disability Due to Substantial Gainful Activity or Medical Improvement § 220.178 Determining medical improvement and its relationship to the annuitant's ability to do work. (a) General. Paragraphs (a), (b), and...

77 FR 76075 - Whistleblower Protection Advisory Committee (WPAC)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... workers and employers, improving the investigative and enforcement process, improvements of regulations..., 49 U.S.C. 42121; the Sarbanes-Oxley Act, 18 U.S.C. 1514A; the Pipeline Safety Improvement Act, 49 U.S... Act, 6 U.S.C. 1142; the Consumer Product Safety Improvement Act, 15 U.S.C. 2087; Section 1558 of the...

Improving Teaching Does Improve Teachers: Evidence from Lesson Study

ERIC Educational Resources Information Center

Lewis, Catherine C.; Perry, Rebecca R.; Friedkin, Shelley; Roth, Jillian R.

2012-01-01

The authors comment on the article by Morris and Hiebert in three ways. First, they add thoughts about why improvement efforts often focus on teachers, rather than teaching. Second, they offer evidence from U.S. lesson study research that focus on teaching can improve both students' learning and teachers' learning. Finally, they suggest that the…

Practical strategies of black walnut genetic improvement—an update

Treesearch

George Rink; J.W. Van Sambeek; Phil O' Connor; Mark Coggeshall

2017-01-01

The ultimate goal of any tree improvement program is the large-scale production and distribution of genetically improved seedlings. In black walnut, projections based on earlier research indicate that genetically improved seedlings could provide growth improvement of between 15 to 25 percent by using seed or seedlings of the proper geographic origin (Bey 1980; Clausen...

16 CFR 1500.88 - Exemptions from lead limits under section 101 of the Consumer Product Safety Improvement Act for...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 101 of the Consumer Product Safety Improvement Act for certain electronic devices. 1500.88 Section... from lead limits under section 101 of the Consumer Product Safety Improvement Act for certain electronic devices. (a) The Consumer Product Safety Improvement Act (CPSIA) provides for specific lead limits...

Development of improved pyroelectric detectors. Measurements of pyroelectric material characteristics and FET characteristics

NASA Technical Reports Server (NTRS)

Weiner, S.; Beerman, H. P.; Schwarz, F. C.

1990-01-01

Research was undertaken to improve the detectivity of the pyroelectric detector with the ultimate goal of operation at or near the temperature-noise limit. Two general areas of investigation were undertaken: (1) to improve responsivity through the use of new materials; and (2) to reduce noise through improved field effect transistor characteristics, and improved electroding of the pyroelectric material. FET's are being obtained from various manufacturers, evaulated, and selected units tested for evaluation of characteristics critical to their use as preamplifiers with pyroelectric detectors.

O (a) improvement of 2D N = (2 , 2) lattice SYM theory

NASA Astrophysics Data System (ADS)

Hanada, Masanori; Kadoh, Daisuke; Matsuura, So; Sugino, Fumihiko

2018-04-01

We perform a tree-level O (a) improvement of two-dimensional N = (2 , 2) supersymmetric Yang-Mills theory on the lattice, motivated by the fast convergence in numerical simulations. The improvement respects an exact supersymmetry Q which is needed for obtaining the correct continuum limit without a parameter fine tuning. The improved lattice action is given within a milder locality condition in which the interactions are decaying as the exponential of the distance on the lattice. We also prove that the path-integral measure is invariant under the improved Q-transformation.

Teaching quality improvement.

PubMed

Murray, Marry Ellen; Douglas, Stephen; Girdley, Diana; Jarzemsky, Paula

2010-08-01

Practicing nurses are required to engage in quality improvement work as a part of their clinical practice, but few undergraduate nursing education programs offer course work and applied experience in this area. This article presents a description of class content and teaching strategies, assignments, and evaluation strategies designed to achieve the Quality and Safety Education in Nursing competencies related to quality improvement and interdisciplinary teams. Students demonstrate their application of the quality improvement process by designing and implementing a small-scale quality improvement project that they report in storyboard format on a virtual conference Web site.

Deodorants, value, and performance.

PubMed

Newcomer, L N

1997-11-01

For the health-care market, like the deodorant market, the message is clear: Add value or your product will not be competitive. For physicians of all specialties, the best way to add value is to measure and improve performance. Performance measurement is critical to improvement in health care. Without measurement, there can be no improvement in quality. Without improvement in quality, there is no added value. Oncologists can take at least two actions to add value for their health plans: (1) measure practice performance and demonstrate a quality improvement; and (2) become the personal-care physician for cancer patients.

9-Ft By 7-Ft Supersonic Wind Tunnel Nozzle Improvement Study

NASA Technical Reports Server (NTRS)

Paciano, Eric N.

2014-01-01

Engineers at the Unitary Plan Wind Tunnel at NASA Ames Research Center have recently embarked on a project focused on improving flow quality and tunnel capabilities in the 9-ft by 7-ft supersonic wind tunnel. Collaborating with Jacobs Tech Group, the project has explored potential improvements to the nozzle design using computational fluid dynamics. Preliminary predictions suggest changes to the nozzle design could significantly improve flow quality at the lower operating range (M1.5-1.8), however potential improvements in the upper operating range have yet to be realized.

Raytheon Stirling/pulse Tube Cryocooler Development

NASA Astrophysics Data System (ADS)

Kirkconnell, C. S.; Hon, R. C.; Kesler, C. H.; Roberts, T.

2008-03-01

The first generation flight-design Stirling/pulse tube "hybrid" two-stage cryocooler has entered initial performance and environmental testing. The status and early results of the testing are presented. Numerous improvements have been implemented as compared to the preceding brassboard versions to improve performance, extend life, and enhance launch survivability. This has largely been accomplished by incorporating successful flight-design features from the Raytheon Stirling one-stage cryocooler product line. These design improvements are described. In parallel with these mechanical cryocooler development efforts, a third generation electronics module is being developed that will support hybrid Stirling/pulse tube and Stirling cryocoolers. Improvements relative to the second generation design relate to improved radiation hardness, reduced parts count, and improved vibration cancellation capability. Progress on the electronics is also presented.

Mindfulness-based cognitive therapy for depressed individuals improves suppression of irrelevant mental-sets.

PubMed

Greenberg, Jonathan; Shapero, Benjamin G; Mischoulon, David; Lazar, Sara W

2017-04-01

An impaired ability to suppress currently irrelevant mental-sets is a key cognitive deficit in depression. Mindfulness-based cognitive therapy (MBCT) was specifically designed to help depressed individuals avoid getting caught in such irrelevant mental-sets. In the current study, a group assigned to MBCT plus treatment-as-usual (n = 22) exhibited significantly lower depression scores and greater improvements in irrelevant mental-set suppression compared to a wait-list plus treatment-as-usual (n = 18) group. Improvements in mental-set-suppression were associated with improvements in depression scores. Results provide the first evidence that MBCT can improve suppression of irrelevant mental-sets and that such improvements are associated with depressive alleviation.

Informatics: essential infrastructure for quality assessment and improvement in nursing.

PubMed Central

Henry, S B

1995-01-01

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge. PMID:7614118

Stories from the Sharp End: Case Studies in Safety Improvement

PubMed Central

McCarthy, Douglas; Blumenthal, David

2006-01-01

Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that promotes continuing innovation and improvement, transcending whatever particular safety methodology is used. Policymakers could help stimulate a culture of safety by linking regulatory goals to safety culture expectations, sponsoring voluntary learning collaborations, rewarding safety improvements, better using publicly reported data, encouraging consumer involvement, and supporting research and education. PMID:16529572

System and method for networking electrochemical devices

DOEpatents

Williams, Mark C.; Wimer, John G.; Archer, David H.

1995-01-01

An improved electrochemically active system and method including a plurality of electrochemical devices, such as fuel cells and fluid separation devices, in which the anode and cathode process-fluid flow chambers are connected in fluid-flow arrangements so that the operating parameters of each of said plurality of electrochemical devices which are dependent upon process-fluid parameters may be individually controlled to provide improved operating efficiency. The improvements in operation include improved power efficiency and improved fuel utilization in fuel cell power generating systems and reduced power consumption in fluid separation devices and the like through interstage process fluid parameter control for series networked electrochemical devices. The improved networking method includes recycling of various process flows to enhance the overall control scheme.

Properties of PMR polyimide composites made with improved high strength graphite fibers

NASA Technical Reports Server (NTRS)

Vannucci, R. D.

1980-01-01

Recent graphite fiber developments have resulted in high strength, intermediate modulus graphite fibers having improved thermo-oxidative resistance. These improved fibers, obtained from various commercial suppliers, were used to fabricate PMR-15 and PMR-11 polyimide composites. Studies were performed to investigate the effects of the improved high strength graphite fibers on composite properties after exposure in air at 600 F. The use of the more oxidatively resistant fibers did not result in improved performance at 600 F. Two of the improved fibers were found to have an adverse effect on the long-term performance of PMR composites. The influence of various factors such as fiber physical properties, surface morphology and chemical composition are also discussed.

Improved Coal-Thickness Measurement

NASA Technical Reports Server (NTRS)

Barr, T. A.

1984-01-01

Summed signals and dielectric-filled antenna improve measurement. Improved FM radar for measuring thickness of coal seam eliminates spectrum splitting and reduces magnitude of echo from front coal surface.

Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

PubMed

McGrath, Susan P; Blike, George T

2015-10-01

A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Improving surgeon utilization in an orthopedic department using simulation modeling

PubMed Central

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

Purpose Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time. Methods The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization. Results The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services. Conclusion This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. PMID:29355193

Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network.

PubMed

Hien, Denise A; Jiang, Huiping; Campbell, Aimee N C; Hu, Mei-Chen; Miele, Gloria M; Cohen, Lisa R; Brigham, Gregory S; Capstick, Carrie; Kulaga, Agatha; Robinson, James; Suarez-Morales, Lourdes; Nunes, Edward V

2010-01-01

The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period. Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions. PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

PubMed Central

Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

2013-01-01

PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis

NASA Astrophysics Data System (ADS)

El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

2014-02-01

This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-α was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFα and beta endorphin.

Driving hospital transformation with SLMTA in a regional hospital in Cameroon

PubMed Central

Asong, Terence; Ngale, Elive; Mangwa, Beatrice; Ndasi, Juliana; Mouladje, Maurice; Lekunze, Remmie; Mbome, Victor; Njukeng, Patrick; Shang, Judith

2014-01-01

Background Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital-wide quality improvement. Objective This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards. Methods In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infection rates, birth outcomes and hospital revenue. Results There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of patients increased as a result of improved services, leading to a 25% increase in hospital revenue. Conclusion The SLMTA programme was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programme for hospital quality improvement. PMID:29043192

Improved physical fitness correlates with improved cognition in multiple sclerosis.

PubMed

Beier, Meghan; Bombardier, Charles H; Hartoonian, Narineh; Motl, Robert W; Kraft, George H

2014-07-01

To determine whether there is an association between improvements in objective measures of physical fitness and performance on cognitive tests in people with multiple sclerosis (MS). Post hoc correlational analysis in which people demonstrating physical improvement were compared with those not demonstrating physical improvement. Individuals with MS residing in the community. Adults with clinically confirmed MS (N=88) who participated in a controlled trial of a telephone-based health promotion intervention, chose to work on exercise, and completed the pre- and postintervention assessments. Participants were measured for strength (isokinetic dynamometer), aerobic fitness (bicycle ergometer), and cognition (Paced Auditory Serial Addition Test [PASAT], Trail Making Test [TMT]) at baseline and 12 weeks later. Change in fitness was calculated by subtracting each participant's baseline score from the outcome score, and then transforming the difference to a z score. Individuals with a z score ≥1 on any fitness measure were placed in the physically improved group (n=25). All others were in the physically not improved group (n=57). After controlling for covariates (age, sex, ethnicity, education, disease activity, MS type), there was a significant group-by-time interaction, suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group demonstrated improved performance on measures of executive functioning after 12 weeks of exercise. The results of this study lend support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

PubMed

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

A clinical nurse specialist-led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement.

PubMed

Russell, Cynthia L

2010-01-01

A clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients as an exemplar population is proposed. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics not only are poor and inconsistent predictors for medication nonadherence but also are not amenable to intervention. Adherence has not meaningfully improved, despite meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients is proposed. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns. Continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process. Future studies should include RCTs comparing educational and/or behavioral interventions to improve medication adherence.

Forced, not voluntary, exercise improves motor function in Parkinson's disease patients.

PubMed

Ridgel, Angela L; Vitek, Jerrold L; Alberts, Jay L

2009-01-01

Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients. The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity. Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate. Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.

Physical function improvements and relief from fatigue and pain are associated with increased productivity at work and at home in rheumatoid arthritis patients treated with certolizumab pegol

PubMed Central

Taylor, Peter; Strand, Vibeke; Purcaru, Oana; Coteur, Geoffroy; Mease, Philip

2010-01-01

Objectives. To evaluate the association between improvements in physical function, fatigue and pain and improvements in productivity at work and at home in patients treated with certolizumab pegol (CZP) in combination with MTX. Methods. Physical function, fatigue and pain were assessed in two CZP clinical trials (Rheumatoid Arthritis PreventIon of structural Damage 1 and 2) using the HAQ-Disability Index (HAQ-DI), Fatigue Assessment Scale (FAS) and Patient Assessment of Pain, with minimal clinically important differences (MCIDs) defined as ≥0.22, ≥1 and ≥10 points, respectively. Work and home productivity were evaluated using the RA-specific Work Productivity Survey (WPS-RA). The odds of achieving an HAQ-DI, FAS or pain ‘response’ at Week 12, defined as improvements ≥MCID, were compared between CZP and control groups. Improvements in productivity at Week 12 were compared between CZP-treated HAQ-DI, FAS or pain responders and non-responders. Results. The odds of achieving improvements ≥MCID were five times higher for pain, and two to three times higher for physical function and fatigue, in patients receiving CZP vs control. Per month, responders reported significantly greater improvements in productivity at work and reduced interference of RA with their work productivity than non-responders. Responders also reported significantly greater improvements in productivity at home and participation in family, social and leisure activities. Conclusions. This study demonstrated a clear association between patient-reported improvements in physical function, fatigue and pain, and improvements in productivity both at work and home. PMID:20547658

Changes in social adjustment with cognitive processing therapy: effects of treatment and association with PTSD symptom change.

PubMed

Monson, Candice M; Macdonald, Alexandra; Vorstenbosch, Valerie; Shnaider, Philippe; Goldstein, Elizabeth S R; Ferrier-Auerbach, Amanda G; Mocciola, Katharine E

2012-10-01

The current study sought to determine if different spheres of social adjustment, social and leisure, family, and work and income improved immediately following a course of cognitive processing therapy (CPT) when compared with those on a waiting list in a sample of 46 U.S. veterans diagnosed with posttraumatic stress disorder (PTSD). We also sought to determine whether changes in different PTSD symptom clusters were associated with changes in these spheres of social adjustment. Overall social adjustment, extended family relationships, and housework completion significantly improved in the CPT versus waiting-list condition, η(2) = .08 to .11. Hierarchical multiple regression analyses revealed that improvements in total clinician-rated PTSD symptoms were associated with improvements in overall social and housework adjustment. When changes in reexperiencing, avoidance, emotional numbing, and hyperarousal were all in the model accounting for changes in total social adjustment, improvements in emotional numbing symptoms were associated with improvements in overall social, extended family, and housework adjustment (β = .38 to .55). In addition, improvements in avoidance symptoms were associated with improvements in housework adjustment (β = .30), but associated with declines in extended family adjustment (β = -.34). Results suggest that it is important to consider the extent to which PTSD treatments effectively reduce specific types of symptoms, particularly emotional numbing and avoidance, to generally improve social adjustment. Copyright © 2012 International Society for Traumatic Stress Studies.

Relationships among emotion regulation and symptoms during trauma-focused CBT for school-aged children.

PubMed

Thornback, Kristin; Muller, Robert T

2015-12-01

This study examined improvement in emotion regulation throughout Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and the degree to which improvement in emotion regulation predicted improvement in symptoms. Traumatized children, 7-12 years (69.9% female), received TF-CBT. Data from 4 time periods were used: pre-assessment (n=107), pre-treatment (n=78), post-treatment (n=58), and 6-month follow-up (n=44). Questionnaires measured emotion regulation in the form of inhibition and dysregulation (Children's Emotion Management Scales) and lability/negativity and emotion regulation skill (Emotion Regulation Checklist), as well as child-reported (Trauma Symptom Checklist for Children) and parent-reported (Trauma Symptom Checklist for Young Children) posttraumatic stress, and internalizing and externalizing problems (Child Behaviuor Checklist). To the extent that children's dysregulation and lability/negativity improved, their parents reported fewer symptoms following therapy. Improvements in inhibition best predicted improvements in child-reported posttraumatic stress (PTS) during clinical services, but change in dysregulation and lability/negativity best predicted improvement in child-reported PTS symptoms at 6-month follow-up. Moreover, statistically significant improvements of small effect size were found following therapy, for inhibition, dysregulation, and lability/negativity, but not emotion regulation skill. These findings suggest that emotion regulation is a worthy target of intervention and that improvements in emotion regulation can be made. Suggestions for future research are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Examining Quality Improvement Programs: The Case of Minnesota Hospitals

PubMed Central

Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M

2008-01-01

Objective To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Data Sources Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. Study Design As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. Data Collection/Data Extraction Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. Conclusions There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases. PMID:18761677