Yb3+-doped rod-type amplifiers with local adiabatic tapers for peak power scaling and beam quality improvement

NASA Astrophysics Data System (ADS)

Zhu, Yuan; Eschrich, Tina; Leich, Martin; Grimm, Stephan; Kobelke, Jens; Lorenz, Martin; Bartelt, Hartmut; Jäger, Matthias

2017-10-01

The use of short local tapers in large mode area fiber amplifiers is proposed for peak power scaling while maintaining good beam quality. To avoid modal distortions, the powder-sintering (REPUSIL) method was employed to obtain core materials with excellent refractive index homogeneity. First experiments with Yb3+-doped rod-type amplifiers delivered 2 ns pulses with peak powers of 540 kW and energies of 1.4 mJ for the untapered rod and 230 kW for the tapered rod (limited by facet damage). The beam quality improved from an M 2 value of approximately 10 to 3.5. The investigation of the taper structure indicates room for further improvement.

Multi-Fresnel lenses pumping approach for improving high-power Nd:YAG solar laser beam quality.

PubMed

Liang, Dawei; Almeida, Joana

2013-07-20

To significantly improve the present-day high-power solar laser beam quality, a three-stage multi-Fresnel lenses approach is proposed for side-pumping either a Nd:YAG single-crystal or a core-doped Sm(3+)Nd:YAG ceramic rod. Optimum pumping and laser beam parameters are found through ZEMAX and LASCAD numerical analysis. The proposed scheme offers a uniform absorption profile along the rod. 167 W laser power can be achieved, corresponding to 29.3 W/m(2) collection efficiency. High brightness figure of merit of 8.34 W is expected for the core-doped rod within a convex-concave resonator, which is 1300 times higher than that of the most-recent high-power solar laser.

Power quality improvement of a stand-alone power system subjected to various disturbances

NASA Astrophysics Data System (ADS)

Lone, Shameem Ahmad; Mufti, Mairaj Ud-Din

In wind-diesel stand-alone power systems, the disturbances like random nature of wind power, turbulent wind, sudden changes in load demand and the wind park disconnection effect continuously the system voltage and frequency. The satisfactory operation of such a system is not an easy task and the control design has to take in to account all these subtleties. For maintaining the power quality, generally, a short-term energy storage device is used. In this paper, the performance of a wind-diesel system associated with a superconducting magnetic energy storage (SMES) system is studied. The effect of installing SMES at wind park bus/load bus, on the system performance is investigated. To control the exchange of real and reactive powers between the SMES unit and the wind-diesel system, a control strategy based on fuzzy logic is proposed. The dynamic models of the hybrid power system for most common scenarios are developed and the results presented.

A quality improvement management model for renal care.

PubMed

Vlchek, D L; Day, L M

1991-04-01

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

Small Steps, Big Reward: Quality Improvement through Pilot Groups.

ERIC Educational Resources Information Center

Bindl, Jim; Schuler, Jim

1988-01-01

Because of a need for quality improvement, Wisconsin Power and Light trained two six-person pilot groups in statistical process control, had them apply that knowledge to actual problems, and showed management the dollars-and-cents savings that come from quality improvement. (JOW)

Adaptive Harmonic Detection Control of Grid Interfaced Solar Photovoltaic Energy System with Power Quality Improvement

NASA Astrophysics Data System (ADS)

Singh, B.; Goel, S.

2015-03-01

This paper presents a grid interfaced solar photovoltaic (SPV) energy system with a novel adaptive harmonic detection control for power quality improvement at ac mains under balanced as well as unbalanced and distorted supply conditions. The SPV energy system is capable of compensation of linear and nonlinear loads with the objectives of load balancing, harmonics elimination, power factor correction and terminal voltage regulation. The proposed control increases the utilization of PV infrastructure and brings down its effective cost due to its other benefits. The adaptive harmonic detection control algorithm is used to detect the fundamental active power component of load currents which are subsequently used for reference source currents estimation. An instantaneous symmetrical component theory is used to obtain instantaneous positive sequence point of common coupling (PCC) voltages which are used to derive inphase and quadrature phase voltage templates. The proposed grid interfaced PV energy system is modelled and simulated in MATLAB Simulink and its performance is verified under various operating conditions.

Effects of a Meditation Program on Nurses' Power and Quality of Life.

PubMed

Chang, Sun Ju; Kwak, Eun Young; Hahm, Bong-Jin; Seo, Se Hee; Lee, Da Woon; Jang, Sun Joo

2016-07-01

This study evaluated the effects of meditation programs on nurses' power and quality of life. In this study, Barrett's power theory derived from Rogers' unitary human being science was used as a theoretical framework. A randomized controlled design with 50 recruited and randomly allocated participants was used. The results demonstrated that the eight-week meditation program significantly improved nurses' power and quality of life. These results suggest that meditation has positive effects on power and quality of life. © The Author(s) 2016.

Research on Holographic Evaluation of Service Quality in Power Data Network

NASA Astrophysics Data System (ADS)

Wei, Chen; Jing, Tao; Ji, Yutong

2018-01-01

With the rapid development of power data network, the continuous development of the Power data application service system, more and more service systems are being put into operation. Following this, the higher requirements for network quality and service quality are raised, in the actual process for the network operation and maintenance. This paper describes the electricity network and data network services status. A holographic assessment model was presented to achieve a comprehensive intelligence assessment on the power data network and quality of service in the operation and maintenance on the power data network. This evaluation method avoids the problems caused by traditional means which performs a single assessment of network performance quality. This intelligent Evaluation method can improve the efficiency of network operation and maintenance guarantee the quality of real-time service in the power data network..

Power quality analysis based on spatial correlation

NASA Astrophysics Data System (ADS)

Li, Jiangtao; Zhao, Gang; Liu, Haibo; Li, Fenghou; Liu, Xiaoli

2018-03-01

With the industrialization and urbanization, the status of electricity in the production and life is getting higher and higher. So the prediction of power quality is the more potential significance. Traditional power quality analysis methods include: power quality data compression, disturbance event pattern classification, disturbance parameter calculation. Under certain conditions, these methods can predict power quality. This paper analyses the temporal variation of power quality of one provincial power grid in China from time angle. The distribution of power quality was analyzed based on spatial autocorrelation. This paper tries to prove that the research idea of geography is effective for mining the potential information of power quality.

Modelling and Simulation of Single-Phase Series Active Compensator for Power Quality Improvement

NASA Astrophysics Data System (ADS)

Verma, Arun Kumar; Mathuria, Kirti; Singh, Bhim; Bhuvaneshwari, G.

2017-10-01

A single-phase active series compensator is proposed in this work to reduce harmonic currents at the ac mains and to regulate the dc link voltage of a diode bridge rectifier (DBR) that acts as the front end converter for a voltage source inverter feeding an ac motor. This ac motor drive is used in any of the domestic, commercial or industrial appliances. Under fluctuating ac mains voltages, the dc link voltage of the DBR depicts wide variations and hence the ac motor is used at reduced rating as compared to its name-plate rating. The active series compensator proposed here provides dual functions of improving the power quality at the ac mains and regulating the dc link voltage thus averting the need for derating of the ac motor.

[Quality assurance and quality improvement. Personal experiences and intentions].

PubMed

Roche, B G; Sommer, C

1995-01-01

test, formulate hypotheses of cause, test those hypotheses, apply remedies, and assess the effect of remedies. Total employee involvement is critical. A power comes from enabling all employees to become involved in quality improvement. A great advantage of CQI is the prevention orientation of the concept. The CQI permeated a collegial approach, people learn how to work together to improve. CQI is a time consuming procedure. During our travel we learned the definition of quality as the customer satisfaction. To build a CQI concept in employed time but all employed are involved in quality improvement. Applying CQI we could be able to refuse Quality control programs.

Automated recognition system for power quality disturbances

NASA Astrophysics Data System (ADS)

Abdelgalil, Tarek

The application of deregulation policies in electric power systems has resulted in the necessity to quantify the quality of electric power. This fact highlights the need for a new monitoring strategy which is capable of tracking, detecting, classifying power quality disturbances, and then identifying the source of the disturbance. The objective of this work is to design an efficient and reliable power quality monitoring strategy that uses the advances in signal processing and pattern recognition to overcome the deficiencies that exist in power quality monitoring devices. The purposed monitoring strategy has two stages. The first stage is to detect, track, and classify any power quality violation by the use of on-line measurements. In the second stage, the source of the classified power quality disturbance must be identified. In the first stage, an adaptive linear combiner is used to detect power quality disturbances. Then, the Teager Energy Operator and Hilbert Transform are utilized for power quality event tracking. After the Fourier, Wavelet, and Walsh Transforms are employed for the feature extraction, two approaches are then exploited to classify the different power quality disturbances. The first approach depends on comparing the disturbance to be classified with a stored set of signatures for different power quality disturbances. The comparison is developed by using Hidden Markov Models and Dynamic Time Warping. The second approach depends on employing an inductive inference to generate the classification rules directly from the data. In the second stage of the new monitoring strategy, only the problem of identifying the location of the switched capacitor which initiates the transients is investigated. The Total Least Square-Estimation of Signal Parameters via Rotational Invariance Technique is adopted to estimate the amplitudes and frequencies of the various modes contained in the voltage signal measured at the facility entrance. After extracting the

A design of wireless sensor networks for a power quality monitoring system.

PubMed

Lim, Yujin; Kim, Hak-Man; Kang, Sanggil

2010-01-01

Power grids deal with the business of generation, transmission, and distribution of electric power. Recently, interest in power quality in electrical distribution systems has increased rapidly. In Korea, the communication network to deliver voltage, current, and temperature measurements gathered from pole transformers to remote monitoring centers employs cellular mobile technology. Due to high cost of the cellular mobile technology, power quality monitoring measurements are limited and data gathering intervals are large. This causes difficulties in providing the power quality monitoring service. To alleviate the problems, in this paper we present a communication infrastructure to provide low cost, reliable data delivery. The communication infrastructure consists of wired connections between substations and monitoring centers, and wireless connections between pole transformers and substations. For the wireless connection, we employ a wireless sensor network and design its corresponding data forwarding protocol to improve the quality of data delivery. For the design, we adopt a tree-based data forwarding protocol in order to customize the distribution pattern of the power quality information. We verify the performance of the proposed data forwarding protocol quantitatively using the NS-2 network simulator.

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.

Fault Analysis in a Grid Integrated DFIG Based Wind Energy System with NA CB_P Circuit for Ridethrough Capability and Power Quality Improvement

NASA Astrophysics Data System (ADS)

Swain, Snehaprava; Ray, Pravat Kumar

2016-12-01

In this paper a three phase fault analysis is done on a DFIG based grid integrated wind energy system. A Novel Active Crowbar Protection (NACB_P) system is proposed to enhance the Fault-ride through (FRT) capability of DFIG both for symmetrical as well as unsymmetrical grid faults. Hence improves the power quality of the system. The protection scheme proposed here is designed with a capacitor in series with the resistor unlike the conventional Crowbar (CB) having only resistors. The major function of the capacitor in the protection circuit is to eliminate the ripples generated in the rotor current and to protect the converter as well as the DC-link capacitor. It also compensates reactive power required by the DFIG during fault. Due to these advantages the proposed scheme enhances the FRT capability of the DFIG and also improves the power quality of the whole system. Experimentally the fault analysis is done on a 3hp slip ring induction generator and simulation results are carried out on a 1.7 MVA DFIG based WECS under different types of grid faults in MATLAB/Simulation and functionality of the proposed scheme is verified.

Improving the light output power of DUV-LED by introducing an intrinsic last quantum barrier interlayer on the high-quality AlN template

NASA Astrophysics Data System (ADS)

Tsai, Chia-Lung; Liu, Hsueh-Hsing; Chen, Jun-Wei; Lu, Chien-Pin; Ikenaga, Kazutada; Tabuchi, Toshiya; Matsumoto, Koh; Fu, Yi-Keng

2017-12-01

We demonstrate that the light output power of deep ultraviolet light-emitting diodes (DUV-LEDs) can be improved by introducing an intrinsic last quantum barrier interlayer to a high quality AlN template. The light output power of the DUV-LEDs can be doubled by substituting the last quantum barrier with an intrinsic last quantum barrier (u-LQB)/Mg-doped LQB for only pure u-LQB in the same thickness with a 35 A/cm2 injection current. It is believed that the improved performance of the DUV LED could be attributed to the decreased diffusion of Mg tunneling into MQW and the reduction of sub-band parasitic emissions.

MATLAB Simulation of UPQC for Power Quality Mitigation Using an Ant Colony Based Fuzzy Control Technique

PubMed Central

Kumarasabapathy, N.; Manoharan, P. S.

2015-01-01

This paper proposes a fuzzy logic based new control scheme for the Unified Power Quality Conditioner (UPQC) for minimizing the voltage sag and total harmonic distortion in the distribution system consequently to improve the power quality. UPQC is a recent power electronic module which guarantees better power quality mitigation as it has both series-active and shunt-active power filters (APFs). The fuzzy logic controller has recently attracted a great deal of attention and possesses conceptually the quality of the simplicity by tackling complex systems with vagueness and ambiguity. In this research, the fuzzy logic controller is utilized for the generation of reference signal controlling the UPQC. To enable this, a systematic approach for creating the fuzzy membership functions is carried out by using an ant colony optimization technique for optimal fuzzy logic control. An exhaustive simulation study using the MATLAB/Simulink is carried out to investigate and demonstrate the performance of the proposed fuzzy logic controller and the simulation results are compared with the PI controller in terms of its performance in improving the power quality by minimizing the voltage sag and total harmonic distortion. PMID:26504895

Binary phase plates cannot improve laser beam quality.

PubMed

Siegman, A E

1993-05-01

Binary phase plates are often suggested as a means for improving the far-field brightness of beams coming from antiphased laser arrays or waveguide lasers operating in higher-order modes. Somewhat surprisingly, however, binary phase plates actually cannot improve at all the second-moment-based beam quality factor M(2) as usually defined for such beams. Even from a power-in-the-bucket viewpoint, their usefulness is debatable.

Power quality considerations for nuclear spectroscopy applications: Grounding

NASA Astrophysics Data System (ADS)

García-Hernández, J. M.; Ramírez-Jiménez, F. J.; Mondragón-Contreras, L.; López-Callejas, R.; Torres-Bribiesca, M. A.; Peña-Eguiluz, R.

2013-11-01

Traditionally the electrical installations are designed for supplying power and to assure the personnel safety. In nuclear analysis laboratories, additional issues about grounding also must be considered for proper operation of high resolution nuclear spectroscopy systems. This paper shows the traditional ways of grounding nuclear spectroscopy systems and through different scenarios, it shows the effects on the more sensitive parameter of these systems: the energy resolution, it also proposes the constant monitoring of a power quality parameter as a way to preserve or to improve the resolution of the systems, avoiding the influence of excessive extrinsic noise.

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.

Power quality load management for large spacecraft electrical power systems

NASA Technical Reports Server (NTRS)

Lollar, Louis F.

1988-01-01

In December, 1986, a Center Director's Discretionary Fund (CDDF) proposal was granted to study power system control techniques in large space electrical power systems. Presented are the accomplishments in the area of power system control by power quality load management. In addition, information concerning the distortion problems in a 20 kHz ac power system is presented.

Effect of Power Ultrasound on Food Quality

NASA Astrophysics Data System (ADS)

Lee, Hyoungill; Feng, Hao

Recent food processing technology innovations have been centered around producing foods with fresh-like attributes through minimal processing or nonthermal processing technologies. Instead of using thermal energy to secure food safety that is often accompanied by quality degradation in processed foods, the newly developed processing modalities utilize other types of physical energy such as high pressure, pulsed electric field or magnetic field, ultraviolet light, or acoustic energy to process foods. An improvement in food quality by the new processing methods has been widely reported. In comparison with its low-energy (high-frequency) counterpart which finds applications in food quality inspection, the use of high-intensity ultrasound, also called power ultrasound, in food processing is a relatively new endeavor. To understand the effect of high-intensity ultrasound treatment on food quality, it is important to understand the interactions between acoustic energy and food ingredients, which is covered in Chapter 10. In this chapter, the focus will be on changes in overall food quality attributes that are caused by ultrasound, such as texture, color, flavor, and nutrients.

Quality-based financial incentives in health care: can we improve quality by paying for it?

PubMed

Conrad, Douglas A; Perry, Lisa

2009-01-01

This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

Power factor improvement in three-phase networks with unbalanced inductive loads using the Roederstein ESTAmat RPR power factor controller

NASA Astrophysics Data System (ADS)

Diniş, C. M.; Cunţan, C. D.; Rob, R. O. S.; Popa, G. N.

2018-01-01

The paper presents the analysis of a power factor with capacitors banks, without series coils, used for improving power factor for a three-phase and single-phase inductive loads. In the experimental measurements, to improve the power factor, the Roederstein ESTAmat RPR power factor controller can command up to twelve capacitors banks, while experimenting using only six capacitors banks. Six delta capacitors banks with approximately equal reactive powers were used for experimentation. The experimental measurements were carried out with a three-phase power quality analyser which worked in three cases: a case without a controller with all capacitors banks permanently parallel connected with network, and two other cases with power factor controller (one with setting power factor at 0.92 and the other one at 1). When performing experiments with the power factor controller, a current transformer was used to measure the current on one phase (at a more charged or less loaded phase).

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

Capacity and reliability analyses with applications to power quality

NASA Astrophysics Data System (ADS)

Azam, Mohammad; Tu, Fang; Shlapak, Yuri; Kirubarajan, Thiagalingam; Pattipati, Krishna R.; Karanam, Rajaiah

2001-07-01

The deregulation of energy markets, the ongoing advances in communication networks, the proliferation of intelligent metering and protective power devices, and the standardization of software/hardware interfaces are creating a dramatic shift in the way facilities acquire and utilize information about their power usage. The currently available power management systems gather a vast amount of information in the form of power usage, voltages, currents, and their time-dependent waveforms from a variety of devices (for example, circuit breakers, transformers, energy and power quality meters, protective relays, programmable logic controllers, motor control centers). What is lacking is an information processing and decision support infrastructure to harness this voluminous information into usable operational and management knowledge to handle the health of their equipment and power quality, minimize downtime and outages, and to optimize operations to improve productivity. This paper considers the problem of evaluating the capacity and reliability analyses of power systems with very high availability requirements (e.g., systems providing energy to data centers and communication networks with desired availability of up to 0.9999999). The real-time capacity and margin analysis helps operators to plan for additional loads and to schedule repair/replacement activities. The reliability analysis, based on computationally efficient sum of disjoint products, enables analysts to decide the optimum levels of redundancy, aids operators in prioritizing the maintenance options for a given budget and monitoring the system for capacity margin. The resulting analytical and software tool is demonstrated on a sample data center.

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

PubMed

Dunagan, Pamela B

2017-12-01

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.

Improvement of Baltic proper water quality using large-scale ecological engineering.

PubMed

Stigebrandt, Anders; Gustafsson, Bo G

2007-04-01

Eutrophication of the Baltic proper has led to impaired water quality, demonstrated by, e.g., extensive blooming of cyanobacteria during the premium summer holiday season and severe oxygen deficit in the deepwater. Sustainable improvements in water quality by the reduction of phosphorus (P) supplies will take several decades before giving full effects because of large P storages both in soils in the watershed and in the water column and bottom sediments of the Baltic proper. In this article it is shown that drastically improved water quality may be obtained within a few years using large-scale ecological engineering methods. Natural variations in the Baltic proper during the last decades have demonstrated how rapid improvements may be achieved. The present article describes the basic dynamics of P, organic matter, and oxygen in the Baltic proper. It also briefly discusses the advantages and disadvantages of different classes of methods of ecological engineering aimed at restoring the Baltic proper from eutrophication effects. Preliminary computations show that the P content might be halved within a few years if about 100 kg O2 s(-1) are supplied to the upper deepwater. This would require 100 pump stations, each transporting about 100 m3 s(-1) of oxygen-rich so-called winter water from about 50 to 125 m depth where the water is released as a buoyant jet. Each pump station needs a power supply of 0.6 MW. Offshore wind power technology seems mature enough to provide the power needed by the pump stations. The cost to install 100 wind-powered pump stations, each with 0.6 MW power, at about 125-m depth is about 200 million Euros.

Development of Real Time Implementation of 5/5 Rule based Fuzzy Logic Controller Shunt Active Power Filter for Power Quality Improvement

NASA Astrophysics Data System (ADS)

Puhan, Pratap Sekhar; Ray, Pravat Kumar; Panda, Gayadhar

2016-12-01

This paper presents the effectiveness of 5/5 Fuzzy rule implementation in Fuzzy Logic Controller conjunction with indirect control technique to enhance the power quality in single phase system, An indirect current controller in conjunction with Fuzzy Logic Controller is applied to the proposed shunt active power filter to estimate the peak reference current and capacitor voltage. Current Controller based pulse width modulation (CCPWM) is used to generate the switching signals of voltage source inverter. Various simulation results are presented to verify the good behaviour of the Shunt active Power Filter (SAPF) with proposed two levels Hysteresis Current Controller (HCC). For verification of Shunt Active Power Filter in real time, the proposed control algorithm has been implemented in laboratory developed setup in dSPACE platform.

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality

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

Power Quality and Reliability Project

NASA Technical Reports Server (NTRS)

Attia, John O.

2001-01-01

One area where universities and industry can link is in the area of power systems reliability and quality - key concepts in the commercial, industrial and public sector engineering environments. Prairie View A&M University (PVAMU) has established a collaborative relationship with the University of'Texas at Arlington (UTA), NASA/Johnson Space Center (JSC), and EP&C Engineering and Technology Group (EP&C) a small disadvantage business that specializes in power quality and engineering services. The primary goal of this collaboration is to facilitate the development and implementation of a Strategic Integrated power/Systems Reliability and Curriculum Enhancement Program. The objectives of first phase of this work are: (a) to develop a course in power quality and reliability, (b) to use the campus of Prairie View A&M University as a laboratory for the study of systems reliability and quality issues, (c) to provide students with NASA/EPC shadowing and Internship experience. In this work, a course, titled "Reliability Analysis of Electrical Facilities" was developed and taught for two semesters. About thirty seven has benefited directly from this course. A laboratory accompanying the course was also developed. Four facilities at Prairie View A&M University were surveyed. Some tests that were performed are (i) earth-ground testing, (ii) voltage, amperage and harmonics of various panels in the buildings, (iii) checking the wire sizes to see if they were the right size for the load that they were carrying, (iv) vibration tests to test the status of the engines or chillers and water pumps, (v) infrared testing to the test arcing or misfiring of electrical or mechanical systems.

Improving the beam quality of high-power laser diodes by introducing lateral periodicity into waveguides

NASA Astrophysics Data System (ADS)

Sobczak, Grzegorz; DÄ browska, ElŻbieta; Teodorczyk, Marian; Kalbarczyk, Joanna; MalÄ g, Andrzej

2013-01-01

Low quality of the optical beam emitted by high-power laser diodes is the main disadvantage of these devices. The two most important reasons are highly non-Gaussian beam profile with relatively wide divergence in the junction plane and the filamentation effect. Designing laser diode as an array of narrow, close to each other single-mode waveguides is one of the solutions to this problem. In such devices called phase locked arrays (PLA) there is no room for filaments formation. The consequence of optical coupling of many single-mode waveguides is the device emission in the form of few almost diffraction limited beams. Because of losses in regions between active stripes the PLA devices have, however, somewhat higher threshold current and lower slope efficiencies compared to wide-stripe devices of similar geometry. In this work the concept of the high-power laser diode resonator consisted of joined PLA and wide stripe segments is proposed. Resulting changes of electro-optical characteristics of PLA are discussed. The devices are based on the asymmetric heterostructure designed for improvement of the catastrophic optical damage threshold as well as thermal and electrical resistances. Due to reduced distance from the active layer to surface in this heterostructure, better stability of current (and gain) distribution with changing drive level is expected. This could lead to better stability of optical field distribution and supermodes control. The beam divergence reduction in the direction perpendicular of the junction plane has been also achieved.

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

Quality Improvement Poster

DTIC Science & Technology

2017-03-30

FROM: 59 MDW/SGYU SUBJECT: Professional Presentation Approval 9 MAR 2017 1. Your paper, entitled Quality Improvement Poster presented at/published...to Improving Outpatient Recognition of VTE in the Ambulatory Setting (Poster) & American College of Physicians Internal Medicine Meeting, San Diego...information so that we can provide quality support for you, your department, and the Medical Center commander. This information is used to document the

An evaluation method of power quality about electrified railways connected to power grid based on PSCAD/EMTDC

NASA Astrophysics Data System (ADS)

Liang, Weibin; Ouyang, Sen; Huang, Xiang; Su, Weijian

2017-05-01

The existing modeling process of power quality about electrified railways connected to power grid is complicated and the simulation scene is incomplete, so this paper puts forward a novel evaluation method of power quality based on PSCAD/ETMDC. Firstly, a model of power quality about electrified railways connected to power grid is established, which is based on testing report or measured data. The equivalent model of electrified locomotive contains power characteristic and harmonic characteristic, which are substituted by load and harmonic source. Secondly, in order to make evaluation more complete, an analysis scheme has been put forward. The scheme uses a combination of three-dimensions of electrified locomotive, which contains types, working conditions and quantity. At last, Shenmao Railway is taken as example to evaluate the power quality at different scenes, and the result shows electrified railways connected to power grid have significant effect on power quality.

Accelerate Water Quality Improvement

EPA Pesticide Factsheets

EPA is committed to accelerating water quality improvement and minimizing negative impacts to aquatic life from contaminants and other stressors in the Bay Delta Estuary by working with California Water Boards to strengthen water quality improvement plans.

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.

Assessment and mitigation of power quality problems for PUSPATI TRIGA Reactor (RTP)

NASA Astrophysics Data System (ADS)

Zakaria, Mohd Fazli; Ramachandaramurthy, Vigna K.

2017-01-01

An electrical power systems are exposed to different types of power quality disturbances. Investigation and monitoring of power quality are necessary to maintain accurate operation of sensitive equipment especially for nuclear installations. This paper will discuss the power quality problems observed at the electrical sources of PUSPATI TRIGA Reactor (RTP). Assessment of power quality requires the identification of any anomalous behavior on a power system, which adversely affects the normal operation of electrical or electronic equipment. A power quality assessment involves gathering data resources; analyzing the data (with reference to power quality standards) then, if problems exist, recommendation of mitigation techniques must be considered. Field power quality data is collected by power quality recorder and analyzed with reference to power quality standards. Normally the electrical power is supplied to the RTP via two sources in order to keep a good reliability where each of them is designed to carry the full load. The assessment of power quality during reactor operation was performed for both electrical sources. There were several disturbances such as voltage harmonics and flicker that exceeded the thresholds. To reduce these disturbances, mitigation techniques have been proposed, such as to install passive harmonic filters to reduce harmonic distortion, dynamic voltage restorer (DVR) to reduce voltage disturbances and isolate all sensitive and critical loads.

Tube focal spot size and power capability impact image quality in the evaluation of intracoronary stents

NASA Astrophysics Data System (ADS)

Cesmeli, Erdogan; Berry, Joel L.; Carr, J. J.

2005-04-01

Proliferation of coronary stent deployment for treatment of coronary heart disease (CHD) creates a need for imaging-based follow-up examinations to assess patency. Technological improvements in multi-detector computer tomography (MDCT) make it a potential non-invasive alternative to coronary catheterization for evaluation of stent patency; however, image quality with MDCT varies based on the size and composition of the stent. We studied the role of tube focal spot size and power in the optimization of image quality in a stationary phantom. A standard uniform physical phantom with a tubular insert was used where coronary stents (4 mm in diameter) were deployed in a tube filled with contrast to simulate a typical imaging condition observed in clinical practice. We utilized different commercially available stents and scanned them with different tube voltage and current settings (LightSpeed Pro16, GE Healthcare Technologies, Waukesha, WI, USA). The scanner used different focal spot size depending on the power load and thus allowed us to assess the combined effect of the focal spot size and the power. A radiologist evaluated the resulting images in terms of image quality and artifacts. For all stents, we found that the small focal spot size yielded better image quality and reduced artifacts. In general, higher power capability for the given focal spot size improved the signal-to-noise ratio in the images allowing improved assessment. Our preliminary study in a non-moving phantom suggests that a CT scanner that can deliver the same power on a small focal spot size is better suited to have an optimized scan protocol for reliable stent assessment.

"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.

Gaining customer knowledge: obtaining and using customer judgments for hospitalwide quality improvement.

PubMed

Nelson, E C; Caldwell, C; Quinn, D; Rose, R

1991-03-01

Customer knowledge is an essential feature of hospitalwide quality improvement. All systems and processes have customers. The aim is to use customer knowledge and voice of the customer measurement to plan, design, improve, and monitor these systems and processes continuously. In this way, the hospital stands the best chance of meeting customers' needs and, hopefully, delivering services that are so outstanding that customers will be surprised and delighted. There are many methods, both soft and hard, that can be used to increase customer knowledge. One useful strategy is to use a family of quality measures that reflect the voice of the customer. These measures can generate practical and powerful customer knowledge information that is essential to performing strategic planning, deploying quality policy, designing new services, finding targets for improvements, and monitoring those continuous improvements based on customers' judgments.

Gender, marital power, and marital quality in later life.

PubMed

Bulanda, Jennifer Roebuck

2011-01-01

This study uses data from the 1992 Health and Retirement Study to examine gender differences in marital power and marital quality among older adults and to assess whether there are gender differences in the correlates of marital quality and marital power in later life. Results show that women report lower marital happiness, marital interaction, and marital power than do men, on average. These differences persist even after controlling for a number of life-course events and transitions. Further, results show that gender differences are also evident in the relationship of employment, childrearing, caregiving, and health factors with marital quality and power.

The role of clinical governance as a strategy for quality improvement in primary care.

PubMed Central

Campbell, Stephen M; Sweeney, Grace M

2002-01-01

This power considers the process of implementing clinical governance in primary care and its impact on quality improvement. It discuss how clinical governance is being implemented both at the level of Primary Care Organisations and general practices, and the challenges to implementing clinical governance. It also suggests a model for promoting the factors that will help clinical governance improve quality of care. The experience of implementing clinical governance is broadly positive to date. However, the government needs to match its commitment to a ten-year programme of change with realistic timetables to secure the cultural and organisational changes needed to improve quality of care. PMID:12389764

Pilot evaluation of electricity-reliability and power-quality monitoring in California's Silicon Valley with the I-Grid(R) system

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

Eto, Joseph; Divan, Deepak; Brumsickle, William

2004-02-01

Power-quality events are of increasing concern for the economy because today's equipment, particularly computers and automated manufacturing devices, is susceptible to these imperceptible voltage changes. A small variation in voltage can cause this equipment to shut down for long periods, resulting in significant business losses. Tiny variations in power quality are difficult to detect except with expensive monitoring equipment used by trained technicians, so many electricity customers are unaware of the role of power-quality events in equipment malfunctioning. This report describes the findings from a pilot study coordinated through the Silicon Valley Manufacturers Group in California to explore the capabilitiesmore » of I-Grid(R), a new power-quality monitoring system. This system is designed to improve the accessibility of power-quality in formation and to increase understanding of the growing importance of electricity reliability and power quality to the economy. The study used data collected by I-Grid sensors at seven Silicon Valley firms to investigate the impacts of power quality on individual study participants as well as to explore the capabilities of the I-Grid system to detect events on the larger electricity grid by means of correlation of data from the sensors at the different sites. In addition, study participants were interviewed about the value they place on power quality, and their efforts to address electricity-reliability and power-quality problems. Issues were identified that should be taken into consideration in developing a larger, potentially nationwide, network of power-quality sensors.« less

International water and steam quality standards on thermal power plants at all-volatile treatment

NASA Astrophysics Data System (ADS)

Petrova, T. I.; Orlov, K. A.; Dooley, R. B.

2016-12-01

One of the methods for the improvement of reliability and efficiency of the equipment at heat power plants is the decrease in the rate of corrosion of structural materials and sedimentation in water/steam circuit. These processes can be reduced to minimum by using the water with low impurity content and coolant treatment. For many years, water and steam quality standards were developed in various countries (United States, Germany, Japan, etc.) for specific types of equipment. The International Association for the Properties of Water and Steam (IAPWS), which brings together specialists from 21 countries, developed the water and steam quality standards for various types of power equipment based on theoretical studies and long-term operating experience of power equipment. Recently, various water-chemistry conditions are applied on heatpower equipment including conventional boilers and HRSGs with combined cycle power plants (Combined Cycle Power Plants (CCPP)). In paper, the maintenance conditions of water chemistry with ammonia or volatile amine dosing are described: reducing AVT(R), oxidizing AVT(O), and oxygen OT. Each of them is provided by the water and steam quality standards and recommendations are given on their maintenance under various operation conditions. It is noted that the quality control of heat carrier must be carried out with a particular care on the HPPs with combined cycle gas turbine units, where frequent starts and halts are performed.

PQScal (Power Quality Score Calculation for Distribution Systems with DER Integration)

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

Power Quality is of great importance to evaluate the “health” of a distribution system, especially when the distributed energy resource (DER) penetration becomes more significant. The individual components that make up power quality, such as voltage magnitude and unbalance, can be measured in simulations or in the field, however, a comprehensive method to incorporate all of these values into a single score doesn't exist. As a result, we propose a methodology to quantify the power quality health using the single number value, named as Power Quality Score (PQS). The PQS is dependent on six metrics that are developed based onmore » both components that directly impact power quality and those are often reference in the context of power quality. These six metrics are named as System Average Voltage Magnitude Violation Index (SAVMVI), System Average Voltage Fluctuation Index (SAVFI), System Average Voltage Unbalance Index (SAVUI), System Control Device Operation Index (SCDOI), System Reactive Power Demand Index (SRPDI) and System Energy Loss Index (SELI). This software tool, PQScal, is developed based on this novel PQS methodology. Besides of traditional distribution systems, PQScal can also measure the power quality for distribution systems with various DER penetrations. PQScal has been tested on two utility distribution feeders with distinct model characteristics and its effectiveness has been proved. In sum, PQScal can help utilities or other parties to measure the power quality of distribution systems with DER integration easily and effectively.« less

Taking health care back: the physician's role in quality improvement.

PubMed

Becher, Elise C; Chassin, Mark R

2002-10-01

Physicians now enjoy a moment of tactical advantage in the evolution of the struggle for control over health care in the United States. The most effective way to capitalize on this-perhaps fleeting-position and to more permanently alter the balance of power in their favor is for physicians to establish strong and visionary leadership in health care quality improvement. Such an undertaking, if successful, could place the very essence of health care-defining, measuring, and improving its quality-in the hands of physicians. To succeed requires understanding the relationships between the different kinds of quality problems that plague our health care system, the various kinds of errors that lead to them, and how amenable these different kinds of errors may be to different interventions. The authors delineate a conceptual framework that describes these relationships, as well as their implications for conducting effective and durable quality improvement. The authors then illustrate how physicians could engage in this activity in three different settings: a four-or-five-physician primary care practice, a 50-physician multispecialty group, and a 450-bed community hospital. Finally, the authors submit that now is an opportune time for physicians and the organizations they direct or guide to take the leadership role in conducting health care quality improvement. Realizing the opportunity will require dedicating significant resources and changing traditional approaches to quality, but in so doing, physicians can regain much of the autonomy over the practice of medicine previously lost to government and managed care.

Structured data quality reports to improve EHR data quality.

PubMed

Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

2015-12-01

To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (p<0.01) over 12 months, but was not sufficient to comply with RACGP standards. Improvement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

PubMed

Cho, Yu Kyung

2016-07-01

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

Creating Quality Improvement Culture in Public Health Agencies

PubMed Central

Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

Creating quality improvement culture in public health agencies.

PubMed

Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

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.

Use of national surgical quality improvement program data as a catalyst for quality improvement.

PubMed

Rowell, Katherine S; Turrentine, Florence E; Hutter, Matthew M; Khuri, Shukri F; Henderson, William G

2007-06-01

Semiannually, the National Surgical Quality Improvement Program (NSQIP) provides its participating sites with observed-to-expected (O/E) ratios for 30-day postoperative mortality and morbidity. At each reporting period, there is typically a small group of hospitals with statistically significantly high O/E ratios, meaning that their patients have experienced more adverse events than would be expected on the basis of the population characteristics. An important issue is to determine which actions a surgical service should take in the presence of a high O/E ratio. This article reviews case studies of how some of the Department of Veterans Affairs and private-sector NSQIP participating sites used the clinically rich NSQIP database for local quality improvement efforts. Data on postoperative adverse events before and after these local quality improvement efforts are presented. After local quality improvement efforts, wound complication rates were reduced at the Salt Lake City Veterans Affairs medical center by 47%, surgical site infections in patients undergoing intraabdominal surgery were reduced at the University of Virginia by 36%, and urinary tract infections in vascular patients were reduced at the Massachusetts General Hospital by 74%. At some sites participating in the NSQIP, notably the Massachusetts General Hospital and the University of Virginia, the NSQIP has served as the basis for surgical service-wide outcomes research and quality improvement programs. The NSQIP not only provides participating sites with risk-adjusted surgical mortality and morbidity outcomes semiannually, but the clinically rich NSQIP database can also serve as a catalyst for local quality improvement programs to significantly reduce postoperative adverse event rates.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

PubMed

Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

2018-06-01

The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

Power Profiles and In Vitro Optical Quality of Scleral Contact Lenses: Effect of the Aperture and Power.

PubMed

Domínguez-Vicent, Alberto; Esteve-Taboada, Jose Juan; Recchioni, Alberto; Brautaset, Rune

2018-05-01

To assess the power profile and in vitro optical quality of scleral contact lenses with different powers as a function of the optical aperture. The mini and semiscleral contact lenses (Procornea) were measured for five powers per design. The NIMO TR-1504 (Lambda-X) was used to assess the power profile and Zernike coefficients of each contact lens. Ten measurements per lens were taken at 3- and 6-mm apertures. Furthermore, the optical quality of each lens was described in Zernike coefficients, modulation transfer function, and point spread function (PSF). A convolution of each lens PSF with an eye-chart image was also computed. The optical power fluctuated less than 0.5 diopters (D) along the optical zone of each lens. However, the optical power obtained for some lenses did not match with its corresponding nominal one, the maximum difference being 0.5 D. In optical quality, small differences were obtained among all lenses within the same design. Although significant differences were obtained among lenses (P<0.05), these showed small impact in the image quality of each convolution. Insignificant power fluctuations were obtained along the optical zone measured for each scleral lens. Additionally, the optical quality of both lenses has showed to be independent of the lens power within the same aperture.

Harnessing the power of enhanced data for healthcare quality improvement: lessons from a Minnesota Hospital Association Pilot Project.

PubMed

Pine, Michael; Sonneborn, Mark; Schindler, Joe; Stanek, Michael; Maeda, Jared Lane; Hanlon, Carrie

2012-01-01

The imperative to achieve quality improvement and cost-containment goals is driving healthcare organizations to make better use of existing health information. One strategy, the construction of hybrid data sets combining clinical and administrative data, has strong potential to improve the cost-effectiveness of hospital quality reporting processes, improve the accuracy of quality measures and rankings, and strengthen data systems. Through a two-year contract with the Agency for Healthcare Research and Quality, the Minnesota Hospital Association launched a pilot project in 2007 to link hospital clinical information to administrative data. Despite some initial challenges, this project was successful. Results showed that the use of hybrid data allowed for more accurate comparisons of risk-adjusted mortality and risk-adjusted complications across Minnesota hospitals. These increases in accuracy represent an important step toward targeting quality improvement efforts in Minnesota and provide important lessons that are being leveraged through ongoing projects to construct additional enhanced data sets. We explore the implementation challenges experienced during the Minnesota Pilot Project and their implications for hospitals pursuing similar data-enhancement projects. We also highlight the key lessons learned from the pilot project's success.

Beam quality improvement by population-dynamic-coupled combined guiding effect in end-pumped Nd:YVO4 laser oscillator

NASA Astrophysics Data System (ADS)

Shen, Yijie; Gong, Mali; Fu, Xing

2018-05-01

Beam quality improvement with pump power increasing in an end-pumped laser oscillator is experimentally realized for the first time, to the best of our knowledge. The phenomenon is caused by the population-dynamic-coupled combined guiding effect, a comprehensive theoretical model of which has been well established, in agreement with the experimental results. Based on an 888 nm in-band dual-end-pumped oscillator using four tandem Nd:YVO4 crystals, the output beam quality of M^2= 1.1/1.1 at the pump power of 25 W is degraded to M^2 = 2.5/1.8 at 75 W pumping and then improved to M^2= 1.8/1.3 at 150 W pumping. The near-TEM_{00} mode is obtained with the highest continuous-wave output power of 72.1 W and the optical-to-optical efficiency of 48.1%. This work demonstrates great potential to further scale the output power of end-pumped laser oscillator while keeping good beam quality.

Do Clinical Practice Guidelines Improve Quality?

PubMed

Baldassari, Cristina M

2017-07-01

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

Power transformation for enhancing responsiveness of quality of life questionnaire.

PubMed

Zhou, YanYan Ange

2015-01-01

We investigate the effect of power transformation of raw scores on the responsiveness of quality of life survey. The procedure maximizes the paired t-test value on the power transformed data to obtain an optimal power range. The parallel between the Box-Cox transformation is also investigated for the quality of life data.

The Quality of Randomized Controlled Trials in Pediatric Orthopaedics: Are We Improving?

PubMed

Dodwell, Emily; Dua, Shiv; Dulai, Sukhdeep K; Astone, Kristina; Mulpuri, Kishore

2015-01-01

The quality of randomized controlled trials (RCTs) in orthopaedics is a topic of considerable importance, as RCTs play a major role in guiding clinical practice. The quality of RCTs published between 1995 and 2005 has previously been documented. The purpose of the current study was to assess and describe the quality of pediatric orthopaedic RCTs published from 2005 to 2012, by identifying study characteristics associated with higher quality and outlining areas for improvement. A standardized literature search was used to identify pediatric orthopaedic RCTs published in 7 well-recognized journals between September 2005 and July 2012 inclusive. The Detsky Quality Assessment Scale and the CONSORT checklist for Non-Pharmacologic Trials were used to assess the quality of the RCTs. Scores for the Detsky and CONSORT were calculated by 2 independent blinded orthopaedic surgeon reviewers with epidemiologic training. Forty RCTs were included in this analysis. The mean percentage score on the Detsky quality scale was 67%. Sixteen (40%) of the articles satisfied the threshold for a satisfactory level of methodological quality (Detsky >75%). Twenty-five (63%) of these studies were negative studies, concluding no difference between treatment arms. In 52% of the negative studies, an a priori sample size analysis was absent, and 28% were self-described as underpowered. In multiple variable regression analysis, only working with a statistician was significantly associated with higher Detsky percentage scores (P=0.01). There is a trend for improving quality in pediatric orthopaedic RCTs. Compared with past reports, the mean Detsky score improved from 53% to 67%, and the proportion meeting an acceptable level of quality improved from 19% to 40%. One of the most concerning findings of this study was the lack of attention to sample size and power analysis, and the potential for underpowered studies. Ongoing efforts are necessary to improve the conduct and reporting of clinical trials

Imaging Arrays With Improved Transmit Power Capability

PubMed Central

Zipparo, Michael J.; Bing, Kristin F.; Nightingale, Kathy R.

2010-01-01

Bonded multilayer ceramics and composites incorporating low-loss piezoceramics have been applied to arrays for ultrasound imaging to improve acoustic transmit power levels and to reduce internal heating. Commercially available hard PZT from multiple vendors has been characterized for microstructure, ability to be processed, and electroacoustic properties. Multilayers using the best materials demonstrate the tradeoffs compared with the softer PZT5-H typically used for imaging arrays. Three-layer PZT4 composites exhibit an effective dielectric constant that is three times that of single layer PZT5H, a 50% higher mechanical Q, a 30% lower acoustic impedance, and only a 10% lower coupling coefficient. Application of low-loss multilayers to linear phased and large curved arrays results in equivalent or better element performance. A 3-layer PZT4 composite array achieved the same transmit intensity at 40% lower transmit voltage and with a 35% lower face temperature increase than the PZT-5 control. Although B-mode images show similar quality, acoustic radiation force impulse (ARFI) images show increased displacement for a given drive voltage. An increased failure rate for the multilayers following extended operation indicates that further development of the bond process will be necessary. In conclusion, bonded multilayer ceramics and composites allow additional design freedom to optimize arrays and improve the overall performance for increased acoustic output while maintaining image quality. PMID:20875996

A new approach to power quality and electricity reliability monitoring-case study illustrations of the capabilities of the I-GridTM system

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

Divan, Deepak; Brumsickle, William; Eto, Joseph

2003-04-01

This report describes a new approach for collecting information on power quality and reliability and making it available in the public domain. Making this information readily available in a form that is meaningful to electricity consumers is necessary for enabling more informed private and public decisions regarding electricity reliability. The system dramatically reduces the cost (and expertise) needed for customers to obtain information on the most significant power quality events, called voltage sags and interruptions. The system also offers widespread access to information on power quality collected from multiple sites and the potential for capturing information on the impacts ofmore » power quality problems, together enabling a wide variety of analysis and benchmarking to improve system reliability. Six case studies demonstrate selected functionality and capabilities of the system, including: Linking measured power quality events to process interruption and downtime; Demonstrating the ability to correlate events recorded by multiple monitors to narrow and confirm the causes of power quality events; and Benchmarking power quality and reliability on a firm and regional basis.« less

"Power quality system," a new system of quality management for globalization: towards innovation and competitive advantages.

PubMed

Abdul-Rahman, H; Berawi, M A

Knowledge Management (KM) addresses the critical issues of organizational adoption, survival and competence in the face of an increasingly changing environment. KM embodies organizational processes that seek a synergistic combination of the data and information processing capabilities of information and communication technologies (ICT), and the creative and innovative capacity of human beings to improve ICT In that role, knowledge management will improve quality management and avoid or minimize losses and weakness that usually come from poor performance as well as increase the competitive level of the company and its ability to survive in the global marketplace. To achieve quality, all parties including the clients, company consultants, contractors, entrepreneurs, suppliers, and the governing bodies (i.e., all involved stake-holders) need to collaborate and commit to achieving quality. The design based organizations in major business and construction companies have to be quality driven to support healthy growth in today's competitive market. In the march towards vision 2020 and globalization (i.e., the one world community) of many companies, their design based organizations need to have superior quality management and knowledge management to anticipate changes. The implementation of a quality system such as the ISO 9000 Standards, Total Quality Management, or Quality Function Deployment (QFD) focuses the company's resources towards achieving faster and better results in the global market with less cost. To anticipate the needs of the marketplace and clients as the world and technology change, a new system, which we call Power Quality System (PQS), has been designed. PQS is a combination of information and communication technologies (ICT) and the creative and innovative capacity of human beings to meet the challenges of the new world business and to develop high quality products.

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

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

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

Helping each other grow: romantic partner support, self-improvement, and relationship quality.

PubMed

Overall, Nickola C; Fletcher, Garth J O; Simpson, Jeffry A

2010-11-01

This research tested whether and how partners' support of self-improvement efforts influences recipients' relationship evaluations and self-improvement success. Study 1 provided an initial test of predictions using self-reports (N = 150). Study 2 assessed support behavior exhibited in couples' (N = 47) discussions of self-improvement desires, and tracked relationship quality and self-improvement every 3 months for 1 year. More nurturing and action-facilitating partner support was more helpful to recipients, whereas partners who criticized and invalidated recipients were less helpful. Receiving more help from the partner, in turn, predicted greater relationship quality and more self-improvement. More negative support seeking also predicted lower self-improvement because recipients' behavior elicited less partner help. These effects were not attributable to partners' general warmth and understanding, global self or relationship evaluations, how much recipients desired or tried to change, or whether targeted attributes posed relationship problems. This research documents the powerful influence that partners' help has on recipients' personal growth.

Reduction technique of drop voltage and power losses to improve power quality using ETAP Power Station simulation model

NASA Astrophysics Data System (ADS)

Satrio, Reza Indra; Subiyanto

2018-03-01

The effect of electric loads growth emerged direct impact in power systems distribution. Drop voltage and power losses one of the important things in power systems distribution. This paper presents modelling approach used to restructrure electrical network configuration, reduce drop voltage, reduce power losses and add new distribution transformer to enhance reliability of power systems distribution. Restructrure electrical network was aimed to analyse and investigate electric loads of a distribution transformer. Measurement of real voltage and real current were finished two times for each consumer, that were morning period and night period or when peak load. Design and simulation were conduct by using ETAP Power Station Software. Based on result of simulation and real measurement precentage of drop voltage and total power losses were mismatch with SPLN (Standard PLN) 72:1987. After added a new distribution transformer and restructrured electricity network configuration, the result of simulation could reduce drop voltage from 1.3 % - 31.3 % to 8.1 % - 9.6 % and power losses from 646.7 watt to 233.29 watt. Result showed, restructrure electricity network configuration and added new distribution transformer can be applied as an effective method to reduce drop voltage and reduce power losses.

Development of an expert system for power quality advisement using CLIPS 6.0

NASA Technical Reports Server (NTRS)

Chandrasekaran, A.; Sarma, P. R. R.; Sundaram, Ashok

1994-01-01

Proliferation of power electronic devices has brought in its wake both deterioration in and demand for quality power supply from the utilities. The power quality problems become apparent when the user's equipment or systems maloperate or fail. Since power quality concerns arise from a wide variety of sources and the problem fixes are better achieved from the expertise of field engineers, development of an expert system for power quality advisement seems to be a very attractive and cost-effective solution for utility applications. An expert system thus developed gives an understanding of the adverse effects of power quality related problems on the system and could help in finding remedial solutions. The paper reports the design of a power quality advisement expert system being developed using CLIPS 6.0. A brief outline of the power quality concerns is first presented. A description of the knowledge base is next given and details of actual implementation include screen output from the program.

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...

The Impact of Transformer Winding Connections of A Grid-Connected PV on Voltage Quality Improvement

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

Muljadi, Eduard; Tumbelaka, Hanny H.; Gao, Wenzhong

In this paper, the high-power PV plant is connected to the weak grid by means of a three-phase power transformer. The selection of transformer winding connection is critical especially when the PV inverter has a reactive power controller. In general, transformer winding connection can be arranged in star-star (with neutral earthed) or star-delta. The reactive power controller supports voltage regulation of the power system particularly under transient faults. Its control strategy is based on utilizing the grid currents to make a three-phase reactive unbalanced current with a small gain. The gain is determined by the system impedance. Simulation results exhibitmore » that the control strategy works very well particularly under disturbance conditions when the transformer winding connection is star-star with both neutrals grounded. The power quality in terms of the voltage quality is improved.« less

Does competition improve health care quality?

PubMed

Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

2008-12-01

To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey(R) (CAHPS) data (calendar years 1998-2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement.

Narrative methods in quality improvement research

PubMed Central

Greenhalgh, T; Russell, J; Swinglehurst, D

2005-01-01



 This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research—narrative interview; naturalistic story gathering; organisational case study; and collective sense-making—and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

Power System Transient Stability Improvement by the Interline Power Flow Controller (IPFC)

NASA Astrophysics Data System (ADS)

Zhang, Jun; Yokoyama, Akihiko

This paper presents a study on the power system transient stability improvement by means of interline power flow controller (IPFC). The power injection model of IPFC in transient analysis is proposed and can be easily incorporated into existing power systems. Based on the energy function analysis, the operation of IPFC should guarantee that the time derivative of the global energy of the system is not greater than zero in order to damp the electromechanical oscillations. Accordingly, control laws of IPFC are proposed for its application to the single-machine infinite-bus (SMIB) system and the multimachine systems, respectively. Numerical simulations on the corresponding model power systems are presented to demonstrate their effectiveness in improving power system transient stability.

Total Quality Education: Profiles of Schools That Demonstrate the Power of Deming's Management Principles.

ERIC Educational Resources Information Center

Schmoker, Michael J.; Wilson, Richard B.

This book presents profiles of schools that have demonstrated the power of Deming's Total Quality Management (TQM) principles. It describes schools that have successfully applied those strategies for change. The book explores what public education needs most--a compelling but flexible action plan for improvement. Chapter 1 offers a rationale for…

Evaluating an integrated approach to clinical quality improvement: clinical guidelines, quality measurement, and supportive system design.

PubMed

Cretin, S; Farley, D O; Dolter, K J; Nicholas, W

2001-08-01

Implementing clinical practice guidelines to change patient outcomes presents a challenge. Studies of single interventions focused on changing provider behavior demonstrate modest effects, suggesting that effective guideline implementation requires a multifaceted approach. Traditional biomedical research designs are not well suited to evaluating systems interventions. RAND and the Army Medical Department collaborated to develop and evaluate a system for implementing guidelines and documenting their effects on patient care. The evaluation design blended quality improvement, case study, and epidemiologic methods. A formative evaluation of implementation process and an outcome evaluation of patient impact were combined. Guidelines were implemented in 3 successive demonstrations targeting low back pain, asthma, and diabetes. This paper reports on the first wave of 4 facilities implementing a low back pain guideline. Organizational climate and culture, motivation, leadership commitment, and resources were assessed. Selected indicators of processes and outcomes of care were compared before, during, and after guideline implementation at the demonstration facilities and at comparison facilities. Logistic regression analysis was used to test for guideline effects on patient care. Process evaluation documented varied approaches to quality improvement across sites. Outcome evaluation revealed a significant downward trend in the percentage of acute low back pain patients referred to physical therapy or chiropractic care (10.7% to 7.2%) at demonstration sites and no such trend at control sites. Preliminary results suggest the power of this design to stimulate improvements in guideline implementation while retaining the power to evaluate rigorously effects on patient care.

The quality improvement strategy.

PubMed

Burns, L R; Beach, L R

1994-01-01

To prepare for managed competition, many hospitals now focus on service quality as a means to improve their competitive position. To aid in decisions about where best to direct limited resources, managers need physician feedback about how the hospital's services compare with its competitors' services (competitive advantage) and about the degree to which the hospital's services fall short of, meet, or exceed physicians' expectations (customer satisfaction). This article describes a strategy for acquiring information about competitive advantage and customer satisfaction and for using the information to identify optimal service improvement opportunities. It then presents a step-by-step application of the Quality Improvement Strategy (QIS) for a large urban hospital.

Anomaly Detection in Power Quality at Data Centers

NASA Technical Reports Server (NTRS)

Grichine, Art; Solano, Wanda M.

2015-01-01

The goal during my internship at the National Center for Critical Information Processing and Storage (NCCIPS) is to implement an anomaly detection method through the StruxureWare SCADA Power Monitoring system. The benefit of the anomaly detection mechanism is to provide the capability to detect and anticipate equipment degradation by monitoring power quality prior to equipment failure. First, a study is conducted that examines the existing techniques of power quality management. Based on these findings, and the capabilities of the existing SCADA resources, recommendations are presented for implementing effective anomaly detection. Since voltage, current, and total harmonic distortion demonstrate Gaussian distributions, effective set-points are computed using this model, while maintaining a low false positive count.

Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

PubMed

Branco, Daniel; Wicks, Angela M; Visich, John K

2017-01-01

The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

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…

Development of software to improve AC power quality on large spacecraft

NASA Technical Reports Server (NTRS)

Kraft, L. Alan

1991-01-01

To insure the reliability of a 20 kHz, AC power system on spacecraft, it is essential to analyze its behavior under many adverse operating conditions. Some of these conditions include overloads, short circuits, switching surges, and harmonic distortions. Harmonic distortions can cause malfunctions in equipment that the power system is supplying, and during extreme distortions such as voltage resonance, it can cause equipment and insulation failures due to the extreme peak voltages. HARMFLO, a power flow computer program, which was capable of analyzing harmonic conditions on three phase, balanced, 60 Hz, AC power systems, was modified to analyze single phase, 20 kHz, AC power systems. Since almost all of the equipment used on spacecraft power systems is electrically different from equipment used on terrestrial power systems, it was also necessary to develop mathematical models for the equipment to be used on the spacecraft. The results are that (1) the harmonic power now has a model of a single phase, voltage controlled, full wave rectifier; and (2) HARMFLO was ported to the SUN workstation platform.

Improving high resolution retinal image quality using speckle illumination HiLo imaging

PubMed Central

Zhou, Xiaolin; Bedggood, Phillip; Metha, Andrew

2014-01-01

Retinal image quality from flood illumination adaptive optics (AO) ophthalmoscopes is adversely affected by out-of-focus light scatter due to the lack of confocality. This effect is more pronounced in small eyes, such as that of rodents, because the requisite high optical power confers a large dioptric thickness to the retina. A recently-developed structured illumination microscopy (SIM) technique called HiLo imaging has been shown to reduce the effect of out-of-focus light scatter in flood illumination microscopes and produce pseudo-confocal images with significantly improved image quality. In this work, we adopted the HiLo technique to a flood AO ophthalmoscope and performed AO imaging in both (physical) model and live rat eyes. The improvement in image quality from HiLo imaging is shown both qualitatively and quantitatively by using spatial spectral analysis. PMID:25136486

Improving high resolution retinal image quality using speckle illumination HiLo imaging.

PubMed

Zhou, Xiaolin; Bedggood, Phillip; Metha, Andrew

2014-08-01

Retinal image quality from flood illumination adaptive optics (AO) ophthalmoscopes is adversely affected by out-of-focus light scatter due to the lack of confocality. This effect is more pronounced in small eyes, such as that of rodents, because the requisite high optical power confers a large dioptric thickness to the retina. A recently-developed structured illumination microscopy (SIM) technique called HiLo imaging has been shown to reduce the effect of out-of-focus light scatter in flood illumination microscopes and produce pseudo-confocal images with significantly improved image quality. In this work, we adopted the HiLo technique to a flood AO ophthalmoscope and performed AO imaging in both (physical) model and live rat eyes. The improvement in image quality from HiLo imaging is shown both qualitatively and quantitatively by using spatial spectral analysis.

Leading quality improvement in primary care: recommendations for success.

PubMed

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

2012-09-01

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

Global quality imaging: improvement actions.

PubMed

Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert

2011-05-01

Workforce shortage, workload increase, workplace changes, and budget challenges are emerging issues around the world, which could place quality imaging at risk. It is important for imaging stakeholders to collaborate, ensure patient safety, improve the quality of care, and address these issues. There is no single panacea. A range of improvement measures, strategies, and actions are required. Examples of improvement actions supporting the 3 quality measures are described under 5 strategies: conducting research, promoting awareness, providing education and training, strengthening infrastructure, and implementing policies. The challenge is to develop long-term, cost-effective, system-based improvement actions that will bring better outcomes and underpin a sustainable future for quality imaging. In an imaging practice, these actions will result in selecting the right procedure (justification), using the right dose (optimization), and preventing errors along the patient journey. To realize this vision and implement these improvement actions, a range of expertise and adequate resources are required. Stakeholders should collaborate and work together. In today's globalized environment, collaboration is strength and provides synergy to achieve better outcomes and greater success. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Power and the Association with Relationship Quality in South African Couples: Implications for HIV/AIDS Interventions

PubMed Central

Conroy, Amy A.; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O.; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A.

2016-01-01

Introduction Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. Methods This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012–2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners’ perceptions of power influences their own (i.e., actor effect) and their partner’s reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). Results For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women’s reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men’s reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women’s reports of intimacy and negatively associated with women’s reports of conflict. Conclusions Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions.

PubMed

Conroy, Amy A; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A

2016-03-01

Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict. Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also

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.

Improving quality of care in substance abuse treatment using five key process improvement principles

PubMed Central

Hoffman, Kim A.; Green, Carla A.; Ford, James H.; Wisdom, Jennifer P.; Gustafson, David H.; McCarty, Dennis

2012-01-01

Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: 1) Understand and involve the customer; 2) Fix key problems; 3) Pick a powerful change leader; 4) Get ideas from outside the organization; and 5) Use rapid-cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate application of each principle. Results suggest that the most successful organizations integrate and apply most, if not all, of the five principles as they develop and test change strategies. PMID:22282129

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

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

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

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...

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

Evaluation of quality improvement programmes

PubMed Central

Ovretveit, J; Gustafson, D

2002-01-01



 In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement. PMID:12486994

The N-Pact Factor: Evaluating the Quality of Empirical Journals with Respect to Sample Size and Statistical Power

PubMed Central

Fraley, R. Chris; Vazire, Simine

2014-01-01

The authors evaluate the quality of research reported in major journals in social-personality psychology by ranking those journals with respect to their N-pact Factors (NF)—the statistical power of the empirical studies they publish to detect typical effect sizes. Power is a particularly important attribute for evaluating research quality because, relative to studies that have low power, studies that have high power are more likely to (a) to provide accurate estimates of effects, (b) to produce literatures with low false positive rates, and (c) to lead to replicable findings. The authors show that the average sample size in social-personality research is 104 and that the power to detect the typical effect size in the field is approximately 50%. Moreover, they show that there is considerable variation among journals in sample sizes and power of the studies they publish, with some journals consistently publishing higher power studies than others. The authors hope that these rankings will be of use to authors who are choosing where to submit their best work, provide hiring and promotion committees with a superior way of quantifying journal quality, and encourage competition among journals to improve their NF rankings. PMID:25296159

International quality improvement initiatives.

PubMed

Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

2017-12-01

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

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.

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.…

A continuous quality improvement project to improve the quality of cervical Papanicolaou smears.

PubMed

Burkman, R T; Ward, R; Balchandani, K; Kini, S

1994-09-01

To improve the quality of cervical Papanicolaou smears by continuous quality improvement techniques. The study used a Papanicolaou smear data base of over 200,000 specimens collected between June 1988 and December 1992. A team approach employing techniques such as process flow-charting, cause and effect diagrams, run charts, and a randomized trial of collection methods was used to evaluate potential causes of Papanicolaou smear reports with the notation "inadequate" or "less than optimal" due to too few or absent endocervical cells. Once a key process variable (method of collection) was identified, the proportion of Papanicolaou smears with inadequate or absent endocervical cells was determined before and after employment of a collection technique using a spatula and Cytobrush. We measured the rate of less than optimal Papanicolaou smears due to too few or absent endocervical cells. Before implementing the new collection technique fully by June 1990, the overall rate of less than optimal cervical Papanicolaou smears ranged from 20-25%; by December 1993, it had stabilized at about 10%. Continuous quality improvement can be used successfully to study a clinical process and implement change that will lead to improvement.

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.

Quality improvement in neonatal digital radiography: implementing the basic quality improvement tools.

PubMed

Eslamy, Hedieh K; Newman, Beverley; Weinberger, Ed

2014-12-01

A quality improvement (QI) program may be implemented using the plan-do-study-act cycle (as a model for making improvements) and the basic QI tools (used to visually display and analyze variation in data). Managing radiation dose has come to the forefront as a safety goal for radiology departments. This is especially true in the pediatric population, which is more radiosensitive than the adult population. In this article, we use neonatal digital radiography to discuss developing a QI program with the principle goals of decreasing the radiation dose, decreasing variation in radiation dose, and optimizing image quality. Copyright © 2014 Elsevier Inc. All rights reserved.

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2014-10-01 2014-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2013-10-01 2013-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

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.

Tracking and sustaining improvement initiatives: leveraging quality dashboards to lead change in a neurosurgical department.

PubMed

McLaughlin, Nancy; Afsar-Manesh, Nasim; Ragland, Victoria; Buxey, Farzad; Martin, Neil A

2014-03-01

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Department of Neurosurgery created a quality dashboard to help manage process measures and outcomes and ultimately to enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually. It was then reviewed monthly to allow the department to make informed decisions. In 2009, the department leadership worked with the UCLA Medical Center to align mutual quality-improvement priorities. The content of the dashboard was redesigned to include 3 areas of priorities: quality and safety, patient satisfaction, and efficiency and use. Throughout time, the neurosurgery quality dashboard has been recognized for its clarity and its success in helping management direct improvement strategies and monitor impact. We describe the creation and design of the neurosurgery quality dashboard at UCLA, summarize the evolution of its assembly process, and illustrate how it can be used as a powerful tool of improvement and change. The potential challenges and future directions of this business intelligence tool are also discussed.

Substantial Air Quality and Climate Co-benefits Achievable Now with Industrial Efficiency Improvements in China

NASA Astrophysics Data System (ADS)

Mauzerall, D. L.; Peng, W.; Wagner, F.; Yang, J.

2016-12-01

China is the world's top carbon emitter and suffers from severe air pollution. It has recently made commitments to improve air quality and peak its carbon emissions by 2030. Here we examine near-term air quality and implications for CO2 emissions of various sector-based policies in China that are widely discussed and technically plausible for immediate implementation. For each sector, we consider the effect of a 20% increase in the installation rate of available air pollution control devices, along with the following sector-specific policies. Power sector (POW): 80% replacement of small coal power plants with larger more efficient ones; Industry sector (IND): 20% improvement in energy efficiency; Transport sector (TRA): replacement of high emitters with average vehicle fleet emissions; and Residential sector (RES): replacement of 20% of coal-based stoves with those using liquefied petroleum gas. We conduct an integrated assessment using the air pollution model WRF-Chem and epidemiological concentration-response relationships to evaluate a 2015 base case and various counterfactual scenarios. We find that the IND scenario would reduce both the total national air-pollution-related deaths and carbon emissions the most of the four sectorial scenarios examined. Benefits of addressing the industrial sector remain large even when efficiency improvements are smaller than 20%. Moreover, we find that simultaneously implementing all the measures in all four sectors (combined, COMB) leads to slightly larger air quality and health benefits than obtained by summing the benefits achieved from the four sectorial scenarios individually. This is because nonlinearity in atmospheric chemistry leads to a larger reduction in fine particulate concentrations when emissions from all sectors are reduced simultaneously. The resulting lower concentrations imply a lower position on the concave human premature mortality relative risk curve with fewer associated deaths. While much effort has

Development of software to improve AC power quality on large spacecraft

NASA Technical Reports Server (NTRS)

Kraft, L. Alan

1991-01-01

To insure the reliability of a 20 kHz, alternating current (AC) power system on spacecraft, it is essential to analyze its behavior under many adverse operating conditions. Some of these conditions include overloads, short circuits, switching surges, and harmonic distortions. Harmonic distortions can become a serious problem. It can cause malfunctions in equipment that the power system is supplying, and, during distortions such as voltage resonance, it can cause equipment and insulation failures due to the extreme peak voltages. To address the harmonic distortion issue, work was begun under the 1990 NASA-ASEE Summer Faculty Fellowship Program. Software, originally developed by EPRI, called HARMFLO, a power flow program capable of analyzing harmonic conditions on three phase, balanced, 60 Hz AC power systems, was modified to analyze single phase, 20 kHz, AC power systems. Since almost all of the equipment used on spacecraft power systems is electrically different from equipment used on terrestrial power systems, it was also necessary to develop mathematical models for the equipment to be used on the spacecraft. The modelling was also started under the same fellowship work period. Details of the modifications and models completed during the 1990 NASA-ASEE Summer Faculty Fellowship Program can be found in a project report. As a continuation of the work to develop a complete package necessary for the full analysis of spacecraft AC power system behavior, deployment work has continued through NASA Grant NAG3-1254. This report details the work covered by the above mentioned grant.

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

PubMed

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

2016-03-01

A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

NASA Astrophysics Data System (ADS)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

Can Technology Improve the Quality of Colonoscopy?

PubMed

Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

2016-07-01

In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

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

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

Improving the estimated cost of sustained power interruptions to electricity customers

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

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

Improving the estimated cost of sustained power interruptions to electricity customers

DOE PAGES

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.; ...

2018-04-18

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

Rolling scheduling of electric power system with wind power based on improved NNIA algorithm

NASA Astrophysics Data System (ADS)

Xu, Q. S.; Luo, C. J.; Yang, D. J.; Fan, Y. H.; Sang, Z. X.; Lei, H.

2017-11-01

This paper puts forth a rolling modification strategy for day-ahead scheduling of electric power system with wind power, which takes the operation cost increment of unit and curtailed wind power of power grid as double modification functions. Additionally, an improved Nondominated Neighbor Immune Algorithm (NNIA) is proposed for solution. The proposed rolling scheduling model has further improved the operation cost of system in the intra-day generation process, enhanced the system’s accommodation capacity of wind power, and modified the key transmission section power flow in a rolling manner to satisfy the security constraint of power grid. The improved NNIA algorithm has defined an antibody preference relation model based on equal incremental rate, regulation deviation constraints and maximum & minimum technical outputs of units. The model can noticeably guide the direction of antibody evolution, and significantly speed up the process of algorithm convergence to final solution, and enhance the local search capability.

Quality Rating and Improvement Systems: A Strategic Movement for Defining Quality

ERIC Educational Resources Information Center

Neugebauer, Roger

2009-01-01

One of the most important trends in the early childhood field is the emergence of quality rating systems (QRS), or quality rating and improvement systems (QRIS), which are designed to assess, improve, and communicate the level of quality of early and school-age care programs. QRS came onto the scene in 1998 when Oklahoma enacted its "Reaching…

76 FR 4147 - Putnam-Cumberland, TN-Improve Power Supply

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... TENNESSEE VALLEY AUTHORITY Putnam-Cumberland, TN--Improve Power Supply AGENCY: Tennessee Valley... proposed electrical power supply improvements in the Putnam and Cumberland region of east-central Tennessee... supplies bulk electric power to Cumberland and Putnam counties and the immediately surrounding areas in...

Networked Improvement Communities: The Discipline of Improvement Science Meets the Power of Networks

ERIC Educational Resources Information Center

LeMahieu, Paul G.; Grunow, Alicia; Baker, Laura; Nordstrum, Lee E.; Gomez, Louis M.

2017-01-01

Purpose: The purpose of this paper is to delineate an approach to quality assurance in education called networked improvement communities (NICs) that focused on integrating the methodologies of improvement science with few of the networks. Quality improvement, the science and practice of continuously improving programs, practices, processes,…

Nursing informatics, outcomes, and quality improvement.

PubMed

Charters, Kathleen G

2003-08-01

Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

Quality assurance program for isotopic power systems

NASA Astrophysics Data System (ADS)

Hannigan, R. L.; Harnar, R. R.

1982-12-01

The Sandia National Laboratories Quality Assurance Program that applies to non-weapon (reimbursable) Radioisotopic Thermoelectric Generators is summarized. The program was implemented over the past 16 years on power supplies used in various space and terrestrial systems. The quality assurance (QA) activity of the program is in support of the Department of Energy, Office of Space Nuclear Projects. Basic elements of the program are described and examples of program documentation are presented.

Assessment of Power Quality based on Fuzzy Logic and Discrete Wavelet Transform for Nonstationary Disturbances

NASA Astrophysics Data System (ADS)

Sinha, Pampa; Nath, Sudipta

2010-10-01

The main aspects of power system delivery are reliability and quality. If all the customers of a power system get uninterrupted power through the year then the system is considered to be reliable. The term power quality may be referred to as maintaining near sinusoidal voltage at rated frequency at the consumers end. The power component definitions are defined according to the IEEE Standard 1459-2000 both for single phase and three phase unbalanced systems based on Fourier Transform (FFT). In the presence of nonstationary power quality (PQ) disturbances results in accurate values due to its sensitivity to the spectral leakage problem. To overcome these limitations the power quality components are calculated using Discrete Wavelet Transform (DWT). In order to handle the uncertainties associated with electric power systems operations fuzzy logic has been incorporated in this paper. A new power quality index has been introduced here which can assess the power quality under nonstationary disturbances.

Development of high-average-power DPSSL with high beam quality

NASA Astrophysics Data System (ADS)

Nakai, Sadao; Kanabe, Tadashi; Kawashima, Toshiyuki; Yamanaka, Masanobu; Izawa, Yasukazu; Nakatuka, Masahiro; Kandasamy, Ranganathan; Kan, Hirofumi; Hiruma, Teruo; Niino, Masayuki

2000-08-01

The recent progress of high power diode laser is opening new fields of laser and its application. We are developing high average power diode pumped solid state laser DPSSL for laser fusion power plant, for space propulsion and for various applications in industry. The common features or requirements of our High Average-power Laser for Nuclear-fusion Application (HALNA) are large pulse energy with relatively low repetition of few tens Hz, good beam quality of order of diffraction limit and high efficiency more than 10%. We constructed HALNA 10 (10J X 10 Hz) and tested the performance to clarify the scalability to higher power system. We have obtained in a preliminary experiment a 8.5 J output energy at 0.5 Hz with beam quality of 2 times diffraction limited far-field pattern.

Improving Operational Readiness through Total Quality Management

DTIC Science & Technology

1991-06-21

DTIC AD-A236 611 EL CT F NAVAL WAR COLL GE C Newport, R. I. IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT by Herb Westphal Defense...IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT (TQM) A Case Study: The Defense Mapping Agency Combat Support Center (DMACSC) initiated a...of the Defense Mapping Agency Combat Support Center’s (DMACSC) Total Quality Management (TQM) improvement methodology. This allows the reader to

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.

A School-Based Quality Improvement Program.

ERIC Educational Resources Information Center

Rappaport, Lewis A.

1993-01-01

As one Brooklyn high school discovered, quality improvement begins with administrator commitment and participants' immersion in the literature. Other key elements include ongoing training of personnel involved in the quality-improvement process, tools such as the Deming Cycle (plan-do-check-act), voluntary and goal-oriented teamwork, and a worthy…

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.

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

Opportunities for Wind Power In Low- and Mid-Quality Resource Regions

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

Lantz, Eric; Mai, Trieu; Heimiller, Donna

2016-05-25

In this presentation for American Wind Energy Association (AWEA) WINDPOWER 2016 conference, the authors discuss wind power today in low and mid-quality resource regions, the anticipated role of wind power in the future electric sector, market potential in low and mid-quality resource regions, and anticipated innovations to capture that market potential.

Achieving more reliable operation of turbine generators at nuclear power plants by improving the water chemistry of the generator stator cooling system

NASA Astrophysics Data System (ADS)

Tyapkov, V. F.; Chudakova, I. Yu.; Alekseenko, O. A.

2011-08-01

Ways of improving the water chemistry used in the turbine generator stator's cooling systems at Russian nuclear power plants are considered. Data obtained from operational chemical monitoring of indicators characterizing the quality of cooling water in the turbine generator stator cooling systems of operating power units at nuclear power plants are presented.

High power far-infrared optical parametric oscillator with high beam quality

NASA Astrophysics Data System (ADS)

Qian, Chuan-Peng; Shen, Ying-Jie; Dai, Tong-Yu; Duan, Xiao-Ming; Yao, Bao-Quan

2016-11-01

A high power ZnGeP2 (ZGP) optical parametric oscillator (OPO) with good beam quality pumped by a Q-switched Ho:YAG laser was demonstrated. The maximum output power of the ZGP OPO with a four-mirror ring cavity was about 5.04 W around 8.1 μm with 83.9 W Ho incident pump power, corresponding to a slope efficiency of 9.2 %. The ZGP OPO produced 36.0 ns far-IR pulse laser in the 8.0-8.3 μm spectral regions. The beam quality was measured to be M2 1.6 at the highest output power.

Thermodynamic analysis of performance improvement by reheat on the CO2 transcritical power cycle

NASA Astrophysics Data System (ADS)

Tuo, Hanfei

2012-06-01

The CO2 transcritical rankine power cycle has been widely investigated recently, because of its better temperature glide matching between sensible heat source and working fluid in vapor generator, and its desirable qualities, such as moderate critical point, little environment impact and low cost. A reheat CO2 transcritical power cycle with two stage expansion is presented to improve baseline cycle performance in this paper. Energy and exergy analysis are carried out to investigate effects of important parameters on cycle performance. The main results show that reheat cycle performance is sensitive to the variation of medium pressures and the optimum medium pressures exist for maximizing work output and thermal efficiency, respectively. Reheat cycle is compared to baseline cycle under the same conditions. More significant improvements by reheat are obtained at lower turbine inlet temperatures and larger high cycle pressure. Work output improvement is much higher than thermal efficiency improvement, because extra waste heat is required to reheat CO2. Based on second law analysis, exergy efficiency of reheat cycle is also higher than that of baseline cycle, because more useful work is converted from waste heat. Reheat with two stage expansion has great potential to improve thermal efficiency and especially net work output of a CO2 transcritical power cycle using a low-grade heat source.

Improving and monitoring air quality.

PubMed

DuPont, André

2018-05-01

Since the authorization of the Clean Air Act Amendments of 1990, the air quality in the USA has significantly improved because of strong public support. The lessons learned over the last 25 years are being shared with the policy analysts, technical professionals, and scientist who endeavor to improve air quality in their communities. This paper will review how the USA has achieved the "high" standard of air quality that was envisioned in the early 1990s. This document will describe SO 2 gas emission reduction technology and highlight operation of emission monitoring technology. This paper describes the basic process operation of an air pollution control scrubber. A technical review of measures required to operate and maintain a large-scale pollution control system will be described. Also, the author explains how quality assurance procedures in performance of continuous emission monitoring plays a significant role in reducing air pollution.

Budget Reform to Improve Higher Education Quality.

ERIC Educational Resources Information Center

Folger, John

A national project designed to examine issues of budget reform and quality improvement in higher education is described. The focus is state-level budget practices and their impact on institutions. Most of the funding for quality improvement has been categorical: a small percent of the budget is set aside to achieve particular quality or…

42 CFR 475.103 - Requirements for performing quality improvement initiatives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Requirements for performing quality improvement... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Quality Improvement Organizations § 475.103 Requirements for performing quality improvement initiatives...

[QUIPS: quality improvement in postoperative pain management].

PubMed

Meissner, Winfried

2011-01-01

Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. Outcome improved in four of the six hospitals. Process indicators, such as routine pain documentation, were only poorly correlated with outcomes. To date, more than 130 German hospitals use QUIPS as a routine quality management tool. An EC-funded parallel project disseminates the concept internationally. QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine. Copyright © 2011. Published by Elsevier GmbH.

Power quality control of an autonomous wind-diesel power system based on hybrid intelligent controller.

PubMed

Ko, Hee-Sang; Lee, Kwang Y; Kang, Min-Jae; Kim, Ho-Chan

2008-12-01

Wind power generation is gaining popularity as the power industry in the world is moving toward more liberalized trade of energy along with public concerns of more environmentally friendly mode of electricity generation. The weakness of wind power generation is its dependence on nature-the power output varies in quite a wide range due to the change of wind speed, which is difficult to model and predict. The excess fluctuation of power output and voltages can influence negatively the quality of electricity in the distribution system connected to the wind power generation plant. In this paper, the authors propose an intelligent adaptive system to control the output of a wind power generation plant to maintain the quality of electricity in the distribution system. The target wind generator is a cost-effective induction generator, while the plant is equipped with a small capacity energy storage based on conventional batteries, heater load for co-generation and braking, and a voltage smoothing device such as a static Var compensator (SVC). Fuzzy logic controller provides a flexible controller covering a wide range of energy/voltage compensation. A neural network inverse model is designed to provide compensating control amount for a system. The system can be optimized to cope with the fluctuating market-based electricity price conditions to lower the cost of electricity consumption or to maximize the power sales opportunities from the wind generation plant.

Compressed Air Quality, A Case Study In Paiton Coal Fired Power Plant Unit 1 And 2

NASA Astrophysics Data System (ADS)

Indah, Nur; Kusuma, Yuriadi; Mardani

2018-03-01

The compressed air system becomes part of a very important utility system in a Plant, including the Steam Power Plant. In PLN’S coal fired power plant, Paiton units 1 and 2, there are four Centrifugal air compressor types, which produce compressed air as much as 5.652 cfm and with electric power capacity of 1200 kW. Electricity consumption to operate centrifugal compressor is 7.104.117 kWh per year. Compressed air generation is not only sufficient in quantity (flow rate) but also meets the required air quality standards. compressed air at Steam Power Plant is used for; service air, Instrument air, and for fly Ash. This study aims to measure some important parameters related to air quality, followed by potential disturbance analysis, equipment breakdown or reduction of energy consumption from existing compressed air conditions. These measurements include counting the number of dust particles, moisture content, relative humidity, and also compressed air pressure. From the measurements, the compressed air pressure generated by the compressor is about 8.4 barg and decreased to 7.7 barg at the furthest point, so the pressure drop is 0.63 barg, this number satisfies the needs in the end user. The measurement of the number of particles contained in compressed air, for particle of 0.3 micron reaches 170,752 particles, while for the particle size 0.5 micron reaches 45,245 particles. Measurements of particles conducted at several points of measurement. For some point measurements the number of dust particle exceeds the standard set by ISO 8573.1-2010 and also NACE Code, so it needs to be improved on the air treatment process. To see the amount of moisture content in compressed air, it is done by measuring pressure dew point temperature (PDP). Measurements were made at several points with results ranging from -28.4 to 30.9 °C. The recommendation of improving compressed air quality in steam power plant, Paiton unit 1 and 2 has the potential to extend the life of

Contract management techniques for improving construction quality

DOT National Transportation Integrated Search

1997-07-01

Efforts to improve quality in highway construction embrace many aspects of the construction process. Quality goals include enhanced efficiency and productivity, optimal cost and delivery time, improved performance, and changes in attitude-promoting a...

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-06-01

This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. The study involved cross-sectional examination of the named relationships. Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

Improved output power of GaN-based light-emitting diodes grown on a nanopatterned sapphire substrate

NASA Astrophysics Data System (ADS)

Chan, Chia-Hua; Hou, Chia-Hung; Tseng, Shao-Ze; Chen, Tsing-Jen; Chien, Hung-Ta; Hsiao, Fu-Li; Lee, Chien-Chieh; Tsai, Yen-Ling; Chen, Chii-Chang

2009-07-01

This letter describes the improved output power of GaN-based light-emitting diodes (LEDs) formed on a nanopatterned sapphire substrate (NPSS) prepared through etching with a self-assembled monolayer of 750-nm-diameter SiO2 nanospheres used as the mask. The output power of NPSS LEDs was 76% greater than that of LEDs on a flat sapphire substrate. Three-dimensional finite-difference time-domain calculation predicted a 40% enhancement in light extraction efficiency of NPSS LEDs. In addition, the reduction of full widths at half maximum in the ω-scan rocking curves for the (0 0 2) and (1 0 2) planes of GaN on NPSS suggested improved crystal quality.

Numerical analysis of high-power broad-area laser diode with improved heat sinking structure using epitaxial liftoff technique

NASA Astrophysics Data System (ADS)

Kim, Younghyun; Sung, Yunsu; Yang, Jung-Tack; Choi, Woo-Young

2018-02-01

The characteristics of high-power broad-area laser diodes with the improved heat sinking structure are numerically analyzed by a technology computer-aided design based self-consistent electro-thermal-optical simulation. The high-power laser diodes consist of a separate confinement heterostructure of a compressively strained InGaAsP quantum well and GaInP optical cavity layers, and a 100-μm-wide rib and a 2000-μm long cavity. In order to overcome the performance deteriorations of high-power laser diodes caused by self-heating such as thermal rollover and thermal blooming, we propose the high-power broad-area laser diode with improved heat-sinking structure, which another effective heat-sinking path toward the substrate side is added by removing a bulk substrate. It is possible to obtain by removing a 400-μm-thick GaAs substrate with an AlAs sacrificial layer utilizing well-known epitaxial liftoff techniques. In this study, we present the performance improvement of the high-power laser diode with the heat-sinking structure by suppressing thermal effects. It is found that the lateral far-field angle as well as quantum well temperature is expected to be improved by the proposed heat-sinking structure which is required for high beam quality and optical output power, respectively.

Methodology of quality improvement projects for the Texas Medicare population.

PubMed

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

1998-07-01

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

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed Central

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-01-01

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult

HOS network-based classification of power quality events via regression algorithms

NASA Astrophysics Data System (ADS)

Palomares Salas, José Carlos; González de la Rosa, Juan José; Sierra Fernández, José María; Pérez, Agustín Agüera

2015-12-01

This work compares seven regression algorithms implemented in artificial neural networks (ANNs) supported by 14 power-quality features, which are based in higher-order statistics. Combining time and frequency domain estimators to deal with non-stationary measurement sequences, the final goal of the system is the implementation in the future smart grid to guarantee compatibility between all equipment connected. The principal results are based in spectral kurtosis measurements, which easily adapt to the impulsive nature of the power quality events. These results verify that the proposed technique is capable of offering interesting results for power quality (PQ) disturbance classification. The best results are obtained using radial basis networks, generalized regression, and multilayer perceptron, mainly due to the non-linear nature of data.

Improving Indoor Air Quality

EPA Pesticide Factsheets

Usually the most effective way to improve indoor air quality is to eliminate individual sources of pollution or to reduce their emissions. Some sources, like those that contain asbestos, can be sealed or enclosed.

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…

Radio-frequency power-assisted performance improvement of a magnetohydrodynamic power generator

NASA Astrophysics Data System (ADS)

Murakami, Tomoyuki; Okuno, Yoshihiro; Yamasaki, Hiroyuki

2005-12-01

We describe a radio-frequency (rf) electromagnetic-field-assisted magnetohydrodynamic power generation experiment, where an inductively coupled rf field (13.56MHz, 5.2kW) is continuously supplied to the disk generator. The rf power assists the precise plasma ignition, by which the otherwise irregular plasma behavior was stabilized. The rf heating suppresses the ionization instability in the plasma behavior and homogenizes the nonuniformity of the plasma structures. The power-generating performance is significantly improved with the aid of the rf power under wide seeding conditions: insufficient, optimum, and excessive seed fractions. The increment of the enthalpy extraction ratio of around 2% is significantly greater than the fraction of the net rf power, that is, 0.16%, to the thermal input.

An educational approach to improve outcomes in acute kidney injury (AKI): report of a quality improvement project.

PubMed

Xu, Gang; Baines, Richard; Westacott, Rachel; Selby, Nick; Carr, Susan

2014-03-20

To assess the impact of a quality improvement project that used a multifaceted educational intervention on how to improve clinician's knowledge, confidence and awareness of acute kidney injury (AKI). 2 large acute teaching hospitals in England, serving a combined population of over 1.5 million people. All secondary care clinicians working in the clinical areas were targeted, with a specific focus on clinicians working in acute admission areas. A multifaceted educational intervention consisting of traditional didactic lectures, case-based teaching in small groups and an interactive web-based learning resource. We assessed clinicians' knowledge of AKI and their self-reported clinical behaviour using an interactive questionnaire before and after the educational intervention. Secondary outcome measures included clinical audit of patient notes before and after the intervention. 26% of clinicians reported that they were aware of local AKI guidelines in the preintervention questionnaire compared to 64% in the follow-up questionnaire (χ²=60.2, p<0.001). There was an improvement in the number of clinicians reporting satisfactory practice when diagnosing AKI, 50% vs 68% (χ²=12.1, p<0.001) and investigating patients with AKI, 48% vs 64% (χ²=9.5, p=0.002). Clinical audit makers showed a trend towards better clinical practice. This quality improvement project utilising a multifaceted educational intervention improved awareness of AKI as demonstrated by changes in the clinician's self-reported management of patients with AKI. Elements of the project have been sustained beyond the project period, and demonstrate the power of quality improvement projects to help initiate changes in practice. Our findings are limited by confounding factors and highlight the need to carry out formal randomised studies to determine the impact of educational initiatives in the clinical setting.

Improving patient safety through quality assurance.

PubMed

Raab, Stephen S

2006-05-01

Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

Improvement of magnetorheological finishing surface quality by nanoparticle jet polishing

NASA Astrophysics Data System (ADS)

Peng, Wenqiang; Li, Shengyi; Guan, Chaoliang; Shen, Xinmin; Dai, Yifan; Wang, Zhuo

2013-04-01

Nanoparticle jet polishing (NJP) is presented as a posttreatment to remove magnetorheological finishing (MRF) marks. In the NJP process the material is removed by chemical impact reaction, and the material removal rate of convex part is larger than that of the concave part. Smoothing thus can progress automatically in the NJP process. In the experiment, a silica glass sample polished by MRF was polished by NJP. Experiment results showed the MRF marks were removed clearly. The uniform polishing process shows that the NJP process can remove the MRF marks without destroying the original surface figure. The surface root-mean-square roughness is improved from 0.72 to 0.41 nm. power spectral density analysis indicates the surface quality is improved, and the experimental result validates effective removal of MRF marks by NJP.

Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents.

PubMed

Canal, David F; Torbeck, Laura; Djuricich, Alexander M

2007-05-01

Surgery residents can learn continuous quality improvement (CQI) principles within a structured curriculum and propose quality improvement projects. Curriculum within a surgical residency program. A university surgical residency program with multiple hospital training sites. Fifteen surgical residents during the dedicated research year. A curriculum in CQI that focuses on devising a quality improvement project. Resident self-reported attitudes about quality improvement and implementation of resident-initiated quality improvement projects. Resident survey data demonstrated an improvement in knowledge, self-efficacy, and experiences within CQI. Fifteen individual residents, within smaller teams, created 4 quality improvement projects worthy of implementation. A structured CQI curriculum can be successfully integrated into a general surgery residency program. Residents can learn the skill of constructing CQI project ideas within the framework of the plan-do-study-act cycle. Residents are eager to make improvements in their local system of residency. By giving them the tools to critically investigate systems improvement and a much needed ear to hear their concerns and suggestions for improvement, we found ways to potentially enhance patient care and developed ideas to improve the education of future surgeons. In doing so, we provided the residents with "buy-in" into their residency program, while addressing the competency of practice-based learning and improvement required by the Accreditation Council for Graduate Medical Education for resident education.

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.

[Quality improvement potential in the pharmaceutical industry].

PubMed

Nusser, Michael

2007-01-01

The performance of the German pharmaceutical industry, future challenges and obstacles to quality improvement are assessed from a systems-of-innovation perspective, using appropriate innovation indicators. The current close-to-market performance indicators paint an unfavourable picture. Early R&D indicators (e.g., publications, patents), however, reveal a positive trend. A lot of obstacles to quality improvements are identified with respect to knowledge base, knowledge/technology transfer, industrial R&D processes, capital markets, market attractiveness and both regulatory and political framework conditions. On this basis, recommendations will finally be derived to improve quality in the pharmaceutical industry.

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

PubMed

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial.

PubMed

Aimola, Lina; Jasim, Sarah; Tripathi, Neeraj; Tucker, Sarah; Worrall, Adrian; Quirk, Alan; Crawford, Mike J

2016-09-21

Quality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period. Standalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization. To our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and

Evaluation of Wind Power Forecasts from the Vermont Weather Analytics Center and Identification of Improvements

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

Optis, Michael; Scott, George N.; Draxl, Caroline

The goal of this analysis was to assess the wind power forecast accuracy of the Vermont Weather Analytics Center (VTWAC) forecast system and to identify potential improvements to the forecasts. Based on the analysis at Georgia Mountain, the following recommendations for improving forecast performance were made: 1. Resolve the significant negative forecast bias in February-March 2017 (50% underprediction on average) 2. Improve the ability of the forecast model to capture the strong diurnal cycle of wind power 3. Add ability for forecast model to assess internal wake loss, particularly at sites where strong diurnal shifts in wind direction are present.more » Data availability and quality limited the robustness of this forecast assessment. A more thorough analysis would be possible given a longer period of record for the data (at least one full year), detailed supervisory control and data acquisition data for each wind plant, and more detailed information on the forecast system input data and methodologies.« less

Utilizing Climate Forecasts for Improving Water and Power Systems Coordination

NASA Astrophysics Data System (ADS)

Arumugam, S.; Queiroz, A.; Patskoski, J.; Mahinthakumar, K.; DeCarolis, J.

2016-12-01

Climate forecasts, typically monthly-to-seasonal precipitation forecasts, are commonly used to develop streamflow forecasts for improving reservoir management. Irrespective of their high skill in forecasting, temperature forecasts in developing power demand forecasts are not often considered along with streamflow forecasts for improving water and power systems coordination. In this study, we consider a prototype system to analyze the utility of climate forecasts, both precipitation and temperature, for improving water and power systems coordination. The prototype system, a unit-commitment model that schedules power generation from various sources, is considered and its performance is compared with an energy system model having an equivalent reservoir representation. Different skill sets of streamflow forecasts and power demand forecasts are forced on both water and power systems representations for understanding the level of model complexity required for utilizing monthly-to-seasonal climate forecasts to improve coordination between these two systems. The analyses also identify various decision-making strategies - forward purchasing of fuel stocks, scheduled maintenance of various power systems and tradeoff on water appropriation between hydropower and other uses - in the context of various water and power systems configurations. Potential application of such analyses for integrating large power systems with multiple river basins is also discussed.

Quantity, Quality, and Availability of Waste Heat from United States Thermal Power Generation.

PubMed

Gingerich, Daniel B; Mauter, Meagan S

2015-07-21

Secondary application of unconverted heat produced during electric power generation has the potential to improve the life-cycle fuel efficiency of the electric power industry and the sectors it serves. This work quantifies the residual heat (also known as waste heat) generated by U.S. thermal power plants and assesses the intermittency and transport issues that must be considered when planning to utilize this heat. Combining Energy Information Administration plant-level data with literature-reported process efficiency data, we develop estimates of the unconverted heat flux from individual U.S. thermal power plants in 2012. Together these power plants discharged an estimated 18.9 billion GJ(th) of residual heat in 2012, 4% of which was discharged at temperatures greater than 90 °C. We also characterize the temperature, spatial distribution, and temporal availability of this residual heat at the plant level and model the implications for the technical and economic feasibility of its end use. Increased implementation of flue gas desulfurization technologies at coal-fired facilities and the higher quality heat generated in the exhaust of natural gas fuel cycles are expected to increase the availability of residual heat generated by 10.6% in 2040.

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.

Continuous quality improvement in the ambulatory endoscopy center.

PubMed

Johanson, John F

2002-04-01

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

Bringing quality improvement into the intensive care unit.

PubMed

McMillan, Tracy R; Hyzy, Robert C

2007-02-01

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

Fuel cells provide a revenue-generating solution to power quality problems

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

King, J.M. Jr.

Electric power quality and reliability are becoming increasingly important as computers and microprocessors assume a larger role in commercial, health care and industrial buildings and processes. At the same time, constraints on transmission and distribution of power from central stations are making local areas vulnerable to low voltage, load addition limitations, power quality and power reliability problems. Many customers currently utilize some form of premium power in the form of standby generators and/or UPS systems. These include customers where continuous power is required because of health and safety or security reasons (hospitals, nursing homes, places of public assembly, air trafficmore » control, military installations, telecommunications, etc.) These also include customers with industrial or commercial processes which can`t tolerance an interruption of power because of product loss or equipment damage. The paper discusses the use of the PC25 fuel cell power plant for backup and parallel power supplies for critical industrial applications. Several PC25 installations are described: the use of propane in a PC25; the use by rural cooperatives; and a demonstration of PC25 technology using landfill gas.« less

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.

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

The ReACH Collaborative--improving quality home care.

PubMed

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

2007-08-01

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

ISTC projects devoted to improving laser beam quality

NASA Astrophysics Data System (ADS)

Malakhov, Yu. I.

2007-05-01

Short overview is done about the activity of ISTC in a direction concerned with improving powerful laser beam quality by means of nonlinear and linear adaptive optics methods. Completed projects #0591 and #1929 resulted in the development of a stimulated Brillouin scattering (SBS) phase conjugation mirror of superhigh fidelity employing the kinoform optical elements (rasters of small lenses) of new generation designed for pulsed or pulse-periodic lasers with nanosecond scale pulse duration. Project #2631 is devoted to development of an adaptive optical system for phase registration and correction of laser beams with wave front vortices. The principles of operation of conventional adaptive systems are based on the assumption that the phase is a smooth continuous function in space. Therefore the solution of the Project tasks will assume a new step in adaptive optics.

Electronic health records improve clinical note quality.

PubMed

Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

2015-01-01

The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (p<0.0001) and 55% (p<0.0001), respectively. All the element and grand mean quality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

[Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

PubMed

Godény, Sándor

2012-02-05

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

Quality of care in reproductive health programmes: education for quality improvement.

PubMed

Kwast, B E

1998-09-01

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Concentrating solar power (CSP) power cycle improvements through application of advanced materials

NASA Astrophysics Data System (ADS)

Siefert, John A.; Libby, Cara; Shingledecker, John

2016-05-01

Concentrating solar power (CSP) systems with thermal energy storage (TES) capability offer unique advantages to other renewable energy technologies in that solar radiation can be captured and stored for utilization when the sun is not shining. This makes the technology attractive as a dispatchable resource, and as such the Electric Power Research Institute (EPRI) has been engaged in research and development activities to understand and track the technology, identify key technical challenges, and enable improvements to meet future cost and performance targets to enable greater adoption of this carbon-free energy resource. EPRI is also involved with technically leading a consortium of manufacturers, government labs, and research organizations to enable the next generation of fossil fired power plants with advanced ultrasupercritical (A-USC) steam temperatures up to 760°C (1400°F). Materials are a key enabling technology for both of these seemingly opposed systems. This paper discusses how major strides in structural materials for A-USC fossil fired power plants may be translated into improved CSP systems which meet target requirements.

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...

Quality Rating and Improvement System State Evaluations and Research

ERIC Educational Resources Information Center

Ferguson, Daniel

2016-01-01

A quality rating and improvement system (QRIS) is a method used by states and local jurisdictions to assess the level of quality of child care and early education programs, improve quality, and convey quality ratings to parents and other consumers. A typical QRIS incorporates the following components: quality standards for participating providers;…

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

PubMed

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

2016-10-01

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

The Power of Process Improvement

ERIC Educational Resources Information Center

Fairfield-Sonn, James W.; Morgan, Sandra; Sumukadas, Narendar

2004-01-01

Over the last several decades many systematic management approaches, such as Total Quality Management, aimed at improving organizational performance and employee satisfaction have captured organizations' attention. Given their origins in statistics, operations management, and engineering, many of the concepts and techniques are technical. When…

Quality Function Deployment Application for Improving Quality of Education in Business Schools

ERIC Educational Resources Information Center

Sagnak, Muhittin; Ada, Nesrin; Kazancoglu, Yigit; Tayaksi, Cansu

2017-01-01

There is an increasing competition between universities globally to attract students. At this point, to compete, it is imperative for the universities to improve the quality of education provided for their stakeholders, including students, parents, and employers. For improving the quality of education, first of all, the universities should make…

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

PubMed

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

A Logistic Life Cycle Cost-Benefit Analysis of Power Quality Management in the Avionics Repair Facility

DTIC Science & Technology

1998-06-01

quality management can have on the intermediate level of maintenance. Power quality management is a preventative process that focuses on identifying and correcting problems that cause bad power. Using cost-benefit analysis we compare the effects of implementing a power quality management program at AIMD Lemoore and AIMD Fallon. The implementation of power quality management can result in wide scale logistical support changes in regards to the life cycle costs of maintaining the DoD’s current inventory

Title IV Quality Control Project, Stage II. Management Option II: Delivery System Quality Improvements.

ERIC Educational Resources Information Center

Advanced Technology, Inc., Reston, VA.

Stage Two of the Title IV Quality Control Project is an integrated study of quality in five related Federal financial aid programs for postsecondary students. Section 1 of the paper establishes a framework for defining quality improvements, in order to identify the types of changes that would tend to improve quality across all facets of the…

Power converter having improved EMI shielding

DOEpatents

Beihoff, Bruce C.; Kehl, Dennis L.; Gettelfinger, Lee A.; Kaishian, Steven C.; Phillips, Mark G.; Radosevich, Lawrence D.

2006-06-13

EMI shielding is provided for power electronics circuits and the like via a direct-mount reference plane support and shielding structure. The thermal support may receive one or more power electronic circuits. The support may aid in removing heat from the circuits through fluid circulating through the support. The support forms a shield from both external EMI/RFI and from interference generated by operation of the power electronic circuits. Features may be provided to permit and enhance connection of the circuitry to external circuitry, such as improved terminal configurations. Modular units may be assembled that may be coupled to electronic circuitry via plug-in arrangements or through interface with a backplane or similar mounting and interconnecting structures.

Improvements to image quality using hybrid and model-based iterative reconstructions: a phantom study.

PubMed

Aurumskjöld, Marie-Louise; Ydström, Kristina; Tingberg, Anders; Söderberg, Marcus

2017-01-01

The number of computed tomography (CT) examinations is increasing and leading to an increase in total patient exposure. It is therefore important to optimize CT scan imaging conditions in order to reduce the radiation dose. The introduction of iterative reconstruction methods has enabled an improvement in image quality and a reduction in radiation dose. To investigate how image quality depends on reconstruction method and to discuss patient dose reduction resulting from the use of hybrid and model-based iterative reconstruction. An image quality phantom (Catphan® 600) and an anthropomorphic torso phantom were examined on a Philips Brilliance iCT. The image quality was evaluated in terms of CT numbers, noise, noise power spectra (NPS), contrast-to-noise ratio (CNR), low-contrast resolution, and spatial resolution for different scan parameters and dose levels. The images were reconstructed using filtered back projection (FBP) and different settings of hybrid (iDose 4 ) and model-based (IMR) iterative reconstruction methods. iDose 4 decreased the noise by 15-45% compared with FBP depending on the level of iDose 4 . The IMR reduced the noise even further, by 60-75% compared to FBP. The results are independent of dose. The NPS showed changes in the noise distribution for different reconstruction methods. The low-contrast resolution and CNR were improved with iDose 4 , and the improvement was even greater with IMR. There is great potential to reduce noise and thereby improve image quality by using hybrid or, in particular, model-based iterative reconstruction methods, or to lower radiation dose and maintain image quality. © The Foundation Acta Radiologica 2016.

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.

Quality measurement and improvement in liver transplantation.

PubMed

Mathur, Amit K; Talwalkar, Jayant

2018-06-01

There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centres. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models. We outline the status quo including the current regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Engaging Clinical Nurses in Quality Improvement Projects.

PubMed

Moore, Susan; Stichler, Jaynelle F

2015-10-01

Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.

Quality improvement in pediatric sepsis.

PubMed

Melendez, Elliot; Bachur, Richard

2015-06-01

Although there is abundant literature detailing the impact of quality improvement in adult sepsis, the pediatric literature is lacking. Despite consensus definitions for sepsis, which patients along the sepsis spectrum should receive aggressive management and the exact onset of sepsis ('time zero') are not clearly established. In the adult emergency department (ED), sepsis onset is defined as the time of entry into the ED; however, this definition cannot be applied to hospitalized patients or patients who evolve during their ED course. Since the time of sepsis onset will dictate the timeliness of subsequent process measures, the variable definitions in the literature make it difficult to generalize findings among prior studies. Despite the variation in defining time zero, aggressive fluid administration, timely antibiotics, and compliance with sepsis bundles have been shown to improve mortality and to reduce hospital and intensive care length of stay. In addition, early identification tools show promise in beginning to define sepsis onset and retrospective search tools may allow improved case finding of those children of concern for sepsis. Quality improvement in pediatric sepsis is evolving. As we continue to define quality measures, we must standardize the definition of sepsis onset. This definition should be applicable to any treatment venue to ensure measures can be evaluated across all settings. In addition, we must delineate which patients along the sepsis spectrum should be candidates for timely interventions and standardize other outcome measures beyond mortality.

Multi-hospital Community NICU Quality Improvement Improves Survival of ELBW Infants.

PubMed

Owens, Jack D; Soltau, Thomas; McCaughn, Danny; Miller, Jason; O'Mara, Patrick; Robbins, Kenny; Temple, David M; Wender, David F

2015-08-01

Quality improvement or high reliability in medicine is an evolving science where we seek to integrate evidence-based medicine, structural resources, process management, leadership models, culture, and education. Newborn Associates is a community-based neonatology practice that staffs and manages neonatal intensive care units (NICU's) at Central Mississippi Medical Center, Mississippi Baptist Medical Center, River Oaks Hospital, St Dominic's Hospital and Woman's Hospital within the Jackson, Mississippi, metropolitan area. These hospitals participate in the Vermont-Oxford Neonatal Network (VON), which is a voluntary national network of about 1000 NICU groups that submit data allowing them to benchmark their patient outcome. This network currently holds data on 1.5 million infants. Participation may also include the Newborn Improvement Quality Collaborative (NICQ) which is an intensive quality improvement program where 40-60 of the almost 1000 VON centers participate each year or the iNICQ, which is an internet-based collaborative involving about 150 centers per year. From 2008-2009, our group concentrated efforts on quality improvement which included consolidating resources of three corporately managed hospitals to allow focused care of babies under 800-1000 grams at a single center, expanding participation in the VON NICQ to include all physicians and centers, and establishing a group QI focused committee aimed at sharing practice bundles and adopting quality improvement methodology. The goal of this article is to report the impact of these QI activities on survival of the smallest preterm infants who weigh less than 1500 grams at birth. Two epochs were compared: 2006-2009, and 2010-2013. 551 VLBW (< 1 500 grams) infants from epoch I were compared to 583 VLBW infants from epoch 2. Mortality in this group decreased from 18% to 11.1% (OR 0.62,95% CI 0.44-0.88). Mortality in the 501-750 grams birth weight category decreased from 45.7% to 18% (OR 0.39,95% CI 0

Improving service quality in primary care.

PubMed

Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

2015-01-01

A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. © 2014 by the American College of Medical Quality.

Unity Power Factor Operated PFC Converter Based Power Supply for Computers

NASA Astrophysics Data System (ADS)

Singh, Shikha; Singh, Bhim; Bhuvaneswari, G.; Bist, Vashist

2017-11-01

Power Supplies (PSs) employed in personal computers pollute the single phase ac mains by drawing distorted current at a substandard Power Factor (PF). The harmonic distortion of the supply current in these personal computers are observed 75% to 90% with the Crest Factor (CF) being very high which escalates losses in the distribution system. To find a tangible solution to these issues, a non-isolated PFC converter is employed at the input of isolated converter that is capable of improving the input power quality apart from regulating the dc voltage at its output. This is given to the isolated stage that yields completely isolated and stiffly regulated multiple output voltages which is the prime requirement of computer PS. The operation of the proposed PS is evaluated under various operating conditions and the results show improved performance depicting nearly unity PF and low input current harmonics. The prototype of this PS is developed in laboratory environment and test results are recorded which corroborate the power quality improvement observed in simulation results under various operating conditions.

The swiss neonatal quality cycle, a monitor for clinical performance and tool for quality improvement

PubMed Central

2013-01-01

Background We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. Methods Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek’s p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps ′guideline – perform - falsify – reform′. Results 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. Conclusions The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity. PMID:24074151

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.

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

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

Modelling voltage sag mitigation using dynamic voltage restorer and analyzing power quality issue

NASA Astrophysics Data System (ADS)

Ismail, Nor Laili; Hidzir, Hizrin Dayana Mohd; Thanakodi, Suresh; Nazar, Nazatul Shiema Moh; Ibrahim, Pungut; Ali, Che Ku Muhammad Sabri Che Ku

2018-02-01

Power quality problem which are arise due to a fault or a pulsed load can have caused an interruption of critical load. The modern power systems are becoming more sensitive to the quality of the power supplied by the utility company. Voltage sags and swells, flicker, interruptions, harmonic distortion and other distortion to the sinusoidal waveform are the examples of the power quality problems. The most affected due to these problems is industrial customers who use a lot of sensitive equipment. There has suffered a huge loss to these problems. Resulting of broken or damage equipment if voltage sag exceeds the sensitive threshold of the equipment. Thus, device such as Static Synchronous Compensator (STATCOM) and Dynamic Voltage Restorer (DVR) has been created to solve this problem among users. DVR is a custom power device that most effective and efficient. This paper intended to report the DVR operations during voltage sag compensation.

Quality improvement in neurology: AAN Parkinson disease quality measures

PubMed Central

Cheng, E.M.; Tonn, S.; Swain-Eng, R.; Factor, S.A.; Weiner, W.J.; Bever, C.T.

2010-01-01

Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this. Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs. Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors. Results: Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes. Conclusion: The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures. GLOSSARY

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

Physical Activity Improves Quality of Life

MedlinePlus

... It Works Healthy Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 ... proven to improve both mental and physical health. Physical activity boosts mental wellness. Regular physical activity can relieve ...

Clinical audit system as a quality improvement tool in the management of breast cancer.

PubMed

Vijayakumar, Chellappa; Maroju, Nanda Kishore; Srinivasan, Krishnamachari; Reddy, K Satyanarayana

2016-11-01

Quality improvement is recognized as a major factor that can transform healthcare management. This study is a clinical audit that aims at analysing treatment time as a quality indicator and explores the role of setting a target treatment time on reducing treatment delays. All newly diagnosed patients with breast cancer between September 2011 and August 2013 were included in the study. Clinical care pathway for breast cancer patients was standardized and the timeliness of care at each step of the pathway was calculated. Data collection was spread over three phases, baseline, audit cycle I, and audit cycle II. Each cycle was preceded by a quality improvement intervention, and followed by analysis. A total of 334 patients with breast cancer were included in the audit. The overall time from first visit to initiation of treatment was 66.3 days during the baseline period. This improved to 40.4 and 28.5 days at the end of Audit cycle I and II, respectively. The idealized target time of 28 days for initiating treatment was achieved in 5, 23.5, and 65.2% of patients in the baseline period, Audit cycle I, and Audit Cycle II, respectively. There was improvement noted across all steps of the clinical care pathway. This study confirms that audit is a powerful tool in quality improvement programs and helps achieve timely care. Gains achieved through an audit process may not be sustainable unless underlying patient factors and resource deficits are addressed. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Quality improvement--boon or boondoggle?

PubMed

Paterson, M A; Wendel, J

1994-01-01

Is quality improvement (QI) reducing healthcare costs while improving patient care? Researchers find that QI has improved employee satisfaction and morale, but it was designed to do more. One solution is to use problem-solving techniques to help teams identify the level at which they want to address a problem, whether that be the subinstitutional, institutional, or system level. If QI is to fulfill its promise, skilled managers must create effective teams capable of defining and solving complex problems.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case

PubMed Central

2014-01-01

Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system

Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

ERIC Educational Resources Information Center

Bradley, Janet

1998-01-01

COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their…

Review of Comprehensive Evaluation Methods for Power Quality and Its Trend in New Generation Energy System

NASA Astrophysics Data System (ADS)

Liu, Ruihua; Wang, Rong; Liu, Qunying; Yang, Li; Xi, Chuan; Wang, Wei; Li, Lingzhou; Zhao, Zhoufang; Zhou, Ying

2018-02-01

With China’s new energy generation grid connected capacity being in the forefront of the world and the uncertainty of new energy sources, such as wind energy and solar energy, it is be of great significance to study scientific and comprehensive assessment of power quality. On the foundation of analysizing the current power quality index systematically and objectively, the new energy grid power quality analysis method and comprehensive evaluation method, this paper tentatively explored the trend of the new generation of energy system power quality comprehensive evaluation.

Ninety to Nothing: a PDSA quality improvement project.

PubMed

Prybutok, Gayle Linda

2018-05-14

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

Using Quality Improvement to Improve Internal and External Coordination and Referrals.

PubMed

Cain, Katherine L; Collins, Ragan P

As part of accreditation, Public Health Accreditation Board site visitors recommended that the New Orleans Health Department strengthen its quality improvement program. With support from the Public Health Accreditation Board, the New Orleans Health Department subsequently embarked on a data-driven planning process through which it prioritized quality improvement projects for 2016. One of these projects aimed to improve referrals to New Orleans Health Department's direct services programs from local clinics and hospitals to better provide our most vulnerable residents with a continuum of care. After completing a cause-and-effect analysis, we implemented a solution involving increased outreach to health care institutions and saw annual participation increase in 3 out of 4 of our programs. We leveraged this work to successfully apply for funding to create a centralized referral system, which will facilitate partnerships among local health and human service agencies and improve access to services. This is one example of how accreditation has benefited our health department and our community. We have found that the accreditation process promotes a culture of quality and helps health departments identify and address areas for improvement.

Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL).

PubMed

Fox, Adam T; Palmer, Roger D; Crossley, James G M; Sekaran, Devanitha; Trewavas, Eira S; Davies, Helena A

2004-08-01

To improve the quality of outpatient letters used as communication between hospital and primary care doctors. On 2 separate occasions, 15 unselected outpatient letters written by each of 7 hospital practitioners were rated by another hospital doctor and a general practitioner (GP) using the Sheffield Assessment Instrument for Letters (SAIL). Individualised feedback was provided to participants following the rating of the first set of letters. The audit cycle was completed 3 months later without forewarning by repeat assessment by the same hospital and GP assessors using the SAIL tool to see if there was any improvement in correspondence. Single centre: general paediatric outpatient department in a large district general hospital. All 7 doctors available for reassessment completed the audit loop, each providing 15 outpatient letters per assessment. The mean of the quality scores, derived for each letter from the summation of a 20-point checklist and a global score, improved from 23.3 (95% CI 22.1-24.4) to 26.6 (95% CI 25.8-27.4) (P = 0.001). The SAIL provides a feasible and reliable method of assessing the quality and content of outpatient clinic letters. This study demonstrates that it can also provide feedback with a powerful educational impact. This approach holds real potential for appraisal and revalidation, providing an effective means for the quality improvement required by clinical governance.

Improving Free-Piston Stirling Engine Power Density

NASA Technical Reports Server (NTRS)

Briggs, Maxwell H.

2016-01-01

Analyses and experiments demonstrate the potential benefits of optimizing piston and displacer motion in a free piston Stirling Engine. Isothermal analysis shows the theoretical limits of power density improvement due to ideal motion in ideal Stirling engines. More realistic models based on nodal analysis show that ideal piston and displacer waveforms are not optimal, often producing less power than engines that use sinusoidal piston and displacer motion. Constrained optimization using nodal analysis predicts that Stirling engine power density can be increased by as much as 58% using optimized higher harmonic piston and displacer motion. An experiment is conducted in which an engine designed for sinusoidal motion is forced to operate with both second and third harmonics, resulting in a maximum piston power increase of 14%. Analytical predictions are compared to experimental data showing close agreement with indirect thermodynamic power calculations, but poor agreement with direct electrical power measurements.

Does Medical Malpractice Law Improve Health Care Quality?

PubMed

Frakes, Michael; Jena, Anupam B

2016-11-01

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

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID

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…

Quality Improvement With Discrete Event Simulation: A Primer for Radiologists.

PubMed

Booker, Michael T; O'Connell, Ryan J; Desai, Bhushan; Duddalwar, Vinay A

2016-04-01

The application of simulation software in health care has transformed quality and process improvement. Specifically, software based on discrete-event simulation (DES) has shown the ability to improve radiology workflows and systems. Nevertheless, despite the successful application of DES in the medical literature, the power and value of simulation remains underutilized. For this reason, the basics of DES modeling are introduced, with specific attention to medical imaging. In an effort to provide readers with the tools necessary to begin their own DES analyses, the practical steps of choosing a software package and building a basic radiology model are discussed. In addition, three radiology system examples are presented, with accompanying DES models that assist in analysis and decision making. Through these simulations, we provide readers with an understanding of the theory, requirements, and benefits of implementing DES in their own radiology practices. Copyright © 2016 American College of Radiology. All rights reserved.

Context in Quality of Care: Improving Teamwork and Resilience.

PubMed

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

2017-09-01

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

Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

PubMed Central

Bergh, Anne-Marie; Etsane, Mama E.; Hugo, Jannie

2015-01-01

Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach. Aim: To describe the process of inducting students into a longitudinal quality-improvement project, using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies. Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations. Method: Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice. Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning. PMID:26245606

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.

Improving influenza vaccination of healthcare workers by means of quality improvement tools.

PubMed

Cadena, Jose; Prigmore, Teresa; Bowling, Jason; Ayala, Beth Ann; Kirkman, Leni; Parekh, Amruta; Scepanski, Theresa; Patterson, Jan E

2011-06-01

For a healthcare worker seasonal influenza vaccination quality improvement project, interventions included support of leadership, distribution of vaccine kits, grand rounds, an influenza website, a screensaver, e-mails, phone messages, and audit feedback. Vaccination rates increased from 58.8% to 76.6% (P < .01). Quality improvement increased the voluntary vaccination rate but did not achieve a rate more than 80%.

Quality improvement to guide the new health system.

PubMed

Merry, M D

2001-03-01

While there are many areas, such as intensive care treatment and pain management, where great gains in quality improvement can be made, the greatest strides will come as the leaders and trustees in health care organizations begin to create "the industrial revolution" in their organizations by creating cultures of quality. Stephen Shortell recommends the following list of things board members can do to improve quality in their organizations.

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

PubMed

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

2011-12-13

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

45 CFR 1304.60 - Deficiencies and quality improvement plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the approved Quality Improvement Plan, the responsible HHS official will issue a letter of termination... 45 Public Welfare 4 2010-10-01 2010-10-01 false Deficiencies and quality improvement plans. 1304... GRANTEE AND DELEGATE AGENCIES Implementation and Enforcement § 1304.60 Deficiencies and quality...

The process of managerial control in quality improvement initiatives.

PubMed

Slovensky, D J; Fottler, M D

1994-11-01

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Does Medical Malpractice Law Improve Health Care Quality?

PubMed Central

Frakes, Michael; Jena, Anupam B.

2016-01-01

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

Interventions to improve water quality for preventing diarrhoea

PubMed Central

Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

2015-01-01

Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

How the national healthcare quality and disparities reports can catalyze quality improvement.

PubMed

McNeill, Dwight; Kelley, Ed

2005-03-01

The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users.

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.

Approaching the Practice Quality Improvement Project in Interventional Radiology.

PubMed

Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

2015-12-01

An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Accounting for quality: on the relationship between accounting and quality improvement in healthcare.

PubMed

Pflueger, Dane

2015-04-23

Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined 'social studies of accounting' literature and illustrative examples. This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control. The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures.

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.

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending

PubMed Central

Song, Zirui; Rose, Sherri; Chernew, Michael E.; Safran, Dana Gelb

2018-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. PMID:28069849

Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

PubMed

Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

2016-01-01

Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.

Improved control strategy for wind-powered refrigerated storage of apples

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

Baldwin, J.D.C.

1979-01-01

The need for an improved control strategy for the operation of a wind-powered refrigeration system for the storage of apples was investigated. The results are applicable to other systems which employ intermittently available power sources, battery and thermal storage, and an auxiliary, direct current power supply. Tests were conducted on the wind-powered refrigeration system at the Virginia Polytechnic Institute and State University Horticulture Research Farm in Blacksburg, Virginia. Tests were conducted on the individual components of the system. In situ windmill performance was also conducted. The results of these tests have been presented. An improved control strategy was developed tomore » improve the utilization of available wind energy and to reduce the need for electrical energy from an external source while maintaining an adequate apple storage environment.« less

Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders.

PubMed

Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J

2016-01-01

Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

The impact of turbulent renewable energy production on power grid stability and quality

NASA Astrophysics Data System (ADS)

Schmietendorf, Katrin; Peinke, Joachim; Kamps, Oliver

2017-11-01

Feed-in fluctuations induced by renewables are one of the key challenges to the stability and quality of electrical power grids. In particular short-term fluctuations disturb the system on a time scale, on which load balancing does not operate yet and the system is intrinsically governed by self-organized synchronization. Wind and solar power are known to be strongly non-Gaussian with intermittent increment statistics in these time scales. We investigate the impact of short-term wind fluctuations on the basis of a Kuramoto-like power grid model considering stability in terms of desynchronization and frequency and voltage quality aspects. We present a procedure to generate realistic feed-in fluctuations with temporal correlations, Kolmogorov power spectrum and intermittent increments. By comparison to correlated Gaussian noise of the same spectrum and Gaussian white noise, we found out that while the correlations are essential to capture the likelihood of severe outages, the intermittent nature of wind power has significant consequences on power quality: intermittency is directly transferred into frequency and voltage fluctuations yielding a novel type of fluctuations, which is beyond engineering status of knowledge.

Using mobile technology to improve healthcare service quality.

PubMed

Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh

2005-01-01

Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

Improved RF Measurements of SRF Cavity Quality Factors

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

Holzbauer, J. P.; Contreras, C.; Pischalnikov, Y.

SRF cavity quality factors can be accurately measured using RF-power based techniques only when the cavity is very close to critically coupled. This limitation is from systematic errors driven by non-ideal RF components. When the cavity is not close to critically coupled, these systematic effects limit the accuracy of the measurements. The combination of the complex base-band envelopes of the cavity RF signals in combination with a trombone in the circuit allow the relative calibration of the RF signals to be extracted from the data and systematic effects to be characterized and suppressed. The improved calibration allows accurate measurements tomore » be made over a much wider range of couplings. Demonstration of these techniques during testing of a single-spoke resonator with a coupling factor of near 7 will be presented, along with recommendations for application of these techniques.« less

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

PubMed

Bowblis, John R; Roberts, Amy Restorick

2018-06-01

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Quality Certification, Regulation and Power in Fair Trade

ERIC Educational Resources Information Center

Renard, Marie-Christine

2005-01-01

This article examines governance changes and shifting power relations within the fair-labelling network. These shifts are framed analytically by reference to broader changes in the agrofoods sector tied to the increasingly key role played by quality relations and standards in the production and marketing of food. The author argues that evident…

Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

PubMed

McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

2014-10-01

Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

PubMed

McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

2015-01-01

Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

Quality and Safety in Health Care, Part XVII: The ACS National Surgical Quality Improvement Program.

PubMed

Harolds, Jay A

2016-12-01

Mainly due to the positive effect on quality and safety from the Veterans Health Administration National Surgical Quality Improvement Program (VASQIP), a National Surgical Quality Improvement Program (NSQIP) for private hospitals was begun, which is now under the auspices of the American College of Surgeons (ACS). More than 600 hospitals now participate in the ACS-NSQIP. The information gained by the institutions is typically utilized to initiate quality improvement activities. The ACS-NSQIP also shares information on how to get better results, has national meetings, and provides other support.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

How to Measure and Interpret Quality Improvement Data.

PubMed

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

2016-05-06

This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.

Issues in Measuring and Improving Health Care Quality

PubMed Central

Friedman, Maria A.

1995-01-01

This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882

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

PubMed Central

2011-01-01

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

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…

Rating methodological quality: toward improved assessment and investigation.

PubMed

Moyer, Anne; Finney, John W

2005-01-01

Assessing methodological quality is considered essential in deciding what investigations to include in research syntheses and in detecting potential sources of bias in meta-analytic results. Quality assessment is also useful in characterizing the strengths and limitations of the research in an area of study. Although numerous instruments to measure research quality have been developed, they have lacked empirically-supported components. In addition, different summary quality scales have yielded different findings when they were used to weight treatment effect estimates for the same body of research. Suggestions for developing improved quality instruments include: distinguishing distinct domains of quality, such as internal validity, external validity, the completeness of the study report, and adherence to ethical practices; focusing on individual aspects, rather than domains of quality; and focusing on empirically-verified criteria. Other ways to facilitate the constructive use of quality assessment are to improve and standardize the reporting of research investigations, so that the quality of studies can be more equitably and thoroughly compared, and to identify optimal methods for incorporating study quality ratings into meta-analyses.

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

PubMed

Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

2017-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. Project HOPE—The People-to-People Health Foundation, Inc.

Developing and executing quality improvement projects (concept, methods, and evaluation).

PubMed

Likosky, Donald S

2014-03-01

Continuous quality improvement, quality assurance, cycles of change--these words of often used to express the process of using data to inform and improve clinical care. Although many of us have been exposed to theories and practice of experimental work (e.g., randomized trial), few of us have been similarly exposed to the science underlying quality improvement. Through the lens of a single-center quality improvement study, this article exposes the reader to methodology for conducting such studies. The reader will gain an understanding of these methods required to embark on such a study.

Cycle chemistry monitoring system as means of improving the reliability of the equipment at the power plants

NASA Astrophysics Data System (ADS)

Yegoshina, O. V.; Voronov, V. N.; Yarovoy, V. O.; Bolshakova, N. A.

2017-11-01

There are many problems in domestic energy at the present that require urgent solutions in the near future. One of these problems - the aging of the main and auxiliary equipment. Wear of equipment is the cause of decrease reliability and efficiency of power plants. Reliability of the equipment are associated with the introduction of cycle chemistry monitoring system. The most damageable equipment’s are boilers (52.2 %), turbines (12.6 %) and heating systems (12.3 %) according to the review of failure rate on the power plants. The most part of the damageability of the boiler is heated surfaces (73.2 %). According to the Russian technical requirements, the monitoring systems are responsible to reduce damageability the boiler heating surfaces and to increase the reliability of the equipment. All power units capacity of over 50 MW are equipped with cycle chemistry monitoring systems in order to maintain water chemistry within operating limits. The main idea of cycle chemistry monitoring systems is to improve water chemistry at power plants. According to the guidelines, cycle chemistry monitoring systems of a single unit depends on its type (drum or once-through boiler) and consists of: 20…50 parameters of on-line chemical analyzers; 20…30 «grab» sample analyses (daily) and about 15…20 on-line monitored operating parameters. The operator of modern power plant uses with many data at different points of steam/water cycle. Operators do not can estimate quality of the cycle chemistry due to the large volume of daily and every shift information and dispersion of data, lack of systematization. In this paper, an algorithm for calculating the quality index developed for improving control the water chemistry of the condensate, feed water and prevent scaling and corrosion in the steam/water cycle.

Artificial enzyme-powered microfish for water-quality testing.

PubMed

Orozco, Jahir; García-Gradilla, Victor; D'Agostino, Mattia; Gao, Wei; Cortés, Allan; Wang, Joseph

2013-01-22

We present a novel micromotor-based strategy for water-quality testing based on changes in the propulsion behavior of artificial biocatalytic microswimmers in the presence of aquatic pollutants. The new micromotor toxicity testing concept mimics live-fish water testing and relies on the toxin-induced inhibition of the enzyme catalase, responsible for the biocatalytic bubble propulsion of tubular microengines. The locomotion and survival of the artificial microfish are thus impaired by exposure to a broad range of contaminants, that lead to distinct time-dependent irreversible losses in the catalase activity, and hence of the propulsion behavior. Such use of enzyme-powered biocompatible polymeric (PEDOT)/Au-catalase tubular microengine offers highly sensitive direct optical visualization of changes in the swimming behavior in the presence of common contaminants and hence to a direct real-time assessment of the water quality. Quantitative data on the adverse effects of the various toxins upon the swimming behavior of the enzyme-powered artificial swimmer are obtained by estimating common ecotoxicological parameters, including the EC(50) (exposure concentration causing 50% attenuation of the microfish locomotion) and the swimmer survival time (lifetime expectancy). Such novel use of artificial microfish addresses major standardization and reproducibility problems as well as ethical concerns associated with live-fish toxicity assays and hence offers an attractive alternative to the common use of aquatic organisms for water-quality testing.

San Francisco Bay Water Quality Improvement Fund

EPA Pesticide Factsheets

EPAs grant program to protect and restore San Francisco Bay. The San Francisco Bay Water Quality Improvement Fund (SFBWQIF) has invested in 58 projects along with 70 partners contributing to restore wetlands, water quality, and reduce polluted runoff.,

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

PubMed

Howell, W T; Nickle, B W

1991-03-01

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

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

PubMed

Wu, Susan; Tyler, Amy; Logsdon, Tina; Holmes, Nicholas M; Balkian, Ara; Brittan, Mark; Hoover, LaVonda; Martin, Sara; Paradis, Melisa; Sparr-Perkins, Rhonda; Stanley, Teresa; Weber, Rachel; Saysana, Michele

2016-08-01

To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings. Copyright © 2016 by the American Academy of Pediatrics.

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

PubMed Central

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

2011-01-01

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

The quality march. National survey profiles quality improvement activities.

PubMed

1993-12-05

This nationwide profile of CQI/TQM adopters and non-adopters provides important baseline information with which to chart the growing involvement of hospitals with formal quality improvement efforts. Using a stringent definition, the findings suggest rather widespread adoption of CQI/TQM, although most of it has been very recent. Further, there are systematic differences by bed size, teaching orientation, and system membership. Though the Deming method is the most popular approach to CQI/TQM, nearly as many hospitals report using a combination of approaches, and approximately 22 percent report that they have not selected any specific approach. Of particular note is the finding that those involved with CQI/TQM activities perceive fewer barriers to their quality improvement efforts than those not involved. The impact of these differences on perceived costs and outcomes will be addressed in the next issue of Hospitals & Health Networks.

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life.

PubMed

Cadore, Eduardo Lusa; Izquierdo, Mikel

2015-06-01

In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients.

PubMed

Booij, Judith C; Zegers, Marieke; Evers, Pauline M P J; Hendriks, Michelle; Delnoij, Diana M J; Rademakers, Jany J D J M

2013-04-23

To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient's perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision.

Prioritizing quality improvement in general surgery.

PubMed

Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for < 1% of excess hospital days. A relatively small number of procedures account for a disproportionate share of the morbidity, mortality, and excess hospital days in general surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

SF Bay Water Quality Improvement Fund: Projects and Accomplishments

EPA Pesticide Factsheets

San Francisco Bay Water Quality Improvement Fund (SFBWQIF) projects listed here are part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

Evidence for the impact of quality improvement collaboratives: systematic review

PubMed Central

2008-01-01

Objective To evaluate the effectiveness of quality improvement collaboratives in improving the quality of care. Data sources Relevant studies through Medline, Embase, PsycINFO, CINAHL, and Cochrane databases. Study selection Two reviewers independently extracted data on topics, participants, setting, study design, and outcomes. Data synthesis Of 1104 articles identified, 72 were included in the study. Twelve reports representing nine studies (including two randomised controlled trials) used a controlled design to measure the effects of the quality improvement collaborative intervention on care processes or outcomes of care. Systematic review of these nine studies showed moderate positive results. Seven studies (including one randomised controlled trial) reported an effect on some of the selected outcome measures. Two studies (including one randomised controlled trial) did not show any significant effect. Conclusions The evidence underlying quality improvement collaboratives is positive but limited and the effects cannot be predicted with great certainty. Considering that quality improvement collaboratives seem to play a key part in current strategies focused on accelerating improvement, but may have only modest effects on outcomes at best, further knowledge of the basic components effectiveness, cost effectiveness, and success factors is crucial to determine the value of quality improvement collaboratives. PMID:18577559

Improving the Context Supporting Quality Improvement in a Neonatal Intensive Care Unit Quality Collaborative: An Exploratory Field Study.

PubMed

Grooms, Heather R; Froehle, Craig M; Provost, Lloyd P; Handyside, James; Kaplan, Heather C

Successful quality improvement (QI) requires a supportive context. The goal was to determine whether a structured curriculum could help QI teams improve the context supporting their QI work. An exploratory field study was conducted of 43 teams participating in a neonatal intensive care unit QI collaborative. Using a curriculum based on the Model for Understanding Success in Quality, teams identified gaps in their context and tested interventions to modify context. Surveys and self-reflective journals were analyzed to understand how teams developed changes to modify context. More than half (55%) targeted contextual improvements within the microsystem, focusing on motivation and culture. "Information sharing" interventions to communicate information about the project as a strategy to engage more staff were the most common interventions tested. Further study is needed to determine if efforts to modify context consistently lead to greater outcome improvements.

A Survey of Architectural Techniques For Improving Cache Power Efficiency

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

Mittal, Sparsh

Modern processors are using increasingly larger sized on-chip caches. Also, with each CMOS technology generation, there has been a significant increase in their leakage energy consumption. For this reason, cache power management has become a crucial research issue in modern processor design. To address this challenge and also meet the goals of sustainable computing, researchers have proposed several techniques for improving energy efficiency of cache architectures. This paper surveys recent architectural techniques for improving cache power efficiency and also presents a classification of these techniques based on their characteristics. For providing an application perspective, this paper also reviews several real-worldmore » processor chips that employ cache energy saving techniques. The aim of this survey is to enable engineers and researchers to get insights into the techniques for improving cache power efficiency and motivate them to invent novel solutions for enabling low-power operation of caches.« less

Improved power and efficiency for tapered lasers with optimized photonic crystal structures

NASA Astrophysics Data System (ADS)

Ma, Xiaolong; Qu, Hongwei; Zhao, Shaoyu; Zhou, Xuyan; Lin, Yuzhe; Zheng, Wanhua

2017-10-01

High power and high beam quality laser sources are required in numerous applications such as nonlinear frequency conversion, optical pumping of solid-state and fiber lasers, material processing and others. Tapered lasers can provide a high output power while keeping a high beam quality. However, the conventional tapered lasers suffer from a large vertical beam divergence. We have demonstrated 2-mm long tapered lasers with photonic crystal structures. A high beam quality and a narrow vertical divergence are achieved. In this paper, we optimized the photonic crystal structure and fabricated a 4-mm long tapered laser to further increase the output power and the wall-plug efficiency. Compared with our precious wafer, the optimized structure has a lower doping level to reduce the internal loss. The period of the photonic crystal structure and the thickness of the upper cladding are also reduced. The device has a 1-mm long ridge-waveguide section and a 3-mm long tapered section. The taper angle is 4°. An output power of 7.3 W is achieved with a peak wall-plug efficiency of 46% in continuous-wave mode. The threshold current is around 500 mA and the slope efficiency is 0.93 W/A. In pulsed mode, the output power is 15.6 W and the maximum wall-plug efficiency is 48.1%. The far-field divergence with full width at half maximum is 6.3° for the lateral direction at 3 A. The vertical far-field beam divergence is around 11° at different injection levels. High beam qualities are demonstrated by beam quality factor M2 of 1.52 for the lateral direction and 1.54 for the vertical direction.

Application of Islanding Detection and Classification of Power Quality Disturbance in Hybrid Energy System

NASA Astrophysics Data System (ADS)

Sun, L. B.; Wu, Z. S.; Yang, K. K.

2018-04-01

Islanding and power quality (PQ) disturbances in hybrid energy system become more serious with the application of renewable energy sources. In this paper, a novel method based on wavelet transform (WT) and modified feed forward neural network (FNN) is proposed to detect islanding and classify PQ problems. First, the performance indices, i.e., the energy content and SD of the transformed signal are extracted from the negative sequence component of the voltage signal at PCC using WT. Afterward, WT indices are fed to train FNNs midfield by Particle Swarm Optimization (PSO) which is a novel heuristic optimization method. Then, the results of simulation based on WT-PSOFNN are discussed in MATLAB/SIMULINK. Simulations on the hybrid power system show that the accuracy can be significantly improved by the proposed method in detecting and classifying of different disturbances connected to multiple distributed generations.

ISTC Projects from RFNC-VNIIEF Devoted to Improving Laser Beam Quality

NASA Astrophysics Data System (ADS)

Starikov, F.; Kochemasov, G.

Information is given about the Projects # 1929 and # 2631 supported by ISTC and concerned with improving laser beam quality and interesting for adaptive optics community. One of them, Project # 1929 has been recently finished. It has been devoted to development of an SBS phase conjugation mirror of superhigh conjugation quality employing the kinoform optics for high-power lasers with nanosecond scale pulse duration. With the purpose of reaching ideal PC fidelity, the SBS mirror includes the raster of small lenses that has been traditionally used as the lenslet in Shack-Hartmann wavefront sensor in adaptive optics. The second of them, Project # 2631, is concerned with the development of an adaptive optical system for phase correction of laser beams with wavefront vortex. The principles of operation of modern adaptive systems are based on the assumption that the phase is a smooth continuous function in space. Therefore the solution of the Project tasks will assume a new step in adaptive optics.

Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

PubMed Central

Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

2015-01-01

Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

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

ERIC Educational Resources Information Center

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

2012-01-01

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

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

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.

Advanced Micro Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy Security, and Power Quality at DoD Installations

DTIC Science & Technology

2016-10-28

assumptions. List of Assumptions: Price of electrical energy : $0.07/kWh flat rate for energy at the base Price of peak power: $15/MW peak power...EW-201147) Advanced Micro-Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy Security, and...12-C-0002 5b. GRANT NUMBER Advanced Micro-Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy

The air quality and regional climate effects of widespread solar power generation under a changing regulatory environment

NASA Astrophysics Data System (ADS)

Millstein, D.; Zhai, P.; Menon, S.

2011-12-01

Over the past decade significant reductions of NOx and SOx emissions from coal burning power plants in the U.S. have been achieved due to regulatory action and substitution of new generation towards natural gas and wind power. Low natural gas prices, ever decreasing solar generation costs, and proposed regulatory changes, such as to the Cross State Air Pollution Rule, promise further long-run coal power plant emission reductions. Reduced power plant emissions have the potential to affect ozone and particulate air quality and influence regional climate through aerosol cloud interactions and visibility effects. Here we investigate, on a national scale, the effects on future (~2030) air quality and regional climate of power plant emission regulations in contrast to and combination with policies designed to aggressively promote solar electricity generation. A sophisticated, economic and engineering based, hourly power generation dispatch model is developed to explore the integration of significant solar generation resources (>10% on an energy basis) at various regions across the county, providing detailed estimates of substitution of solar generation for fossil fuel generation resources. Future air pollutant emissions from all sectors of the economy are scaled based on the U.S. Environmental Protection Agency's National Emission Inventory to account for activity changes based on population and economic projections derived from county level U.S. Census data and the Energy Information Administration's Annual Energy Outlook. Further adjustments are made for technological and regulatory changes applicable within various sectors, for example, emission intensity adjustments to on-road diesel trucking due to exhaust treatment and improved engine design. The future year 2030 is selected for the emissions scenarios to allow for the development of significant solar generation resources. A regional climate and air quality model (Weather Research and Forecasting, WRF model) is

A Hearing-Based, Frequency Domain Sound Quality Model for Combined Aerodynamic and Power Transmission Response with Application to Rotorcraft Interior Noise

NASA Astrophysics Data System (ADS)

Sondkar, Pravin B.

The severity of combined aerodynamics and power transmission response in high-speed, high power density systems such as a rotorcraft is still a major cause of annoyance in spite of recent advancement in passive, semi-active and active control. With further increase in the capacity and power of this class of machinery systems, the acoustic noise levels are expected to increase even more. To achieve further improvements in sound quality, a more refined understanding of the factors and attributes controlling human perception is needed. In the case of rotorcraft systems, the perceived quality of the interior sound field is a major determining factor of passenger comfort. Traditionally, this sound quality factor is determined by measuring the response of a chosen set of juries who are asked to compare their qualitative reactions to two or more sounds based on their subjective impressions. This type of testing is very time-consuming, costly, often inconsistent, and not useful for practical design purposes. Furthermore, there is no known universal model for sound quality. The primary aim of this research is to achieve significant improvements in quantifying the sound quality of combined aerodynamic and power transmission response in high-speed, high power density machinery systems such as a rotorcraft by applying relevant objective measures related to the spectral characteristics of the sound field. Two models have been proposed in this dissertation research. First, a classical multivariate regression analysis model based on currently known sound quality metrics as well some new metrics derived in this study is presented. Even though the analysis resulted in the best possible multivariate model as a measure of the acoustic noise quality, it lacks incorporation of human judgment mechanism. The regression model can change depending on specific application, nature of the sounds and types of juries used in the study. Also, it predicts only the averaged preference scores and

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

PubMed

Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

2012-01-01

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

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...

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.

Improved decryption quality and security of a joint transform correlator-based encryption system

NASA Astrophysics Data System (ADS)

Vilardy, Juan M.; Millán, María S.; Pérez-Cabré, Elisabet

2013-02-01

Some image encryption systems based on modified double random phase encoding and joint transform correlator architecture produce low quality decrypted images and are vulnerable to a variety of attacks. In this work, we analyse the algorithm of some reported methods that optically implement the double random phase encryption in a joint transform correlator. We show that it is possible to significantly improve the quality of the decrypted image by introducing a simple nonlinear operation in the encrypted function that contains the joint power spectrum. This nonlinearity also makes the system more resistant to chosen-plaintext attacks. We additionally explore the system resistance against this type of attack when a variety of probability density functions are used to generate the two random phase masks of the encryption-decryption process. Numerical results are presented and discussed.

Overview of Power Quality and Integrated Testing at JSC

NASA Technical Reports Server (NTRS)

Davies, Francis

2018-01-01

This presentation describes the basic philosophy behind integrated testing and partially integrated testing. It lists some well known errors in space systems that were or could have been caught during integrated testing. Two examples of integrated testing at the Johnson Space Center (JSC) are mentioned, and then an overview of two test facilities that do power testing (partially integrated testing) at JSC are presented, with information on the capabilities of each. Finally a list of three projects that has problems caught during power quality or Electromagnetic Interference (EMI) testing is presented.

Systematic Review of International Colposcopy Quality Improvement Guidelines.

PubMed

Mayeaux, Edward J; Novetsky, Akiva P; Chelmow, David; Choma, Kim; Garcia, Francisco; Liu, Angela H; Papasozomenos, Theognosia; Einstein, Mark H

2017-10-01

The American Society for Colposcopy and Cervical Pathology Colposcopy Standards Committee organized multiple working groups to draft colposcopy standards for the United States. As part of this project, international quality assurance and improvement measures were examined. The quality improvement working group performed a systematic review of the literature to collate international guidelines related to quality improvement. Source guidelines were collected using searches in Medline, Google Scholar, the International Federation of Cervical Pathology and Colposcopy Web site, other regional colposcopy group's Web sites, and communications with International Federation of Cervical Pathology and Colposcopy board of directors' members and other expert members of various national groups. Once identified, the sources were reviewed by multiple workgroup members for potential guideline materials. Fifty-six unique documents were identified, of which 18 met inclusion criteria and contributed data to the analysis. Information was abstracted and grouped by related subject. Wide variation exists in colposcopy guidance and quality indicators from regional and national colposcopy societies. Abstracted international guidelines are presented.

AN EMPIRICAL METHOD FOR IMPROVING THE QUALITY OF RXTE HEXTE SPECTRA

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

Garcia, Javier A.; Steiner, James F.; McClintock, Jeffrey E.

2016-03-01

We have developed a correction tool to improve the quality of Rossi X-ray Timing Explorer (RXTE) High Energy X-ray Timing Experiment (HEXTE) spectra by employing the same method we used earlier to improve the quality of RXTE Proportional Counter Array (PCA) spectra. We fit all of the hundreds of HEXTE spectra of the Crab individually to a simple power-law model, some 37 million counts in total for Cluster A and 39 million counts for Cluster B, and we create for each cluster a combined spectrum of residuals. We find that the residual spectrum of Cluster A is free of instrumental artifacts while that of Clustermore » B contains significant features with amplitudes ∼1%; the most prominent is in the energy range 30–50 keV, which coincides with the iodine K edge. Starting with the residual spectrum for Cluster B, via an iterative procedure we created the calibration tool hexBcorr for correcting any Cluster B spectrum of interest. We demonstrate the efficacy of the tool by applying it to Cluster B spectra of two bright black holes, which contain several million counts apiece. For these spectra, application of the tool significantly improves the goodness of fit, while affecting only slightly the broadband fit parameters. The tool may be important for the study of spectral features, such as cyclotron lines, a topic that is beyond the scope of this paper.« less

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

Best Practices: Power Quality and Integrated Testing at JSC

NASA Technical Reports Server (NTRS)

Davis, Lydia

2018-01-01

This presentation discusses Best Practices for Power Quality and Integrated Testing at JSC in regards to electrical systems. These high-level charts include mostly generic information; however, a specific issue is discussed involving flight hardware that could have been discovered prior to flight with an integrated test.

An improved AVC strategy applied in distributed wind power system

NASA Astrophysics Data System (ADS)

Zhao, Y. N.; Liu, Q. H.; Song, S. Y.; Mao, W.

2016-08-01

Traditional AVC strategy is mainly used in wind farm and only concerns about grid connection point, which is not suitable for distributed wind power system. Therefore, this paper comes up with an improved AVC strategy applied in distributed wind power system. The strategy takes all nodes of distribution network into consideration and chooses the node having the most serious voltage deviation as control point to calculate the reactive power reference. In addition, distribution principles can be divided into two conditions: when wind generators access to network on single node, the reactive power reference is distributed according to reactive power capacity; when wind generators access to network on multi-node, the reference is distributed according to sensitivity. Simulation results show the correctness and reliability of the strategy. Compared with traditional control strategy, the strategy described in this paper can make full use of generators reactive power output ability according to the distribution network voltage condition and improve the distribution network voltage level effectively.

Does updating improve the methodological and reporting quality of systematic reviews?

PubMed

Shea, Beverley; Boers, Maarten; Grimshaw, Jeremy M; Hamel, Candyce; Bouter, Lex M

2006-06-13

Systematic reviews (SRs) must be of high quality. The purpose of our research was to compare the methodological and reporting quality of original versus updated Cochrane SRs to determine whether updating had improved these two quality dimensions. We identified updated Cochrane SRs published in issue 4, 2002 of the Cochrane Library. We assessed the updated and original versions of the SRs using two instruments: the 10 item enhanced Overview Quality Assessment Questionnaire (OQAQ), and an 18-item reporting quality checklist and flow chart based upon the Quality of Reporting of Meta-analyses (QUOROM) statement. At least two reviewers extracted data and assessed quality. We calculated the percentage (with a 95% confidence interval) of 'yes' answers to each question. We calculated mean differences in percentage, 95% confidence intervals and p-values for each of the individual items and the overall methodological quality score of the updated and pre-updated versions using OQAQ. We assessed 53 SRs. There was no significant improvement in the global quality score of the OQAQ (mean difference 0.11 (-0.28; 0.70 p = 0.52)). Updated reviews showed a significant improvement of 18.9 (7.2; 30.6 p < .01) on the OQAQ item assessing whether the conclusions drawn by the author(s) were supported by the data and/or analysis presented in the SR. The QUOROM statement showed that the quality of reporting of Cochrane reviews improved in some areas with updating. Improvements were seen on the items relating to data sources reported in the abstract, with a significant difference of 17.0 (9.8; 28.7 p = 0.01), review methods, reported in the abstract 35 (24.1; 49.1 p = 0.00), searching methods 18.9 (9.7; 31.6 p = 0.01), and data abstraction 18.9 (11.7; 30.9 p = 0.00). The overall quality of Cochrane SRs is fair-to-good. Although reporting quality improved on certain individual items there was no overall improvement seen with updating and methodological quality remained unchanged. Further

Instructional analysis of lecture video recordings and its application for quality improvement of medical lectures.

PubMed

Baek, Sunyong; Im, Sun Ju; Lee, Sun Hee; Kam, Beesung; Yune, So Joung; Lee, Sang Soo; Lee, Jung A; Lee, Yuna; Lee, Sang Yeoup

2011-12-01

The lecture is a technique for delivering knowledge and information cost-effectively to large medical classes in medical education. The aim of this study was to analyze teaching quality, based on triangle analysis of video recordings of medical lectures, to strengthen teaching competency in medical school. The subjects of this study were 13 medical professors who taught 1st- and 2nd-year medical students and agreed to a triangle analysis of video recordings of their lectures. We first performed triangle analysis, which consisted of a professional analysis of video recordings, self-assessment by teaching professors, and feedback from students, and the data were crosschecked by five school consultants for reliability and consistency. Most of the distress that teachers experienced during the lecture occurred in uniform teaching environments, such as larger lecture classes. Larger lectures that primarily used PowerPoint as a medium to deliver information effected poor interaction with students. Other distressing factors in the lecture were personal characteristics and lack of strategic faculty development. Triangle analysis of video recordings of medical lectures gives teachers an opportunity and motive to improve teaching quality. Faculty development and various improvement strategies, based on this analysis, are expected to help teachers succeed as effective, efficient, and attractive lecturers while improving the quality of larger lecture classes.

International Accreditations as Drivers of Business School Quality Improvement

ERIC Educational Resources Information Center

Bryant, Michael

2013-01-01

Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

A Total Quality Leadership Process Improvement Model

DTIC Science & Technology

1993-12-01

Leadership Process Improvement Model by Archester Houston, Ph.D. and Steven L. Dockstader, Ph.D. DTICS ELECTE tleaese oand sale itsFeat ben proe 94-12058...tTl ’AND SIATE COVERID0 Z lits Z40 uerI’Ll12/93 IFinalS.FNR IM F A Total Quality Leadership Process Improvement Model M ARRhOW~ Archester Houston, Ph.D...and Steven L. Dockstader, Ph.D. ?. 7PEJORMING ORG-AN1:AION NAMEIS) AND 00-RESS(ES) L PERFORMIN4 ORAINIZATION Total Quality Leadership OfficeREOTNMR

A single activity with a practice quality improvement project for faculty and a quality improvement project for residents.

PubMed

Kim, Hyun; Malatesta, Theresa M; Simone, Nicole L; Den, Robert B; McAna, John; Dicker, Adam P; Bar Ad, Voichita

2016-01-01

The Next Accreditation System (NAS) requires radiation oncology residents to do a formal quality improvement project during their residency. The American Board of Radiology (ABR) Maintenance of Certification (MOC) program requires certified physicians to complete a Practice Quality Improvement (PQI) project approximately every 3 years. The purpose of our project was to develop a clinical transition of care policy via a process that resulted in quality improvement project credit for residents and PQI credit for participating faculty. Approval for project implementation was obtained from the ABR MOC committee. The PQI project consisted of an initial survey to assess resident perception on resident transition of care in our department, formal sign-out training, and 2 postintervention surveys after 1 and 11 months. The primary endpoint was the percentage of questions with ≤1 unfavorable responses. Sign-test was used to determine response difference from neutral. One hundred percent of surveyed residents completed the preintervention (n = 6), postintervention 1 (n = 7), and postintervention 2 (n = 8) surveys. In the preintervention, postintervention 1, and postintervention 2 surveys, 71.4%, 57.1%, and 57.1% of questions were answered with ≤1 unfavorable response, respectively. The number of questions with ≥75% favorable response was 7 (50%), 7 (50%), and 11 (78.5%) in the preintervention, postintervention 1, and postintervention 2 surveys, respectively (P = .13). A written sign-out template and monthly protected sign-out meetings were instituted. One resident and 3 attending physicians received credit for Accreditation Council of Graduate Medical Education NAS quality improvement and ABR MOC PQI projects, respectively. This project shows the feasibility of a combined attending and resident physician effort to improve patient care and fulfill his or her respective ABR MOC PQI and Accreditation Council of Graduate Medical Education NAS requirements. Attending and

Improving Power Density of Free-Piston Stirling Engines

NASA Technical Reports Server (NTRS)

Briggs, Maxwell H.; Prahl, Joseph; Loparo, Kenneth

2016-01-01

Analyses and experiments demonstrate the potential benefits of optimizing piston and displacer motion in a free piston Stirling Engine. Isothermal analysis shows the theoretical limits of power density improvement due to ideal motion in ideal Stirling engines. More realistic models based on nodal analysis show that ideal piston and displacer waveforms are not optimal, often producing less power than engines that use sinusoidal piston and displacer motion. Constrained optimization using nodal analysis predicts that Stirling engine power density can be increased by as much as 58 using optimized higher harmonic piston and displacer motion. An experiment is conducted in which an engine designed for sinusoidal motion is forced to operate with both second and third harmonics, resulting in a maximum piston power increase of 14. Analytical predictions are compared to experimental data showing close agreement with indirect thermodynamic power calculations, but poor agreement with direct electrical power measurements.

Interventions to improve water quality for preventing diarrhoea.

PubMed

Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

2015-10-20

Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with unimproved water sources (30 studies) and unimproved or unclear sanitation (34 studies). The primary

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

PubMed

Chawla, Deepak; Suresh, Gautham K

2014-12-01

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

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.

Multifunctional voltage source inverter for renewable energy integration and power quality conditioning.

PubMed

Dai, NingYi; Lam, Chi-Seng; Zhang, WenChen

2014-01-01

In order to utilize the energy from the renewable energy sources, power conversion system is necessary, in which the voltage source inverter (VSI) is usually the last stage for injecting power to the grid. It is an economical solution to add the function of power quality conditioning to the grid-connected VSI in the low-voltage distribution system. Two multifunctional VSIs are studied in this paper, that is, inductive-coupling VSI and capacitive-coupling VSI, which are named after the fundamental frequency impedance of their coupling branch. The operation voltages of the two VSIs are compared when they are used for renewable energy integration and power quality conditioning simultaneously. The operation voltage of the capacitive-coupling VSI can be set much lower than that of the inductive-coupling VSI when reactive power is for compensating inductive loads. Since a large portion of the loads in the distribution system are inductive, the capacitive-coupling VSI is further studied. The design and control method of the multifunctional capacitive-coupling VSI are proposed in this paper. Simulation and experimental results are provided to show its validity.

Air quality impact of the coal-fired power plants in the northern passageway of the China West-East Power Transmission Project.

PubMed

Xue, Zhigang; Hao, Jiming; Chai, Fahe; Duan, Ning; Chen, Yizhen; Li, Jindan; Chen, Fu; Liu, Simei; Pu, Wenqing

2005-12-01

This paper analyzes the air quality impacts of coal-fired power plants in the northern passageway of the West-East Power Transmission Project in China. A three-layer Lagrangian model called ATMOS, was used to simulate the spatial distribution of incremental sulfur dioxide (SO2) and coarse particulate matter (PM10) concentrations under different emission control scenarios. In the year 2005, the emissions from planned power plants mainly affected the air quality of Shanxi, Shaanxi, the common boundary of Inner Mongolia and Shanxi, and the area around the boundary between Inner Mongolia and Ningxia. In these areas, the annually averaged incremental SO2 and PM10 concentrations exceed 2 and 2.5 microg/m3, respectively. The maximum increases of the annually averaged SO2 and PM10 concentrations are 8.3 and 7.2 microg/m3, respectively, which occur around Hancheng city, near the boundary of the Shaanxi and Shanxi provinces. After integrated control measures are considered, the maximum increases of annually averaged SO2 and PM10 concentrations fall to 4.9 and 4 microg/m3, respectively. In the year 2010, the areas affected by planned power plants are mainly North Shaanxi, North Ningxia, and Northwest Shanxi. The maximum increases of the annually averaged SO2 and PM10, concentrations are, respectively, 6.3 and 5.6 microg/m3, occurring in Northwest Shanxi, which decline to 4.4 and 4.1 microg/m3 after the control measures are implemented. The results showed that the proposed power plants mainly affect the air quality of the region where the power plants are built, with little impact on East China where the electricity will be used. The influences of planned power plants on air quality will be decreased greatly by implementing integrated control measures.

Simulations of far-field optical beam quality influenced by the thermal distortion of the secondary mirror for high-power laser system

NASA Astrophysics Data System (ADS)

Guo, Ruhai; Chen, Ning; Zhuang, Xinyu; Wang, Bing

2015-02-01

In order to research the influence on the beam quality due to thermal deformation of the secondary mirror in the high power laser system, the theoretical simulation study is performed. Firstly, three typical laser power 10kW, 50kW and 100kW with the wavelength 1.064μm are selected to analyze thermal deformation of mirror through the finite element analyze of thermodynamics instantaneous method. Then the wavefront aberration can be calculated by ray-tracing theory. Finally, focus spot radius，beam quality (BQ) of far-filed beam can be calculated and comparably analyzed by Fresnel diffraction integration. The simulation results show that with the increasing laser power, the optical aberration of beam director gets worse, the far-field optical beam quality decrease, which makes the laser focus spot broadening and the peak optical intensity of center decreasing dramatically. Comparing the clamping ring and the three-point clamping, the former is better than the latter because the former only induces the rotation symmetric deformation and the latter introduces additional astigmatism. The far-field optical beam quality can be improved partly by simply adjusting the distance between the main mirror and the secondary mirror. But the far-field power density is still the one tenth as that without the heat distortion of secondary mirror. These results can also provide the reference to the thermal aberration analyze for high power laser system and can be applied to the field of laser communication system and laser weapon etc.

40 CFR 64.8 - Quality improvement plan (QIP) requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a...

40 CFR 64.8 - Quality improvement plan (QIP) requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a...

Research on construction quality and improvement of assembly construction

NASA Astrophysics Data System (ADS)

Cheng, Fei

2017-11-01

Based on the acceleration of the urbanization process and the improvement of the quality of life of our residents, the demand for building construction has been increasing. In this context, the construction industry in order to promote the construction efficiency, quality improvement, to meet the needs of the development of the times to strengthen the new technology, the use of new technologies. At present, China’s engineering construction units in the process of carrying out the project to strengthen the use of assembly-type construction technology, which thus achieved for the traditional construction work low-level, high time-consuming issues, and promote the steady improvement of production efficiency. Based on this, this paper focuses on the analysis of the connotation of the assembly structure and analyzes the quality problems in the construction process of the construction projects and puts forward the improvement measures to promote the improvement of the building quality and the construction of the building Construction speed. Based on this, this paper analyzes the structural system and design of prefabricated building.

[Continuous quality improvement in anesthesia].

PubMed

Gaitini, L; Vaida, S; Madgar, S

1998-01-01

Slow continuous quality improvement (SCQI) in anesthesia is a process that allows identification of problems and their causes. Implementing measures to correct them and continuous monitoring to ensure that the problems have been eliminated are necessary. The basic assumption of CQI is that the employees of an organization are competent and working to the best of their abilities. If problems occur they are the consequences of inadequacies in the process rather that in the individual. The CQI program is a dynamic but gradual system that invokes a slower rate of response in comparison with other quality methods, like quality assurance. Spectacular results following a system change are not to be expected an the ideal is slow and continuous improvement. A SCQI program was adapted by our department in May 1994, according to the recommendations of the American Society of Anesthesiologists. Problem identification was based on 65 clinical indicators, reflecting negative events related to anesthesia. Data were collected using a specially designed computer database. 4 events were identified as crossing previously established thresholds (hypertension, hypotension, hypoxia and inadequate nerve block). Statistical process control was used to establish stability of the system and whether negative events were influenced only by the common causes. The causes responsible for these negative events were identified using specific SCQI tools, such as control-charts, cause-effect diagrams and Pareto diagrams. Hypertension and inadequate nerve block were successfully managed. The implementation of corrective measures for the other events that cross the threshold is still in evolution. This program requires considerable dedication on the part of the staff, and it is hoped that it will improve our clinical performance.

Improving Teaching Quality and the Learning Organisation

ERIC Educational Resources Information Center

Collie, Sarah L.; Taylor, Alton L.

2004-01-01

This study applied a learning organisation framework to understand academic departments' efforts to improve teaching quality. The theoretical framework was generated from literature on learning organisations, organisations devoted to continuous improvement through continuous learning. Research questions addressed relationships among departments'…

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)…

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

PubMed

Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

2017-06-02

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right

Measuring and Costing Quality in Education: Using Quality and Productivity Methods To Improve Schools.

ERIC Educational Resources Information Center

Spanbauer, Stanley J.

The Measurement and Costing Model (MCM) described in this book was developed and tested at Fox Valley Technical College (FVTC), Wisconsin, to enhance the college's quality improvement process and to serve as a guide to other institutions interested in improving their quality. The book presents a description of the model and outlines seven steps…

Effective interventions on service quality improvement in a physiotherapy clinic.

PubMed

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Improving the quality of mass produced maps

USGS Publications Warehouse

Simley, J.

2001-01-01

Quality is critical in cartography because key decisions are often made based on the information the map communicates. The mass production of digital cartographic information to support geographic information science has now added a new dimension to the problem of cartographic quality, as problems once limited to small volumes can now proliferate in mass production programs. These problems can also affect the economics of map production by diverting a sizeable portion of production cost to pay for rework on maps with poor quality. Such problems are common to general industry-in response, the quality engineering profession has developed a number of successful methods to overcome these problems. Two important methods are the reduction of error through statistical analysis and addressing the quality environment in which people work. Once initial and obvious quality problems have been solved, outside influences periodically appear that cause adverse variations in quality and consequently increase production costs. Such errors can be difficult to detect before the customer is affected. However, a number of statistical techniques can be employed to detect variation so that the problem is eliminated before significant damage is caused. Additionally, the environment in which the workforce operates must be conductive to quality. Managers have a powerful responsibility to create this environment. Two sets of guidelines, known as Deming's Fourteen Points and ISO-9000, provide models for this environment.

[Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature].

PubMed

Vecchi, Simona; Agabiti, Nera; Mitrova, Susanna; Cacciani, Laura; Amato, Laura; Davoli, Marina; Bargagli, Anna Maria

2016-01-01

we analysed evidence on effective interventions to improve the quality of care and management in patients with diabetes type 2. This review focuses particularly on audit and feedback intervention, targeted to healthcare providers, and continuous quality improvement (CQI) involving health professionals and health care systems, respectively. we searched The Cochrane Library, PubMed, and EMBASE (search period: January 2005-December 2015) to identify systematic reviews (SR) and randomized controlled trials (RCTs) considering patients' outcomes and process measures as quality indicators in diabetes care. Selection of studies and data extraction were carried out independently by two reviewers. Methodological quality of individual studies was assessed using the checklist «Assessment of methodological quality of systematic review» (AMSTAR) and the Cochrane's tool, respectively. We produced summaries of results for each study design. the search process resulted in 810 citations. One SR and 7 RCTs that compared any intervention in which audit and feedback and CQI was a component vs. other interventions were selected. The SR found that audit and feedback activity was associated with improvements of glycaemic (mean difference: 0.26; 95%CI 0.08;0.44) and cholesterol control (mean difference: 0.03; 95%CI -0.04;0.10). CQI interventions were not associated with an improvement of quality of diabetes care. The RCTs considered in this review compared a broad range of interventions including feedback as unique activity or as part of more complex strategies. The methodological quality was generally poor in all the included trials. the available evidence suggests that audit and feedback and CQI improve quality of care in diabetic patients, although the effect is small and heterogeneous among process and outcomes indicators.

Creating a quality-improvement dialogue: utilizing knowledge from frontline staff, managers, and experts to foster health care quality improvement.

PubMed

Parker, Louise E; Kirchner, JoAnn E; Bonner, Laura M; Fickel, Jacqueline J; Ritchie, Mona J; Simons, Carol E; Yano, Elizabeth M

2009-02-01

There is a growing consensus that a hybrid of two common approaches to quality improvement (QI), local participatory QI and expert QI, might be the best method for achieving quality care. Achieving such a hybrid requires that content experts establish an ongoing dialogue with both frontline staff members and managers. In this study we examined frontline staff members' and managers' preferences regarding how to conduct such a dialogue, and we provide practical suggestions for implementation. The two groups shared a number of preferences (e.g., verbal face-to-face exchanges, discussions focused on quality of care). There were also some differences. For example, although managers were interested in discussions of business aspects (e.g., costs), frontline staff members were concerned with workload issues. Finally, although informants acknowledged that engaging in a QI dialogue was time consuming, they also believed it was essential if health care organizations are to improve the quality of care they provide.

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.

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients

PubMed Central

2013-01-01

Background To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. Methods We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. Results The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. Conclusions The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. PMID:23617741

Improving Power Density of Free-Piston Stirling Engines

NASA Technical Reports Server (NTRS)

Briggs, Maxwell H.; Prahl, Joseph M.; Loparo, Kenneth A.

2016-01-01

Analyses and experiments demonstrate the potential benefits of optimizing piston and displacer motion in a free-piston Stirling Engine. Isothermal analysis shows the theoretical limits of power density improvement due to ideal motion in ideal Stirling engines. More realistic models based on nodal analysis show that ideal piston and displacer waveforms are not optimal, often producing less power than engines that use sinusoidal piston and displacer motion. Constrained optimization using nodal analysis predicts that Stirling engine power density can be increased by as much as 58 percent using optimized higher harmonic piston and displacer motion. An experiment is conducted in which an engine designed for sinusoidal motion is forced to operate with both second and third harmonics, resulting in a piston power increase of as much as 14 percent. Analytical predictions are compared to experimental data and show close agreement with indirect thermodynamic power calculations, but poor agreement with direct electrical power measurements.

Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

ERIC Educational Resources Information Center

Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

2014-01-01

Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

Sustainability in the AAP Bronchiolitis Quality Improvement Project.

PubMed

Shadman, Kristin A; Ralston, Shawn L; Garber, Matthew D; Eickhoff, Jens; Mussman, Grant M; Walley, Susan C; Rice-Conboy, Elizabeth; Coller, Ryan J

2017-11-01

Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the

Improving geothermal power plants with a binary cycle

NASA Astrophysics Data System (ADS)

Tomarov, G. V.; Shipkov, A. A.; Sorokina, E. V.

2015-12-01

The recent development of binary geothermal technology is analyzed. General trends in the introduction of low-temperature geothermal sources are summarized. The use of single-phase low-temperature geothermal fluids in binary power plants proves possible and expedient. The benefits of power plants with a binary cycle in comparison with traditional systems are shown. The selection of the working fluid is considered, and the influence of the fluid's physicochemical properties on the design of the binary power plant is discussed. The design of binary power plants is based on the chemical composition and energy potential of the geothermal fluids and on the landscape and climatic conditions at the intended location. Experience in developing a prototype 2.5 MW Russian binary power unit at Pauzhetka geothermal power plant (Kamchatka) is outlined. Most binary systems are designed individually for a specific location. Means of improving the technology and equipment at binary geothermal power plants are identified. One option is the development of modular systems based on several binary systems that employ the heat from the working fluid at different temperatures.

Power converter having improved fluid cooling

DOEpatents

Meyer, Andreas A.; Radosevich, Lawrence D.; Beihoff, Bruce C.; Kehl, Dennis L.; Kannenberg, Daniel G.

2007-03-06

A thermal support may receive one or more power electronic circuits. The support may aid in removing heat from the circuits through fluid circulating through the support, which may be controlled in a closed-loop manner. Interfacing between circuits, circuit mounting structure, and the support provide for greatly enhanced cooling. The support may form a shield from both external EMI/RFI and from interference generated by operation of the power electronic circuits. Features may be provided to permit and enhance connection of the circuitry to external circuitry, such as improved terminal configurations. Modular units may be assembled that may be coupled to electronic circuitry via plug-in arrangements or through interface with a backplane or similar mounting and interconnecting structures.

Culture shock: Improving software quality

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

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

1988-01-01

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

Communicating quality improvement through a hospital newsletter.

PubMed

Tietz, A; Tabor, R

1995-01-01

Healthcare organizations across the United States are embracing the tenets of continuous quality improvement. The challenge is to disseminate information about this quality activity throughout the organization. A monthly newsletter serves two vital purposes: to share the improvements and to generate more enthusiasm and participation by staff members. This article gives practical suggestions for promoting a monthly newsletter. Preparation of an informative newsletter requires a significant investment of time and effort. However, the positive results of providing facilitywide communications can make it worth the effort. The current availability of relatively inexpensive desktop publishing computer software programs has made the process much easier.

E-MSD: improving data deposition and structure quality.

PubMed

Tagari, M; Tate, J; Swaminathan, G J; Newman, R; Naim, A; Vranken, W; Kapopoulou, A; Hussain, A; Fillon, J; Henrick, K; Velankar, S

2006-01-01

The Macromolecular Structure Database (MSD) (http://www.ebi.ac.uk/msd/) [H. Boutselakis, D. Dimitropoulos, J. Fillon, A. Golovin, K. Henrick, A. Hussain, J. Ionides, M. John, P. A. Keller, E. Krissinel et al. (2003) E-MSD: the European Bioinformatics Institute Macromolecular Structure Database. Nucleic Acids Res., 31, 458-462.] group is one of the three partners in the worldwide Protein DataBank (wwPDB), the consortium entrusted with the collation, maintenance and distribution of the global repository of macromolecular structure data [H. Berman, K. Henrick and H. Nakamura (2003) Announcing the worldwide Protein Data Bank. Nature Struct. Biol., 10, 980.]. Since its inception, the MSD group has worked with partners around the world to improve the quality of PDB data, through a clean up programme that addresses inconsistencies and inaccuracies in the legacy archive. The improvements in data quality in the legacy archive have been achieved largely through the creation of a unified data archive, in the form of a relational database that stores all of the data in the wwPDB. The three partners are working towards improving the tools and methods for the deposition of new data by the community at large. The implementation of the MSD database, together with the parallel development of improved tools and methodologies for data harvesting, validation and archival, has lead to significant improvements in the quality of data that enters the archive. Through this and related projects in the NMR and EM realms the MSD continues to improve the quality of publicly available structural data.

Institutionalizing urban forestry as a "biotechnology" to improve environmental quality

Treesearch

David J. Nowak

2006-01-01

Urban forests can provide multiple environmental benefits. As urban areas expand, the role of urban vegetation in improving environmental quality will increase in importance. Quantification of these benefits has revealed that urban forests can significantly improve air quality. As a result, national air quality regulations are now willing to potentially credit tree...

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

PubMed Central

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-01-01

Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

Student laboratory reports: an approach to improving feedback and quality