Healthier Schools: A Review of State Policies for Improving Indoor Air Quality. Research Report.

ERIC Educational Resources Information Center

Bernstein, Tobie

Existing indoor air quality (IAQ) policies for schools reflect the variety of institutional, political, social, and economic contexts that exist within individual states. The purpose of this report is to provide a better understanding of the types of policy strategies used by states in addressing general indoor air quality problems. The policies…

Food Price Policies May Improve Diet but Increase Socioeconomic Inequalities in Nutrition.

PubMed

Darmon, Nicole; Lacroix, Anne; Muller, Laurent; Ruffieux, Bernard

2016-01-01

Unhealthy eating is more prevalent among women and people with a low socioeconomic status. Policies that affect the price of food have been proposed to improve diet quality. The study's objective was to compare the impact of food price policies on the nutritional quality of food baskets chosen by low-income and medium-income women. Experimental economics was used to simulate a fruit and vegetable subsidy and a mixed policy subsidizing healthy products and taxing unhealthy ones. Food classification was based on the Score of Nutritional Adequacy of Individual Foods, Score of Nutrients to Be Limited nutrient profiling system. Low-income (n = 95) and medium-income (n = 33) women selected a daily food basket first at current prices and then at policy prices. Energy density (ED) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline, low-income women selected less healthy baskets than medium-income women (less fruit and vegetables, more unhealthy products, higher ED, lower MAR). Both policies improved nutritional quality (fruit and vegetable quantities increased, ED decreased, the MAR increased), but the magnitude of the improvement was often lower among low-income women. For instance, ED decreased by 5.3% with the fruit and vegetable subsidy and by 7.3% with the mixed subsidy, whereas decreases of 13.2 and 12.6%, respectively, were recorded for the medium-income group. Finally, both policies improved dietary quality, but they increased socioeconomic inequalities in nutrition. © 2016 S. Karger AG, Basel.

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

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

PubMed

Berenson, Robert A; Rice, Thomas

2015-12-01

The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

[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.

Value for money of changing healthcare services? Economic evaluation of quality improvement

PubMed Central

Severens, J

2003-01-01



 There are many instances of perceived or real inefficiencies in health service delivery. Both healthcare providers and policy makers need to know the impact and cost of applying strategies to change the behaviour of individuals or organisations. Quality improvement or implementation research is concerned with evaluating the methods of behavioural change. Addressing inefficiencies in healthcare services raises a series of issues, beginning with how inefficiency itself should be defined. The basic concepts of cost analysis and economic evaluations are explained and a model for working through the economic issues of quality improvement is discussed. This model combines the costs and benefits of corrected inefficiency with the costs and degree of behavioural change achieved by a quality improvement method in the policy maker's locality. It shows why it may not always be cost effective for policy makers to address suboptimal behaviour. Both the interpretation of quality improvement research findings and their local application need careful consideration. The limited availability of applicable quality improvement research may make it difficult to provide robust advice on the value for money of many behavioural quality improvement strategies. PMID:14532369

The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice

PubMed Central

Shimkhada, Riti; Peabody, John W; Quimbo, Stella A; Solon, Orville

2008-01-01

Background Randomized trials have long been the gold-standard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS), an example of a large randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions. Methods In 1999 the Philippine government proposed sweeping reforms in the National Health Sector Reform Agenda. We recognized the unique opportunity to conduct a social experiment. Our ongoing goal has been to generate results that inform health policy. Early on we concentrated on developing a multi-institutional collaborative effort. The QIDS team then developed hypotheses that specifically evaluated the impact of two policy reforms on both the delivery of care and long-term health status in children. We formed an experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-in-difference estimation. Results We found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data collection effort to account for

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.

State Policies and Planning to Increase Attainment, Quality, and Productivity

ERIC Educational Resources Information Center

Lingenfelter, Paul E.

2007-01-01

This article examines why state planning and policy for higher education are increasingly focused on increasing educational attainment, quality, and the productivity of the system. It presents four "stories" which illustrate initiatives to improve attainment, quality, and productivity, but fall far short of exhausting the available material.

The Belgian commitment to pharmaceutical quality: a model policy to improve quality assurance of medicines available through humanitarian and development programs.

PubMed

Ravinetto, Raffaella; Roosen, Tim; Dujardin, Catherine

2018-01-01

Today, a combination of globalization of pharmaceutical production, lack of regulatory harmonization, and weakness of Medicines Regulatory Authorities, creates the "perfect conditions" for poor-quality medicine to circulate in the global market and to penetrate the less-regulated countries. Medicines regulation is the responsibility of the national regulatory authorities in the recipient country, but in the poorer countries, in practice, the responsibility of supply of quality-assured medicines is often taken by Non-Governmental Organizations and other implementers. But with some notable exceptions, many donors lack a pharmaceutical procurement policy with adequate quality requirements; and many implementers lack the skills and expertise needed to orient themselves in the complex web of global pharmaceutical supply. Thus, patients served by humanitarian or development programs may remain exposed to the risk of poor-quality medicines. When public money is used to purchase medicines for medical programs to be carried out overseas, adequate policies should be in place to assure that the same quality requirements are set that would be required for medicines marketed in the "donor" country. We will describe here a policy recently adopted in Belgium, i.e. the "Commitment to Quality Assurance for Pharmaceutical Products", signed in October 2017 by the Vice Prime Minister and Minister for Development Cooperation and 19 Belgian implementing agencies. By signing the new policy, the counterparts committed to ensure quality of medicines in the programs funded by Belgium's Official Development Assistance, and to build quality-assurance capacity in the recipient countries. Implementers are requested to integrate in their financing applications a section for pharmaceutical quality assurance, with a justified budget. They are also invited to consider how costs could be rationalized and mutualized by aligning the strengths of the various implementers. This model policy has the

Analyzing the cost effectiveness of Santiago, Chile's policy of using urban forests to improve air quality.

PubMed

Escobedo, Francisco J; Wagner, John E; Nowak, David J; De la Maza, Carmen Luz; Rodriguez, Manuel; Crane, Daniel E

2008-01-01

Santiago, Chile has the distinction of having among the worst urban air pollution problems in Latin America. As part of an atmospheric pollution reduction plan, the Santiago Regional Metropolitan government defined an environmental policy goal of using urban forests to remove particulate matter less than 10 microm (PM(10)) in the Gran Santiago area. We used cost effectiveness, or the process of establishing costs and selecting least cost alternatives for obtaining a defined policy goal of PM(10) removal, to analyze this policy goal. For this study, we quantified PM(10) removal by Santiago's urban forests based on socioeconomic strata and using field and real-time pollution and climate data via a dry deposition urban forest effects model. Municipal urban forest management costs were estimated using management cost surveys and Chilean Ministry of Planning and Cooperation documents. Results indicate that managing municipal urban forests (trees, shrubs, and grass whose management is under the jurisdiction of Santiago's 36 municipalities) to remove PM(10) was a cost-effective policy for abating PM(10) based on criteria set by the World Bank. In addition, we compared the cost effectiveness of managing municipal urban forests and street trees to other control policies (e.g. alternative fuels) to abate PM(10) in Santiago and determined that municipal urban forest management efficiency was similar to these other air quality improvement measures.

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.

How to Improve the Supply of High-Quality Teachers

ERIC Educational Resources Information Center

Hanushek, Eric Alan; Rivkin, Steven G.

2004-01-01

Virtually everybody interested in improving the performance of schools concentrates on the importance of teacher quality. Yet policy recommendations related to teacher quality frequently do not incorporate existing evidence about performance. This paper reviews the various strands of research related to teacher quality, including the role of…

75 FR 16088 - Proposed Information Quality Guidelines Policy

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

... ELECTION ASSISTANCE COMMISSION Proposed Information Quality Guidelines Policy AGENCY: U.S... Quality Guidelines Policy. SUMMARY: The U.S. Election Assistance Commission (EAC) seeks public comment on the Proposed Information Quality Guidelines policy. The policy outlines the EAC's directives and...

Turning Data Into Information: Opportunities to Advance Rehabilitation Quality, Research, and Policy.

PubMed

Bettger, Janet Prvu; Nguyen, Vu Q C; Thomas, J George; Guerrier, Tami; Yang, Qing; Hirsch, Mark A; Pugh, Terrence; Harris, Gabrielle; Eller, Mary Ann; Pereira, Carol; Hamm, Deanna; Rinehardt, Eric A; Shall, Matthew; Niemeier, Janet P

2018-06-01

Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Quality of care: measuring a neglected driver of improved health

PubMed Central

Kruk, Margaret E

2017-01-01

Abstract The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact. PMID:28603313

The Role of Staff in Quality Improvement in Early Childhood

ERIC Educational Resources Information Center

Sims, Margaret; Waniganayake, Manjula

2015-01-01

There is international recognition of the importance of high quality services for young children with a consensus that three pillars contribute to quality improvement: adult: child ratios, staff qualifications and group size. In Australia over the past 5 years, early childhood policy has attempted to drive improvements in early childhood service…

Co-benefits of air quality and climate change policies on air quality of the Mediterranean

NASA Astrophysics Data System (ADS)

Pozzoli, Luca; Mert Gokturk, Ozan; Unal, Alper; Kindap, Tayfun; Janssens-Maenhout, Greet

2015-04-01

The Mediterranean basin is one of the regions of the world where significant impacts due to climate changes are predicted to occur in the future. Observations and model simulations are used to provide to the policy makers scientifically based estimates of the necessity to adjust national emission reductions needed to achieve air quality objectives in the context of a changing climate, which is not only driven by GHGs, but also by short lived climate pollutants, such as tropospheric ozone and aerosols. There is an increasing interest and need to design cost-benefit emission reduction strategies, which could improve both regional air quality and global climate change. In this study we used the WRF-CMAQ air quality modelling system to quantify the contribution of anthropogenic emissions to ozone and particulate matter concentrations in Europe and the Eastern Mediterranean and to understand how this contribution could change in different future scenarios. We have investigated four different future scenarios for year 2050 defined during the European Project CIRCE: a "business as usual" scenario (BAU) where no or just actual measures are taken into account; an "air quality" scenario (BAP) which implements the National Emission Ceiling directive 2001/81/EC member states of the European Union (EU-27); a "climate change" scenario (CC) which implements global climate policies decoupled from air pollution policies; and an "integrated air quality and climate policy" scenario (CAP) which explores the co-benefit of global climate and EU-27 air pollution policies. The BAP scenario largely decreases summer ozone concentrations over almost the entire continent, while the CC and CAP scenarios similarly determine lower decreases in summer ozone but extending all over the Mediterranean, the Middle East countries and Russia. Similar patterns are found for winter PM concentrations; BAP scenario improves pollution levels only in the Western EU countries, and the CAP scenario determines

Can a District-Level Teacher Salary Incentive Policy Improve Teacher Recruitment and Retention? Policy Brief 13-4

ERIC Educational Resources Information Center

Hough, Heather J.; Loeb, Susanna

2013-01-01

In this policy brief, Heather Hough and Susanna Loeb examine the effect of the Quality Teacher and Education Act of 2008 (QTEA) on teacher recruitment, retention, and overall teacher quality in the San Francisco Unified School District (SFUSD). They provide evidence that a salary increase can improve a school district's attractiveness within their…

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.

Improving Indoor Air Quality in St. Cloud Schools.

ERIC Educational Resources Information Center

Forer, Mike; Haus, El

2000-01-01

Describes how the St. Cloud Area School District (Minnesota), using Tools for Schools provided by the U.S. Environmental Protection Agency, managed the improvement of their school building indoor air quality (IAQ). The district goals of the IAQ Management Committee and the policy elements used to maintain high classroom air quality are…

Operative blood transfusion quality improvement audit.

PubMed

Al Sohaibani, Mazen; Al Malki, Assaf; Pogaku, Venumadhav; Al Dossary, Saad; Al Bernawi, Hanan

2014-01-01

To determine how current anesthesia team handless the identification of surgical anaesthetized patient (right patient). And the check of blood unit before collecting and immediately before blood administration (right blood) in operating rooms where nurses have minimal duties and responsibility to handle blood for transfusion in anaesthetized patients. To elicit the degree of anesthesia staff compliance with new policies and procedures for anaesthetized surgical patient the blood transfusion administration. A large tertiary care reference and teaching hospital. A prospective quality improvement. Elaboration on steps for administration of transfusion from policies and procedures to anaesthetized patients; and analysis of the audit forms for conducted transfusions. An audit form was used to get key performance indicators (KPIs) observed in all procedures involve blood transfusion and was ticked as item was met, partially met, not met or not applicable. Descriptive statistics as number and percentage Microsoft excel 2003. Central quality improvement committee presented the results in number percentage and graphs. The degree of compliance in performing the phases of blood transfusion by anesthesia staff reached high percentage which let us feel certain that the quality is assured that the internal policy and procedures (IPP) are followed in the great majority of all types of red cells and other blood products transfusion from the start of requesting the blood or blood product to the prescript of checking the patient in the immediate post-transfusion period. Specific problem area of giving blood transfusion to anaesthetized patient was checking KPI concerning the phases of blood transfusion was audited and assured the investigators of high quality performance in procedures of transfusion.

Quality of nursing doctoral education in Korea: towards policy development.

PubMed

Ja Kim, Mi; Gi Park, Chang; Kim, Minju; Lee, Hyeonkyeong; Ahn, Yang-Heui; Kim, Euisook; Yun, Soon-Nyoung; Lee, Kwang-Ja

2012-07-01

This article is a report on an international study of the quality of nursing doctoral education; herein, we report findings for Korea. Specific aims were to: examine the validity and reliability of the quality of nursing doctoral education questionnaire; and identify contributing factors and domain(s) for improvement. The quality of nursing doctoral education has been a worldwide concern with the recent rapid increase in number of nursing doctoral programmes around the world, and comprehensive evaluation is needed for policy recommendations. A cross-sectional descriptive study, conducted from October 2006 to January 2007, used an online questionnaire evaluating four domains: programme, faculty, resources and evaluation. Seven deans, 48 faculty, 52 graduates and 87 students from 14 nursing schools participated. Content and construct validity, and construct reliability of the questionnaire were established. Overall, participants reported that the perceived quality of private universities/schools was significantly higher than that of public/national universities. A higher ratio of doctoral to non-doctoral students was significantly associated with higher quality. The domains of programme, faculty and resources were highly correlated. The programme was the most important domain; availability of sufficient materials and information for students most needed improvement. Overall, faculty perceived the quality of the programme, faculty and resources as more positively than did the graduates and students. This study provides useful policy guidance for nurse educators worldwide for improving doctoral programmes and faculty's role in educating students. Further study is recommended that examines contributing factors to quality doctoral education. © 2011 Blackwell Publishing Ltd.

Getting from Here to There: The Roles of Policy Makers and Principals in Increasing Science Teacher Quality

NASA Astrophysics Data System (ADS)

Shen, Ji; Gerard, Libby; Bowyer, Jane

2010-04-01

In this study we investigate how federal and state policy makers, and school principals are working to improve science teacher quality. Interviews, focused discussions, and policy documents serve as the primary data source. Findings suggest that both policy makers and principals prioritize increasing incentives for teachers entering the science teaching profession, providing professional development for new teachers, and using students’ data to evaluate and improve instruction. Differences between the two leadership groups emerged in terms of the grain size and practicality of their concerns. Our findings indicate that the complexity of educational challenges to improve science teacher quality call for the co-construction of policy by multiple constituent groups including school principals, federal and state policy makers, and science education researchers.

Differentiated strategies for improving streaming service quality

NASA Astrophysics Data System (ADS)

An, Hui; Chen, Xin-Meng

2005-02-01

With the explosive growth of streaming services, users are becoming more and more sensitive to its quality of service. To handle these problems, the research community focuses of the application of caching and replication techniques. But most approaches try to find specific strategies of caching of replication that suit for streaming service characteristics and to design some kind of universal policy to deal with all streaming objects. This paper explores the combination of caching and replication for improving streaming service quality and demonstrates that it makes sense to incorporate two technologies. It provides a system model and discusses some related issues of how to determining a refreshable streaming object and which refreshment policies a refreshable object should use.

Quality Malaysian English Language Teachers: Examining a Policy Strategy

ERIC Educational Resources Information Center

Kepol, Napisah

2017-01-01

Purpose: The purpose of this paper is to examine and discuss one of the strategies in the latest Malaysian language education policy "Memartabatkan Bahasa Malaysia Memperkukuh Bahasa Inggeris" (MBMMBI) (To Uphold Bahasa Malaysia and to Strengthen the English Language). The strategy in focus is aimed at improving the quality of English…

Do Health Reforms to Improve Quality Have Long-Term Effects? Results of a Follow-Up on a Randomized Policy Experiment in the Philippines.

PubMed

Quimbo, Stella; Wagner, Natascha; Florentino, Jhiedon; Solon, Orville; Peabody, John

2016-02-01

We tracked doctors who had previously participated in a randomized policy experiment in the Philippines. The original experiment involved 30 district hospitals divided equally into one control site and two intervention sites that increased insurance payments (full insurance support for children under 5 years old) or made bonus payments to hospital staff. During the 3 years of the intervention, quality-as measured by clinical performance and value vignettes-improved and was sustained in both intervention sites compared with controls. Five years after the interventions were discontinued, we remeasured the quality of care of the doctors. We found that the intervention sites continued to have significantly higher quality compared with the control sites. The previously documented quality improvement in intervention sites appears to be sustained; moreover, it was subject to a very low (less than 1% per year) rate of decay in quality scores. Copyright © 2015 John Wiley & Sons, Ltd.

Improving the Quality of Early Childhood Education in Chile: Tensions between Public Policy and Teacher Discourses over the Schoolarisation of Early Childhood Education

ERIC Educational Resources Information Center

Pardo, Marcela; Woodrow, Christine

2014-01-01

This article problematises emerging tensions in Chile, in relation to the discourses of early childhood teachers and public policies aimed at improving the quality of early childhood education. The aim of the analysis is to contribute to developing more nuanced understandings of these tensions, through the analytical lenses provided by the…

Policy of Quality Assurance in Hong Kong Preschools

ERIC Educational Resources Information Center

Dora, Ho Choi-wa

2007-01-01

This article discusses the sources, processes and impact of the quality assurance policy implemented in Hong Kong preschools. Regarded as a sort of policy alignment between the subsystems of pre-primary, primary and secondary education, the introduction of a quality assurance policy has been directly and indirectly transforming the settlements in…

Forty years of improvements in European air quality: regional policy-industry interactions with global impacts

NASA Astrophysics Data System (ADS)

Crippa, Monica; Janssens-Maenhout, Greet; Dentener, Frank; Guizzardi, Diego; Sindelarova, Katerina; Muntean, Marilena; Van Dingenen, Rita; Granier, Claire

2016-03-01

The EDGARv4.3.1 (Emissions Database for Global Atmospheric Research) global anthropogenic emissions inventory of gaseous (SO2, NOx, CO, non-methane volatile organic compounds and NH3) and particulate (PM10, PM2.5, black and organic carbon) air pollutants for the period 1970-2010 is used to develop retrospective air pollution emissions scenarios to quantify the roles and contributions of changes in energy consumption and efficiency, technology progress and end-of-pipe emission reduction measures and their resulting impact on health and crop yields at European and global scale. The reference EDGARv4.3.1 emissions include observed and reported changes in activity data, fuel consumption and air pollution abatement technologies over the past 4 decades, combined with Tier 1 and region-specific Tier 2 emission factors. Two further retrospective scenarios assess the interplay of policy and industry. The highest emission STAG_TECH scenario assesses the impact of the technology and end-of-pipe reduction measures in the European Union, by considering historical fuel consumption, along with a stagnation of technology with constant emission factors since 1970, and assuming no further abatement measures and improvement imposed by European emission standards. The lowest emission STAG_ENERGY scenario evaluates the impact of increased fuel consumption by considering unchanged energy consumption since the year 1970, but assuming the technological development, end-of-pipe reductions, fuel mix and energy efficiency of 2010. Our scenario analysis focuses on the three most important and most regulated sectors (power generation, manufacturing industry and road transport), which are subject to multi-pollutant European Union Air Quality regulations. Stagnation of technology and air pollution reduction measures at 1970 levels would have led to 129 % (or factor 2.3) higher SO2, 71 % higher NOx and 69 % higher PM2.5 emissions in Europe (EU27), demonstrating the large role that technology has

Assessing quality of nursing home care: the foundation for improving resident outcomes.

PubMed

Rantz, M J; Mehr, D R; Conn, V S; Hicks, L L; Porter, R; Madsen, R W; Petrowski, G F; Maas, M

1996-07-01

Efforts to improve the quality of care and outcomes for nursing home residents are constantly of concern to state and federal regulators, nursing home providers, nursing home advocacy groups, and health policy researchers. The article describes a study that analyzed the quality indicators identified by the Health Care Financing Administration-sponsored Case Mix and Quality Demonstration Project using the Missouri nursing home Minimum Data Set database. The range of performance was considerable, and five of the indicators analyzed were risk adjusted to account for variation in resident acuity within facilities. Determining quality of care from assessment information that is routinely collected for nursing home residents has the potential to influence dramatically public policy decisions regarding reimbursement, recertification, and regulation and can play a vital role in improving resident outcomes.

Revisiting Educational Equity and Quality in China through Confucianism, Policy, Research, and Practice

ERIC Educational Resources Information Center

Mu, Guanglun Michael; Zheng, Xinrong; Jia, Ning; Li, Xiaohua; Wang, Shaoyi; Chen, Yanchuan; He, Ying; May, Lyn; Carter, Merilyn; Dooley, Karen; Berwick, Adon; Sobyra, Angela; Diezmann, Carmel

2013-01-01

The promotion of educational equity and improvement of educational quality in China are contextualised in tenets of Confucianism and policy directives, inspiring educational research and practice. In this paper, we first explore the historical and cultural roots of educational equity and quality through Confucianism and elaborate on the current…

Discussion of Policies for Achieving Continuous Improvement in Community Colleges. Commission on Innovation Policy Discussion Paper Number 1.

ERIC Educational Resources Information Center

BW Associates, Berkeley, CA.

Intended to provide background information and preliminary options for the California Community Colleges' Commission on Innovation, this document describes the principles of Continuous Quality Improvement (CQI) and describes policy options for implementation in the state's community colleges. Following introductory materials, the paper recommends…

EPA's Quality Policy and Procedure CIO Policy Transmittal 09-001

EPA Pesticide Factsheets

The purpose of this memo is to (1) issue the final versions of the Quality Policy and Procedure documents (with a Q&A document for your reference as well) and (2) call for members of a new advisory group to guide Policy implementation activities.

Policy Implications of Air Quality Research

NASA Astrophysics Data System (ADS)

Sheinbaum, C.

2004-12-01

While an integrated assessment approach will be required to achieve and sustain improvements in the air quality of Mexico City Metropolitan Area's (MCMA), policy strategies must be based on a solid understanding of the pollutant emissions and atmospheric processes that lead to unacceptable levels of air pollution. The required level of understanding can only be achieved by comprehensive atmospheric measurements followed by a coordinated atmospheric modeling program. The innovative, two-phase atmospheric measurement program, which was a collaborative effort between Massachusetts Institute of Technology and the Mexican Metropolitan Environmental Commission, with exploratory measurements in February 2002 and extensive measurements from late March through early May of 2003, was an important step towards meeting these requirements. Although the extensive data sets from the two measurement programs are still being analyzed by the investigators, their preliminary analysis efforts have yielded important insights into the nature and extent of air pollution problem in the MCMA, which in turn will have important policy implications.

Air Quality in Mexico City: Policies Implemented for its Improvement

NASA Astrophysics Data System (ADS)

Paramo, V.

2007-12-01

Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more

The Quality of Teacher Educators in the European Policy Debate: Actions and Measures to Improve the Professionalism of Teacher Educators

ERIC Educational Resources Information Center

Snoek, Marco; Swennen, Anja; van der Klink, Marcel

2011-01-01

This study examines how the contemporary European policy debate addresses the further development of the quality of teacher educators. A classification framework based on the literature on professionalism was used to compare European and Member State policy actions and measures on the quality of teacher educators through an analysis of seven…

Impacts of Climate Policy on Regional Air Quality, Health, and Air Quality Regulatory Procedures

NASA Astrophysics Data System (ADS)

Thompson, T. M.; Selin, N. E.

2011-12-01

Both the changing climate, and the policy implemented to address climate change can impact regional air quality. We evaluate the impacts of potential selected climate policies on modeled regional air quality with respect to national pollution standards, human health and the sensitivity of health uncertainty ranges. To assess changes in air quality due to climate policy, we couple output from a regional computable general equilibrium economic model (the US Regional Energy Policy [USREP] model), with a regional air quality model (the Comprehensive Air Quality Model with Extensions [CAMx]). USREP uses economic variables to determine how potential future U.S. climate policy would change emissions of regional pollutants (CO, VOC, NOx, SO2, NH3, black carbon, and organic carbon) from ten emissions-heavy sectors of the economy (electricity, coal, gas, crude oil, refined oil, energy intensive industry, other industry, service, agriculture, and transportation [light duty and heavy duty]). Changes in emissions are then modeled using CAMx to determine the impact on air quality in several cities in the Northeast US. We first calculate the impact of climate policy by using regulatory procedures used to show attainment with National Ambient Air Quality Standards (NAAQS) for ozone and particulate matter. Building on previous work, we compare those results with the calculated results and uncertainties associated with human health impacts due to climate policy. This work addresses a potential disconnect between NAAQS regulatory procedures and the cost/benefit analysis required for and by the Clean Air Act.

Developing policy, standard orders, and quality-assurance monitoring for palliative sedation therapy.

PubMed

Ghafoor, Virginia L; Silus, Lauren S

2011-03-15

The development of a policy, evidence-based standard orders, and monitoring for palliative sedation therapy (PST) is described. Concerns regarding PST at the University of Minnesota Medical Center (UMMC) arose and needed to be addressed in a formal process. A multidisciplinary group consisting of palliative care physicians, nurse practitioners, clinical nurse specialists, and clinical pharmacy specialists reached consensus on the practice model and medications to be used for PST. Major elements of the plan included the development and implementation of an institutional policy for palliative sedation; standard orders for patient care, sedation, and monitoring; education for staff, patients, and patients' family members; and quality-assurance monitoring. A literature review was performed to identify research and guidelines defining the practice of PST. Policy content includes the use of a standard order set linking patient care, medication administration, the monitoring of sedation, and symptom management. Approval of the policy involved several UMMC committees. An evaluation matrix was used to determine critical areas for PST monitoring and to guide development of a form to monitor quality. A retrospective chart audit using the quality-assurance monitoring form assessed baseline sedation medication and patient outcomes. Assessment of compliance began in the fall of 2008, after the policy and standard orders were approved by the UMMC medical executive committee. In 2008, two cases of PST were monitored using the standardized form. PST cases will be continually monitored and analyzed. Development of policy, standard orders, and quality-assurance monitoring for PST required a formal multidisciplinary process. A process-improvement process is critical to defining institutional policy, educational goals, and outcome metrics for PST.

The role of policy in improving diets: experiences from the Pacific Obesity Prevention in Communities food policy project.

PubMed

Thow, A M; Snowdon, W; Schultz, J T; Leeder, S; Vivili, P; Swinburn, B A

2011-11-01

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

The reporting characteristics and methodological quality of Cochrane reviews about health policy research.

PubMed

Xiu-xia, Li; Ya, Zheng; Yao-long, Chen; Ke-hu, Yang; Zong-jiu, Zhang

2015-04-01

The systematic review has increasingly become a popular tool for researching health policy. However, due to the complexity and diversity in the health policy research, it has also encountered more challenges. We set out the Cochrane reviews on health policy research as a representative to provide the first examination of epidemiological and descriptive characteristics as well as the compliance of methodological quality with the AMSTAR. 99 reviews were included by inclusion criteria, 73% of which were Implementation Strategies, 15% were Financial Arrangements and 12% were Governance Arrangements; involved Public Health (34%), Theoretical Exploration (18%), Hospital Management (17%), Medical Insurance (12%), Pharmaceutical Policy (9%), Community Health (7%) and Rural Health (2%). Only 39% conducted meta-analysis, and 49% reported being updates, and none was rated low methodological quality. Our research reveals that the quantity and quality of the evidence should be improved, especially Financial Arrangements and Governance Arrangements involved Rural Health, Health Care Reform and Health Equity, etc. And the reliability of AMSTAR needs to be tested in larger range in this field. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effective Evaluation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief OPRE 2011-11a

ERIC Educational Resources Information Center

Zellman, Gail L.; Brandon, Richard N.; Boller, Kimberly; Kreader, J. Lee

2011-01-01

It is important to evaluate Quality Rating and Improvement Systems (QRISs) so that policy makers and stakeholders can learn how well they are working and how they might be improved. Well-designed QRIS evaluations go beyond a "pass/fail" judgment to identify implementation successes and problems and assess what needs to be done to improve…

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

PubMed

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

1994-01-01

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

Whose Quality? The (Mis)Uses of Quality Reform in Early Childhood and Education Policy

ERIC Educational Resources Information Center

Hunkin, Elise

2018-01-01

This paper reports on the findings of an in-depth genealogical study of the discourse of quality in Australian Early Childhood Education and Care (ECEC) policy. Quality reform has become the foremost global policy agenda for ECEC due to assumptions about the economic potentials of quality services. In Australia, the recent National Quality…

48 CFR 1646.201 - Contract Quality Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Contract Quality Policy. 1646.201 Section 1646.201 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Quality...

48 CFR 1646.201 - Contract Quality Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Contract Quality Policy. 1646.201 Section 1646.201 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Quality...

48 CFR 1646.201 - Contract Quality Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Contract Quality Policy. 1646.201 Section 1646.201 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Quality...

48 CFR 1646.201 - Contract Quality Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Contract Quality Policy. 1646.201 Section 1646.201 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Quality...

Improving the quality of life.

PubMed

Suyono, H

1993-12-01

It is encouraging that most developing countries now have population policies, but it is discouraging that some countries have been unable to implement their policies. Therefore, Indonesia believes technical cooperation should be strengthened among developing countries. International cooperation is working in 108 developing countries, but the desired impact has yet to be reached, and the quality of life in many countries is still unacceptable. For example, life expectancy at birth in developing countries is 14-17 years shorter for females and 10-13 years shorter for males as compared to developed countries which have superior health and welfare systems. The speed of population growth is also hindering efforts to help improve living conditions, and the biggest increase in growth will occur in Asia and Africa. This will increase the numbers of poor, hungry, and illiterate in developing countries and will lead to a lack of arable land, deterioration in education, and increase in unsafe sanitation. In order to slow population growth, quality family planning (FP) services must be provided to those who want them. By the year 2000, developed countries and donors should be ready to provide half of the required US$10.5 billion to FP services in developing countries. In Indonesia, population programs and policies have been governed by the National FP Coordinating Board as well as by the State Ministry for Population and the Environment, which was divided into two ministries in 1993 in order to deal with the enormity and seriousness of the two issues.

Assessing Public Metabolomics Metadata, Towards Improving Quality.

PubMed

Ferreira, João D; Inácio, Bruno; Salek, Reza M; Couto, Francisco M

2017-12-13

Public resources need to be appropriately annotated with metadata in order to make them discoverable, reproducible and traceable, further enabling them to be interoperable or integrated with other datasets. While data-sharing policies exist to promote the annotation process by data owners, these guidelines are still largely ignored. In this manuscript, we analyse automatic measures of metadata quality, and suggest their application as a mean to encourage data owners to increase the metadata quality of their resources and submissions, thereby contributing to higher quality data, improved data sharing, and the overall accountability of scientific publications. We analyse these metadata quality measures in the context of a real-world repository of metabolomics data (i.e. MetaboLights), including a manual validation of the measures, and an analysis of their evolution over time. Our findings suggest that the proposed measures can be used to mimic a manual assessment of metadata quality.

Financial incentives and measurement improved physicians' quality of care in the Philippines.

PubMed

Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville

2011-04-01

The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.

Improving Academic Outcomes for Disadvantaged Students: Scaling up Individualized Tutorials. Policy Proposal 2016-02

ERIC Educational Resources Information Center

Ander, Roseanna; Guryan, Jonathan; Ludwig, Jens

2016-01-01

Improving the educational outcomes of economically disadvantaged children is a policy priority in the United States, and yet relatively little progress has been made in recent decades. Education reforms that aim to help economically disadvantaged students often focus on improving the quality with which grade-level material is taught, or the…

Appraising the evidence for public health policy components using the quality and impact of component evidence assessment.

PubMed

Barbero, Colleen; Gilchrist, Siobhan; Schooley, Michael W; Chriqui, Jamie F; Luke, Douglas A; Eyler, Amy A

2015-03-01

An essential strategy expected to reduce the global burden of chronic and cardiovascular disease is evidence-based policy. However, it is often unknown what specific components should constitute an evidence-based policy intervention. We have developed an expedient method to appraise and compare the strengths of the evidence bases suggesting that individual components of a policy intervention will contribute to the positive public health impact of that intervention. Using a new definition of "best available evidence," the Quality and Impact of Component (QuIC) Evidence Assessment analyzes dimensions of evidence quality and evidence of public health impact to categorize multiple policy component evidence bases along a continuum of "emerging," "promising impact," "promising quality," and "best." QuIC was recently applied to components from 2 policy interventions to prevent and improve the outcomes of cardiovascular disease: public-access defibrillation and community health workers. Results illustrate QuIC's utility in international policy practice and research. Copyright © 2015 World Heart Federation (Geneva). 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.

Heterogeneity in general practitioners' preferences for quality improvement programs: a choice experiment and policy simulation in France.

PubMed

Ammi, Mehdi; Peyron, Christine

2016-12-01

Despite increasing popularity, quality improvement programs (QIP) have had modest and variable impacts on enhancing the quality of physician practice. We investigate the heterogeneity of physicians' preferences as a potential explanation of these mixed results in France, where the national voluntary QIP - the CAPI - has been cancelled due to its unpopularity. We rely on a discrete choice experiment to elicit heterogeneity in physicians' preferences for the financial and non-financial components of QIP. Using mixed and latent class logit models, results show that the two models should be used in concert to shed light on different aspects of the heterogeneity in preferences. In particular, the mixed logit demonstrates that heterogeneity in preferences is concentrated on the pay-for-performance component of the QIP, while the latent class model shows that physicians can be grouped in four homogeneous groups with specific preference patterns. Using policy simulation, we compare the French CAPI with other possible QIPs, and show that the majority of the physician subgroups modelled dislike the CAPI, while favouring a QIP using only non-financial interventions. We underline the importance of modelling preference heterogeneity in designing and implementing QIPs.

48 CFR 1646.201 - Contract Quality Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ensure that services acquired under the FEHB contract conform to the contract's quality and audit requirements. (b) OPM will periodically evaluate the contractor's system of internal controls under the quality... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Contract Quality Policy...

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.

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.

Teaching Matters: How State and Local Policymakers Can Improve the Quality of Teachers and Teaching. CPRE Policy Briefs RB-48

ERIC Educational Resources Information Center

Corcoran, Thomas B.

2007-01-01

This issue of CPRE Policy Briefs summarizes the findings on issues related to teacher quality in the chapter authored by Thomas B. Corcoran in the book, "The State of Education Policy Research." The report also draws on discussions that took place during a 2006 policy briefing on teacher labor-market issues held in Chicago and sponsored by the…

Air Quality and Health Benefits of China's Recent Stringent Environmental Policy

NASA Astrophysics Data System (ADS)

Zheng, Y.; Xue, T.; Zhang, Q.; Geng, G.; He, K.

2016-12-01

Aggressive emission control measures were taken by China's central and local governments after the promulgation of the "Air Pollution Prevention and Control Action Plan" in 2013. We evaluated the air quality and health benefits of this ever most stringent air pollution control policy during 2013-2015 by utilizing a two-stage data fusion model and newly-developed cause-specific integrated exposure-response functions (IER) developed for the Global Burden of Disease (GBD). The two-stage data fusion model predicts spatiotemporal continuous PM2.5 (particulate matter with aerodynamic diameter less than 2.5 µm) concentrations by integrating satellite-derived aerosol optical depth (AOD) measurements, PM2.5 concentrations from measurement and air quality model, and other ancillary information. During the years of analysis, PM2.5 concentration dropped significantly on national average and over heavily polluted regions as identified by Mann-Kendall analysis. The national PM2.5-attributable mortality decreased by 72.8 (95% CI: 59.4, 85.2) thousand (6%) from 1.23 (95% CI: 1.06, 1.39) million in 2013 to 1.15 (95% CI: 0.98, 1.31) million in 2015 due to considerable reduction (i.e. 18%) of population-weighted PM2.5 from 61.4 to 50.5 µg/m3. Meteorological variations between 2013 and 2015 were estimated to raise the PM2.5 levels by 0.24 µg/m3 and national mortality by 2.1 (95% CI: 1.6, 2.6) thousand through sensitivity tests, which implies the dominant role of anthropogenic impacts on PM2.5 abatement and attributable mortality reduction. Our study affirms the effectiveness of China's recent air quality policy, however, due to the possible supralinear shape of C-R functions, health benefits induced by air quality improvement in these years are limited. We therefore appeal for continuous implementation of current policies and further stringent measures from both air quality improvement and public health protection perspectives.

Supporting Success: Why and How to Improve Quality in After-School Programs

ERIC Educational Resources Information Center

Sheldon, Jessica; Hopkins, Leigh

2008-01-01

This report examines the program improvement strategies, step-by-step, that allowed The James Irvine Foundation's Communities Organizing to Advance Learning (CORAL) initiative to achieve the levels of quality needed to boost the academic success of participating students, and makes policy and funding suggestions for improving program performance.…

Air quality management: evolution of policy and practice in the UK as exemplified by the experience of English local government

NASA Astrophysics Data System (ADS)

Beattie, C. I.; Longhurst, J. W. S.; Woodfield, N. K.

The air quality management (AQM) framework in the UK is designed to be an effects-based solution to air pollutants currently affecting human health. The AQM process has been legislated through The Environment Act 1995, which required the National Air Quality Strategy (NAQS) to be published. AQM practice and capability within local authorities has flourished since the publication of the NAQS in March 1997. This paper outlines the policy framework within which the UK operates, both at a domestic and European level, and reviews the air quality management process relating to current UK policy and EU policy. Data from questionnaire surveys are used to indicate the involvement of various sectors of local government in the air quality management process. These data indicate an increasing use of monitoring, and use of air dispersion modelling by English local authorities. Data relating to the management of air quality, for example, the existence and work of air quality groups, dissemination of information to the public and policy measures in place on a local scale to improve air quality, have also been reported. The UK NAQS has been reviewed in 1999 to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the socio-economic issues involved. The AQM process, as implemented by UK local authorities, provides an effective model for other European member states with regards to the implementation of the Air Quality Framework Directive. The future direction of air quality policy in the UK is also discussed.

Quality Early Childhood Education in Costa Rica? Policy, Practice, Outcomes and Challenges

ERIC Educational Resources Information Center

San Francisco, Andrea Rolla; Arias, Melissa; Villers, Renata

2005-01-01

High-quality early childhood education has been shown to improve school outcomes in several developing and developed nations. The history of policy around pre-school education in Costa Rica is described as background to presenting cross-sectional data on the emergent literacy skills of low-income Costa Rican children in kindergarten, 1st and 2nd…

76 FR 8753 - Final Information Quality Guidelines Policy

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

... DEPARTMENT OF HOMELAND SECURITY Final Information Quality Guidelines Policy AGENCY: Department of Homeland Security. ACTION: Notice and request for public comment on Final Information Quality Guidelines. SUMMARY: These guidelines should be used to ensure and maximize the quality of disseminated information...

75 FR 37819 - Proposed Information Quality Guidelines Policy

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... DEPARTMENT OF HOMELAND SECURITY Proposed Information Quality Guidelines Policy ACTION: Notice and request for public comment on Proposed Information Quality Guidelines. SUMMARY: These guidelines should be used to ensure and maximize the quality of disseminated information. The Department's guidelines are...

The need for a formalised system of Quality Control for environmental policy-science.

PubMed

Larcombe, Piers; Ridd, Peter

2018-01-01

Research science used to inform public policy decisions, herein defined as "Policy-Science", is rarely subjected to rigorous checking, testing and replication. Studies of biomedical and other sciences indicate that a considerable fraction of published peer-reviewed scientific literature, perhaps half, has significant flaws. To demonstrate the potential failings of the present approaches to scientific Quality Control (QC), we describe examples of science associated with perceived threats to the Great Barrier Reef (GBR), Australia. There appears a serious risk of efforts to improve the health of the GBR being directed inefficiently and/or away from the more serious threats. We suggest the need for a new organisation to undertake quality reviews and audits of important scientific results that underpin government spending decisions on the environment. Logically, such a body could also examine policy science in other key areas where governments rely heavily upon scientific results, such as education, health and criminology. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Modeling Study on Air Quality Improvement due to Mobile Source Emission control Plan in Seoul Metropolitan Area

NASA Astrophysics Data System (ADS)

Kim, Y. J.; Sunwoo, Y.; Hwang, I.; Song, S.; Sin, J.; Kim, D.

2015-12-01

A very high population and corresponding high number of vehicles in the Seoul Metropolitan Area (SMA) are aggravating the air quality of this region. The Korean government continues to make concerted efforts to improve air quality. One of the major policies that the Ministry of Environment of Korea enforced is "The Special Act for Improvement of Air Quality in SMA" and "The 1st Air Quality Management Plan of SMA". Mobile Source emission controls are an important part of the policy. Thus, it is timely to evaluate the air quality improvement due to the controls. Therefore, we performed a quantitative analysis of the difference in air quality using the Community Multiscale Air Quality (CMAQ) model and December, 2011 was set as the target period to capture the impact of the above control plans. We considered four fuel-type vehicle emission scenarios and compared the air quality improvement differences between them. The scenarios are as follows: no-control, gasoline vehicle control only, diesel vehicle control only, and control of both; utilizing the revised mobile source emissions from the Clean Air Policy Support System (CAPSS), which is the national emission inventory reflecting current policy.In order to improve the accuracy of the modeling data, we developed new temporal allocation coefficients based on traffic volume observation data and spatially reallocated the mobile source emissions using vehicle flow survey data. Furthermore, we calculated the PM10 and PM2.5 emissions of gasoline vehicles which is omitted in CAPSS.The results of the air quality modeling shows that vehicle control plans for both gasoline and diesel lead to a decrease of 0.65ppb~8.75ppb and 0.02㎍/㎥~7.09㎍/㎥ in NO2 and PM10 monthly average concentrations, respectively. The large percentage decreases mainly appear near the center of the metropolis. However, the largest NO2 decrease percentages are found in the northeast region of Gyeonggi-do, which is the province that surrounds the

Working Toward Policy-Relevant Air Quality Emissions Scenarios

NASA Astrophysics Data System (ADS)

Holloway, T.

2010-12-01

Though much work has been done to develop accurate chemical emission inventories, few publicly available inventories are appropriate for realistic policy analysis. Emissions from the electricity and transportation sectors, in particular, respond in complex ways to policy, technology, and energy use change. Many widely used inventories, such as the EPA National Emissions Inventory, are well-suited for modeling current air quality, but do not have the specificity needed to address "what if?" questions. Changes in electricity demand, fuel prices, new power sources, and emission controls all influence the emissions from regional power production, requiring a plant-by-plant assessment to capture the spatially explicit impacts. Similarly, land use, freight distribution, or driving behavior will yield differentiated transportation emissions for urban areas, suburbs, and rural highways. We here present results from three recent research projects at the University of Wisconsin—Madison, where bottom-up emission inventories for electricity, freight transport, and urban vehicle use were constructed to support policy-relevant air quality research. These three studies include: 1) Using the MyPower electricity dispatch model to calculate emissions and air quality impacts of Renewable Portfolio Standards and other carbon-management strategies; 2) Using advanced vehicle and commodity flow data from the Federal Highway Administration to evaluate the potential to shift commodities from truck to rail (assuming expanded infrastructure), and assess a range of alternative fuel suggestions; and 3) Working with urban planners to connect urban density with vehicle use to evaluate the air quality impacts of smart-growth in major Midwest cities. Drawing on the results of these three studies, and on challenges overcome in their execution, we discuss the current state of policy-relevant emission dataset generation, as well as techniques and attributes that need to be further refined in order

From community-based pilot testing to region-wide systems change: lessons from a local quality improvement collaborative.

PubMed

Keyser, Donna J; Pincus, Harold Alan

2010-01-01

A community-based collaborative conducted a 2-year pilot study to inform efforts for improving maternal and child health care practice and policy in Allegheny County, Pennsylvania. (1) To test whether three small-scale versions of an evidence-based, systems improvement approach would be workable in local community settings and (2) to identify specific policy/infrastructure reforms for sustaining improvements. A mixed methods approach was used, including quantitative performance measurement supplemented with qualitative data about factors related to outcomes of interest, as well as key stakeholder interviews and a literature review/Internet search. Quantitative performance results varied; qualitative data revealed critical factors for the success and failure of the practices tested. Policy/infrastructure recommendations were developed to address specific practice barriers. This information was important for designing a region-wide quality improvement initiative focused on maternal depression. The processes and outcomes provide valuable insights for other communities interested in conducting similar quality improvement initiatives.

A Case of Successful Teaching Policy: Connecticut's Long-Term Efforts To Improve Teaching and Learning. A Research Report.

ERIC Educational Resources Information Center

Wilson, Suzanne M.; Darling-Hammond, Linda; Berry, Barnett

In this monograph, the authors describe Connecticut's long-term efforts to implement a comprehensive set of teaching quality policies to support improved student learning. The authors begin by describing the 15-year evolution of policies designed to recruit, prepare, and support teachers, while also creating greater accountability for the…

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.

Analysis of a government policy to address nursing shortage and nursing education quality.

PubMed

Abhicharttibutra, K; Kunaviktikul, W; Turale, S; Wichaikhum, O-A; Srisuphan, W

2017-03-01

A well-educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies. Describe policy-making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality. A qualitative study employing Longest's model to examine policy-making processes. Data were obtained from 28 in-depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data. Three policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities. Not all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses' abilities and need to be involved in policy. Nurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand. Lessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy-making table to try to reduce nursing

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

Educational Quality, Outcomes Assessment, and Policy Change: The Virginia Example

ERIC Educational Resources Information Center

Culver, Steve

2010-01-01

The higher education system in the Commonwealth of Virginia in the United States provides a case model for how discussions regarding educational quality and assessment of that quality have affected institutions' policy decisions and implementation. Using Levin's (1998) policy analysis framework, this essay explores how assessment of student…

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial

PubMed Central

Subramaniam, Hamsa L.; Prust, Margaret L.; Prescott, Marta R.; Mpasela, Felton; Mwango, Albert; Namonje, Leah; Moyo, Crispin; Chibuye, Benjamin; van den Broek, Jan Willem; Hehman, Lindsey; Moberley, Sarah

2017-01-01

Introduction In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. Methods Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention’s impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services. Results The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2–48.5; P = 0.2). Conclusion A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.

PubMed

McCarthy, Elizabeth A; Subramaniam, Hamsa L; Prust, Margaret L; Prescott, Marta R; Mpasela, Felton; Mwango, Albert; Namonje, Leah; Moyo, Crispin; Chibuye, Benjamin; van den Broek, Jan Willem; Hehman, Lindsey; Moberley, Sarah

2017-01-01

In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services. The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2). A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable

Continuous quality improvement for the clinical decision unit.

PubMed

Mace, Sharon E

2004-01-01

Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

Effect of beach management policies on recreational water quality.

PubMed

Kelly, Elizabeth A; Feng, Zhixuan; Gidley, Maribeth L; Sinigalliano, Christopher D; Kumar, Naresh; Donahue, Allison G; Reniers, Adrianus J H M; Solo-Gabriele, Helena M

2018-04-15

When beach water monitoring programs identify poor water quality, the causes are frequently unknown. We hypothesize that management policies play an important role in the frequency of fecal indicator bacteria (FIB) exceedances (enterococci and fecal coliform) at recreational beaches. To test this hypothesis we implemented an innovative approach utilizing large amounts of monitoring data (n > 150,000 measurements per FIB) to determine associations between the frequency of contaminant exceedances and beach management practices. The large FIB database was augmented with results from a survey designed to assess management policies for 316 beaches throughout the state of Florida. The FIB and survey data were analyzed using t-tests, ANOVA, factor analysis, and linear regression. Results show that beach geomorphology (beach type) was highly associated with exceedance of regulatory standards. Low enterococci exceedances were associated with open coast beaches (n = 211) that have sparse human densities, no homeless populations, low densities of dogs and birds, bird management policies, low densities of seaweed, beach renourishment, charge access fees, employ lifeguards, without nearby marinas, and those that manage storm water. Factor analysis and a linear regression confirmed beach type as the predominant factor with secondary influences from grooming activities (including seaweed densities and beach renourishment) and beach access (including charging fees, employing lifeguards, and without nearby marinas). Our results were observable primarily because of the very large public FIB database available for analyses; similar approaches can be adopted at other beaches. The findings of this research have important policy implications because the selected beach management practices that were associated with low levels of FIB can be implemented in other parts of the US and around the world to improve recreational beach water quality. Copyright © 2018 Elsevier Ltd. All

Recent Changes to ABR Maintenance of Certification Part 4 (PQI): Acknowledgment of Radiologists' Activities to Improve Quality and Safety.

PubMed

Donnelly, Lane F; Mathews, Vincent P; Laszakovits, David J; Jackson, Valerie P; Guiberteau, Milton J

2016-02-01

The ABR has recently reviewed and revised its policy establishing how ABR diplomates may comply with requirements for Maintenance of Certification Part 4: Practice Quality Improvement (PQI). The changes were deemed necessary by the Board of Trustees to acknowledge and credit the numerous ways in which radiology professionals contribute to improving patient care through existing and evolving activities available to them within the radiology community. In addition to meeting requirements by completing a traditional PQI project, the policy revision now allows diplomates to meet criteria by completing one of a number of activities in an expanded spectrum of PQI options recognized by the ABR. The new policy also acknowledges the maturing state of quality improvement science by permitting PQI projects to use "any standard quality improvement methodology," such as Six Sigma, Lean, the Institute for Healthcare Improvement's Model for Improvement, and others in addition to the previously prescribed three-phase plan-do-study-act format. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Relationship between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality among Rural U.S. Hospitals.

PubMed

Kozhimannil, Katy B; Hung, Peiyin; Casey, Michelle M; Henning-Smith, Carrie; Prasad, Shailendra; Moscovice, Ira S

2016-01-01

Many hospitals are adopting quality improvement strategies in obstetrics. This study characterized rural U.S. hospitals based on their hospital staffing and clinical management policies for labor induction and cesarean delivery, and assessed the relationship between policies and performance on maternity care quality. We surveyed all 306 rural maternity hospitals in nine states and used data from the Healthcare Cost and Utilization Project Statewide Inpatient Database hospital discharge database. We found staffing policies were more prevalent at lower-volume hospitals (92% vs. 86% for cesarean and 82% vs. 79%, both p < .01). Using multivariable logistic regression, we found hospitals with policies for cesarean delivery had up to 24% lower odds of low-risk cesarean (adjusted odds ratio = 0.76; 95% confidence interval=[0.67-0.86]) and non-indicated cesarean (0.78 [0.70-0.88]), with variability across birth volume. Clinical management and staffing policies are common, but not universal, among rural U.S. hospitals providing obstetric services and are generally positively associated with quality.

Sharpening policy instruments with catchment evaluations and the water quality continuum

NASA Astrophysics Data System (ADS)

Jordan, P.; Melland, A. R.; Mellander, P.-E.; Murphy, P.; Shortle, G.; Wall, D.; Mechan, S.; Shine, O.

2012-04-01

There is a scale dichotomy in water quality management in European agricultural catchments due to the fact that impacts identified at river basin scale are mitigated by management that is typically asserted from research at field or plot scale and implemented at farm scale. Evaluations of management impact are then undertaken back at the river basin scale. The policy instruments in place to mitigate water quality impacts are also based on the integration of scientific research and stakeholder negotiations and can sometimes be blunt compromises. Nevertheless, expectations of accruing water quality benefits remain high and sometimes unchallenged. Evaluating all catchment components of a pollution transfer continuum from source to impact enables important elements such as lag time between policy implementation and water quality response, water body sampling frequency and allocation of correct dose-response mechanisms to be assessed. These points are particularly important in complex agricultural catchments where multiple nutrient pollution sources have variable impacts on different water body types - and at different times of year. The tools of catchment water quality policy evaluation are diverse and include metrics of natural resource management, soil and water chemistry, hydrology, ecology and palaeolimnology. Used in combination and with river basin scale and site-specific data inventories, they can provide a powerful suite of evidence for further iterations of water quality policy and projecting realistic expectations of policy success.

Mentoring for Quality Improvement: A Case Study of a Mentor Teacher in the Reform Process

ERIC Educational Resources Information Center

Ryan, Sharon; Hornbeck, Amy

2004-01-01

As qualified teachers are central to children receiving a high-quality preschool education, many policy initiatives aimed at improving program quality are thwarted when insufficient attention is paid to the professional development of the workforce. One response to this issue has been to create teacher leadership roles so that teachers mentor…

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

Trading Quality across Borders: Colonial Discourse and International Quality Assurance Policies in Higher Education

ERIC Educational Resources Information Center

Blanco Ramírez, Gerardo

2014-01-01

Accountability and quality assurance have become central discourses in higher education policy throughout the world. However, accountability and quality assurance involve power and control. Practices and ideas about quality developed in the Global North are spreading rapidly across the Global South, leading to increased uniformity in the…

Education Policy-Making and Time

ERIC Educational Resources Information Center

Thompson, Greg; Cook, Ian

2014-01-01

This paper examines the global policy convergence toward high-stakes testing in schools and the use of test results to "steer at a distance", particularly as it applies to policy-makers' promise to improve teacher quality. Using Deleuze's three syntheses of time in the context of the Australian policy blueprint Quality Education, this…

A study of the influence of regional environmental expenditure on air quality in China: the effectiveness of environmental policy.

PubMed

He, Lingyun; Wu, Meng; Wang, Deqing; Zhong, Zhangqi

2018-03-01

Based on the panel data model, data on environmental expenditures, the air quality index, economic aggregates, industrial structures, etc., of seven seriously polluted cities in China, from the period 2007-2015, were collected, and this paper estimates the general relationship between environmental expenditures and the air quality index. Besides, the impact of the fuel tax policy on air quality as well as on the relationship between environmental expenditure and the air quality index is tested using the method of regression discontinuity. We find that there is a long-term equilibrium relationship between environmental expenditure and air quality index as well as a 0.0507% positive effect of the former on the latter. Second, for Beijing, Taiyuan, Chongqing, and Lanzhou, a 1% increase in environmental expenditure leads to 0.0773, 0.0125, 0.0965, and 0.0912% decreases in the air quality index, respectively; however, for Shijiazhuang, Ji'nan, and Urumqi, effect of environmental expenditure on air quality is insignificant. Third, both economic growth and optimization of the industrial structure can lead to an improvement of air quality. Fourth, since the implementation of the fuel tax policy in 2009, the air quality of the sample cities has improved, and the pulling effect of environmental expenditure on the air quality index has decreased from 0.0507 to 0.0048%. Our findings cannot only clarify the effect of environmental expenditures on air quality but can also objectively judge the effectiveness of environmental policies of China to a certain extent. It may benefit Chinese government to effectively govern air pollution with fiscal tools in conjunction with economic and environmental characteristics.

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

ERIC Educational Resources Information Center

Lawrence, Sharmila; Stephens, Samuel A.

2016-01-01

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

Ethnographic Exploration of Empowerment to Improve Elderly Residents' Quality of Life.

PubMed

Tabatabaei, Seyed Zia; Ebrahimi, Fatemeh; Hamzah, Azimi Bin Hj; Rezaeian, Mohsen; Kamrani, Mahnaz Akbari

2017-01-01

Evidence underscores that empowerment is central to improve the elderly residents' quality of life. In truth, empowerment is a process through which individuals gain better control over their life. The aim of this study was to explore how perceived empowerment influence on the quality of life among elderly Malay residents. A focus ethnographic approach was employed in a Malaysian residential home between May 2011 and January 2012. Data were gathered from participant observations, field notes, in-depth interviews, and exploring related documents. The analysis of the data gathered in the current study resulted in the development of three themes - social life and its requirements, caregivers' skills empowerment, and listening and supporting. Findings of the study provide new insights that are useful in charting new guideline for care providers and policy makers to improve the elderly residents' quality of life.

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

Curriculum Reform: Quality in Basic Education. Background/Policy Paper. Improving the Quality of Basic Education. Volume I.

ERIC Educational Resources Information Center

Bacchus, Kazim; And Others

The theme of the 1990 meeting of the Ministers of Education of the Commonwealth of Nations was improving the quality of basic education. Basic education was defined as "the activities of primary and junior secondary schools, and of programmes of out-of-school education at an equivalent level, both for children and for adults." This…

Implications of measures of quality of life for policy development.

PubMed

Mosteller, F

1987-01-01

Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.

Improving adolescent health policy: incorporating a framework for assessing state-level policies.

PubMed

Brindis, Claire D; Moore, Kristin

2014-01-01

Many US policies that affect health are made at the state, not the federal, level. Identifying state-level policies and data to analyze how different policies affect outcomes may help policy makers ascertain the usefulness of their public policies and funding decisions in improving the health of adolescent populations. A framework for describing and assessing the role of federal and state policies on adolescent health and well-being is proposed; an example of how the framework might be applied to the issue of teen childbearing is included. Such a framework can also help inform analyses of whether and how state and federal policies contribute to the variation across states in meeting adolescent health needs. A database on state policies, contextual variables, and health outcomes data can further enable researchers and policy makers to examine how these factors are associated with behaviors they aim to impact.

Does Agency Competition Improve the Quality of Policy Analysis? Evidence from OMB and CBO Fiscal Projections

ERIC Educational Resources Information Center

Krause, George A.; Douglas, James W.

2006-01-01

Public management scholars often claim that agency competition provides an effective institutional check on monopoly authority, and hence, leads to improvement of administrative performance in public sector agencies. This logic was central for creating the Congressional Budget Office (CBO) in 1975 to challenge the policy information provided by…

Bee pollination improves crop quality, shelf life and commercial value.

PubMed

Klatt, Björn K; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

2014-01-22

Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar-acid-ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality.

Meeting the challenge: using policy to improve children's health.

PubMed

Brush, Charles Adam; Kelly, Maggie M; Green, Denise; Gaffney, Marcus; Kattwinkel, John; French, Molly

2005-11-01

We reflect on the proceedings of a symposium at a conference of the Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities. We present examples of bridging the gap between science and policy to achieve improvements in children's health through case studies in early hearing detection and intervention, folic acid fortification to prevent birth defects, sleep positioning recommendations to reduce infant mortality, and workplace lactation support programs. We discuss case studies that present different policy strategies (public health law and voluntary practices) for improving public health. These case studies demonstrate both the power of policy as a tool for improving children's health and the challenges of communicating public health research to policy decisionmakers.

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

An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines.

PubMed

Solon, Orville; Peabody, John W; Woo, Kimberly; Quimbo, Stella A; Florentino, Jhiedon; Shimkhada, Riti

2009-09-01

Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment. We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.

An Evaluation of the Cost-effectiveness of Policy Navigators to Improve Access to Care for the Poor in the Philippines

PubMed Central

Solon, Orville; Peabody, John W.; Woo, Kimberly; Quimbo, Stella A.; Florentino, Jhiedon; Shimkhada, Riti

2009-01-01

Objectives Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. Methods We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost effectiveness of marginal increases in enrollment. Results We found that Policy Navigators improved enrollment in health insurance between 39 and 102% compared to the controls. Policy navigators were cost-effective at $0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Conclusion Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment. PMID:19349090

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

A Multilevel, Statewide Investigation of School District Anti-Bullying Policy Quality and Student Bullying Involvement.

PubMed

Gower, Amy L; Cousin, Molly; Borowsky, Iris W

2017-03-01

Although nearly all states in the United States require school districts to adopt anti-bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti-bullying policies and student bullying involvement and adjustment. School district anti-bullying policies (N = 208) were coded for their quality based on established criteria. District-level data were combined with student reports of bullying involvement, emotional distress, and school connectedness from a state surveillance survey of 6th, 9th, and 12th grade students (N = 93,437). Results indicated that policy quality was positively related to bullying victimization. Furthermore, students reporting frequent perpetration/victimization who also attended districts with high-quality policies reported more emotional distress and less school connectedness compared with students attending districts with low quality policies. Although statistically significant, the magnitude of these associations was small. Having a high-quality school district anti-bullying policy is not sufficient to reduce bullying and protect bullying-involved young people. Future studies examining policy implementation will inform best practices in bullying prevention. © 2017, American School Health Association.

Misdiagnosing the Teacher Quality Problem. CPRE Policy Briefs. RB-49

ERIC Educational Resources Information Center

Ingersoll, Richard M.

2007-01-01

This issue of CPRE Policy Briefs summarizes the findings on issues related to teacher quality in the chapter by the author in the book, "The State of Education Policy Research" (Cohen, Fuhrman, Mosher, Eds., 2007). This report also draws on discussions that took place during a summer, 2006, policy briefing on teacher labor-market issues…

Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

PubMed

Whitson, Heather E; Hastings, S Nicole; McConnell, Eleanor S; Lekan-Rutledge, Deborah A

2006-09-01

To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups. Descriptive pilot project. Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina. Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project. In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors. Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party's time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of non-urgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area. Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians.

The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

2016-10-18

Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable

Identifying Opportunities for Improving the Quality of Life of Older Age Groups.

ERIC Educational Resources Information Center

Flanagan, John C.

The situations and feelings of representative national samples of 50- and 70-year-olds were investigated in order to provide a representative, adequate data base for planning programs and policies that will result in maximum improvement in the quality of life of older Americans at minimum costs to taxpayers. Intensive case studies of 1,000…

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

PubMed

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

2012-07-01

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

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.

Assessing community values for reducing agricultural emissions to improve water quality and protect coral health in the Great Barrier Reef

NASA Astrophysics Data System (ADS)

Rolfe, John; Windle, Jill

2011-12-01

Policymakers wanting to increase protection of the Great Barrier Reef from pollutants generated by agriculture need to identify when measures to improve water quality generate benefits to society that outweigh the costs involved. The research reported in this paper makes a contribution in several ways. First, it uses the improved science understanding about the links between management changes and reef health to bring together the analysis of costs and benefits of marginal changes, helping to demonstrate the appropriate way of addressing policy questions relating to reef protection. Second, it uses the scientific relationships to frame a choice experiment to value the benefits of improved reef health, with the results of mixed logit (random parameter) models linking improvements explicitly to changes in "water quality units." Third, the research demonstrates how protection values are consistent across a broader population, with some limited evidence of distance effects. Fourth, the information on marginal costs and benefits that are reported provide policymakers with information to help improve management decisions. The results indicate that while there is potential for water quality improvements to generate net benefits, high cost water quality improvements are generally uneconomic. A major policy implication is that cost thresholds for key pollutants should be set to avoid more expensive water quality proposals being selected.

Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.

PubMed

Wickizer, T M; Franklin, G; Plaeger-Brockway, R; Mootz, R D

2001-01-01

This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational

"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.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Standards-Based Assessments in the Classroom: A Feasible Approach to Improving the Quality of Students' Learning

ERIC Educational Resources Information Center

Sharma, Priyanka

2015-01-01

In the new millennium, the Indian education system has experienced a major shift and the issue of the quality of education has taken centre stage in policy discussion fora. Globally, assessment has become an important means of improving the quality of education, both at the systemic level and at the level of individual students. It necessitates…

Attitudes and Opinions of Canadian Nephrologists Toward Continuous Quality Improvement Options.

PubMed

Iskander, Carina; McQuillan, Rory; Nesrallah, Gihad; Rabbat, Christian; Mendelssohn, David C

2017-01-01

A shift to holding individual physicians accountable for patient outcomes, rather than facilities, is intuitively attractive to policy makers and to the public. We were interested in nephrologists' attitudes to, and awareness of, quality metrics and how nephrologists would view a potential switch from the current model of facility-based quality measurement and reporting to publically available reports at the individual physician level. The study was conducted using a web-based survey instrument (Online Appendix 1). The survey was initially pilot tested on a group of 8 nephrologists from across Canada. The survey was then finalized and e-mailed to 330 nephrologists through the Canadian Society of Nephrology (CSN) e-mail distribution list. The 127 respondents were 80% university based, and 33% were medical/dialysis directors. The response rate was 43%. Results demonstrate that 89% of Canadian nephrologists are engaged in efforts to improve the quality of patient care. A minority of those surveyed (29%) had training in quality improvement. They feel accountable for this and would welcome the inclusion of patient-centered metrics of care quality. Support for public reporting as an effective strategy on an individual nephrologist level was 30%. Support for public reporting of individual nephrologist performance was low. The care of nephrology patients will be best served by the continued development of a critical mass of physicians trained in patient safety and quality improvement, by focusing on patient-centered metrics of care delivery, and by validating that all proposed new methods are shown to improve patient care and outcomes.

Potential impact of a US climate policy and air quality regulations on future air quality and climate change

NASA Astrophysics Data System (ADS)

Lee, Y. H.; Shindell, D. T.; Faluvegi, G.; Pinder, R. W.

2015-11-01

We have investigated how future air quality and climate change are influenced by the US air quality regulations that existed or were proposed in 2013 and a hypothetical climate mitigation policy that reduces 2050 CO2 emissions to be 50 % below 2005 emissions. Using NASA GISS ModelE2, we look at the impacts in year 2030 and 2055. The US energy-sector emissions are from the GLIMPSE project (GEOS-Chem LIDORT Integrated with MARKAL for the Purpose of Scenario Exploration), and other US emissions and the rest of the world emissions are based on the RCP4.5 scenario. The US air quality regulations are projected to have a strong beneficial impact on US air quality and public health in the future but result in positive radiative forcing. Surface PM2.5 is reduced by ~ 2 μg m-3 on average over the US, and surface ozone by ~ 8 ppbv. The improved air quality prevents about 91 400 premature deaths in the US, mainly due to the PM2.5 reduction (~ 74 200 lives saved). The air quality regulations reduces the light-reflecting aerosols (i.e., sulfate and organic matter) more than the light-absorbing species (i.e., black carbon and ozone), leading a strong positive radiative forcing (RF) by both aerosols direct and indirect forcing: total RF is ~ 0.04 W m-2 over the globe; ~ 0.8 W m-2 over the US. Under the hypothetical climate policy, future US energy relies less on coal and thus SO2 emissions are noticeably reduced. This provides air quality co-benefits, but it leads to climate dis-benefits over the US. In 2055, the US mean total RF is +0.22 W m-2 due to positive aerosol direct and indirect forcing, while the global mean total RF is -0.06 W m-2 due to the dominant negative CO2 RF (instantaneous RF). To achieve a regional-scale climate benefit via a climate policy, it is critical (1) to have multi-national efforts to reduce GHGs emissions and (2) to target emission reduction of light-absorbing species (e.g., BC and O3) on top of long-lived species. The latter is very desirable as the

Using public policy to improve outcomes for asthmatic children in schools.

PubMed

Lynn, Jewlya; Oppenheimer, Sophie; Zimmer, Lorena

2014-12-01

School-based services to improve asthma management need to be accompanied by public policies that can help sustain services, scale effective interventions, create greater equity across schools, and improve outcomes for children. Several national organizations, including the Centers for Disease Control and Prevention, have recommended specific public policies the adoption of which in school settings can improve asthma outcomes for children. Although many states and school districts have adopted some of these policies, adoption is not universal, and implementation is not always successful, leaving inequities in children's access to asthma services and supports. These issues can be addressed by changing public policy. Policy change is a complex process, but it is one that will benefit from greater involvement by asthma experts, including the researchers who generate the knowledge base on what services, supports, and policies have the best outcomes for children. Asthma experts can participate in the policy process by helping to build awareness of the need for school-based asthma policy, estimating the costs associated with policy options and with inaction, advocating for the selection of specific policies, assisting in implementation (including providing feedback), conducting the research that can evaluate the effectiveness of implementation, and ultimately providing information back into the policy process to allow for improvements to the policies. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

PubMed

Roche, B G; Sommer, C

1995-01-01

In may 1994 we were selected by the surgical Swiss association to make a study about quality in USA. During our travel we visited 3 types of institutions: Hospitals, National Institute of standard and Technology, Industry, Johnson & Johnson. We appreciate to compare 2 types of quality programs: Quality Assurance (QA) and Continuous Quality Improvement (CQI). In traditional healthcare circles, QA is the process established to meet external regulatory requirements and to assure that patient care is consistent with established standards. In a modern quality terms, QA outside of healthcare means designing a product or service, as well as controlling its production, so well that quality is inevitable. The ideas of W. Edward Deming is that there is never improvement just by inspection. He developed a theory based on 14 principles. A productive work is accomplished through processes. Understanding the variability of processes is a key to improve quality. Quality management sees each person in an organisation as part of one or more processes. The job of every worker is to receive the work of others, add value to that work, and supply it to the next person in the process. This is called the triple role the workers as customer, processor, and supplier. The main source of quality defects is problems in the process. The old assumption is that quality fails when people do the right thing wrong; the new assumption is that, more often, quality failures arise when people do the wrong think right. Exhortation, incentives and discipline of workers are unlikely to improve quality. If quality is failing when people do their jobs as designed, then exhorting them to do better is managerial nonsense. Modern quality theory is customer focused. Customers are identified internally and externally. The modern approach to quality is thoroughly grounded in scientific and statistical thinking. Like in medicine, the symptom is a defect in quality. The therapist of process must perform diagnostic

EPA Quality Assurance Policy Statement

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

A research agenda to advance quality measurement and improvement.

PubMed

Leatherman, Sheila T; Hibbard, Judith H; McGlynn, Elizabeth A

2003-01-01

In developing a conceptual framework for the design of a national quality measurement and reporting system (NQMRS), the Strategic Framework Board (SFB) recommends that such a system be built on a strong evidence base. To identify critical gaps in the evidence needed for a fully functional NQMRS and to recommend a starting point for the development of a research agenda. Selective review of literature in quality of care measurement and reporting and identification of strategic issues that must be addressed. There is some limited evidence that measurement and reporting can improve quality. Substantial advances have been made in the science of measurement and reporting but important gaps remain, specifically in (1) measurement methods and tools, (2) uses of quality performance data, (3) organizational and cultural factors, (4) information and informatics, and (5) impact evaluation/research. To achieve a sustainable research agenda, three strategic issues will have to be addressed: (1) the policy rationale for the research agenda, (2) adequate levels of public-sector funding, and (3) sustainability in a rapidly changing environment.

An integrated assessment of two decades of air pollution policy making in Spain: Impacts, costs and improvements.

PubMed

Vedrenne, Michel; Borge, Rafael; Lumbreras, Julio; Conlan, Beth; Rodríguez, María Encarnación; de Andrés, Juan Manuel; de la Paz, David; Pérez, Javier; Narros, Adolfo

2015-09-15

This paper analyses the effects of policy making for air pollution abatement in Spain between 2000 and 2020 under an integrated assessment approach with the AERIS model for number of pollutants (NOx/NO2, PM10/PM2.5, O3, SO2, NH3 and VOC). The analysis of the effects of air pollution focused on different aspects: compliance with the European limit values of Directive 2008/50/EC for NO2 and PM10 for the Spanish air quality management areas; the evaluation of impacts caused by the deposition of atmospheric sulphur and nitrogen on ecosystems; the exceedance of critical levels of NO2 and SO2 in forest areas; the analysis of O3-induced crop damage for grapes, maize, potato, rice, tobacco, tomato, watermelon and wheat; health impacts caused by human exposure to O3 and PM2.5; and costs on society due to crop losses (O3), disability-related absence of work staff and damage to buildings and public property due to soot-related soiling (PM2.5). In general, air quality policy making has delivered improvements in air quality levels throughout Spain and has mitigated the severity of the impacts on ecosystems, health and vegetation in 2020 as target year. The findings of this work constitute an appropriate diagnosis for identifying improvement potentials for further mitigation for policy makers and stakeholders in Spain. Copyright © 2015 Elsevier B.V. All rights reserved.

Quality Assurance Policies and Practices in Scandinavian Higher Education Systems: Convergence or Different Paths?

ERIC Educational Resources Information Center

Kalpazidou Schmidt, Evanthia

2017-01-01

Because there is close cooperation on quality assurance in the Scandinavian countries, one would expect there to be convergence of quality assurance policies and practices in Scandinavian higher education. Few studies have analysed these quality assurance policies and practices from a comparative viewpoint. Based on empirical evidence produced in…

Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.

PubMed

Zurovac, Dejan; Githinji, Sophie; Memusi, Dorothy; Kigen, Samuel; Machini, Beatrice; Muturi, Alex; Otieno, Gabriel; Snow, Robert W; Nyandigisi, Andrew

2014-01-01

Monitoring implementation of the "test and treat" case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Using health facility surveys we monitored health systems readiness and malaria case-management practices prior to and following implementation of the 2010 "test and treat" policy in Kenya. Between 2010 and 2013 six national, cross-sectional, health facility surveys were undertaken. The number of facilities assessed ranged between 172 and 176, health workers interviewed between 216 and 237 and outpatient consultations for febrile patients evaluated between 1,208 and 2,408 across six surveys. Comparing baseline and the last survey results, all readiness indicators showed significant (p<0.005) improvements: availability of parasitological diagnosis (55.2% to 90.7%); RDT availability (7.5% to 69.8%); total artemether-lumefantrine (AL) stock-out (27.2% to 7.0%); stock-out of one or more AL packs (59.5% to 21.6%); training coverage (0 to 50.2%); guidelines access (0 to 58.1%) and supervision (17.9% to 30.8%). Testing increased by 34.0% (23.9% to 57.9%; p<0.001) while testing and treatment according to test result increased by 34.2% (15.7% to 49.9%; p<0.001). Treatment adherence for test positive patients improved from 83.3% to 90.3% (p = 0.138) and for test negative patients from 47.9% to 83.4% (p<0.001). Significant testing and treatment improvements were observed in children and adults. There was no difference in practices with respect to the type and result of malaria test (RDT vs microscopy). Of eight dosing, dispensing and counseling tasks, improvements were observed for four tasks. Overall AL use for febrile patients decreased from 63.5% to 35.6% (p<0.001). Major improvements in the implementation of "test and treat" policy were observed in Kenya. Some gaps towards universal targets still remained. Other

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.

Improved Management of Water and Natural Resources Requires Open, Cognizant, Adaptive Science and Policy

NASA Astrophysics Data System (ADS)

Glynn, P. D.; Voinov, A. A.; Shapiro, C. D.; Jenni, K. E.

2017-12-01

Water issues impact the availability and use of other natural resources as well as environmental conditions. In an increasingly populated hyper-connected world, water issues are increasingly "wicked problems": complex problems with high uncertainties and no independent observers. Water is essential to life, and life affects water quality and availability. Scientists, managers, decision-makers, and the greater public all have a stake in improving the management of water resources. In turn, they are part of the systems that they are studying, deciding on, affecting, or trying to improve. Governance of water issues requires greater accessibility, traceability, and accountability (ATA) in science and policy. Water-related studies and decision-making need transdisciplinary science, inclusive participatory processes, and consideration and acceptance of multiple perspectives. Biases, Beliefs, Heuristics, and Values (BBHV) shape much of our perceptions and knowledge, and inevitably, affect both science and policy. Understanding the role of BBHV is critical to (1) understanding individual and group judgments and choices, (2) recognizing potential differences between societal "wants" and societal "needs", and (3) identifying "winners" and "losers" of policy decisions. Societal acceptance of proposed policies and actions can be fostered by enhancing participatory processes and by providing greater ATA in science, in policy, and in development of the laws, rules, and traditions that constrain decision-making. An adaptive science-infused governance framework is proposed that seeks greater cognizance of the role of BBHV in shaping science and policy choices and decisions, and that also seeks "Open Traceable Accountable Policy" to complement "Open Science". We discuss the limitations of the governance that we suggest, as well as tools and approaches to help implementation.

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.

Autonomy vs. Control: Quality Assurance and Governmental Policy in Flanders

ERIC Educational Resources Information Center

De Wit, Kurt; Verhoeven, Jef C.

2004-01-01

Higher education in Flanders has seen some major changes in the 1990s. One of the key elements of the new higher education regulations was the quality assessment system. This exemplified best the government's policy of granting all institutions of higher education autonomy, making them responsible for their policies, while still keeping the…

Handling Practicalities in Agricultural Policy Optimization for Water Quality Improvements

EPA Science Inventory

Bilevel and multi-objective optimization methods are often useful to spatially target agri-environmental policy throughout a watershed. This type of problem is complex and is comprised of a number of practicalities: (i) a large number of decision variables, (ii) at least two inte...

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 cost-efficiency and health benefit approach to improve urban air quality.

PubMed

Miranda, A I; Ferreira, J; Silveira, C; Relvas, H; Duque, L; Roebeling, P; Lopes, M; Costa, S; Monteiro, A; Gama, C; Sá, E; Borrego, C; Teixeira, J P

2016-11-01

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored. Copyright © 2016. Published by Elsevier B.V.

The Victorian Lung Cancer Registry pilot: improving the quality of lung cancer care through the use of a disease quality registry.

PubMed

Stirling, Rob G; Evans, S M; McLaughlin, P; Senthuren, M; Millar, J; Gooi, J; Irving, L; Mitchell, P; Haydon, A; Ruben, J; Conron, M; Leong, T; Watkins, N; McNeil, J J

2014-10-01

Lung cancer remains a major disease burden in Victoria (Australia) and requires a complex and multidisciplinary approach to ensure optimal care and outcomes. To date, no uniform mechanism is available to capture standardized population-based outcomes and thereby provide benchmarking. The establishment of such a data platform is, therefore, a primary requisite to enable description of process and outcome in lung cancer care and to drive improvement in the quality of care provided to individuals with lung cancer. A disease quality registry pilot has been established to capture prospective data on all adult patients with clinical or tissue diagnoses of small cell and non-small cell lung cancer. Steering and management committees provide clinical governance and supervise quality indicator selection. Quality indicators were selected following extensive literature review and evaluation of established clinical practice guidelines. A minimum dataset has been established and training and data capture by data collectors is facilitated using a web-based portal. Case ascertainment is established by regular institutional reporting of ICD-10 discharge coding. Recruitment is optimized by provision of opt-out consent. The collection of a standardized minimum data set optimizes capacity for harmonized population-based data capture. Data collection has commenced in a variety of settings reflecting metropolitan and rural, and public, and private health care institutions. The data set provides scope for the construction of a risk-adjusted model for outcomes. A data access policy and a mechanism for escalation policy for outcome outliers has been established. The Victorian Lung Cancer Registry provides a unique capacity to provide and confirm quality assessment in lung cancer and to drive improvement in quality of care across multidisciplinary stakeholders.

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.

Evidence-based policy: implications for nursing and policy involvement.

PubMed

Hewison, Alistair

2008-11-01

Evidence-based policy making is espoused as a central feature of government in the United Kingdom. However, an expectation that this will improve the quality of policy produced and provide a path to increased involvement of nurses in the policy process is misplaced. The purpose of this article is to demonstrate that the emphasis on evidence-based policy is problematic and cannot be regarded as a "new model" of policy making. Also, it could deflect attention from more practical approaches to policy involvement on the part of nurses. Policy development activities, acquisition of skills in policy analysis, and other forms of involvement are needed if nurses are to move along the continuum from policy literacy, through policy acumen, to policy competence. This involves taking a critical stance on the notion of evidence-based policy.

Does knowledge brokering improve the quality of rapid review proposals? A before and after study.

PubMed

Moore, Gabriel; Redman, Sally; D'Este, Catherine; Makkar, Steve; Turner, Tari

2017-01-28

Rapid reviews are increasingly being used to help policy makers access research in short time frames. A clear articulation of the review's purpose, questions, scope, methods and reporting format is thought to improve the quality and generalisability of review findings. The aim of the study is to explore the effectiveness of knowledge brokering in improving the perceived clarity of rapid review proposals from the perspective of potential reviewers. To conduct the study, we drew on the Evidence Check program, where policy makers draft a review proposal (a pre knowledge brokering proposal) and have a 1-hour session with a knowledge broker, who re-drafts the proposal based on the discussion (a post knowledge brokering proposal). We asked 30 reviewers who had previously undertaken Evidence Check reviews to examine the quality of 60 pre and 60 post knowledge brokering proposals. Reviewers were blind to whether the review proposals they received were pre or post knowledge brokering. Using a six-point Likert scale, reviewers scored six questions examining clarity of information about the review's purpose, questions, scope, method and format and reviewers' confidence that they could meet policy makers' needs. Each reviewer was allocated two pre and two post knowledge brokering proposals, randomly ordered, from the 60 reviews, ensuring no reviewer received a pre and post knowledge brokering proposal from the same review. The results showed that knowledge brokering significantly improved the scores for all six questions addressing the perceived clarity of the review proposal and confidence in meeting policy makers' needs; with average changes of 0.68 to 1.23 from pre to post across the six domains. This study found that knowledge brokering increased the perceived clarity of information provided in Evidence Check rapid review proposals and the confidence of reviewers that they could meet policy makers' needs. Further research is needed to identify how the knowledge brokering

Assessing the Validity of the Qualistar Early Learning Quality Rating and Improvement System as a Tool for Improving Child-Care Quality

ERIC Educational Resources Information Center

Zellman, Gail L.; Perlman, Michal; Le, Vi-Nhuan; Setodji, Claude Messan

2008-01-01

As a result of the generally low quality of child care in the United States and the increased emphasis on accountability in education policy, quality rating systems (QRSs) are proliferating in the child-care arena. QRSs assess child-care providers on multiple dimensions of quality and integrate these assessments into an easily understood summary…

Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad.

PubMed

Kwamie, Aku; Nabyonga-Orem, Juliet

2016-07-18

Harmonisation is a key principle of the Paris Declaration. The Universal Health Coverage (UHC) Partnership, an initiative of the European Union, the Government of Luxembourg and the World Health Organization, supported health policy dialogues between 2012 and 2015 in identified countries in the WHO African Region. The UHC Partnership has amongst its key objectives to strengthen national health policy development. In Guinea and Chad, policy dialogue focused on elaborating the national health plan and other key documents. This study is an analytical reflection inspired by realist evaluative approaches to understand whether policy dialogue led to improved harmonisation amongst health actors in Guinea and Chad, and if so, how and why. Interviews were conducted in Guinea and Chad with key informants at the national and sub-national government levels, civil society, and development partners. A review of relevant policy documents and reports was added to data collection to construct a full picture of the policy dialogue process. Context-mechanism-outcome configurations were used as the realist framework to guide the analysis on how participants' understanding of what policy dialogue was and the way the policy dialogue process unfolded led to improved harmonisation. Improved harmonisation as a result of policy dialogue was perceived to be stronger in Guinea than in Chad. While in both countries the participants held a shared view of what policy dialogue was and what it could achieve, and both policy dialogue processes were considered to be well implemented (i.e., well-facilitated, evidence-based, participatory, and consisted of recurring meetings and activities), certain contextual factors in Chad tempered the view of harmonisation as having improved. These were the pre-existence of dialogic policy processes that had exposed the actors to the potential that policy dialogue could have; a focus on elaborating provincial level strategies, which gave the sense that the process

77 FR 31615 - Improving Mail Management Policies, Procedures, and Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... Mail Management Policies, Procedures, and Activities AGENCY: Office of Governmentwide Policy, General... Administration (GSA) has issued Federal Management Regulation (FMR) Bulletin G-03 which provides guidance to Executive Branch agencies for improving mail management policies, procedures, and activities. FMR Bulletin G...

Teacher Competence Frameworks in Europe: Policy-as-Discourse and Policy-as-Practice

ERIC Educational Resources Information Center

Caena, Francesca

2014-01-01

This article analyses the growing focus on teacher competences in European policy discourse against the backdrop of global convergences in education reforms. It traces key ideas, policy recommendations, peer learning and documents which underscore the relevance of teacher quality for education improvement, as recently stressed in the European…

International perspectives on air quality: risk management principles for policy development--conference statement.

PubMed

Craig, Lorraine; Krewski, Dan; Samet, Jonathan; Shortreed, John; van Bree, Leendert; Krupnick, Alan J

2008-01-01

This statement is the result of discussions held at the 2005 NERAM IV Colloquium "International Perspectives on Air Quality: Risk Management Principles for Policy Development" and represents the collective views of 35 delegates, including international air quality policy analysts, academics, nongovernmental organizations, industry representatives, and decision makers from Mexico, Canada, the United States, the United Kingdom, Brazil, Hong Kong, and The Netherlands on principles for global air quality management. The objective of the colloquium was to "establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation." This statement represents the main findings of a breakout group discussion session, presentations of an international panel of speakers from Canada, the United States, Mexico, and Hong Kong and views of the delegates expressed in plenary discussions. NERAM undertook a transparent process to try to ensure that the statement would accurately reflect the conference discussions, including documenting the proceedings and inviting delegates' comments on draft versions of the statement.

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

Potential impact of a US climate policy and air quality regulations on future air quality and climate change

NASA Astrophysics Data System (ADS)

Lee, Yunha; Shindell, Drew T.; Faluvegi, Greg; Pinder, Rob W.

2016-04-01

We have investigated how future air quality and climate change are influenced by the US air quality regulations that existed or were proposed in 2013 and a hypothetical climate mitigation policy that aims to reduce 2050 CO2 emissions to be 50 % below 2005 emissions. Using the NASA GISS ModelE2 general circulation model, we look at the impacts for year 2030 and 2055. The US energy-sector emissions are from the GLIMPSE project (GEOS-Chem LIDORT Integrated with MARKAL (MARKet ALlocation) for the Purpose of Scenario Exploration), and other US emissions data sets and the rest of the world emissions data sets are based on the RCP4.5 scenario. The US air quality regulations are projected to have a strong beneficial impact on US air quality and public health in year 2030 and 2055 but result in positive radiative forcing. Under this scenario, no more emission constraints are added after 2020, and the impacts on air quality and climate change are similar between year 2030 and 2055. Surface particulate matter with a diameter smaller than 2.5 µm (PM2.5) is reduced by ˜ 2 µg m-3 on average over the USA, and surface ozone by ˜ 8 ppbv. The improved air quality prevents about 91 400 premature deaths in the USA, mainly due to the PM2.5 reduction (˜ 74 200 lives saved). The air quality regulations reduce the light-reflecting aerosols (i.e., sulfate and organic matter) more than the light-absorbing species (i.e., black carbon and ozone), leading to a strong positive radiative forcing (RF) over the USA by both aerosols' direct and indirect forcing: the total RF is ˜ 0.04 W m-2 over the globe, and ˜ 0.8 W m-2 over the USA. Under the hypothetical climate policy, a future CO2 emissions cut is achieved in part by relying less on coal, and thus SO2 emissions are noticeably reduced. This provides air quality co-benefits, but it could lead to potential climate disbenefits over the USA. In 2055, the US mean total RF is +0.22 W m-2 due to positive aerosol direct and indirect forcing

Potential Impact of a US Climate Policy and Air Quality Regulations on Future Air Quality and Climate Change

NASA Technical Reports Server (NTRS)

Lee, Y. H.; Faluvegi, Gregory S.

2016-01-01

We have investigated how future air quality and climate change are influenced by the US air quality regulations that existed or were proposed in 2013 and a hypothetical climate mitigation policy that aims to reduce 2050 CO2 emissions to be 50% below 2005 emissions. Using the NASA GISS ModelE2 general circulation model, we look at the impacts for year 2030 and 2055. The US energy-sector emissions are from the GLIMPSE project (GEOS-Chem LIDORT Integrated with MARKAL (MARKet ALlocation) for the Purpose of Scenario Exploration), and other US emissions data sets and the rest of the world emissions data sets are based on the RCP4.5 scenario. The US air quality regulations are projected to have a strong beneficial impact on US air quality and public health in year 2030 and 2055 but result in positive radiative forcing. Under this scenario, no more emission constraints are added after 2020, and the impacts on air quality and climate change are similar between year 2030 and 2055. Surface particulate matter with a diameter smaller than 2.5 micron PM(sub 2:5) is reduced by 2 approximately µg/m(sup -3) on average over the USA, and surface ozone by approximately 8 ppbv. The improved air quality prevents about 91 400 premature deaths in the USA, mainly due to the PM(sub 2:5) reduction approximately (74 200 lives saved). The air quality regulations reduce the light-reflecting aerosols (i.e., sulfate and organic matter) more than the light-absorbing species (i.e., black carbon and ozone), leading to a strong positive radiative forcing (RF) over the USA by both aerosols' direct and indirect forcing: the total RF is approximately 0.04 W m(sup -2) over the globe, and approximately 0.8 W m(sup -2) over the USA. Under the hypothetical climate policy, a future CO2 emissions cut is achieved in part by relying less on coal, and thus SO2 emissions are noticeably reduced. This provides air quality co-benefits, but it could lead to potential climate disbenefits over the USA. In 2055, the US

Furthering the quality agenda in Aboriginal community controlled health services: understanding the relationship between accreditation, continuous quality improvement and national key performance indicator reporting.

PubMed

Sibthorpe, Beverly; Gardner, Karen; McAullay, Daniel

2016-01-01

A rapidly expanding interest in quality in the Aboriginal-community-controlled health sector has led to widespread uptake of accreditation using more than one set of standards, a proliferation of continuous quality improvement programs and the introduction of key performance indicators. As yet, there has been no overarching logic that shows how they relate to each other, with consequent confusion within and outside the sector. We map the three approaches to the Framework for Performance Assessment in Primary Health Care, demonstrating their key differences and complementarity. There needs to be greater attention in both policy and practice to the purposes and alignment of the three approaches if they are to embed a system-wide focus that supports quality improvement at the service level.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

PubMed

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

Air quality improvements and health benefits from China’s clean air action since 2013

NASA Astrophysics Data System (ADS)

Zheng, Yixuan; Xue, Tao; Zhang, Qiang; Geng, Guannan; Tong, Dan; Li, Xin; He, Kebin

2017-11-01

Aggressive emission control measures were taken by the Chinese government after the promulgation of the ‘Air Pollution Prevention and Control Action Plan’ in 2013. Here we evaluated the air quality and health benefits associated with this stringent policy during 2013-2015 by using surface PM2.5 concentrations estimated from a three-stage data fusion model and cause-specific integrated exposure-response functions. The population-weighted annual mean PM2.5 concentrations decreased by 21.5% over China during 2013-2015, reducing from 60.5 in 2013 to 47.5 μg m-3 in 2015. Subsequently, the national PM2.5-attributable mortality decreased from 1.22 million (95% CI: 1.05, 1.37) in 2013 to 1.10 million (95% CI: 0.95, 1.25) in 2015, which is a 9.1% reduction. The limited health benefits compared to air quality improvements are mainly due to the supralinear responses of mortality to PM2.5 over the high concentration end of the concentration-response functions. Our study affirms the effectiveness of China’s recent air quality policy; however, due to the nonlinear responses of mortality to PM2.5 variations, current policies should remain in place and more stringent measures should be implemented to protect public health.

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...

A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

PubMed

Carnero, María Carmen; Gómez, Andrés

2016-04-23

Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a

Prioritization for Plastic Surgery Procedures Aimed to Improve Quality of Life: Moral Considerations

PubMed Central

Kolby, Lars; Elander, Anna

2017-01-01

Background: Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions. Methods: We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non–life-threatening conditions. Results: A specific anatomical feature is not always an indicator of patient’s well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care. A policy should identify who preoperatively are the worst-off and come to some plausible measure of how much they can be expected to benefit from an operation. Policies that do not track these principles in any reliable way can cause discrimination. Conclusions: A patient-centered operating system and patient’s informed preferences might be implemented in the process of prioritizing health. In circumstances when the effectiveness of a specific treatment is unproven, professionals should not make assumptions based on their own values. PMID:28894658

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Great Lakes Water Quality Initiative Antidegradation Policy E Appendix E to Part 132 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Part 132—Great Lakes Water Quality Initiative Antidegradation Policy Great Lakes States and Tribes...

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

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.

Making quality improvement programs more effective.

PubMed

Shaw-Taylor, Yoku

2014-01-01

In the past 25 years, and as recent as 2011, all external evaluations of the Quality Improvement Organization (QIO) Program have found its impact to be small or difficult to discern. The QIO program costs about $200 million on average to administer each year to improve quality of healthcare for people of 65 years or older. The program was created to address questionable quality of care. QIOs review how care is provided based on performance measures. The paper aims to discuss these issues. In 2012, the author supported the production of quarterly reports and reviewed internal monitoring and evaluation protocols of the program. The task also required reviewing all previous program evaluations. The task involved many conversations about the complexities of the program, why impact is difficult to discern and possible ways for eventual improvement. Process flow charts were created to simulate the data life cycle and discrete event models were created based on the sequence of data collection and reporting to identify gaps in data flow. The internal evaluation uncovered data gaps within the program. The need for a system of specification rules for data conceptualization, collection, distribution, discovery, analysis and repurposing is clear. There were data inconsistencies and difficulty of integrating data from one instance of measurement to the next. The lack of good and reliable data makes it difficult to discern true impact. The prescription is for a formal data policy or data governance structure to integrate and document all aspects of the data life cycle. The specification rules for governance are exemplified by the Data Documentation Initiative and the requirements published by the Data Governance Institute. The elements are all in place for a solid foundation of the data governance structure. These recommendations will increase the value of program data. The model specifies which agency units must be included in the governance authority and the data team. The

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…

Discourses and Policies on Educational Quality in Argentina, 1990-2010

ERIC Educational Resources Information Center

Gorostiaga, Jorge M.; Ferreira, Adrian

2012-01-01

This article analyses the relationships between different notions of education quality and policies on primary and secondary schools implemented in Argentina during the last two decades. The authors focus on three moments: (1) the emergence of the discussion about quality (at the end of the 1980s) in Latin America and in Argentina; (2) the…

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.

Working to improve the management of sarcoma patients across Europe: a policy checklist.

PubMed

Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

2018-04-16

The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

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.

Tensions in Constructions of Quality in Australian Early Childhood Education and Care Policy History

ERIC Educational Resources Information Center

Logan, Helen

2017-01-01

In pronouncements of early childhood education and care (ECEC) policy the importance of quality appears as a seemingly irrefutable concept. Yet, attention to ECEC policy history reveals tensions between discourses that construct quality in ways that endure whereas other ways are ostensibly forgotten. Drawing on a Foucauldian-influenced…

Improving quality for maternal care - a case study from Kerala, India

PubMed Central

Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

2016-01-01

Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context. PMID:27441084

[Recommendations for implementing the quality policy and organisation of a quality management system].

PubMed

Daunizeau, A

2013-06-01

Preliminary issues to implement a quality management system are described. They include the definition of the structure, a hierarchical and functional organization chart and the engagement of the whole personnel to apply the requirements of the standard EN ISO 15189. The policy has to be translated into objectives.

Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

PubMed

Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

2018-03-31

To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs.

PubMed

Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M

2018-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

PubMed Central

Konetzka, R. Tamara; Skira, Meghan M.; Werner, Rachel M.

2017-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement. PMID:29594189

Study of the Impacts of the Quality Assessment of Undergraduate Education Policy in China: Students' Perceptions

ERIC Educational Resources Information Center

Liu, Shuiyun; Yu, Hui

2014-01-01

This paper analyzes a higher education policy issued in China in 2002: "the Quality Assessment of Undergraduate Education Policy." It examines students' perceptions of the policy impacts and students' roles in the evaluation process by semi-structured interviews and questionnaire surveys. It reveals that the quality assessment in China…

40 CFR 1518.3 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OFFICE OF ENVIRONMENTAL QUALITY MANAGEMENT FUND § 1518.3 Policy. (a) All studies and projects financed through the OEQ Management Fund shall be... Quality Improvement Act. (b) Agency funds accepted by the Director for transfer into the OEQ Management...

Dynamic water allocation policies improve the global efficiency of storage systems

NASA Astrophysics Data System (ADS)

Niayifar, Amin; Perona, Paolo

2017-06-01

Water impoundment by dams strongly affects the river natural flow regime, its attributes and the related ecosystem biodiversity. Fostering the sustainability of water uses e.g., hydropower systems thus implies searching for innovative operational policies able to generate Dynamic Environmental Flows (DEF) that mimic natural flow variability. The objective of this study is to propose a Direct Policy Search (DPS) framework based on defining dynamic flow release rules to improve the global efficiency of storage systems. The water allocation policies proposed for dammed systems are an extension of previously developed flow redistribution rules for small hydropower plants by Razurel et al. (2016).The mathematical form of the Fermi-Dirac statistical distribution applied to lake equations for the stored water in the dam is used to formulate non-proportional redistribution rules that partition the flow for energy production and environmental use. While energy production is computed from technical data, riverine ecological benefits associated with DEF are computed by integrating the Weighted Usable Area (WUA) for fishes with Richter's hydrological indicators. Then, multiobjective evolutionary algorithms (MOEAs) are applied to build ecological versus economic efficiency plot and locate its (Pareto) frontier. This study benchmarks two MOEAs (NSGA II and Borg MOEA) and compares their efficiency in terms of the quality of Pareto's frontier and computational cost. A detailed analysis of dam characteristics is performed to examine their impact on the global system efficiency and choice of the best redistribution rule. Finally, it is found that non-proportional flow releases can statistically improve the global efficiency, specifically the ecological one, of the hydropower system when compared to constant minimal flows.

The Quality Imperative: Tracing the Rise of "Quality" in Australian Early Childhood Education and Care Policy

ERIC Educational Resources Information Center

Logan, Helen; Press, Frances; Sumsion, Jennifer

2012-01-01

Quality in early childhood development was barely mentioned in government policy four decades ago. But this has changed. Using discourses and gazes as analytical tools, and by examining the recent past (1972-2009), this article traces how and why "quality" has become a key component of the current Council of Australian Governments'…

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

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.

Decision makers, scientists and the public as stakeholders: the connection between traffic intervention policy and air quality in a local context.

NASA Astrophysics Data System (ADS)

Weiand, L.; von Schneidemesser, E.; Schmitz, S.; Niehoff, N.

2017-12-01

Urban mobility is a key issue to make cities more inclusive, safer, and more environmentally friendly. To ensure a sustainable future, local policy should, among other actions, aim to improve access to sustainable transport systems and enhance mobility opportunities, while at the same time addressing critical environmental and health targets. In order to assess whether these objectives are met, measures should be informed and evaluated from a social and environmental perspective. Citizens' opinions and the acceptance of environmental policies are crucial to successful implementation of urban mobility measures. The complexity of urban air quality issues require transparent decision-making processes that are grounded in evidence-based research and embrace local knowledge. From this basis, our research group and the city council collaborated to assess a new policy action intended to address environmental and health targets. This talk will present the results from the assessment of this new policy, that was implemented in large part to alleviate air quality exceedances, from the perspective of public acceptability of the measure and the approach taken by the city council to implement the measure. Parallel to assessing the effect of this policy on the recorded levels of air pollution and traffic counts, we conducted a social survey to examine public opinions of this measure, as well as the link between air quality awareness and mobility decisions. 4661 responses were collected over a one month period. Survey participants were those most affected by the traffic measure, including commuters and local residents. The results show that there is an overall low acceptance rate of the measure (8%) as well as low concern for air quality (2,90 - where 1 = not concerned and 6 = very concerned). We also found that there is a negative relationship between air quality rating and air quality concern. A similar approach was taken to understand climate change concern, which will be

Evidence and Impact: How Scholarship Can Improve Policy and Practice

ERIC Educational Resources Information Center

Lingenfelter, Paul E.

2011-01-01

Researchers, policy makers, and practitioners share a sincere interest in improving the human condition. Academics may be tempted to fault irrationality, ideology, or ignorance for the failure of research to inform policy and practice more powerfully, but policy makers and practitioners want academics to tell them "what works" in order to find a…

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

Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement.

PubMed

Renedo, Alicia; Marston, Cicely

2015-04-23

Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the

Argumentation in Educational Policy Disputes: Competing Visions of Quality and Equity

ERIC Educational Resources Information Center

Anagnostopoulos, Dorothea; Lingard, Bob; Sellar, Sam

2016-01-01

Current debates about test-based accountability policies revolve around questions of how to ensure that all students have access to high-quality schools and teachers. Whether and how one can meet this goal depend, in part, on the nature of the arguments that policy proponents and opponents mobilize in these debates. This article examines these…

Incorporating discrete event simulation into quality improvement efforts in health care systems.

PubMed

Rutberg, Matthew Harris; Wenczel, Sharon; Devaney, John; Goldlust, Eric Jonathan; Day, Theodore Eugene

2015-01-01

Quality improvement (QI) efforts are an indispensable aspect of health care delivery, particularly in an environment of increasing financial and regulatory pressures. The ability to test predictions of proposed changes to flow, policy, staffing, and other process-level changes using discrete event simulation (DES) has shown significant promise and is well reported in the literature. This article describes how to incorporate DES into QI departments and programs in order to support QI efforts, develop high-fidelity simulation models, conduct experiments, make recommendations, and support adoption of results. The authors describe how DES-enabled QI teams can partner with clinical services and administration to plan, conduct, and sustain QI investigations. © 2013 by the American College of Medical Quality.

An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso.

PubMed

Belaid, Loubna; Ridde, Valéry

2012-12-08

To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the effectiveness of the policy

An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

PubMed Central

2012-01-01

Background To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. Methods The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. Results All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the

Child Care Quality in Different State Policy Contexts

ERIC Educational Resources Information Center

Rigby, Elizabeth; Ryan, Rebecca M.; Brooks-Gunn, Jeanne

2007-01-01

Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a…

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability—An Emerging Framework

PubMed Central

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four “pillars” of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two “foundational considerations,” adaptive capacity and policy levers, are also discussed. PMID:25848557

Clinical audit and quality improvement - time for a rethink?

PubMed

Bowie, Paul; Bradley, Nicholas A; Rushmer, Rosemary

2012-02-01

Evidence of the benefits of clinical audit to patient care is limited, despite its longevity. Additionally, numerous attitudinal, professional and organizational barriers impede its effectiveness. Yet, audit remains a favoured quality improvement (QI) policy lever. Growing interest in QI techniques suggest it is timely to re-examine audit. Clinical audit advisors assist health care teams, so hold unique cross-cutting perspectives on the strategic and practical application of audit in NHS organizations. We aimed to explore their views and experiences of their role in supporting health care teams in the audit process. Qualitative study using semi-structured and focus group interviews. Participants were purposively sampled (n = 21) across health sectors in two large Scottish NHS Boards. Interviews were audio-taped, transcribed and a thematic analysis performed. Work pressure and lack of protected time were cited as audit barriers, but these hide other reasons for non-engagement. Different professions experience varying opportunities to participate. Doctors have more opportunities and may dominate or frustrate the process. Audit is perceived as a time-consuming, additional chore and a managerially driven exercise with no associated professional rewards. Management failure to support and resource changes fuels low motivation and disillusionment. Audit is regarded as a 'political' tool stifled by inter-professional differences and contextual constraints. The findings echo previous studies. We found limited evidence that audit as presently defined and used is meeting policy makers' aspirations. The quality and safety improvement focus is shifting towards 'alternative' systems-based QI methods, but research to suggest that these will be any more impactful is also lacking. Additionally, identified professional, educational and organizational barriers still need to be overcome. A debate on how best to overcome the limitations of audit and its place alongside other approaches

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

Impacts of potential CO2-reduction policies on air quality in the United States.

PubMed

Trail, Marcus A; Tsimpidi, Alexandra P; Liu, Peng; Tsigaridis, Kostas; Hu, Yongtao; Rudokas, Jason R; Miller, Paul J; Nenes, Athanasios; Russell, Armistead G

2015-04-21

Impacts of emissions changes from four potential U.S. CO2 emission reduction policies on 2050 air quality are analyzed using the community multiscale air quality model (CMAQ). Future meteorology was downscaled from the Goddard Institute for Space Studies (GISS) ModelE General Circulation Model (GCM) to the regional scale using the Weather Research Forecasting (WRF) model. We use emissions growth factors from the EPAUS9r MARKAL model to project emissions inventories for two climate tax scenarios, a combined transportation and energy scenario, a biomass energy scenario and a reference case. Implementation of a relatively aggressive carbon tax leads to improved PM2.5 air quality compared to the reference case as incentives increase for facilities to install flue-gas desulfurization (FGD) and carbon capture and sequestration (CCS) technologies. However, less capital is available to install NOX reduction technologies, resulting in an O3 increase. A policy aimed at reducing CO2 from the transportation sector and electricity production sectors leads to reduced emissions of mobile source NOX, thus reducing O3. Over most of the U.S., this scenario leads to reduced PM2.5 concentrations. However, increased primary PM2.5 emissions associated with fuel switching in the residential and industrial sectors leads to increased organic matter (OM) and PM2.5 in some cities.

Doing the Right Thing for Women and Babies: Policy Initiatives to Improve Maternity Care Quality and Value

PubMed Central

Corry, Maureen P; Jolivet, Rima

2009-01-01

When defined within the context of maternity care, the Institute of Medicine's six aims for health-care quality improvement provide a framework for Childbirth Connection's Maternity Quality Matters Initiative, a multipronged program agenda intended to foster a maternity care system that delivers care of the highest quality and value in order to achieve optimal health outcomes and experiences for mothers and babies. These aims also provide childbirth educators and others in the maternity care community with an ethical framework for efforts to serve childbearing women and families and ensure the best outcomes for women, babies, and families. PMID:19436596

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.

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.

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.…

Expanding Access to Quality Pre-K Is Sound Public Policy

ERIC Educational Resources Information Center

Barnett, W. Steven

2013-01-01

In 2013, preschool education received more attention in the media and public policy circles than it has for some time, in part because of a series of high-profile proposals to expand access to quality pre-K. The scientific basis for these proposed expansions of quality pre-K is impressive. This paper brings to bear the full weight of the evidence…

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.

Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care

PubMed Central

Williams, Kendal; Brennan, Patrick J.

2010-01-01

Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined. PMID:20697961

Formal quality improvement curriculum and DMAIC method results in interdisciplinary collaboration and process improvement in renal transplant patients.

PubMed

Leaphart, Cynthia L; Gonwa, Thomas A; Mai, Martin L; Prendergast, Mary B; Wadei, Hani M; Tepas, Joseph J; Taner, C Burcin

2012-09-01

Broad-based formal quality improvement curriculum emphasizing Six Sigma and the DMAIC approach developed by our institution is required for physicians in training. DMAIC methods evaluated the common outcome of postoperative hyponatremia, thus resulting in collaboration to prevent hyponatremia in the renal transplant population. To define postoperative hyponatremia in renal transplant recipients, a project charter outlined project aims. To measure postoperative hyponatremia, serum sodium at admission and immediately postoperative were recorded by retrospective review of renal transplant recipient charts from June 29, 2010 to December 31, 2011. An Ishikawa diagram was generated to analyze potential causative factors. Interdisciplinary collaboration and hospital policy assessment determined necessary improvements to prevent hyponatremia. Continuous monitoring in control phase was performed by establishing the goal of <10% of transplant recipients with abnormal serum sodium annually through quarterly reduction of hyponatremia by 30% to reach this goal. Of 54 transplant recipients, postoperative hyponatremia occurred in 92.6% of patients. These potential causes were evaluated: 1) Hemodialysis was more common than peritoneal dialysis. 2) Alemtuzumab induction was more common than antithymocyte globulin. 3) A primary diagnosis of diabetes existed in 16 patients (30%). 4) Strikingly, 51 patients received 0.45% sodium chloride intraoperatively, suggesting this as the most likely cause of postoperative hyponatremia. A hospital policy change to administer 0.9% sodium chloride during renal transplantation resulted in normal serum sodium levels postoperatively in 59 of 64 patients (92.2%). The DMAIC approach and formal quality curriculum for trainees addresses core competencies by providing a framework for problem solving, interdisciplinary collaboration, and process improvement. Copyright © 2012 Elsevier Inc. All rights reserved.

Information for mental health systems: an instrument for policy-making and system service quality.

PubMed

Lora, A; Lesage, A; Pathare, S; Levav, I

2017-08-01

Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward. Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries. Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models. Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited

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.

Stochastic abstract policies: generalizing knowledge to improve reinforcement learning.

PubMed

Koga, Marcelo L; Freire, Valdinei; Costa, Anna H R

2015-01-01

Reinforcement learning (RL) enables an agent to learn behavior by acquiring experience through trial-and-error interactions with a dynamic environment. However, knowledge is usually built from scratch and learning to behave may take a long time. Here, we improve the learning performance by leveraging prior knowledge; that is, the learner shows proper behavior from the beginning of a target task, using the knowledge from a set of known, previously solved, source tasks. In this paper, we argue that building stochastic abstract policies that generalize over past experiences is an effective way to provide such improvement and this generalization outperforms the current practice of using a library of policies. We achieve that contributing with a new algorithm, AbsProb-PI-multiple and a framework for transferring knowledge represented as a stochastic abstract policy in new RL tasks. Stochastic abstract policies offer an effective way to encode knowledge because the abstraction they provide not only generalizes solutions but also facilitates extracting the similarities among tasks. We perform experiments in a robotic navigation environment and analyze the agent's behavior throughout the learning process and also assess the transfer ratio for different amounts of source tasks. We compare our method with the transfer of a library of policies, and experiments show that the use of a generalized policy produces better results by more effectively guiding the agent when learning a target task.

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

Improving student-perceived benefit of academic advising within education of occupational and physical therapy in the United States: a quality improvement initiative.

PubMed

Barnes, Lisa J; Parish, Robin

2017-01-01

Academic advising is a key role for faculty in the educational process of health professionals; however, the best practice of effective academic advising for occupational and physical therapy students has not been identified in the current literature. The purpose of this quality improvement initiative was to assess and improve the faculty/student advisor/advisee process within occupational and physical therapy programs within a school of allied health professions in the United States in 2015. A quality improvement initiative utilizing quantitative and qualitative information was gathered via survey focused on the assessment and improvement of an advisor/advisee process. The overall initiative utilized an adaptive iterative design incorporating the plan-do-study-act model which included a three-step process over a one year time frame utilizing 2 cohorts, the first with 80 students and the second with 88 students. Baseline data were gathered prior to initiating the new process. A pilot was conducted and assessed during the first semester of the occupational and physical therapy programs. Final information was gathered after one full academic year with final comparisons made to baseline. Defining an effective advisory program with an established framework led to improved awareness and participation by students and faculty. Early initiation of the process combined with increased frequency of interaction led to improved student satisfaction. Based on student perceptions, programmatic policies were initiated to promote advisory meetings early and often to establish a positive relationship. The policies focus on academic advising as one of proactivity in which the advisor serves as a portal which the student may access leading to a more successful academic experience.

Staff Preparation, Reward, and Support: Are Quality Rating and Improvement Systems Addressing All of the Key Ingredients Necessary for Change? Policy Report

ERIC Educational Resources Information Center

Austin, Lea J. E.; Whitebook, Marcy; Connors, Maia; Darrah, Rory

2011-01-01

Reflecting the growing momentum in support of quality rating and improvement systems (QRISs) as a key strategy to improve early care and education quality, significant amounts of public dollars have been devoted to their development and implementation. In this brief, the authors report on their investigation of both quality rating and improvement…

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

PubMed

Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

2007-10-06

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

Improving tsunami resiliency: California's Tsunami Policy Working Group

USGS Publications Warehouse

Real, Charles R.; Johnson, Laurie; Jones, Lucile M.; Ross, Stephanie L.; Kontar, Y.A.; Santiago-Fandiño, V.; Takahashi, T.

2014-01-01

California has established a Tsunami Policy Working Group to facilitate development of policy recommendations for tsunami hazard mitigation. The Tsunami Policy Working Group brings together government and industry specialists from diverse fields including tsunami, seismic, and flood hazards, local and regional planning, structural engineering, natural hazard policy, and coastal engineering. The group is acting on findings from two parallel efforts: The USGS SAFRR Tsunami Scenario project, a comprehensive impact analysis of a large credible tsunami originating from an M 9.1 earthquake in the Aleutian Islands Subduction Zone striking California’s coastline, and the State’s Tsunami Preparedness and Hazard Mitigation Program. The unique dual-track approach provides a comprehensive assessment of vulnerability and risk within which the policy group can identify gaps and issues in current tsunami hazard mitigation and risk reduction, make recommendations that will help eliminate these impediments, and provide advice that will assist development and implementation of effective tsunami hazard risk communication products to improve community resiliency.

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.

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

The Logic of the Thai Higher Education Sector on Quality Assessment Policy

ERIC Educational Resources Information Center

Sae-Lao, Rattana

2013-01-01

Although the concept of quality has been an essential part of the higher education sector, the global quest for Quality Assessment (QA hereafter) has raised attention to quality to a new level. Van Vught and Westerheijden (1994) argue that the common charateristics of QA policy include: meta-level organization to conduct external evaluation,…

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

Neurosurgery value and quality in the context of the Affordable Care Act: a policy perspective.

PubMed

Menger, Richard P; Guthikonda, Bharat; Storey, Christopher M; Nanda, Anil; McGirt, Matthew; Asher, Anthony

2015-12-01

Neurosurgeons provide direct individualized care to patients. However, the majority of regulations affecting the relative value of patient-related care are drafted by policy experts whose focus is typically system- and population-based. A central, prospectively gathered, national outcomes-related database serves as neurosurgery's best opportunity to bring patient-centered outcomes to the policy arena. In this study the authors analyze the impact of the Affordable Care Act (ACA) on the determination of quality and value in neurosurgery care through the scope, language, and terminology of policy experts. The methods by which the ACA came into law and the subsequent quality implications this legislation has for neurosurgery will be discussed. The necessity of neurosurgical patient-oriented clinical registries will be discussed in the context of imminent and dramatic reforms related to medical cost containment. In the policy debate moving forward, the strength of neurosurgery's argument will rest on data, unity, and proactiveness. The National Neurosurgery Quality and Outcomes Database (N(2)QOD) allows neurosurgeons to generate objective data on specialty-specific value and quality determinations; it allows neurosurgeons to bring the patient-physician interaction to the policy debate.

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.

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

PubMed

Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí

2014-09-18

In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. This study uses Kingdon's Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval

Visiting hours policies in New England intensive care units: strategies for improvement.

PubMed

Lee, Melissa D; Friedenberg, Allison S; Mukpo, David H; Conray, Kayla; Palmisciano, Amy; Levy, Mitchell M

2007-02-01

Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy. Two-part study: survey and focus groups. ICUs in New England and one medical ICU in a tertiary care hospital. Registered nurses employed in medical ICUs. Adult ICUs in the six New England states were located using a library listing of all regional hospitals. A telephone questionnaire interview was used to ascertain visiting hours policies in each ICU. Six focus-group sessions were conducted with nursing staff who work in an urban, northeastern ICU with 8 yrs of experience with an unrestricted visiting hours policy. A total of 171 hospitals completed the questionnaire (96%). From all ICUs surveyed, 62 (32%) had unrestricted, open visiting hours. Out of these, 57 (92%) were medical ICUs or mixed medical/surgical ICUs. Nursing staff identified three major areas of concern with an open visiting hours policy: space, conflict, and burden. Strategies for resolution that are either employed or advocated by nursing staff are described. The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and

Do Energy Efficiency Standards Improve Quality? Evidence from a Revealed Preference Approach

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

Houde, Sebastien; Spurlock, C. Anna

Minimum energy efficiency standards have occupied a central role in U.S. energy policy for more than three decades, but little is known about their welfare effects. In this paper, we employ a revealed preference approach to quantify the impact of past revisions in energy efficiency standards on product quality. The micro-foundation of our approach is a discrete choice model that allows us to compute a price-adjusted index of vertical quality. Focusing on the appliance market, we show that several standard revisions during the period 2001-2011 have led to an increase in quality. We also show that these standards have hadmore » a modest effect on prices, and in some cases they even led to decreases in prices. For revision events where overall quality increases and prices decrease, the consumer welfare effect of tightening the standards is unambiguously positive. Finally, we show that after controlling for the effect of improvement in energy efficiency, standards have induced an expansion of quality in the non-energy dimension. We discuss how imperfect competition can rationalize these results.« less

State Teacher Policy Yearbook: Progress on Teacher Quality, 2007. Colorado State Summary

ERIC Educational Resources Information Center

National Council on Teacher Quality, 2007

2007-01-01

The "State Teacher Policy Yearbook" examines what is arguably the single most powerful authority over the teaching profession: state government. This Colorado edition of the National Council on Teacher Quality's (NCTQ's) "State Teacher Policy Yearbook" is the first of what will be an annual look at the status of state policies…

Comparing HE Policies in Europe

ERIC Educational Resources Information Center

Bleiklie, Ivar; Michelsen, Svein

2013-01-01

The purpose of this paper is to develop a conceptual framework for a comparative analysis of Higher Education policies that enables us to investigate the explanatory power of structural characteristics of politico-administrative systems. The policies that are studied aim at improving the efficiency and quality of institutional performance. The…

What are the most effective strategies for improving quality and safety of health care?

PubMed

Scott, I

2009-06-01

There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy-maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS-related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta-review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy-maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician-directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small-group case discussions, and patient-mediated clinician reminders. Pay-for-performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy-maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

The quality of school wellness policies and energy-balance behaviors of adolescent mothers.

PubMed

Haire-Joshu, Debra; Yount, Byron W; Budd, Elizabeth L; Schwarz, Cynthia; Schermbeck, Rebecca; Green, Scoie; Elliott, Michael

2011-03-01

In this study, we 1) compared the quality of school wellness policies among schools participating in Moms for a Healthy Balance (BALANCE), a school- and home-based weight loss study conducted with postpartum adolescents in 27 states; and 2) assessed the relationship between policy quality with energy-balance behaviors and body mass index z scores of postpartum adolescents. As a part of BALANCE, we collected data on high-calorie food and beverage consumption, minutes spent walking, and height and weight for 647 participants. The School Wellness Policy Coding Tool was used to assess the strength and comprehensiveness of school district wellness policies from 251 schools attended by participating adolescent mothers. Schools averaged low scores for wellness policy comprehensiveness and strength. When compared with participants in schools with the lowest policy comprehensiveness scores, adolescent mothers in schools with the highest scores reported consuming significantly fewer daily calories from sweetened beverages while reporting higher consumption of water (P = .04 and P = .01, respectively). School wellness policy strength was associated with lower BMI z scores among adolescent mothers (P = .01). School wellness policies associated with BALANCE may be limited in their ability to promote a healthy school environment. Future studies are needed to evaluate the effect of the strength and comprehensiveness of policy language on energy balance in high-risk postpartum adolescents. Evidence from this work can provide additional guidance to federal or state government in mandating not only policy content, but also systematic evaluation.

Representations of a High-Quality System of Undergraduate Education in English Higher Education Policy Documents

ERIC Educational Resources Information Center

Ashwin, Paul; Abbas, Andrea; McLean, Monica

2015-01-01

This article examines the ways in which a high-quality system of undergraduate education is represented in recent policy documents from a range of actors interested in higher education. Drawing on Basil Bernstein's ideas, the authors conceptualise the policy documents as reflecting a struggle over competing views of quality that are expressed…

Getting the product right: how competition policy can improve health care markets.

PubMed

Sage, William M

2014-06-01

As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the sector's long history of government regulation. This article directs policy makers to a neglected dimension of health care competition that has been altered by regulation: the product. Competition may have failed to significantly lower costs, increase access, or improve quality in health care because we have been buying and selling the wrong things. Competition policy makers-meaning both antitrust enforcers and regulators-should force the health care industry to define and market products that can be assembled and warranted to consumers while keeping emerging sectors such as mHealth free from overregulation, wasteful subsidy, and appropriation by established insurer and provider interests. Project HOPE—The People-to-People Health Foundation, Inc.

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…

Government employees' perception of urban air pollution and willingness to pay for improved quality: a cross-sectional survey study in Nanchang, China.

PubMed

Liu, Xiaojun; Wu, Yanyan; Hu, Yongxin; Liu, Denglai; Zhang, Jin; Chen, Cheng; Yuan, Zhaokang; Lu, Yuanan

2016-11-01

To improve the public's awareness of urban air pollution and promote establishment of more efficient policy toward urban air pollution, we investigated the government employees' perceptions of current urban air pollution and their willingness to pay (WTP) taxes for improved quality in Nanchang, China. Stratified cluster sampling strategy was used to distribute 629 questionnaires, and 608 were completed anonymously, yielding a 96.7 % response rate. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were performed to assess the associations of perception of urban air quality and WTP versus demographic variables. We found low awareness of urban air pollution (34.5 %) as well as low WTP (44.9 %), especially among the middle aged people (age 30-39 and age 40-49). Our study shows that female employees have better awareness of urban air pollution but much less willingness to pay for air quality improvement. Majority of the government employees showed their support to the government for more effective policies toward environmental protection, indicating more enhanced public education and environmental protection campaigns to improve the public's awareness of air pollution and work with every citizen to improve air quality. This study also obtained baseline information useful to the local regional and even national government in developing nations in their attempt to control urban air pollution in future.

Are We at the Crossroads for Wisconsin Child Care? Policies in Conflict

ERIC Educational Resources Information Center

Wisconsin Council on Children and Families, 2016

2016-01-01

This report examines the conflicting public policies in child care and their implications. The policy analysis tracks the history of two major child care programs, the Wisconsin Shares child care subsidy program and the YoungStar Quality Rating and Improvement System. While YoungStar shows promising trends in improving the quality of early care…

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 and Equality: The Mask of Discursive Conflation in Education Policy Texts

ERIC Educational Resources Information Center

Gillies, Donald

2008-01-01

Two key themes of recent UK education policy texts have been a focus on "quality" in public sector performance, and on "equality" in the form of New Labour's stated commitment to equality of opportunity as a key policy objective. This twin approach can be seen at its most obvious in the concept of "excellence for…

Emissions reduction policies and recent trends in Southern California's ambient air quality.

PubMed

Lurmann, Fred; Avol, Ed; Gilliland, Frank

2015-03-01

To assess accountability and effectiveness of air regulatory policies, we reviewed more than 20 years of monitoring data, emissions estimates, and regulatory policies across several southern California communities participating in a long-term study of children's health. Between 1994 and 2011, air quality improved for NO2 and PM2.5 in virtually all the monitored communities. Average NO2 declined 28% to 53%, and PM2.5 decreased 13% to 54%. Year-to-year PM2.5 variability at lower pollution sites was large compared to changes in long-term trends. PM10 and O3 decreases were largest in communities that were initially among the most polluted. Trends in annual average NO2, PM2.5, and PM10 concentrations in higher pollution communities were generally consistent with NOx, ROG, SOx, PM2.5, and PM10 emissions decreases. Reductions observed at one of the higher PM2.5 sites, Mira Loma, were generally within the range expected from reductions observed in ROG, NOx, SOx, and PM2.5 emissions. Despite a 38% increase in regional motor vehicle activity, vigorous economic growth, and a 30% population increase, total estimated emissions of NOx, ROG, SOx, PM2.5, and PM10 decreased by 54%, 65%, 40%, 21%, and 15%, respectively, during the 20-year time period. Emission control strategies in California have achieved dramatic reductions in ambient NO2, O3, PM2.5, and PM10. However, additional reductions will still be needed to achieve current health-based clean air standards. For many cities facing the challenge of reducing air pollution to meet health-based standards, the emission control policies and pollution reduction programs adopted in southern California should serve as an example of the potential success of aggressive, comprehensive, and integrated approaches. Policies targeting on-road mobile emissions were the single most important element for observed improvements in the Los Angeles region. However, overall program success was the result of a much broader approach designed to

HIV policy and implementation: a national policy review and an implementation case study of a rural area of northern Malawi.

PubMed

Dasgupta, Aisha N Z; Wringe, Alison; Crampin, Amelia C; Chisambo, Christina; Koole, Olivier; Makombe, Simon; Sungani, Charles; Todd, Jim; Church, Kathryn

2016-09-01

Malawi is a global leader in the design and implementation of progressive HIV policies. However, there continues to be substantial attrition of people living with HIV across the "cascade" of HIV services from diagnosis to treatment, and program outcomes could improve further. Ability to successfully implement national HIV policy, especially in rural areas, may have an impact on consistency of service uptake. We reviewed Malawian policies and guidelines published between 2003 and 2013 relating to accessibility of adult HIV testing, prevention of mother-to-child transmission and HIV care and treatment services using a policy extraction tool, with gaps completed through key informant interviews. A health facility survey was conducted in six facilities serving the population of a demographic surveillance site in rural northern Malawi to investigate service-level policy implementation. Survey data were analyzed using descriptive statistics. Policy implementation was assessed by comparing policy content and facility practice using pre-defined indicators covering service access: quality of care, service coordination and patient tracking, patient support, and medical management. ART was rolled out in Malawi in 2004 and became available in the study area in 2005. In most areas, practices in the surveyed health facilities complied with or exceeded national policy, including those designed to promote rapid initiation onto treatment, such as free services and task-shifting for treatment initiation. However, policy and/or practice were/was lacking in certain areas, in particular those strategies to promote retention in HIV care (e.g., adherence monitoring and home-based care). In some instances, though, facilities implemented alternative progressive practices aimed at improving quality of care and encouraging adherence. While Malawi has formulated a range of progressive policies aiming to promote rapid initiation onto ART, increased investment in policy implementation

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

PubMed

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

2018-06-01

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

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.

Public Reporting of Nursing Home Quality of Care: Lessons from the United States Experience for Canadian Policy Discussion

PubMed Central

Hutchinson, Alison M.; Draper, Kellie; Sales, Anne E.

2009-01-01

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy. PMID:21037828

The Free Senior High Policy: An Appropriate Replacement to the Progressive Free Senior High Policy

ERIC Educational Resources Information Center

Abdul-Rahaman, Nurudeen; Rahaman, Abdul Basit Abdul; Ming, Wan; Ahmed, Abdul-Rahim; Salma, Abdul-Rahaman S.

2018-01-01

Governments all over the world have been improving their educational sector through funding programs aimed at reducing the financial burden on parents, increasing access and quality to education. The government of Ghana in 2017 switched policy to a free senior high school policy to reduce poverty by finally eliminating the financial burdens…

The impact of a bundled policy intervention on improving the performance of rural healthcare in China.

PubMed

Wu, Jian; Li, Xiaofang; Song, Yao; Shao, Hui; Shi, Qian; Qin, Doudou; Xie, Shuangbao; Shi, Lizheng

2016-03-10

The strategy of health policy has been changed for improving the performances to meeting the increasing healthcare demands. However, limited evidences were found to prove that the bundled payment was valid for service delivering in public sector. This study was designed to evaluate the effectiveness of a bundled policy on strengthening the county-village communication and improving the quality of chronic disease management. This is a retrospective cohort study using the data collected in 2011, 2012 and 2014 from the Rural Health Development Project in China. The policy intervention included performance-related contract with health facilities, developing technical guideline for doctors and nurses, routine monitoring of performance, and efforts to increase public awareness about the services. There were two intervention counties in Henan Province, China, while one county with similar characteristics in Henan was selected as control. Funding allocation, work load and salary for health care workers, volume of township-to-village technical assistance were reported before and after the policy was implemented. Our study also examined the policy impacts on improving treatment outcomes of diabetes and hypertension care. There were substantial increases in the provision of the basic package of services including 96.6 % of patients with hypertension, 91.2 % of patients with diabetes under the health management system. After the intervention, there were 34.3 % (hypertension) and 42.0 % (diabetes) increase in regular follow-up visit rates, 24.6 and 17.2 % increase in blood pressure and blood glucose control rates, respectively. The family health records system covered 96 % of the rural families. Technical assistance between township health centres and village clinics were enhanced. Compared with baseline, the monthly training meeting and field supervision & guidance between township health centres and village clinics increased 1.0 meeting, 1.5 field visits, respectively, while

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.

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…

Improving the care of older persons in Australian prisons using the Policy Delphi method.

PubMed

Patterson, Karen; Newman, Claire; Doona, Katherine

2016-09-01

There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims. © The Author(s) 2014.

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.

Policies for Improving Oral Health in Europe

ERIC Educational Resources Information Center

Blinkhorn, Anthony S.; Downer, Martin C.; Drugan, Caroline S.

2005-01-01

Background and Objective: The main purpose of this review was to rehearse the available evidence of good practice in dental public health in order to define policies that could improve oral health in the enlarged European Union and associated countries. Secondary objectives were to describe the basic principles of health service organisation and…

Training and support to improve ICD coding quality: A controlled before-and-after impact evaluation.

PubMed

Dyers, Robin; Ward, Grant; Du Plooy, Shane; Fourie, Stephanus; Evans, Juliet; Mahomed, Hassan

2017-05-24

The proposed National Health Insurance policy for South Africa (SA) requires hospitals to maintain high-quality International Statistical Classification of Diseases (ICD) codes for patient records. While considerable strides had been made to improve ICD coding coverage by digitising the discharge process in the Western Cape Province, further intervention was required to improve data quality. The aim of this controlled before-and-after study was to evaluate the impact of a clinician training and support initiative to improve ICD coding quality. To compare ICD coding quality between two central hospitals in the Western Cape before and after the implementation of a training and support initiative for clinicians at one of the sites. The difference in differences in data quality between the intervention site and the control site was calculated. Multiple logistic regression was also used to determine the odds of data quality improvement after the intervention and to adjust for potential differences between the groups. The intervention had a positive impact of 38.0% on ICD coding completeness over and above changes that occurred at the control site. Relative to the baseline, patient records at the intervention site had a 6.6 (95% confidence interval 3.5 - 16.2) adjusted odds ratio of having a complete set of ICD codes for an admission episode after the introduction of the training and support package. The findings on impact on ICD coding accuracy were not significant. There is sufficient pragmatic evidence that a training and support package will have a considerable positive impact on ICD coding completeness in the SA setting.

Promoting Student Achievement through Improved Health Policy. Policy Update. Vol. 22, No. 11

ERIC Educational Resources Information Center

Fobbs, Erima

2015-01-01

"Promoting Student Achievement through Improved Health Policy" is a quick primer of the [Centers for Disease Control and Prevention] CDC's "Whole School, Whole Community, Whole Child" model, which highlights 10 important areas for connecting health and learning: health education; physical education and physical activity;…

Association Between State Assistance on the Topic of Indoor Air Quality and School District-Level Policies That Promote Indoor Air Quality in Schools.

PubMed

Everett Jones, Sherry; Doroski, Brenda; Glick, Sherry

2015-12-01

Nationally representative data from the 2012 School Health Policies and Practices Study examined whether state assistance on indoor air quality (IAQ) was associated with district-level policies and practices related to IAQ and integrated pest management (IPM). Districts in states that provided assistance on IAQ were more likely than districts not in such states to (1) have an IAQ management program (p < .001); (2) require schools to conduct periodic inspections of the heating, ventilation, and air conditioning system (p < .05); of the building for cracks, leaks, or past water damage (p < .01); for mold (p < .01); for clutter that prevents effective cleaning and maintenance (p < .05); of the plumbing system (p < .01); and for condensation in and around school facilities (p < .001); (3) have an engine idling reduction program ( < .001); (4) have a policy to purchase low-emitting products (p < .05); and (5) require IPM strategies (p < .05). Increasing the number of states that provide IAQ-related assistance to school districts and schools may improve school IAQ. © The Author(s) 2015.

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

PubMed Central

2013-01-01

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study.

PubMed

Campmans-Kuijpers, Marjo J E; Lemmens, Lidwien C; Baan, Caroline A; Gorter, Kees J; Groothuis, Jolanda; van Vuure, Klementine H; Rutten, Guy E H M

2013-04-05

Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well.

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...

Plain packaging: an opportunity for improved international policy coherence?

PubMed Central

Lencucha, Raphael; Drope, Jeffrey

2015-01-01

This paper highlights two salient challenges at the intersection of tobacco control and macroeconomic policy-making: (i) the use of trade and investment disputes to undermine and/or stall tobacco control legislation and (ii) the inconsistency, and thus unpredictability, of country positions across the two spheres. In the interest of improving international policy coherence, the authors suggest possible solutions to these two challenges at the national and intergovernmental levels. PMID:23723441

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…

[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.

Teacher Quality Roadmap: Improving Policies and Practices in Pittsburgh Public Schools

ERIC Educational Resources Information Center

Gonzalez, Angel; Kumar, Sudipti; Waymack, Nancy

2014-01-01

The Pittsburgh Public Schools study is the 12th district study since the National Council on Teacher Quality (NCTQ) began studying districts in-depth in 2009. The intent of these studies is to give select communities a comprehensive look at what is happening in their local school districts that may be either helping or hurting teacher quality, and…

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.

Improving the Quality of Electronic Documentation in Critical Care Nursing

ERIC Educational Resources Information Center

Stevens, Brent

2017-01-01

Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General…

Improving drug policy: The potential of broader democratic participation.

PubMed

Ritter, Alison; Lancaster, Kari; Diprose, Rosalyn

2018-05-01

Policies concerned with illicit drugs vex governments. While the 'evidence-based policy' paradigm argues that governments should be informed by 'what works', in practice policy makers rarely operate this way. Moreover the evidence-based policy paradigm fails to account for democratic participatory processes, particularly how community members and people who use drugs might be included. The aim of this paper is to explore the political science thinking about democratic participation and the potential afforded in 'deliberative democracy' approaches, such as Citizens Juries and other mini-publics for improved drug policy processes. Deliberative democracy, through its focus on inclusion, equality and reasoned discussion, shows potential for drug policy reform and shifts the focus from reliance on and privileging of experts and scientific evidence. But the very nature of this kind of 'deliberation' may delimit participation, notably through its insistence on authorised modes of communication. Other forms of participation beyond reasoned deliberation aligned with the ontological view that participatory processes themselves are constitutive of subject positions and policy problems, may generate opportunities for considering how the deleterious effects of authorised modes of communication might be overcome. Copyright © 2018 Elsevier B.V. All rights reserved.

The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.

PubMed

Winters, S; Kool, R B; Klazinga, N S; Huijsman, R

2014-08-01

To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in

More Than Maintenance: Sustaining Improvement Efforts over the Long Run. Policy Brief

ERIC Educational Resources Information Center

Jerald, Craig

2005-01-01

This is the last in a series of four policy briefs to be published by The Center for Comprehensive School Reform and Improvement in 2005. The briefs are intended to provide fresh insights and useful advice to policymakers and school assistance providers. The first part of this policy brief breaks down the process of sustaining improvement and…

Do competition and managed care improve quality?

PubMed

Sari, Nazmi

2002-10-01

In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.

State Teacher Policy Yearbook: Progress on Teacher Quality, 2007. New Jersey State Summary

ERIC Educational Resources Information Center

National Council on Teacher Quality, 2007

2007-01-01

The "State Teacher Policy Yearbook" examines what is arguably the single most powerful authority over the teaching profession: state government. This New Jersey edition of the National Council on Teacher Quality's (NCTQ's) "State Teacher Policy Yearbook" is the first of what will be an annual look at the status of state…

State Teacher Policy Yearbook: Progress on Teacher Quality, 2007. New Mexico State Summary

ERIC Educational Resources Information Center

National Council on Teacher Quality, 2007

2007-01-01

The "State Teacher Policy Yearbook" examines what is arguably the single most powerful authority over the teaching profession: state government. This New Mexico edition of the National Council on Teacher Quality's (NCTQ's) "State Teacher Policy Yearbook" is the first of what will be an annual look at the status of state…

State Teacher Policy Yearbook: Progress on Teacher Quality, 2007. New Hampshire State Summary

ERIC Educational Resources Information Center

National Council on Teacher Quality, 2007

2007-01-01

The "State Teacher Policy Yearbook" examines what is arguably the single most powerful authority over the teaching profession: state government. This New Hampshire edition of the National Council on Teacher Quality's (NCTQ's) "State Teacher Policy Yearbook" is the first of what will be an annual look at the status of state…

Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

PubMed

Ogunbekun, I; Adeyi, O; Wouters, A; Morrow, R H

1996-12-01

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.

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.

A Multilevel, Statewide Investigation of School District Anti-Bullying Policy Quality and Student Bullying Involvement

ERIC Educational Resources Information Center

Gower, Amy L.; Cousin, Molly; Borowsky, Iris W.

2017-01-01

Background: Although nearly all states in the United States require school districts to adopt anti-bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti-bullying policies and student bullying…

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

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…

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.

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

Deming meets Braverman: toward a progressive analysis of the continuous quality improvement paradigm.

PubMed

Schiff, G D; Goldfield, N I

1994-01-01

The continuous quality improvement (CQI) model has rapidly become the dominant management paradigm in U.S. industrial and health care leadership circles. Despite its widespread corporate acceptance and its relevance to public sector policy issues, there has been a paucity of progressive analysis of CQI. The authors begin by noting remarkable similarities between CQI critiques of Taylorism (so-called scientific management of work) with those made by Braverman, a leading Marxist analyst of the work process. Each of the 14 principles of CQI pioneer W. E. Deming are explained and analyzed for their progressive content. These pluses are then contrasted with 18 problematic issues in an attempt to challenge and go beyond the constraints of CQI as it is currently being applied in health care and other sectors. These issues include (1) mismatch between rhetoric and reality, (2) public sector issues, and (3) broader contradictions. The authors emphasize the genuine need for improving health care quality and the relevance of CQI for addressing this need. They challenge progressives to grapple with the profound contradictions by the CQI paradigm inviting a broader dialogue on CQI's meaning for improving the public's health.

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.

Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research.

PubMed

Fredriksson, Mio; Eldh, Ann Catrine; Vengberg, Sofie; Dahlström, Tobias; Halford, Christina; Wallin, Lars; Winblad, Ulrika

2014-12-28

Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement's intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. The politicians' and administrators' perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians' role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. The Swedish experiences show that a government

Air quality management in Mexico.

PubMed

Fernández-Bremauntz, Adrián

2008-01-01

Several significant program and policy measures have been implemented in Mexico over the past 15 yr to improve air quality. This article provides an overview of air quality management strategies in Mexico, including (1) policy initiatives such as vehicle use restrictions, air quality standards, vehicle emissions, and fuel quality standards, and (2) supporting programs including establishment of a national emission inventory, an air pollution episodes program, and the implementation of exposure and health effects studies. Trends in air pollution episodes and ambient air pollutant concentrations are described.

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.

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.

Economic aspects of addiction policy.

PubMed

Maynard, A

1986-05-01

One definition of policy or government action in the Oxford English Dictionary is "craftiness" i.e. cunning or deceit. Such qualities have to be employed by governments because of the potential vote-losing effects of radical addiction policies. Health promotion, in relation to addictive substances such as alcohol and tobacco in particular, involves a trade-off between the costs of such policies, especially to industry (which seeks regulation to protect itself from competitors), and the benefits--improvements in the quality and length of life. Measures of such benefits (quality-adjusted life-years or QALYs) are available now to use in the evaluation of competing health promotion policies to determine their efficiency at the margin. Analysis of the market for tobacco indicates that consumption has been falling generally in the UK except among teenagers who appear to be the target of the industry's advertising and sponsorship efforts. This fall in consumption appears to be explained by health promotion rather than the active use of fiscal instruments of control. The recognition of the health effects of passive smoking and the impact of advertising and sponsorship, especially on the young, are policy areas requiring careful review and the evaluation of the costs and benefits of competing policies.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

Diffusion of innovation in mental health policy adoption: what should we ask about the quality of policy and the role of stakeholders in this process? Comment on "Cross-national diffusion of mental health policy".

PubMed

Lee, Lucy

2015-03-10

In his recent study, Gordon Shen analyses a pertinent question facing the global mental health research and practice community today; that of how and why mental health policy is or is not adopted by national governments. This study identifies becoming a World Health Organization (WHO) member nation, and being in regional proximity to countries which have adopted a mental health policy as supportive of mental health policy adoption, but no support for its hypothesis that country recipients of higher levels of aid would have adopted a mental health policy due to conditionalities imposed on aid recipients by donors. Asking further questions of each may help to understand more not only about how and why mental health policies may be adopted, but also about the relevance and quality of implementation of these policies and the role of specific actors in achieving adoption and implementation of high quality mental health policies. © 2015 by Kerman University of Medical Sciences.

Do school based food and nutrition policies improve diet and reduce obesity?

PubMed

Jaime, Patricia Constante; Lock, Karen

2009-01-01

To review the effectiveness of school food and nutrition policies world wide in improving the school food environment, student's dietary intake, and decreasing overweight and obesity. Systematic review of published and unpublished literature up to November 2007 of three categories of nutrition policy; nutrition guidelines, regulation of food and/or beverage availability, and price interventions applied in preschools, primary and secondary schools. 18 studies met the inclusion criteria. Most evidence of effectiveness was found for the impact of both nutrition guidelines and price interventions on intake and availability of food and drinks, with less conclusive research on product regulation. Despite the introduction of school food policies worldwide few large scale or national policies have been evaluated, and all included studies were from the USA and Europe. Some current school policies have been effective in improving the food environment and dietary intake in schools, but there is little evaluation of their impact on BMI. As schools have been proposed worldwide as a major setting for tackling childhood obesity it is essential that future policy evaluations measure the long term effectiveness of a range of school food policies in tackling both dietary intake and overweight and obesity.

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.

Strategies to improve the dietary quality of Supplemental Nutrition Assistance Program (SNAP) beneficiaries: an assessment of stakeholder opinions.

PubMed

Blumenthal, Susan J; Hoffnagle, Elena E; Leung, Cindy W; Lofink, Hayley; Jensen, Helen H; Foerster, Susan B; Cheung, Lilian Wy; Nestle, Marion; Willett, Walter C

2014-12-01

To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants. Participants answered a thirty-eight-item web-based survey assessing opinions and perceptions of SNAP and programme policy changes. Survey of 522 individuals with stakeholder interest in SNAP, conducted in October through December 2011. The top three barriers to improving dietary quality identified were: (i) unhealthy foods marketed in low-income communities; (ii) the high cost of healthy foods; and (iii) lifestyle challenges faced by low-income individuals. Many respondents (70 %) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78 %) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55 %) believed retailers could easily implement such restrictions. A majority of respondents (58 %) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83 %) believed that the US Department of Agriculture should collect data on the foods purchased with SNAP benefits. Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity.

Quality Management in Hungarian Higher Education: Organisational Responses to Governmental Policy

ERIC Educational Resources Information Center

Csizmadia, Tibor; Enders, Jurgen; Westerheijden, Don F.

2008-01-01

This article focuses on responses of higher education institutions to governmental policy. We investigate the influence of organisational characteristics on the implementation of quality management in Hungarian higher education institutions. Our theoretical framework is based on organisational theories (resource dependency and…

Improved clinical outcomes combining house staff self-assessment with an audit-based quality improvement program.

PubMed

Kirschenbaum, Linda; Kurtz, Susannah; Astiz, Mark

2010-10-01

There is a focus on integrating quality improvement with medical education and advancement of the American College of Graduate Medical Education (ACGME) core competencies. To determine if audits of patients with unexpected admission to the medical intensive care unit using a self-assessment tool and a focused Morbidity and Mortality (M&M) conference improves patient care. Charts from patients transferred from the general medical floor (GMF) to the medical intensive care unit (ICU) were reviewed by a multidisciplinary team. Physician and nursing self-assessment tools and a targeted monthly M&M conference were part of the educational component. Physicians and nurses participated in root cause analysis. Records of all patients transferred from a general medical floor (GMF) to the ICU were audited. One hundred ninety-four cases were reviewed over a 10-month period. New policies regarding vital signs and house staff escalation of care were initiated. The percentage of calls for patients who met medical emergency response team/critical care consult criteria increased from 53% to 73%, nurse notification of a change in a patient's condition increased from 65% to 100%, nursing documentation of the change in the patients condition and follow-up actions increased from 65% percent to a high of 90%, the number of cardiac arrests on a GMF decreased from 3.1/1,000 discharges to 0.6/1,000 discharges (p = 0.002), and deaths on the Medicine Service decreased from 34/1,000 discharges to 24/1,000 discharges (p = 0.024). We describe an audit-based program that involves nurses, house staff, a self-assessment tool and a focused M&M conference. The program resulted in significant policy changes, more rapid assessment of unstable patients and improved hospital outcomes.

Trade transport and environment linkages at the U.S.-Mexico border: which policies matter?

PubMed

Fernandez, Linda; Das, Monica

2011-03-01

We apply a fixed-effects model to examine the impact of trade and environmental policies on air quality at ports along the U.S.-Mexico border. We control for other factors influencing air quality, such as air quality of cities near the border, volume of traffic flows and congestion. Results show the air quality improved after 2004, when the diesel engine policy was applied. We see mixed results for the trade policy, whose implementation time varies across ports along the international border. Controlling for air quality in cities near the border is essential for assessing the policy contributions to air quality. Copyright © 2010. Published by Elsevier Ltd.

Directing Improvements in Primary Care Patient Experience through Analysis of Service Quality.

PubMed

Hudson Smith, Mel; Smith, David

2018-06-03

To examine the influence of dimensions of service quality on patient experience of primary care. Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. Expert panel and principal component analysis helped identify relevant dimensions of service quality. Regression was then used to examine the relationships between these dimensions and reported patient experience. Aggregated scores for each practice were used, comprising the proportion of positive responses to each element of the study. Of eight service quality dimensions identified, six have statistically significant impacts on patient experience but only two have large effects. Patient experience is highly influenced by practice responsiveness and the interactions with the physician. Other dimensions have small or even slightly negative influence. Service quality provided by nurses has negligible effect on patient experience. To improve patient experience in primary health care, efforts should focus on practice responsiveness and interactions with the physician. Other areas have little influence over patient experience. This suggests a gap in patients' perspectives on health care, which has policy implications for patient education. © Health Research and Educational Trust.

Air Quality Co-Benefits of a Carbon Policy: Regional Implementation

NASA Astrophysics Data System (ADS)

Thompson, T. M.; Rausch, S.; Saari, R.; Selin, N. E.

2013-12-01

We use an integrated modeling framework to assess the air quality influence of climate change policies in the Northeast U.S. states for air pollution, and their relative health and economic benefits. We analyze three carbon policy scenarios, each reducing the same total amount of GHG emissions in the Northeast United States: an economy-wide Cap and Trade (CAT) program reducing emissions from all sectors of the economy, a Clean Energy Scenario (CES) reducing emissions from the electricity sector only, and a Transportation Scenario (TRN) reducing emissions from the transportation sector only. Regional CES policy and a regional TRN policy will cost about 10 times and 50 times more than a CAT policy, respectively. Regional CAT policy will lead to a 6% greater reduction in carbon emissions nationally in the year 2030 compared to an electric or transportation sector cap with the same regional targets. This is because, unlike a total economy cap, targeted policy options will likely cause increases in carbon emissions outside of the region covered (called carbon leakage). The human health benefits of the CAT, CES and TRN policies are 530%, 118%, and 10% of the costs of each policy respectively, meaning that the CAT and CES policies will likely fully pay for themselves in the NE U.S. We estimate that the value of human health co-benefits associated with reductions of ground level ozone and particulate matter of the CES scenario is twice that of the CAT and TRN scenarios. Economic welfare costs for each of three regionally applied carbon emissions reduction scenario are shown in blue. The calculated dollar amount of the human health benefits point estimate is shown in red with the 95% confidence interval, associated with human health response only, shown using the green line. Values are in billions of year 2006 US dollars.

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.

Attitudes of pharmacists and physicians to antibiotic policies in hospitals.

PubMed

Adu, A; Simpson, J M; Armour, C L

1999-06-01

Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.

Expanding Public/Private Partnerships For Improving Basic Education through School Sponsorship in the Dominican Republic. Final Report. Basic Education and Policy Support Activity.

ERIC Educational Resources Information Center

Craig, Patricia; Kane, Michael

The Basic Education and Policy Support Activity (BEPS), a new five-year initiative sponsored by United States Agency for International Development's (USAID) Center for Human Capacity Development, is designed to improve the quality, effectiveness, and access to formal and nonformal basic education. BEPS operates through both core funds and buy-ins…

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

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.

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.

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

Policy Development of Quality Assurance: A Critical Perspective on Past and Future Issues.

ERIC Educational Resources Information Center

van der Westhuizen, L. J.

2000-01-01

Provides an overview of the initiatives and development of policies to establish a workable quality assurance system for institutions of higher education in South Africa in the last decade. Notes challenges such as the government's emphasis on programs of study and its requirement that quality assurance systems include institutional auditing,…

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.

[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.

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.

Implementing Medical Teaching Policy in University Hospitals

ERIC Educational Resources Information Center

Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

2017-01-01

Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

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.

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.

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…

Plain packaging: an opportunity for improved international policy coherence?

PubMed

Lencucha, Raphael; Drope, Jeffrey

2015-06-01

This paper highlights two salient challenges at the intersection of tobacco control and macroeconomic policy-making: (i) the use of trade and investment disputes to undermine and/or stall tobacco control legislation and (ii) the inconsistency, and thus unpredictability, of country positions across the two spheres. In the interest of improving international policy coherence, the authors suggest possible solutions to these two challenges at the national and intergovernmental levels. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

PubMed

Wandersman, Abraham; Chien, Victoria H; Katz, Jason

2012-12-01

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

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…

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.

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

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.

Dataset Lifecycle Policy

NASA Technical Reports Server (NTRS)

Armstrong, Edward; Tauer, Eric

2013-01-01

The presentation focused on describing a new dataset lifecycle policy that the NASA Physical Oceanography DAAC (PO.DAAC) has implemented for its new and current datasets to foster improved stewardship and consistency across its archive. The overarching goal is to implement this dataset lifecycle policy for all new GHRSST GDS2 datasets and bridge the mission statements from the GHRSST Project Office and PO.DAAC to provide the best quality SST data in a cost-effective, efficient manner, preserving its integrity so that it will be available and usable to a wide audience.

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.

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.

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.

National Policy on Education and Higher Education

ERIC Educational Resources Information Center

Varughese, Rajan

2017-01-01

The Ministry of Human Resource Development (MHRD) has come out with the draft of 'National Education Policy (NEP) 2016' in April 2016. The new NEP 2016 seeks to create conditions to improve the quality of teaching, learning and assessment, and promote transparency in the management of education in the country. The policy prescriptions enunciated…

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

Policy considerations for improving influenza vaccination rates among pregnant women.

PubMed

Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

2014-01-01

Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

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

[Animal drugs quality status and reason analysis].

PubMed

Ding, Qing; Qiu, Ya-jing; Fang, Ke-hui; Hu, Hao-bin; Wu, Yue

2015-11-01

In order to reaction the quality present situation, problems on the current quality of animal sources of drugs are summed up by using test data analysis, literature search and marketing research. This paper can also help the improvement of the quality management, the revision of the relevant department policy system and the improvement of standards.

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 ...

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

Effects of agriculture upon the air quality and climate: research, policy, and regulations.

PubMed

Aneja, Viney P; Schlesinger, William H; Erisman, Jan Willem

2009-06-15

Scientific assessments of agricultural air quality, including estimates of emissions and potential sequestration of greenhouse gases, are an important emerging area of environmental science that offers significant challenges to policy and regulatory authorities. Improvements are needed in measurements, modeling, emission controls, and farm operation management. Controlling emissions of gases and particulate matter from agriculture is notoriously difficult as this sector affects the most basic need of humans, i.e., food. Current policies combine an inadequate science covering a very disparate range of activities in a complex industry with social and political overlays. Moreover, agricultural emissions derive from both area and point sources. In the United States, agricultural emissions play an important role in several atmospherically mediated processes of environmental and public health concerns. These atmospheric processes affect local and regional environmental quality, including odor, particulate matter (PM) exposure, eutrophication, acidification, exposure to toxics, climate, and pathogens. Agricultural emissions also contribute to the global problems caused by greenhouse gas emissions. Agricultural emissions are variable in space and time and in how they interact within the various processes and media affected. Most important in the U.S. are ammonia (where agriculture accounts for approximately 90% of total emissions), reduced sulfur (unquantified), PM25 (approximately 16%), PM110 (approximately 18%), methane (approximately 29%), nitrous oxide (approximately 72%), and odor and emissions of pathogens (both unquantified). Agriculture also consumes fossil fuels for fertilizer production and farm operations, thus emitting carbon dioxide (CO2), oxides of nitrogen (NO(x)), sulfur oxides (SO(x)), and particulates. Current research priorities include the quantification of point and nonpoint sources, the biosphere-atmosphere exchange of ammonia, reduced sulfur

Air Quality Co-benefits of Energy Policy in China: Evidence from Iron & Steel and Cement Industries

NASA Astrophysics Data System (ADS)

Qiu, M.; Weng, Y.; Selin, N. E.; Karplus, V. J.; Cao, J.

2017-12-01

Previous literature has calculated large air quality co-benefits from policies that reduce CO2 emissions and increase energy efficiency. These (often prospective) studies rely on assumptions about how air pollutant emissions respond to energy use changes. Using a unique firm-level data set from China, we examine how a real-world energy efficiency policy affected SO2 emissions, estimate its actual effects on atmospheric PM2.5, and compare to ex ante theoretical estimates. During the 11th Five-year plan (2006-2010), the Chinese government implemented policies directing large energy-consuming firms to reduce their energy consumption per unit of economic output. The Top 1000 Enterprises Program (T1000P) set binding energy intensity targets for China's 1000 highest energy-consuming firms. This program is widely considered a policy success, as 92% of firms met their energy intensity target. Focusing on the cement and iron and steel industry, we examine how T1000P (and related provincial policies) affected firms' SO2 emissions and coal consumption from 2005 to 2008. By comparing T1000P firms with similar firms not subject to the policy, we find that T1000P had a very limited incremental effect on energy use or on air quality co-benefits. Compared to firms not subject to the policy, T1000P firms had 14.7% (cement) and 24.0% (iron & steel) lower reductions in SO2 emission per unit energy use. We also observe large, heterogeneous changes in emission factors (defined as SO2 emissions per unit of coal consumption) among all firms during this period. In comparison to co-benefits estimates that assume constant emission factors, SO2 emissions from T1000P firms in the post-policy period are 23.2% (iron and steel) and 40.2% (cement) lower, but spatially heterogeneous, with some regions experiencing increases. Using the GEOS-Chem model, we estimate the air quality co-benefits of the T1000P policy with realized SO2 emissions changes and compare them with two theoretical estimations

Improving School Leadership. Volume 1: Policy and Practice

ERIC Educational Resources Information Center

OECD Publishing (NJ3), 2008

2008-01-01

As countries strive to reform education systems and improve student results, school leadership is high on education policy agendas. But in many countries, the men and women who run schools are overburdened, underpaid and near retirement. And few people are lining up for their jobs. Based on an OECD study of school leadership practices and policies…

Strategies to Improve the Dietary Quality of Supplemental Nutrition Assistance Program (SNAP) Beneficiaries: An Assessment of Stakeholder Opinions

PubMed Central

Blumenthal, Susan J.; Hoffnagle, Elena E.; Leung, Cindy W.; Lofink, Hayley; Jensen, Helen H.; Foerster, Susan B.; Cheung, Lilian W.Y.; Nestle, Marion; Willet, Walter C.

2013-01-01

Objective To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants. Design Participants answered a 38-item web-based survey assessing opinions and perceptions of SNAP and program policy changes. Setting U.S.A. Subjects Survey of 522 individuals with stakeholder interest in the Supplemental Nutrition Assistance Program (SNAP) conducted in October through December 2011. Results The top three barriers to improving dietary quality identified were: 1) unhealthy foods marketed in low-income communities; 2) the high cost of healthy foods; and 3) lifestyle challenges faced by low-income individuals. Many respondents (70%) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons, or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78%) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55%) believed retailers could easily implement such restrictions. A majority of respondents (58%) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83%) believed that the USDA should collect data on the foods purchased with SNAP benefits. Conclusions Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity. PMID:24476898

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.

Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US.

PubMed

Huang, Yue; Pomeranz, Jennifer; Wilde, Parke; Capewell, Simon; Gaziano, Tom; O'Flaherty, Martin; Kersh, Rogan; Whitsel, Laurie; Mozaffarian, Dariush; Micha, Renata

2018-04-14

Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels

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.

Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter.

PubMed

Kemeny, M Elizabeth; Mabry, J Beth

2017-01-01

Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

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