Development of Quality Indicators to Address Abuse and Neglect in Home-Based Primary Care and Palliative Care.

PubMed

Sheehan, Orla C; Ritchie, Christine S; Fathi, Roya; Garrigues, Sarah K; Saliba, Debra; Leff, Bruce

2016-12-01

To develop candidate quality indicators (QIs) for the quality standard of "addressing abuse and neglect" in the setting of home-based medical care. Systematic literature review of both the peer-reviewed and gray literature. Home-based primary and palliative care practices. Homebound community-dwelling older adults. Articles were identified to inform the development of candidate indicators of the quality by which home-based primary and palliative care practices addressed abuse and neglect. The literature guided the development of patient-level QIs and practice-level quality standards. A technical expert panel (TEP) representing exemplary home-based primary care and palliative care providers then participated in a modified Delphi process to assess the validity and feasibility of each measure and identify candidate QIs suitable for testing in the field. The literature review yielded 4,371 titles and abstracts that were reviewed; 25 publications met final inclusion criteria and informed development of nine candidate QIs. The TEP rated all but one of the nine candidate indicators as having high validity and feasibility. Translating the complex problem of addressing abuse and neglect into QIs may ultimately serve to improve care delivered to vulnerable home-limited adults who receive home-based medical care. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Air quality as respiratory health indicator: a critical review.

PubMed

Moshammer, Hanns; Wallner, Peter

2011-09-01

As part of the European Public Health project IMCA II validity and practicability of "air pollution" as a respiratory health indicator were analyzed. The definitions of air quality as an indicator proposed by the WHO project ECOEHIS and by IMCA I were compared. The public availability of the necessary data was checked through access to web-based data-bases. Practicability and interpretation of the indicator were discussed with project partners and external experts. Air quality serves as a kind of benchmark for the good health-related environmental policy. In this sense, it is a relevant health indicator. Although air quality is not directly in the responsibility of health policy, its vital importance for the population's health should not be neglected. In principle, data is available to calculate this IMCA indicator for any chosen area in Europe. The indicator is relevant and informative, but calculation and interpretation need input from local expert knowledge. The European health policy is well advised to take air quality into account. To that end, an interdisciplinary approach is warranted. The proposed definition of air quality as a (respiratory) health indicator is workable, but correct interpretation depends on expert and local knowledge.

[Impact of quality-indicator-based measures to improve the treatment of acute poisoning in pediatric emergency patients].

PubMed

Martínez Sánchez, Lidia; Trenchs Sainz de la Maza, Victoria; Azkunaga Santibáñez, Beatriz; Nogué-Xarau, Santiago; Ferrer Bosch, Nuria; García González, Elsa; Luaces I Cubells, Carles

2016-02-01

To analyze the impact of quality-indicator-based measures for improving quality of care for acute poisoning in pediatric emergency departments. Recent assessments of quality indicators were compared with benchmark targets and with results from previous studies. The first study evaluated 6 basic indicators in the pediatric emergency departments of members of to the working group on poisoning of the Spanish Society of Pediatric Emergency Medicine (GTI-SEUP). The second study evaluated 20 indicators in a single emergency department of GTI-SEUP members. Based on the results of those studies, the departments implemented the following corrective measures: creation of a team for gastric lavage follow-up, preparation of a new GTI-SEUP manual on poisoning, implementation of a protocol for poisoning incidents, and creation of specific poisoning-related fields for computerized patient records. The benchmark targets were reached on 4 quality indicators in the first study. Improvements were seen in the availability of protocols, as indicators exceeded the target in all the pediatric emergency departments (vs 29.2% of the departments in an earlier study, P < .001). No other significant improvements were observed. In the second study the benchmarks were reached on 13 indicators. Improvements were seen in compliance with incident reporting to the police (recently, 44.4% vs 19.2% previously, P = .036), case registration in the minimum basic data set (51.0% vs 1.9%, P < .001), and a trend toward increased administration of activated carbon within 2 hours (93.1% vs 83.5%, P = .099). No other significant improvements were seen. The corrective measures led to improvements in some quality indicators. There is still room for improvement in these emergency departamens' care of pediatric poisoning.

A Proposed Roadmap for Inpatient Neurology Quality Indicators

PubMed Central

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

Background/Purpose: In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses. Methods: We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators. Results: We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed. Conclusions: There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators. PMID:23983832

Performance of biotic indices in comparison to chemical-based Water Quality Index (WQI) in evaluating the water quality of urban river.

PubMed

Wan Abdul Ghani, Wan Mohd Hafezul; Abas Kutty, Ahmad; Mahazar, Mohd Akmal; Al-Shami, Salman Abdo; Ab Hamid, Suhaila

2018-04-19

In order to evaluate the water quality of one of the most polluted urban river in Malaysia, the Penchala River, performance of eight biotic indices, Biomonitoring Working Party (BMWP), BMWP Thai , BMWP Viet , Average Score Per Taxon (ASPT), ASPT Thai , BMWP Viet , Family Biotic Index (FBI), and Singapore Biotic Index (SingScore), was compared. The water quality categorization based on these biotic indices was then compared with the categorization of Malaysian Water Quality Index (WQI) derived from measurements of six water physicochemical parameters (pH, BOD, COD, NH 3 -N, DO, and TSS). The river was divided into four sections: upstream section (recreational area), middle stream 1 (residential area), middle stream 2 (commercial area), and downstream. Abundance and diversity of the macroinvertebrates were the highest in the upstream section (407 individual and H' = 1.56, respectively), followed by the middle stream 1 (356 individual and H' = 0.82). The least abundance was recorded in the downstream section (214 individual). Among all biotic indices, BMWP was the most reliable in evaluating the water quality of this urban river as their classifications were comparable to the WQI. BMWPs in this study have strong relationships with dissolved oxygen (DO) content. Our results demonstrated that the biotic indices were more sensitive towards organic pollution than the WQI. BMWP indices especially BMWP Viet were the most reliable and could be adopted along with the WQI for assessment of water quality in urban rivers.

An environmental scan of quality indicators in critical care.

PubMed

Valiani, Sabira; Rigal, Romain; Stelfox, Henry T; Muscedere, John; Martin, Claudio M; Dodek, Peter; Lamontagne, François; Fowler, Robert; Gheshmy, Afshan; Cook, Deborah J; Forster, Alan J; Hébert, Paul C

2017-06-21

We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. We convened a panel of experts ( n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. Copyright 2017, Joule Inc. or its licensors.

An environmental scan of quality indicators in critical care

PubMed Central

Valiani, Sabira; Rigal, Romain; Stelfox, Henry T.; Muscedere, John; Martin, Claudio M.; Dodek, Peter; Lamontagne, François; Fowler, Robert; Gheshmy, Afshan; Cook, Deborah J.; Forster, Alan J.; Hébert, Paul C.

2017-01-01

Background: We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. Methods: We convened a panel of experts (n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. Results: From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. Interpretation: There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. PMID:28637683

Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

PubMed Central

Maaskant, Jolanda M.; de Boer, Monica; Krediet, C. T. Paul; Nieveen van Dijkum, Els J. M.

2015-01-01

Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form. Results The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights. Conclusion Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting

Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators.

PubMed

Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

2016-02-01

We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. This study aims to investigate the quality of detection and management of falls in the elderly population by general practitioners in the Netherlands, using the Assessing Care of Vulnerable Elders (ACOVE) quality indicators. Community-dwelling persons aged 70 years or above, registered in participating general practices, were asked to fill in a questionnaire designed to determine general practitioner (GP) adherence to fall-related indicators. We used logistic regression to estimate the association between increased risk for functional decline-quantified by the Identification of Seniors At Risk for Primary Care score-and adherence. We then cross-validated the self-reported falls with medical records. Of the 950 elders responding to our questionnaire, only 10.6 % reported that their GP proactively asked them about falls. Of the 160 patients who reported two or more falls, or one fall for which they visited the GP, only 23.1 % had fall documentation in their records. Adherence ranged between 13.6 and 48.6 %. There was a significant positive association between the ISAR-PC scores and adherence in four QIs. Documentation of falls was highest (36.7 %) in patients whom the GP had proactively asked about falls. Based on patient self-reports, adherence to the ACOVE fall-related indicators was poor, suggesting that the quality of evaluation and management of falls in community-dwelling older persons in the Netherlands is poor. The documentation of falls and fall-related risk factors was also poor

Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

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

PubMed

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

2018-05-25

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

Combining Archetypes, Ontologies and Formalization Enables Automated Computation of Quality Indicators.

PubMed

Legaz-García, María Del Carmen; Dentler, Kathrin; Fernández-Breis, Jesualdo Tomás; Cornet, Ronald

2017-01-01

ArchMS is a framework that represents clinical information and knowledge using ontologies in OWL, which facilitates semantic interoperability and thereby the exploitation and secondary use of clinical data. However, it does not yet support the automated assessment of quality of care. CLIF is a stepwise method to formalize quality indicators. The method has been implemented in the CLIF tool which supports its users in generating computable queries based on a patient data model which can be based on archetypes. To enable the automated computation of quality indicators using ontologies and archetypes, we tested whether ArchMS and the CLIF tool can be integrated. We successfully automated the process of generating SPARQL queries from quality indicators that have been formalized with CLIF and integrated them into ArchMS. Hence, ontologies and archetypes can be combined for the execution of formalized quality indicators.

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

[Family physicians attitude towards quality indicator program].

PubMed

Shani, Michal; Nakar, Sasson; Azuri, Yossi

2012-10-01

Quality indicator programs for primary care are implanted throughout the world improving quality in health care. In this study, we have assessed family physicians attitudes towards the quality indicators program in Israel. Questionnaires were distributed to family physicians in various continuing educational programs. The questionnaire addressed demographics, whether the physician dealt with quality indicators, time devoted by the physician to quality indicators, pressure placed on the physician related to quality indicators, and the working environment. A total of 140 questionnaires were distributed and 91 (65%) were completed. The average physician age was 49 years (range 33-65 years]; the average working experience as a family physician was 17.8 years (range 0.5-42); 58 physicians were family medicine specialist (65.9%). Quality indicators were part of the routine work of 94% of the physicians; 72% of the physicians noted the importance of quality indicators; 84% of the physicians noted that quality indicators demand better team work; 76% of the physicians noted that quality indicators have reduced their professional independence. Pressure to deal with quality indicators was noted by 72% of the family physicians. Pressure to deal with quality indicators was related to reduced loyalty to their employer (P = 0.001), reducing their interest to practice family medicine (p < 0.001), and increasing their burnout at work (p = 0.001). It is important that policy makers find the way to leverage the advantages of quality indicator programs, without creating a heavy burden on the work of family physicians.

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

PubMed

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

2012-03-01

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

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

ERIC Educational Resources Information Center

Grasso, Marco; Canova, Luciano

2008-01-01

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

Baby-MONITOR: A Composite Indicator of NICU Quality

PubMed Central

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

2014-01-01

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

Indicators in Perspective. The Use of Quality Indicators in Vocational Education and Training. CEDEFOP Document.

ERIC Educational Resources Information Center

Van den Berghe, Wouter

Indicators are used in quite different ways in vocational education and training, from control and accountability to performance and quality purposes. A classification model has been proposed in which many indicators can fit. It is based on two important dimensions of indicators: (1) the "message" relating to the information content,…

Linking quality indicators to clinical trials: an automated approach

PubMed Central

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

2017-01-01

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

Indicators for the evaluation of diet quality.

PubMed

Gil, Ángel; Martinez de Victoria, Emilio; Olza, Josune

2015-02-26

The role of diet quality and physical activity in reducing the progression of chronic disease is becoming increasingly important. Dietary Quality Indices or Indicators (DQIs) are algorithms aiming to evaluate the overall diet and categorize individuals according to the extent to which their eating behaviour is "healthy". Predefined indexes assess dietary patterns based on current nutrition knowledge and they have been developed primarily for nutritional epidemiology to assess dietary risk factors for non-communicable diseases. There are many different types of DQIs. There are three major categories of DQIs: a) nutrient-based indicators; b) food/food group based indicators; and c) combination indexes, the vast majority of DQIs, which often include a measure of diet variety within and across food groups, a measure of adequacy i.e. nutrients (compared to requirements) or food groups (quantities or servings), a measure of nutrients/foods to consume in moderation, and an overall balance of macronutrients. The Healthy Eating Index (HEI), the Diet Quality Index (DQI), the Healthy Diet Indicator (HDI) and the Mediterranean Diet Score (MDS) are the four 'original' diet quality scores that have been referred to and validated most extensively. Several indexes have been adapted and modified from those originals. In particular, many variations on the MDS have been proposed, included different alternate MDS and Mediterranean Diet Adherence Screener (MEDAS). Primary data source of DQI's are individual dietary data collection tools, namely 24 h quantitative intake recalls, dietary records and food frequency questionnaires. Nutrients found in many scores are total fat, saturated fatty acids or the ratio of monounsaturated fatty acids to saturated fatty acids or the latter SFA to polyunsaturated fatty acids. Cholesterol, protein content and quality, complex carbohydrates, mono- and disaccharides, dietary fibre and sodium are also found in various scores. All DQIs, except those that

Quality Indicators for Global Benchmarking of Localized Prostate Cancer Management.

PubMed

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

2018-03-01

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

Measurement of Health Care Quality in Atopic Dermatitis - Development and Application of a Set of Quality Indicators.

PubMed

Steinke, S; Beikert, F C; Langenbruch, A; Fölster-Holst, R; Ring, J; Schmitt, J; Werfel, T; Hintzen, S; Franzke, N; Augustin, M

2018-05-15

Quality indicators are essential tools for the assessment of health care, in particular for guideline-based procedures. 1) Development of a set of indicators for the evaluation of process and outcomes quality in atopic dermatitis (AD) care. 2) Application of the indicators to a cross-sectional study and creation of a global process quality index. An expert committee consisting of 10 members of the German guideline group on atopic dermatitis condensed potential quality indicators to a final set of 5 outcomes quality and 12 process quality indicators using a Delphi panel. The outcomes quality and 7 resp. 8 process quality indicators were retrospectively applied to a nationwide study on 1,678 patients with atopic dermatitis (AtopicHealth). Each individual process quality indicator score was then summed up to a global index (ranges from 0 (no quality achieved) to 100 (full quality achieved)) displaying the quality of health care. In total, the global process quality index revealed a median value of 62.5 and did not or only slightly correlate to outcome indicators as the median SCORAD (SCORing Atopic Dermatitis; rp =0.08), Dermatology Life Quality Index (DLQI; rp = 0.256), and Patient Benefit Index (PBI; rp = -0.151). Process quality of AD care is moderate to good. The health care process quality index does not substantially correlate to the health status of AD patients measured by 5 different outcomes quality indicators. Further research should include the investigation of reliability, responsiveness, and feasibility of the proposed quality indicators for AD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation.

PubMed

Stelfox, Henry T; Straus, Sharon E

2013-12-01

In this article, we describe one approach for developing and evaluating quality indicators. We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices. Copyright © 2013 Elsevier Inc. All rights reserved.

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

PubMed

Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

2015-12-01

Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

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

PubMed

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

2017-07-11

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2011-08-10

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

Developing quality indicators for community services: the case of district nursing.

PubMed

Davies, Philippa; Wye, Lesley; Horrocks, Sue; Salisbury, Chris; Sharp, Debbie

2011-01-01

Quality indicators exist for the acute and primary care sectors in the National Health Service (NHS), but until recently little attention has been given to measuring the quality of community services. The innovative project described in this paper attempted to address that gap. To produce a framework for developing quality indicators for Bristol Community Health services. To develop a set of initial indicators for Bristol Community Health services using the proposed framework. After familiarising ourselves with community services and NHS policy, gathering the views of stakeholders and consulting the literature on quality indicators, we designed a framework for indicator development, using the 'test' case of the district nursing service. The long list of possible indicators came from best practice guidelines for wound, diabetes and end of life care, the three conditions most commonly treated by district nurses. To narrow down this list we surveyed and held workshops with district nurses, interviewed service users by telephone and met with commissioners and senior community health managers. The final set of quality indicators for district nurses included 23 organisational and clinical process and outcome indicators and eight patient experience indicators. These indicators are now being piloted, together with two potential tools identified to capture patient reported outcomes. Developing quality indicators for community services is time consuming and resource intensive. A range of skills are needed including clinical expertise, project management and skills in evidence-based medicine. The commitment and involvement of front-line professionals is crucial.

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

PubMed Central

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

2012-01-01

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

Quality indicators for hip fracture care, a systematic review.

PubMed

Voeten, S C; Krijnen, P; Voeten, D M; Hegeman, J H; Wouters, M W J M; Schipper, I B

2018-05-17

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

Future Development of Nursing Home Quality Indicators

ERIC Educational Resources Information Center

Arling, Greg; Kane, Robert L.; Lewis, Teresa; Mueller, Christine

2005-01-01

Nursing home quality indicators have been developed over the past 10 years to quantify nursing home quality and to draw systematic comparisons between facilities. Although these indicators have been applied widely for nursing home regulation, quality improvement, and public reporting, researchers and stakeholders have raised concerns about their…

Quality-of-care indicators among remote-dwelling hemodialysis patients: a cohort study.

PubMed

Thompson, Stephanie; Bello, Aminu; Wiebe, Natasha; Manns, Braden; Hemmelgarn, Brenda; Klarenbach, Scott; Pelletier, Rick; Tonelli, Marcello

2013-08-01

We hypothesized that the higher mortality for hemodialysis patients who live farther from the closest attending nephrologist compared with patients living closer might be due to lower quality of care. Population-based longitudinal study. All adult maintenance hemodialysis patients with measurements of quality-of-care indicators initiating hemodialysis therapy between January 2001 and June 2010 in Northern Alberta, Canada. Hemodialysis patients were classified into categories based on the distance by road from their residence to the closest nephrologist: ≤50 (referent), 50.1-150, 150.1-300, and >300 km. Quality-of-care indicators were based on published guidelines. Quality-of-care indicators at 90 days following initiation of hemodialysis therapy and, in a secondary analysis, at 1 year. Measurements were available for 1,784 patients. At baseline, the proportions of patients residing in each category were 69% for ≤50 km to closest nephrologist; 17%, 50.1-150 km; 7%, 150.1-300 km; and 7%, >300 km. Those who lived farther away from the closest nephrologist were less likely to have seen a nephrologist 90 days prior to the initiation of hemodialysis therapy (P for trend = 0.008) and were less likely to receive Kt/V of 1.2 (adjusted OR, 0.50; 95% CI, 0.30-0.84; P for trend = 0.01). Remote location also was associated with suboptimal levels of phosphate control (P for trend = 0.005). There were no differences in the prevalence of arteriovenous fistulas or grafts or hemoglobin levels across distance categories. Registry data with limited data for non-guideline-based quality indicators. Although several quality-of-care indicators were less common in remote-dwelling hemodialysis patients, these differences do not appear sufficient to explain the previously noted disparities in clinical outcomes by residence location. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2016-06-01

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

Are hospital process quality indicators influenced by socio-demographic health determinants.

PubMed

Buja, Alessandra; Canavese, Daniel; Furlan, Patrizia; Lago, Laura; Saia, Mario; Baldo, Vincenzo

2015-10-01

This population-level health service study aimed to address whether hospitals assure the same quality of care to people in equal need, i.e. to see if any associations exist between social determinants and adherence to four hospital process indicators clearly identified as being linked to better health outcomes for patients. This was a retrospective cohort study based on administrative data collected in the Veneto Region (northeast Italy). We included residents of the Veneto Region hospitalized for ST-segment elevation myocardial infarction (STEMI) or acute myocardial infarction (AMI), hip fracture, or cholecystitis, and women giving birth, who were discharged from any hospital operating under the Veneto Regional Health Service between January 2012 and December 2012. The following quality indicator rates were calculated: patients with STEMI-AMI treated with percutaneous coronary intervention, elderly patients with hip fractures who underwent surgery within 48 h of admission, laparoscopic cholecystectomies and women who underwent cesarean section. A multilevel, multivariable logistic regression analyses were conducted to test the association between age, gender, formal education or citizenship and the quality of hospital care processes. All the inpatient hospital care process quality indicators measured were associated with an undesirable number of disparities concerning the social determinants. Monitoring the evidence-based hospital health care process indicators reveals undesirable disparities. Administrative data sets are of considerable practical value in broad-based quality assessments and as a screening tool, also in the health disparities domain. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Water quality indicators: bacteria, coliphages, enteric viruses.

PubMed

Lin, Johnson; Ganesh, Atheesha

2013-12-01

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

Investigating Drought Onset, Termination and Recovery According to Water Quality Indicators

NASA Astrophysics Data System (ADS)

Ahmadi, B.; Moradkhani, H.

2016-12-01

Frequency and severity of droughts are increasing globally. Reduced catchment runoff and river flows caused by the meteorological drivers leads to hydrological drought. Hydrological droughts have significant impacts not only on water quantity but also on water quality. In this study, first the onset of historical hydrological droughts is estimated using daily threshold-based indicators. Then drought termination and recovery period in terms of water quantity is analyzed. This is followed by examination of water quality during these detected hydrological droughts. Four water quality parameters, i.e., water temperature, dissolved oxygen, pH and turbidity are investigated over Willamette river basin located in northwestern Oregon in the United States. Drought vulnerability and resiliency are analyzed for the study period. Droughts and the recovery period are found to have significant impact on water quality parameters. Also, the results indicate a deterioration of water quality during droughts and longer drought recovery if water quality indicators are considered in the analysis.

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

PubMed

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

2016-09-01

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

A systematic review of diet quality indices in relation to obesity.

PubMed

Asghari, Golaleh; Mirmiran, Parvin; Yuzbashian, Emad; Azizi, Fereidoun

2017-04-01

Tools, called 'diet/dietary quality indices', evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

Physical soil quality indicators for monitoring British soils

NASA Astrophysics Data System (ADS)

Corstanje, Ron; Mercer, Theresa G.; Rickson, Jane R.; Deeks, Lynda K.; Newell-Price, Paul; Holman, Ian; Kechavarsi, Cedric; Waine, Toby W.

2017-09-01

Soil condition or quality determines its ability to deliver a range of functions that support ecosystem services, human health and wellbeing. The increasing policy imperative to implement successful soil monitoring programmes has resulted in the demand for reliable soil quality indicators (SQIs) for physical, biological and chemical soil properties. The selection of these indicators needs to ensure that they are sensitive and responsive to pressure and change, e.g. they change across space and time in relation to natural perturbations and land management practices. Using a logical sieve approach based on key policy-related soil functions, this research assessed whether physical soil properties can be used to indicate the quality of British soils in terms of their capacity to deliver ecosystem goods and services. The resultant prioritised list of physical SQIs was tested for robustness, spatial and temporal variability, and expected rate of change using statistical analysis and modelling. Seven SQIs were prioritised: soil packing density, soil water retention characteristics, aggregate stability, rate of soil erosion, depth of soil, soil structure (assessed by visual soil evaluation) and soil sealing. These all have direct relevance to current and likely future soil and environmental policy and are appropriate for implementation in soil monitoring programmes.

Measures and Indicators of Vgi Quality: AN Overview

NASA Astrophysics Data System (ADS)

Antoniou, V.; Skopeliti, A.

2015-08-01

The evaluation of VGI quality has been a very interesting and popular issue amongst academics and researchers. Various metrics and indicators have been proposed for evaluating VGI quality elements. Various efforts have focused on the use of well-established methodologies for the evaluation of VGI quality elements against authoritative data. In this paper, a number of research papers have been reviewed and summarized in a detailed report on measures for each spatial data quality element. Emphasis is given on the methodology followed and the data used in order to assess and evaluate the quality of the VGI datasets. However, as the use of authoritative data is not always possible many researchers have turned their focus on the analysis of new quality indicators that can function as proxies for the understanding of VGI quality. In this paper, the difficulties in using authoritative datasets are briefly presented and new proposed quality indicators are discussed, as recorded through the literature review. We classify theses new indicators in four main categories that relate with: i) data, ii) demographics, iii) socio-economic situation and iv) contributors. This paper presents a dense, yet comprehensive overview of the research on this field and provides the basis for the ongoing academic effort to create a practical quality evaluation method through the use of appropriate quality indicators.

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

PubMed

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

2004-08-01

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

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

PubMed

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

2012-08-01

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

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Selecting clinical quality indicators for laboratory medicine.

PubMed

Barth, Julian H

2012-05-01

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

Recreation trends: indicators of environmental quality

Treesearch

Roy Feuchter

1980-01-01

As you probably know, tomorrow is Earth Day-80, the 10th anniversary of the original Earth Day, so it is certainly appropriate that we talk these next few days about environmental quality and the relationship of outdoor recreation to that quality. However, perhaps the title should be more of a question such as: Are recreation trends indicators of environmental quality...

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.

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

ERIC Educational Resources Information Center

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

2013-01-01

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

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

PubMed

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

2015-01-01

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

Quality of Web-based information on cocaine addiction.

PubMed

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

2008-08-01

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

Quality of web-based information on cannabis addiction.

PubMed

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

2008-01-01

This study evaluated the quality of Web-based information on cannabis use and addiction and investigated particular content quality indicators. Three keywords ("cannabis addiction," "cannabis dependence," and "cannabis abuse") were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability, and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of the 94 Websites identified, 57 were included. Most were commercial sites. Based on outcome measures, the overall quality of the sites turned out to be poor. A global score (the sum of accountability, interactivity, content quality and esthetic criteria) appeared as a good content quality indicator. While cannabis education Websites for patients are widespread, their global quality is poor. There is a need for better evidence-based information about cannabis use and addiction on the Web.

Water quality assessment of Australian ports using water quality evaluation indices

PubMed Central

Jahan, Sayka

2017-01-01

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

Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands.

PubMed

Botje, Daan; Ten Asbroek, Guus; Plochg, Thomas; Anema, Helen; Kringos, Dionne S; Fischer, Claudia; Wagner, Cordula; Klazinga, Niek S

2016-10-13

Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. The semi-structured interviews were recorded and summarised. Based on the data, themes were synthesised and the analyses were executed systematically by two analysts independently. The findings were validated through comparison. The hospitals we investigated collect data for performance indicators in different ways. Similarly, these hospitals have different ways of using such data to support their quality management, while some do not seem to use the data for this purpose at all. Factors like 'linking pin champions', pro-active quality managers and engaged medical specialists seem to make a difference. In addition, a comprehensive hospital data infrastructure with electronic patient records and robust data collection software appears to be a prerequisite to produce reliable external performance indicators for internal quality improvement. Hospitals often fail to use performance indicators as a means to support internal quality management. Such data, then, are not used to its full potential. Hospitals are recommended to focus their human resource policy on 'linking pin champions', the engagement of professionals and a pro-active quality manager, and to invest in a comprehensive data infrastructure. Furthermore, the differences in data collection processes between Dutch hospitals make it difficult to draw

GROWTH, SURVIVAL AND MOVEMENT OF JUVENILE SALMONIDS AS INDICATORS OF HABITAT QUALITY

EPA Science Inventory

Fish-habitat relationships have often relied on measures of fish abundance as indices of habitat quality. Indices based on abundance measures may be misleading, however, due to high turnover rates in suboptimal habitats, seasonality of habitat use, or lagged responses to habitat...

Water-quality effects on phytoplankton species and density and trophic state indices at Big Base and Little Base Lakes, Little Rock Air Force Base, Arkansas, June through August, 2015

USGS Publications Warehouse

Driver, Lucas; Justus, Billy

2016-01-01

Big Base and Little Base Lakes are located on Little Rock Air Force Base, Arkansas, and their close proximity to a dense residential population and an active military/aircraft installation make the lakes vulnerable to water-quality degradation. The U.S. Geological Survey (USGS) conducted a study from June through August 2015 to investigate the effects of water quality on phytoplankton species and density and trophic state in Big Base and Little Base Lakes, with particular regard to nutrient concentrations. Nutrient concentrations, trophic-state indices, and the large part of the phytoplankton biovolume composed of cyanobacteria, indicate eutrophic conditions were prevalent for Big Base and Little Base Lakes, particularly in August 2015. Cyanobacteria densities and biovolumes measured in this study likely pose a low to moderate risk of adverse algal toxicity, and the high proportion of filamentous cyanobacteria in the lakes, in relation to other algal groups, is important from a fisheries standpoint because these algae are a poor food source for many aquatic taxa. In both lakes, total nitrogen to total phosphorus (N:P) ratios declined over the sampling period as total phosphorus concentrations increased relative to nitrogen concentrations. The N:P ratios in the August samples (20:1 and 15:1 in Big Base and Little Base Lakes, respectively) and other indications of eutrophic conditions are of concern and suggest that exposure of the two lakes to additional nutrients could cause unfavorable dissolved-oxygen conditions and increase the risk of cyanobacteria blooms and associated cyanotoxin issues.

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

PubMed

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

2015-12-01

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

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

ERIC Educational Resources Information Center

Sukboonyasatit, Kritsana; Thanapaisarn, Chaiwit; Manmar, Lampang

2011-01-01

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

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

PubMed

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

2017-01-01

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

WATER QUALITY INDICES: A SURVEY OF INDICES USED IN THE UNITED STATES

EPA Science Inventory

This study documents the extent to which water quality indices currently are being used in the United States. It reviews the indices published in the literature and surveys the States and interstate commissions to determine: (1) which agencies are using indices, (2) the type of i...

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.

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

PubMed

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

2017-02-01

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

Evidence-Based Practice: Quality Indicator Analysis of Antecedent Exercise in Autism Spectrum Disorders

ERIC Educational Resources Information Center

Kasner, Melanie; Reid, Greg; MacDonald, Cathy

2012-01-01

The purpose of the research was to conduct a quality indicator analysis of studies exploring the effects of antecedent exercise on self-stimulatory behaviors of individuals with autism spectrum disorders (ASD). Educational Resources Information Center (ERIC), Google Scholar, SPORTDiscus, PsychINFO, and PubMed/MedLine databases from 1980 to October…

How Well Does Your IEP Measure Up?: Quality Indicators for Effective Service Delivery.

ERIC Educational Resources Information Center

Twachtman-Cullen, Diane; Twachtman-Reilly, Jennifer

This book is intended to offer guidance in writing individualized education programs (IEPs) that deliver high-quality, need-based educational programming for students with autism spectrum disorders. Following an introductory historical overview of special education law, the remaining chapters in part 1 address the quality indicators for each of…

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

PubMed

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

2012-11-24

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

A set of care quality indicators for stroke management.

PubMed

Navarro Soler, I M; Ignacio García, E; Masjuan Vallejo, J; Gállego Culleré, J; Mira Solves, J J

2017-06-22

This study proposes a set of quality indicators for care outcomes in patients with acute cerebral infarction. These indicators are understandable and relevant from a clinical viewpoint, as well as being acceptable and feasible in terms of time required, ease of data capture, and interpretability. The method consisted of reaching consensus among doctors after having reviewed the literature on quality indicators in stroke. We then designed and conducted a field study to assess the understandability and feasibility of the set of indicators. Consensus yielded 8 structural indicators, 5 process indicators, and 12 result indicators. Additionally, standards of reference were established for each indicator. This set of indicators can be used to monitor the quality care for stroke patients, identify strengths, and potentially to identify areas needing improvement. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Selection indices for quality evaluation in wheat breeding.

PubMed

Branlard, G; Pierre, J; Rousset, M

1992-06-01

From multilocation trials involving 125 cultivars of wheat of mainly French and European origin four tests - protein content, Pelshenke, modified Zeleny and the mixograph - were used to establish six selection indices. Three of these indices - IW1, IW2 and IW3 - were calculated in order to evaluate the genetic potentiality of the lines for dough strength as given by the Chopin alveograph. The indices IV1, IV2 and IV3 were established to evaluate loaf volume as measured by the French bread-making standard. A quality index IQ was calculated from the allelic effects of the high-molecular-weight (HMW) subunits of glutenin from 195 cultivars assessed by the Chopin alveograph and the Pelshenke test. Comparison of the relative efficiency of each of the six indices to the individual tests revealed the superiority of the indices over one or several technological parameters. The six selection indices and the quality index were compared using 30 very diverse F4 lines. Their ability to retain the good quality lines is discussed in particular.

A first-approximation urban-air-quality indicator

Treesearch

David M. Paproski; Julian R. Walker

1977-01-01

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

Water quality evaluation of Al-Gharraf river by two water quality indices

NASA Astrophysics Data System (ADS)

Ewaid, Salam Hussein

2017-11-01

Water quality of Al-Gharraf river, the largest branch of Tigris River south of Iraq, was evaluated by the National Sanitation Foundation Water Quality Index (NFS WQI) and the Heavy Metal Pollution Index (HPI) depending on 13 physical, chemical, and biological parameters of water quality measured monthly at ten stations on the river during 2015. The NSF-WQI range obtained for the sampling sites was 61-70 indicating a medium water quality. The HPI value was 98.6 slightly below the critical value for drinking water of 100, and the water quality in the upstream stations is better than downstream due to decrease in water and the accumulation of contaminants along the river. This study explains the significance of applying the water quality indices that show the aggregate impact of ecological factors in charge of water pollution of surface water and which permits translation of the monitoring data to assist the decision makers.

Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer.

PubMed

Quan, May Lynn; Wells, Bryan J; McCready, David; Wright, Frances C; Fraser, Novlette; Gagliardi, Anna R

2010-02-01

Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure. We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review. The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level. A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.

Quality Indicators of Online Programs

ERIC Educational Resources Information Center

Hirner, Leo; Kochtanek, Thomas

2012-01-01

The continued growth of online programs in higher education has resulted in concerns about how institutions monitor the quality of their online programs. These concerns indicate a need for a process by which online programs may be evaluated and compared. They provided the impetus for this study, the goals of which were to identify quality…

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

PubMed

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

2012-01-01

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

Speech Clarity Index (Ψ): A Distance-Based Speech Quality Indicator and Recognition Rate Prediction for Dysarthric Speakers with Cerebral Palsy

NASA Astrophysics Data System (ADS)

Kayasith, Prakasith; Theeramunkong, Thanaruk

It is a tedious and subjective task to measure severity of a dysarthria by manually evaluating his/her speech using available standard assessment methods based on human perception. This paper presents an automated approach to assess speech quality of a dysarthric speaker with cerebral palsy. With the consideration of two complementary factors, speech consistency and speech distinction, a speech quality indicator called speech clarity index (Ψ) is proposed as a measure of the speaker's ability to produce consistent speech signal for a certain word and distinguished speech signal for different words. As an application, it can be used to assess speech quality and forecast speech recognition rate of speech made by an individual dysarthric speaker before actual exhaustive implementation of an automatic speech recognition system for the speaker. The effectiveness of Ψ as a speech recognition rate predictor is evaluated by rank-order inconsistency, correlation coefficient, and root-mean-square of difference. The evaluations had been done by comparing its predicted recognition rates with ones predicted by the standard methods called the articulatory and intelligibility tests based on the two recognition systems (HMM and ANN). The results show that Ψ is a promising indicator for predicting recognition rate of dysarthric speech. All experiments had been done on speech corpus composed of speech data from eight normal speakers and eight dysarthric speakers.

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

PubMed

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

2003-01-01

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

[Certified quality management according to DIN ISO 9001 in a radiology department at a university hospital: measurable changes in academic quality indicators?].

PubMed

Lorenzen, J; Habermann, C; Utler, C; Grzyska, U; Weber, C; Adam, G; Koops, A

2009-10-01

To evaluate the changes in academic quality indicators after implementation of a quality management system according to DIN ISO 9001:2000. After implementation and certification of a quality management system, the actual state based on quality indicators from the fields of student teaching, research, continuing education and the satisfaction of referring physician was determined. After implementation of an action plan for the individual areas, the temporal changes in the ratios were documented in the follow-up. The evaluation of teaching performance obtained by questionnaire among the students of the radiology course showed a steady increase in satisfaction (mean value 2003: 2.7; 2007: 3.9). In the field of research an increase in scientific output was achieved based on the number of an internal publication score (2002: 99 points; 2006: 509). Repeated opinion surveys among our referring physicians found improvements in indicators for the appointment of investigations, consulting service and waiting times for the investigation, while the waiting times for internal transport service did not improve. Exemplary measurements of the success of the advanced training of the staff demonstrated the need for continuing education for quality improvement. The evaluation of quality indicators showed over time a measurable positive impact on processes of a radiological University Hospital after implementation of a QM system according to DIN ISO 9001:2000. Georg Thieme Verlag KG Stuttgart-New York.

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

PubMed

Doebler, Klaus; Geraedts, Max

2017-12-20

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

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the

Nursing students' evaluation of quality indicators during learning in clinical practice.

PubMed

Jansson, Inger; Ene, Kerstin W

2016-09-01

A supportive clinical learning environment is important for nursing students' learning. In this study, a contract between a county and a university involving a preceptor model of clinical education for nursing students is described. The aim of this study was to describe nursing students' clinical education based on quality indicators and to describe the students' experiences of what facilitated or hindered the learning process during their clinical practice. During autumn 2012 and spring 2013, 269 student evaluations with quantitative and qualitative answers were filled out anonymously. Quantitative data from the questionnaires concerning the quality indicators: Administration/information, Assessments/examinations and Reflection were processed to generate descriptive statistics that revealed gaps in what the preceptor model demands and what the students reported. The answers from the qualitative questions concerning the quality indicator Learning were analysed using content analysis. Four categories emerged: Independence and responsibility, continuity of learning, time, and the competence and attitudes of the staff. The study underlines that reflection, continuity, communication and feedback were important for the students' learning process, whereas heavy workload among staff and being supervised by many different preceptors were experienced as stressful and hindering by students. Copyright © 2016 Elsevier Ltd. All rights reserved.

Quality indicators for family support services and their relationship to organizational social context.

PubMed

Olin, S Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E

2014-01-01

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs-those targeting the program and staff-were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed.

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

PubMed Central

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

2003-01-01

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

Sterols indicate water quality and wastewater treatment efficiency.

PubMed

Reichwaldt, Elke S; Ho, Wei Y; Zhou, Wenxu; Ghadouani, Anas

2017-01-01

As the world's population continues to grow, water pollution is presenting one of the biggest challenges worldwide. More wastewater is being generated and the demand for clean water is increasing. To ensure the safety and health of humans and the environment, highly efficient wastewater treatment systems, and a reliable assessment of water quality and pollutants are required. The advance of holistic approaches to water quality management and the increasing use of ecological water treatment technologies, such as constructed wetlands and waste stabilisation ponds (WSPs), challenge the appropriateness of commonly used water quality indicators. Instead, additional indicators, which are direct measures of the processes involved in the stabilisation of human waste, have to be established to provide an in-depth understanding of system performance. In this study we identified the sterol composition of wastewater treated in WSPs and assessed the suitability of human sterol levels as a bioindicator of treatment efficiency of wastewater in WSPs. As treatment progressed in WSPs, the relative abundance of human faecal sterols, such as coprostanol, epicoprostanol, 24-ethylcoprostanol, and sitostanol decreased significantly and the sterol composition in wastewater changed significantly. Furthermore, sterol levels were found to be correlated with commonly used wastewater quality indicators, such as BOD, TSS and E. coli. Three of the seven sterol ratios that have previously been used to track sewage pollution in the environment, detected a faecal signal in the effluent of WSPs, however, the others were influenced by high prevalence of sterols originating from algal and fungal activities. This finding poses a concern for environmental assessment studies, because environmental pollution from waste stabilisation ponds can go unnoticed. In conclusion, faecal sterols and their ratios can be used as reliable indicators of treatment efficiency and water quality during wastewater

Performance criteria and quality indicators for the post-analytical phase.

PubMed

Sciacovelli, Laura; Aita, Ada; Padoan, Andrea; Pelloso, Michela; Antonelli, Giorgia; Piva, Elisa; Chiozza, Maria Laura; Plebani, Mario

2016-07-01

Quality indicators (QIs) used as performance measurements are an effective tool in accurately estimating quality, identifying problems that may need to be addressed, and monitoring the processes over time. In Laboratory Medicine, QIs should cover all steps of the testing process, as error studies have confirmed that most errors occur in the pre- and post-analytical phase of testing. Aim of the present study is to provide preliminary results on QIs and related performance criteria in the post-analytical phase. This work was conducted according to a previously described study design based on the voluntary participation of clinical laboratories in the project on QIs of the Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Overall, data collected highlighted an improvement or stability in performances over time for all reported indicators thus demonstrating that the use of QIs is effective in the quality improvement strategy. Moreover, QIs data are an important source for defining the state-of-the-art concerning the error rate in the total testing process. The definition of performance specifications based on the state-of-the-art, as suggested by consensus documents, is a valuable benchmark point in evaluating the performance of each laboratory. Laboratory tests play a relevant role in the monitoring and evaluation of the efficacy of patient outcome thus assisting clinicians in decision-making. Laboratory performance evaluation is therefore crucial to providing patients with safe, effective and efficient care.

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

PubMed Central

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

2011-01-01

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

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

PubMed

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

2011-01-01

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

High-quality Italian rice cultivars: chemical indices of ageing and aroma quality.

PubMed

Griglione, Alessandra; Liberto, Erica; Cordero, Chiara; Bressanello, Davide; Cagliero, Cecilia; Rubiolo, Patrizia; Bicchi, Carlo; Sgorbini, Barbara

2015-04-01

The volatile fractions of six Italian high-quality rice cultivars were investigated by HS-SPME-GC-MS to define fingerprinting and identify chemical markers and/or indices of ageing and aroma quality. In particular, four non-aromatic (Carnaroli, Carnise, Cerere and Antares) and two aromatic (Apollo and Venere) rices, harvested in 2010 and 2011, were monitored over 12months. Twenty-five aroma components were considered and, despite considerable inter-annual variability, some of them showed similar trends over time, including 2-(E)-octenal as a marker of ageing for all cultivars, and heptanal, octanal and 2-ethyl hexanol as cultivar-specific indicators. The area ratios 2-acetyl-1-pyrroline/1-octen-3-ol, for Venere, and 3-methyl-1-butanol/2-methyl-1-butanol, for Apollo, were also found to act as ageing indices. Additional information on release of key-aroma compounds was also obtained from quantitation and its dependence on grain shape and chemical composition. Heptanal/1-octen-3-ol and heptanal/octanal ratios were also defined as characterising the aroma quality indices of the six Italian rice cultivars investigated. Copyright © 2014 Elsevier Ltd. All rights reserved.

A multi-objective assessment of an air quality monitoring network using environmental, economic, and social indicators and GIS-based models.

PubMed

Pope, Ronald; Wu, Jianguo

2014-06-01

In the United States, air pollution is primarily measured by Air Quality Monitoring Networks (AQMN). These AQMNs have multiple objectives, including characterizing pollution patterns, protecting the public health, and determining compliance with air quality standards. In 2006, the U.S. Environmental Protection Agency issued a directive that air pollution agencies assess the performance of their AQMNs. Although various methods to design and assess AQMNs exist, here we demonstrate a geographic information system (GIS)-based approach that combines environmental, economic, and social indicators through the assessment of the ozone (O3) and particulate matter (PM10) networks in Maricopa County, Arizona. The assessment was conducted in three phases: (1) to evaluate the performance of the existing networks, (2) to identify areas that would benefit from the addition of new monitoring stations, and (3) to recommend changes to the AQMN. A comprehensive set of indicators was created for evaluating differing aspects of the AQMNs' objectives, and weights were applied to emphasize important indicators. Indicators were also classified according to their sustainable development goal. Our results showed that O3 was well represented in the county with some redundancy in terms of the urban monitors. The addition of weights to the indicators only had a minimal effect on the results. For O3, urban monitors had greater social scores, while rural monitors had greater environmental scores. The results did not suggest a need for adding more O3 monitoring sites. For PM10, clustered urban monitors were redundant, and weights also had a minimal effect on the results. The clustered urban monitors had overall low scores; sites near point sources had high environmental scores. Several areas were identified as needing additional PM10 monitors. This study demonstrates the usefulness of a multi-indicator approach to assess AQMNs. Network managers and planners may use this method to assess the

Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study.

PubMed

Koksal, Eda; Karacil Ermumcu, Merve Seyda; Mortas, Hande

2017-03-20

This study aims to describe the dietary status of Turkish adults using two different versions of the Healthy Eating Index (HEI). In this cross sectional study, 494 healthy participants (311 females) with randomly selected and living in Ankara were included between September 2013 and March 2014. A questionnaire was completed and anthropometric measurements (weight and height) were performed. The 24-h dietary recall of individuals was collected. Diet quality was measured through HEI-2005 and HEI-2010 scores. The mean age, body mass index (BMI), HEI-2005 and HEI-2010 scores of individuals were 32.9 ± 10.8 years; 25.0 ± 4.8 kg/m 2 ; 56.1 ± 13.9 and 41.5 ± 13.7 points, respectively. Significant differences were found between mean HEI-2005 and HEI-2010 scores (p < 0.05). The individual's whose diet quality needs to be improved according to mean HEI-2005 score, had poorer diet based on mean HEI-2010 scores. The highest mean HEI-2005 and HEI-2010 scores were stated in female, in subjects had low education levels, aged 51 years or older and in overweight groups (p <0.05). Both versions of healthy eating indices were correlated positively with BMI and age CONCLUSION: Diet qualities of the individuals are associated with age, gender, education and BMI. Although the components and scores in HEI-2010 version were changed from the version of HEI-2005, the changes may encourage healthy choices of some food group. HEI-2010 gives more attention to food quality than HEI-2005. Thus, in the present study it was concluded that HEI-2010 provided more precise results about diet quality.

Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators.

PubMed

Mattsson, Maria Søe; Mattsson, Nick; Jørsboe, Hanne B

2014-11-05

The Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting. Quasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of an ED. Patients admitted at Nykøbing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbæk Hospital works as a control hospital. Chi-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P < 0.05 was considered statistically significant. We assessed 4584 patient cases from RKKP. A significant positive change was seen in all of the additional eight indicators related to stroke at NFS (P < 0.001); however, COPD indicators were unchanged in both hospitals. In NFS two of eight heart failure indicators were significantly improved after the reorganization (p < 0.01). In patients admitted with a bleeding ulcer 2 of 5 indicators were significantly improved after the reorganization in NFS and HOL (p < 0.01). Both compared hospitals showed significant improvements in the two indicators concerning hip fracture (p < 0.001). Significant reductions in the 30 day-mortality in patients admitted with stroke were seen when the pre- and the post-intervention data were compared for both NFS and HOL (p = 0.024). During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality

Performance Indicators and Quality Review in Australian Universities.

ERIC Educational Resources Information Center

Stanley, Gordon; Reynolds, Pat

1995-01-01

A study examined the relationship between quantitative performance and diversity indicators and the quality rankings of Australian universities made by the Commission for Quality Assurance in Higher Education. Correlations between three performance factors (traditional research university performance, teaching performance, competitive research…

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

Treesearch

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

2012-01-01

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

Quality Indicators for Family Support Services and Their Relationship to Organizational Social Context

PubMed Central

Olin, S. Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E.

2013-01-01

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs —those targeting the program and staff -- were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed. PMID:23709286

Characterizing multi-pollutant air pollution in China: Comparison of three air quality indices.

PubMed

Hu, Jianlin; Ying, Qi; Wang, Yungang; Zhang, Hongliang

2015-11-01

Multi-pollutant air pollution (i.e., several pollutants reaching very high concentrations simultaneously) frequently occurs in many regions across China. Air quality index (AQI) is used worldwide to inform the public about levels of air pollution and associated health risks. The current AQI approach used in China is based on the maximum value of individual pollutants, and does not consider the combined health effects of exposure to multiple pollutants. In this study, two novel alternative indices--aggregate air quality index (AAQI) and health-risk based air quality index (HAQI)--were calculated based on data collected in six megacities of China (Beijing, Shanghai, Guangzhou, Shjiazhuang, Xi'an, and Wuhan) during 2013 to 2014. Both AAQI and HAQI take into account the combined health effects of various pollutants, and the HAQI considers the exposure (or concentration)-response relationships of pollutants. AAQI and HAQI were compared to AQI to examine the effectiveness of the current AQI in characterizing multi-pollutant air pollution in China. The AAQI and HAQI values are higher than the AQI on days when two or more pollutants simultaneously exceed the Chinese Ambient Air Quality Standards (CAAQS) 24-hour Grade II standards. The results of the comparison of the classification of risk categories based on the three indices indicate that the current AQI approach underestimates the severity of health risk associated with exposure to multi-pollutant air pollution. For the AQI-based risk category of 'unhealthy', 96% and 80% of the days would be 'very unhealthy' or 'hazardous' if based on AAQI and HAQI, respectively; and for the AQI-based risk category of 'very unhealthy', 67% and 75% of the days would be 'hazardous' if based on AAQI and HAQI, respectively. The results suggest that the general public, especially sensitive population groups such as children and the elderly, should take more stringent actions than those currently suggested based on the AQI approach during

Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey.

PubMed

Persenius, Mona; Hall-Lord, Marie-Louise; Wilde-Larsson, Bodil; Carlsson, Eva

2015-09-01

To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework. © 2013 John Wiley & Sons Ltd.

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

PubMed

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

2009-03-01

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

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

NASA Astrophysics Data System (ADS)

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

2011-04-01

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

A new approach to the identification of Landscape Quality Objectives (LQOs) as a set of indicators.

PubMed

Sowińska-Świerkosz, Barbara Natalia; Chmielewski, Tadeusz J

2016-12-15

The objective of the paper is threefold: (1) to introduce Landscape Quality Objectives (LQOs) as a set of indicators; (2) to present a method of linking social and expert opinion in the process of the formulation of landscape indicators; and (3) to present a methodological framework for the identification of LQOs. The implementation of these goals adopted a six-stage procedure based on the use of landscape units: (1) GIS analysis; (2) classification; (3) social survey; (4) expert value judgement; (5) quality assessment; and (6) guidelines formulation. The essence of the research was the presentation of features that determine landscape quality according to public opinion as a set of indicators. The results showed that 80 such indicators were identified, of both a qualitative (49) and a quantitative character (31). Among the analysed units, 60% (18 objects) featured socially expected (and confirmed by experts) levels of landscape quality, and 20% (6 objects) required overall quality improvement in terms of both public and expert opinion. The adopted procedure provides a new tool for integrating social responsibility into environmental management. The advantage of the presented method is the possibility of its application in the territories of various European countries. It is flexible enough to be based on cartographic studies, landscape research methods, and environmental quality standards existing in a given country. Copyright © 2016 Elsevier Ltd. All rights reserved.

Quality of web-based information on social phobia: a cross-sectional study.

PubMed

Khazaal, Yasser; Fernandez, Sebastien; Cochand, Sophie; Reboh, Isabel; Zullino, Daniele

2008-01-01

The objective of the study is to evaluate the quality of web-based information on social phobia and to investigate particular quality indicators. Two keywords, "Social phobia" and "Social Anxiety Disorder", were entered into five popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability, and content quality. "Health On the Net" (HON) quality label and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. This study evaluates the quality of web-based information on social phobia. On the 200 identified links, 58 were included. On the basis of outcome measures, the overall quality of the sites turned out to be poor. DISCERN and HON label were indicators of good quality indicators. Accountability criteria were poor indicators of site quality. Although social phobia education Websites for patients are common, educational material highly varies in quality and content. There is a need for better evidence-based information about social phobia on the Web and a need to reconsider the role of accountability criteria as indicators of site quality. Clinicians should advise patients of the HON label and DISCERN as useful indicators of site quality. (c) 2007 Wiley-Liss, Inc.

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

PubMed

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

2015-10-01

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

Study on Quality Indicator System of Rhythmic Gymnasts in Analytic Hierarchy Process

NASA Astrophysics Data System (ADS)

Luo, Lin

2017-08-01

The rhythmic gymnastics (RG) is a sport item with the direct aim of winning as well as a good ornamental value. The scientific selection by the rhythmic gymnasts is necessary for the success, and also the beginning for the scientific training of the gymnasts in their special training stage. According to RG characteristics and the physical characteristics of the gymnasts, also in combination with the investigations & interviews to the coaches who have years of training experience in RG, the experts & scholars on RG study & teaching in universities, and by referring to relevant documents, this paper established the quality indicator system in analytic hierarchy process (AHP). We summarized and selected several indicators obviously influencing the RG training and divided them into the three types of factors: physical factors, flexibility & strength factors, and speed & dexterity factors, according to which 12 specific indicators, their weights and comprehensive evaluation coefficients. Based on these indicators, we established the quality indicator system of the gymnasts, and developed corresponding software system, providing scientific theoretical basis & practical application basis for the selection & evaluation of the gymnasts.

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

PubMed

Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

2017-01-01

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

PubMed

Mansky, Thomas; Völzke, Tatjana; Nimptsch, Ulrike

2015-01-01

Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement. The concept of the German Inpatient Quality Indicators is explained. These indicators cover volume, mortality, and other information by a disease specific approach, which includes information for potential patients as well as specific feedback to the physicians responsible for the respective specialty. This article focuses on the feedback to the hospitals and explains how these indicators can be used for improvement in conjunction with a peer review process. The indicators provide information to the hospitals regarding their relative position because German reference values are available for all indicators. Thus, the indicators can serve as a trigger instrument for identifying possible quality problems. Based on these indications, peer review can be used to analyze the treatment processes and to eventually verify weaknesses and define actions for improvement. The first studies indicate that the use of this approach within hospital quality management can largely improve hospital outcomes in hospitals with subpar results compared to the German average. Copyright © 2015. Published by Elsevier GmbH.

Quality indicators for hip fracture patients: a scoping review protocol

PubMed Central

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

2014-01-01

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

Developing a national framework of quality indicators for public hospitals.

PubMed

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

2014-01-01

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

Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators.

PubMed

van der Veer, Sabine N; van Biesen, Wim; Couchoud, Cécile; Tomson, Charles R V; Jager, Kitty J

2014-08-01

This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

PubMed

Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

2018-02-01

Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of

Quality indicators in inflammatory bowel disease.

PubMed

Berry, Sameer K; Melmed, Gil Y

2018-01-01

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

Teaching Quality Management Model for the Training of Innovation Ability and the Multilevel Decomposition Indicators

ERIC Educational Resources Information Center

Lu, Xingjiang; Yao, Chen; Zheng, Jianmin

2013-01-01

This paper focuses on the training of undergraduate students' innovation ability. On top of the theoretical framework of the Quality Function Deployment (QFD), we propose a teaching quality management model. Based on this model, we establish a multilevel decomposition indicator system, which integrates innovation ability characterized by four…

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

PubMed

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

2016-01-01

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

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

PubMed

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

2016-02-20

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

Assessment of Ganga river ecosystem at Haridwar, Uttarakhand, India with reference to water quality indices

NASA Astrophysics Data System (ADS)

Bhutiani, R.; Khanna, D. R.; Kulkarni, Dipali Bhaskar; Ruhela, Mukesh

2016-06-01

The river Ganges is regarded as one of the most holy and sacred rivers of the world from time immemorial. The evaluation of river water quality is a critical element in the assessment of water resources. The quality/potability of water that is consumed defines the base line of protection against many diseases and infections. The present study aimed to calculate Water Quality Index (WQI) by the analysis of sixteen physico-chemical parameters on the basis of River Ganga index of Ved Prakash, weighted arithmetic index and WQI by National sanitation foundation (NSF) to assess the suitability of water for drinking, irrigation purposes and other human uses. These three water quality indices have been used to assess variation in the quality of the River Ganga at monitored locations over an 11-year period. Application of three different indexes to assess the water quality over a period of 11 years shows minor variations in water quality. Index values as per River Ganga Index by Ved Prakash et al. from 2000 to 2010 ranged between medium to good, Index values as per NSF Index for years 2000-2010 indicate good water quality, while Index values as per the weighted arithmetic index method for the study period indicate poor water quality.

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

PubMed

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

2014-10-21

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

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

Treesearch

Floyd G. Timson

1980-01-01

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

Use of quality indicators by obstetric caregivers in the Netherlands: A descriptive study.

PubMed

Cellissen, Evelien; Franx, Arie; Roes, Kit C B

2017-04-01

To evaluate the use of quality indicators by obstetric caregivers in hospitals in the Netherlands. An anonymous, self-administered survey was conducted in a convenience sample of obstetricians and clinical midwives in Dutch hospitals. Descriptive statistics were used to analyse the data, both for all caregivers and stratified by hospital setting and profession (obstetricians and midwives). Differences between strata were tested at a 5% significance level. The response rate to the online questionnaire was 61% (n=171/279). Of all respondents 83% were aware of the quality indicators and 63% contributed to their registration. Caregivers received information about the indicators by mail or in meetings according to 64% (internal indicators) and 48% (external indicators) of the respondents. Of the respondents 56% (internal indicators) and 41% (external indicators) stated to use the results of indicators when designing plans to improve the quality of care. We conclude that obstetric quality indicators are not widely used by obstetricians and midwives in Dutch hospitals to improve quality of care. To improve quality of care and the effective use of quality indicators we suggest to focus first on registering outcome indicators. These indicators should be implemented in quality structures that ensure that action is taken. Copyright © 2017 Elsevier B.V. All rights reserved.

A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist.

PubMed

van Daalen, Frederike V; Prins, Jan M; Opmeer, Brent C; Boermeester, Marja A; Visser, Caroline E; van Hest, Reinier M; Hulscher, Marlies E J L; Geerlings, Suzanne E

2015-03-19

Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of (cost-) effectiveness. The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route. A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least 810 patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Secondary endpoints are appropriate antibiotic use measured by the quality indicators, admission to and duration of intensive care unit stay, readmission within 30 days, mortality, total antibiotic use, and costs associated with implementation and hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used. A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist. If (cost-) effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics. Dutch trial registry: NTR4872.

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

PubMed

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

2012-10-01

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

Sperm quality variables as indicators of bull fertility may be breed dependent.

PubMed

Morrell, Jane M; Nongbua, Thanapol; Valeanu, Sabina; Lima Verde, Isabel; Lundstedt-Enkel, Katrin; Edman, Anders; Johannisson, Anders

2017-10-01

A means of discriminating among bulls of high fertility based on sperm quality is needed by breeding centers. The objective of the study was to examine parameters of sperm quality in bulls of known fertility to identify useful indicators of fertility. Frozen semen was available from bulls of known fertility (Viking Genetics, Skara, Sweden): Swedish Red (n=31), Holstein (n=25) and Others (one each of Charolais, Limousin, Blonde, SKB). After thawing, the sperm samples were analyzed for motility (computer assisted sperm analysis), plasma membrane integrity, chromatin integrity, acrosome status, mitochondrial activity and reactive oxygen species. A fertility index score based on the adjusted 56-day non-return rate for >1000 inseminations was available for each bull. Multivariate data analysis (Partial Least Squares Regression and Orthogonal Partial Least Squares Regression) was performed to identify variables related to fertility; Pearson univariate correlations were made on the parameters of interest. Breed of bull affected the relationship of sperm quality variables and fertility index score, as follows: Swedish Red: %DNA Fragmentation Index, r=-0.56, P<0.01; intact plasma membrane, r=0.40, P<0.05; membrane damaged, not acrosome reacted, r=-0.6, P<0.01; Linearity, r=0.37, P<0.05; there was a trend towards significance for Wobble, r=0.34, P=0.08. Holstein: Linearity was significant r=0.46, P<0.05; there was a trend towards significance for Wobble, r=0.45, P=0.08. In conclusion, breed has a greater effect on sperm quality than previously realized; different parameters of sperm quality are needed to indicate potential fertility in different breeds. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed Central

2012-01-01

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

The Indicators of the Quality and Changes of Teachers' Work

ERIC Educational Resources Information Center

Fuzi, Beatrix; Suplicz, Sándor

2016-01-01

We present the indicators chosen for the determination of the quality of teacher's work: their popularity, effectiveness and disposition. As part of an empirical research project, their suitability as indicators was examined. It was discussed if a significant change can occur in the teachers' quality spontaneously or as a result of mentoring. To…

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

PubMed

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

2012-03-01

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

Reflections on the Quality Indicator Process

ERIC Educational Resources Information Center

Barrett, James R.; Taggart, Germaine

2011-01-01

The purpose of this paper is to share a description of the process used by Fort Hays State University (FHSU) as a self-study of the FHSU alternative certification program, known as Transition to Teaching. Team members used the Quality Indicators designed as a part of a Department of Education Transition to Teaching Grant called the KNOTtT Project.…

[Will publication of quality indicators in the health service improve the quality? International experiences and Danish perspectives].

PubMed

Endahl, Lars A; Utzon, Jan

2002-09-16

It is well known that publication of hospital quality indicators may lead to improving of treatments. But the publication can also have some negative side effects: Focus may shift to the evaluated areas at the expense of non-evaluated areas. The most ill patients may be sorted out and high risk patients may be transferred to other hospitals or discharged in order to avoid their dying during hospitalisation and improve statistics. Overestimation of patient risk in order to improve relative treatment outcome. Increasing flow of patients to hospitals with high scores on quality indicators may cause imbalance between activities and budgets and hence longer waiting times and reduced quality of treatment. Negative publicity due to low scores on quality indicators may lead to under-utilisation of hospital capacity, patient and staff insecurity and staff wastage. Thus, publication of quality indicators may improve quality within the health sector, but it is very important to recognise potential pitfalls and negative side effects.

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

PubMed Central

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

2007-01-01

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

Assessing and monitoring soil quality at agricultural waste disposal areas-Soil Indicators

NASA Astrophysics Data System (ADS)

Doula, Maria; Kavvadias, Victor; Sarris, Apostolos; Lolos, Polykarpos; Liakopoulou, Nektaria; Hliaoutakis, Aggelos; Kydonakis, Aris

2014-05-01

. Results indicate that there are soil parameters that can be used as indictors to assess soil quality at such areas. For the two cases, i.e pistachio wastes and olive oil mill wastes, different soil parameters were identified as potential indicators. In specific, for OMW the proposed indicators are: organic matter, electrical conductivity, total N, total polyphenols, exchangeable K, DTPA-available Fe, available P and pH (for the cases of acid soils). For pistachio wastes, it seems that the most appropriate indictors are: organic matter, electrical conductivity, exchangeable Mg, DTPA-available Fe, DTPA-available Cu, available B. A monitoring system was developed which may assist authorities and policy makers to continuously monitor the disposal areas or areas where wastes are used for fertilization/irrigation. For this, soil parameters were mapped with respect to the depth, date and temporal variations of their spatial distribution (spatial surfaces). Interpolated surfaces based on the Inverse Distance Weighted method (IDW) were created and integrated within a geospatial web based map application tool.

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

PubMed

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

2013-12-01

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

Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval.

PubMed

Siegel, Erin M; Jacobsen, Paul B; Lee, Ji-Hyun; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Smith, Jesusa Corazon R; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip; Markham, Merry-Jennifer; Shibata, David

2014-01-01

The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and

Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

PubMed

Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

2016-12-01

The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

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

PubMed Central

2013-01-01

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

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study

PubMed Central

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-01-01

Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study.

PubMed

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-05-11

To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains

Biological and biochemical soil quality indicators for agricultural management

NASA Astrophysics Data System (ADS)

Bongiorno, Giulia

2017-04-01

Soil quality is defined as the capacity of a soil to perform multiple functions. Agricultural soils can, in principle, sustain a wide range of functions. However, negative pressure exerted by natural and anthropogenic soil threats such as soil erosion, soil organic matter losses and soil compaction have the potential to permanently damage soil quality. Soil chemical, physical and biological parameters can be used as indicators of soil quality. The specific objective of this study is to assess the suitability of novel soil parameters as soil quality indicators. We focus on biological/biochemical parameters, due to the unique role of soil biota in soil functions and to their high sensitivity to disturbances. The novel indicators are assessed in ten European long-term field experiments (LTEs) with different agricultural land use (arable and permanent crops), management regimes and pedo-climatic characteristics. The contrasts in agricultural management are represented by conventional/reduced tillage, organic/mineral fertilization and organic matter addition/no organic matter addition. We measured two different pools of labile organic carbon (dissolved organic carbon (DOC), and permanganate oxidizable carbon (POXC)), and determined DOC quality through its fractionation in hydrophobic and hydrophilic compounds. In addition, total nematode abundance has been assessed with qPCR. These parameters will be related to soil functions which have been measured with a minimum data set of indicators for soil quality (including TOC, macronutrients, and soil respiration). As a preliminary analysis, the Sensitivity Index (SI) for a given LTE was calculated for DOC and POXC according to Bolinder et al., 1999 as the ratio of the soil attribute under modified practices (e.g. reduced tillage) compared to the conventional practices (e.g. conventional tillage). The overall effect of the sustainable management on the indicators has been derived by calculating an average SI for those LTEs

Scoping review of potential quality indicators for hip fracture patient care

PubMed Central

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

2017-01-01

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

Transition from in-hospital ventilation to home ventilation: process description and quality indicators

PubMed Central

Kastrup, Marc; Tittmann, Benjamin; Sawatzki, Tanja; Gersch, Martin; Vogt, Charlotte; Rosenthal, Max; Rosseau, Simone; Spies, Claudia

2017-01-01

The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory) ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process. This project describes an ideal sequence of processes (process chain), based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment. The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions. PMID:29308061

Development of on package indicator sensor for real-time monitoring of meat quality

PubMed Central

Shukla, Vivek; Kandeepan, G.; Vishnuraj, M. R.

2015-01-01

Aim: The aim was to develop an indicator sensor for real-time monitoring of meat quality and to compare the response of indicator sensor with meat quality parameters at ambient temperature. Materials and Methods: Indicator sensor was prepared using bromophenol blue (1% w/v) as indicator solution and filter paper as indicator carrier. Indicator sensor was fabricated by coating indicator solution onto carrier by centrifugation. To observe the response of indicator sensor buffalo meat was packed in polystyrene foam trays covered with PVC film and indicator sensor was attached to the inner side of packaging film. The pattern of color change in indicator sensor was monitored and compared with meat quality parameters viz. total volatile basic nitrogen, D-glucose, standard plate count and tyrosine value to correlate ability of indicator sensor for its suitability to predict the meat quality and storage life. Results: The indicator sensor changed its color from yellow to blue starting from margins during the storage period of 24 h at ambient temperature and this correlated well with changes in meat quality parameters. Conclusions: The indicator sensor can be used for real-time monitoring of meat quality as the color of indicator sensor changed from yellow to blue starting from margins when meat deteriorates with advancement of the storage period. Thus by observing the color of indicator sensor quality of meat and shelf life can be predicted. PMID:27047103

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

PubMed

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

2013-01-01

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

78 FR 13365 - Prospective Grant of Exclusive License: Food Quality Indicators

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

... reacts with the gases released during food decomposition, and changes color. Thus a rapid and informed... Exclusive License: Food Quality Indicators AGENCY: National Institutes of Health, Public Health Service, HHS.... No. E-093-1997/0 ``Food Quality Indicator;'' [[Page 13366

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

PubMed Central

2011-01-01

Background Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities. Methods We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed. Discussion We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public

[Comparative assessment of sanitary and epidemic importance of indicator coliform indices of drinking water quality].

PubMed

Rakhmanin, Yu A; Ivanova, L V; Artemova, T Z; Gipp, E K; Zagaynova, A V; Maksimkina, T N; Krasnyak, A V; Zhuravlev, P V; Aleshnya, V V; Panasovets, O P

2016-01-01

The used methodology of the scientific substantiation of indicators is in the establishment of the conformity of laws of vital activity of indicator and pathogenic microorganisms in the real conditions of the action of the complex of factors, including disinfecting agents. In the one water sample simultaneously there were determined both the general indicator (GICB), thermotolerant (TTCB), glucose positive (GPCB) coliform bacteria, E.coli. On the base of long-term research in the various regions of the Russian Federation, as well with bearing in mind the analysis of domestic and foreign data, comparing the water quality and the incidence of intestinal infections in population it is recommended to use the index of determination of the total number glucose positive coliform bacteria (GPCB), which brings together a much broader range of bacteria of the Enterobacteriaceae family in comparison with total coliform bacteria (TCB) and thermotolerant coliform bacteria (TTCB) and warrants the absence in the test volume of water as an indicator lactose positive (E.coli, TCB, TTCB) and pathogens (salmonella) and potentially pathogenic bacteria which do not ferment lactose. Proposed index of GPCB is shown to allow to assess epidemiological risks not only more accurate, but also more efficiently without increasing the cost performance of bacteriological research.

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

NASA Astrophysics Data System (ADS)

Koshkina, S.; Ostrinskaya, L.

2018-04-01

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

Performance indicators used to assess the quality of primary dental care.

PubMed

González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M

2006-12-01

An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.

Assessing soil quality indicator under different land use and soil erosion using multivariate statistical techniques.

PubMed

Nosrati, Kazem

2013-04-01

Soil degradation associated with soil erosion and land use is a critical problem in Iran and there is little or insufficient scientific information in assessing soil quality indicator. In this study, factor analysis (FA) and discriminant analysis (DA) were used to identify the most sensitive indicators of soil quality for evaluating land use and soil erosion within the Hiv catchment in Iran and subsequently compare soil quality assessment using expert opinion based on soil surface factors (SSF) form of Bureau of Land Management (BLM) method. Therefore, 19 soil physical, chemical, and biochemical properties were measured from 56 different sampling sites covering three land use/soil erosion categories (rangeland/surface erosion, orchard/surface erosion, and rangeland/stream bank erosion). FA identified four factors that explained for 82 % of the variation in soil properties. Three factors showed significant differences among the three land use/soil erosion categories. The results indicated that based upon backward-mode DA, dehydrogenase, silt, and manganese allowed more than 80 % of the samples to be correctly assigned to their land use and erosional status. Canonical scores of discriminant functions were significantly correlated to the six soil surface indices derived of BLM method. Stepwise linear regression revealed that soil surface indices: soil movement, surface litter, pedestalling, and sum of SSF were also positively related to the dehydrogenase and silt. This suggests that dehydrogenase and silt are most sensitive to land use and soil erosion.

Motivational Gaps and Perceptual Bias of Initial Motivation Additional Indicators of Quality for e-Learning Courses

ERIC Educational Resources Information Center

Cação, Rosário

2017-01-01

We describe a study on the motivation of trainees in e-learning-based professional training and on the effect of their motivation upon the perceptions they build about the quality of the courses. We propose the concepts of "perceived motivational gap" and "real motivational gap" as indicators of e-learning quality, which…

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

PubMed

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

2016-06-01

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

From Computer-interpretable Guidelines to Computer-interpretable Quality Indicators: A Case for an Ontology.

PubMed

White, Pam; Roudsari, Abdul

2014-01-01

In the United Kingdom's National Health Service, quality indicators are generally measured electronically by using queries and data extraction, resulting in overlap and duplication of query components. Electronic measurement of health care quality indicators could be improved through an ontology intended to reduce duplication of effort during healthcare quality monitoring. While much research has been published on ontologies for computer-interpretable guidelines, quality indicators have lagged behind. We aimed to determine progress on the use of ontologies to facilitate computer-interpretable healthcare quality indicators. We assessed potential for improvements to computer-interpretable healthcare quality indicators in England. We concluded that an ontology for a large, diverse set of healthcare quality indicators could benefit the NHS and reduce workload, with potential lessons for other countries.

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

PubMed

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

2018-04-01

Few studies have evaluated the quality of oral anticoagulant management by community pharmacists. There is no complete set of quality indicators available for this purpose. To develop a set of specific quality indicators to assess oral anticoagulant management by community pharmacists for patients with atrial fibrillation (AF). Quality indicators were developed in 3 phases. In phase 1, potential quality indicators were generated based on clinical guidelines and a literature review. In phase 2, a modified RAND appropriateness method involving 2 rounds was implemented with 9 experts, who judged the appropriateness of quality indicators generated in phase 1 based on the extent to which they were accurate, based on evidence, relevant, representative of best practices, and measurable in community pharmacies. Phase 3 consisted of a feasibility assessment in 5 community pharmacies on 2 patients each. The final set included 38 quality indicators grouped into 6 categories: documentation (n = 29), risk assessment (n = 3), clinical control (n = 1), clinical follow-up (n = 15), choice of therapy (n = 11), and interaction management (n = 8). The quality indicators referred to process of care (n = 34), clinical outcomes (n = 2), or structure of care (n = 2). There were 24 quality indicators related to vitamin K antagonists (VKAs), and 17 were related to direct oral anticoagulants (DOACs). To assess quality indicators, a questionnaire was developed for completion by community pharmacists for each patient, which included 17 questions about VKA patients and 12 questions about DOAC patients. A first set of quality indicators is now available to assess the quality of oral anticoagulant management by community pharmacists for patients with AF. This research was supported by the Réseau Québécois de recherche sur le médicament (RQRM); the Blueprint for Pharmacy in collaboration with Pfizer Canada; and the Cercle du Doyen of the Faculty of Pharmacy, University of Montreal. The study

Performance Indicators, Accountability, and Quality: An Analysis of Key Indicators at Two Georgia Postsecondary Institutions

ERIC Educational Resources Information Center

Christopher, Minolar T.

2010-01-01

Quality in higher education today is often measured by institutional accountability indicators. The purpose of this study was to examine trends and explore correlational relationships of the performance indicators deemed important to the stakeholders of two postsecondary institutions in the State of Georgia--retention rate, graduation rate, and…

The role of perceived impact on relationship quality in pharmacists' willingness to influence indication-based off-label prescribing decisions.

PubMed

Basak, Ramsankar; Bentley, John P; McCaffrey, David J; Bouldin, Alicia S; Banahan, Benjamin F

2015-05-01

Little is known about factors that affect pharmacists' roles in off-label prescribing. This study examined the effect of perceived impact on relationship quality (IRQ) on hospital pharmacists' willingness to influence a physician's decision regarding an indication-based off-label medication order (WTIP) (i.e., beyond FDA-approved indications) and the moderating roles of the appropriateness of the medication order and the relative expert power of the pharmacist. Pharmacists practicing in U.S. hospitals, recruited from membership rolls of state affiliates of the American Society of Health-System Pharmacists, were sent an electronic link to a questionnaire via their respective affiliates. A cross-sectional, randomized, 2 × 2 experimental design was used; participants were assigned to one of the indication-based off-label medication order scenarios. Relative expert power (i.e., power differential between the pharmacist and the physician) and appropriateness of the prescription were manipulated. Perceived IRQ was measured with multiple items. Pharmacists' WTIP in the scenario was the outcome variable. A total of 243 responses were included in multiple linear regression analyses. After controlling for dependence power, information power, communication effectiveness, perceived responsibility, and attitude, pharmacists' WTIP was negatively affected by perceived IRQ (estimate = -0.309, P < 0.05). This effect was more pronounced in groups exposed to the scenario where the pharmacist had lower relative expert power (estimate = -0.438, P < 0.05) and where the medication was less appropriate (estimate = -0.503, P < 0.05). Although willing to ensure rationality of off-label prescribing, pharmacists' WTIP was affected by a complex array of factors - the perceived impact of influence attempts on relationship quality between the pharmacist and the prescriber, the pharmacist's relative expert power, and the appropriateness of the off-label prescription. Increasing

Quality of Web-Based Information on Cannabis Addiction

ERIC Educational Resources Information Center

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

2008-01-01

This study evaluated the quality of Web-based information on cannabis use and addiction and investigated particular content quality indicators. Three keywords ("cannabis addiction," "cannabis dependence," and "cannabis abuse") were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed…

Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

PubMed

Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

2013-05-01

Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

[Study on the optimization of monitoring indicators of drinking water quality during health supervision].

PubMed

Ye, Bixiong; E, Xueli; Zhang, Lan

2015-01-01

To optimize non-regular drinking water quality indices (except Giardia and Cryptosporidium) of urban drinking water. Several methods including drinking water quality exceed the standard, the risk of exceeding standard, the frequency of detecting concentrations below the detection limit, water quality comprehensive index evaluation method, and attribute reduction algorithm of rough set theory were applied, redundancy factor of water quality indicators were eliminated, control factors that play a leading role in drinking water safety were found. Optimization results showed in 62 unconventional water quality monitoring indicators of urban drinking water, 42 water quality indicators could be optimized reduction by comprehensively evaluation combined with attribute reduction of rough set. Optimization of the water quality monitoring indicators and reduction of monitoring indicators and monitoring frequency could ensure the safety of drinking water quality while lowering monitoring costs and reducing monitoring pressure of the sanitation supervision departments.

[Quality indicators in the storage and dispensing process in a Hospital Pharmacy].

PubMed

Rabuñal-Álvarez, M T; Calvin-Lamas, M; Feal-Cortizas, B; Martínez-López, L M; Pedreira-Vázquez, I; Martín-Herranz, M I

2014-01-01

To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%). Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Key Performance Indicators in the Evaluation of the Quality of Radiation Safety Programs.

PubMed

Schultz, Cheryl Culver; Shaffer, Sheila; Fink-Bennett, Darlene; Winokur, Kay

2016-08-01

Beaumont is a multiple hospital health care system with a centralized radiation safety department. The health system operates under a broad scope Nuclear Regulatory Commission license but also maintains several other limited use NRC licenses in off-site facilities and clinics. The hospital-based program is expansive including diagnostic radiology and nuclear medicine (molecular imaging), interventional radiology, a comprehensive cardiovascular program, multiple forms of radiation therapy (low dose rate brachytherapy, high dose rate brachytherapy, external beam radiotherapy, and gamma knife), and the Research Institute (including basic bench top, human and animal). Each year, in the annual report, data is analyzed and then tracked and trended. While any summary report will, by nature, include items such as the number of pieces of equipment, inspections performed, staff monitored and educated and other similar parameters, not all include an objective review of the quality and effectiveness of the program. Through objective numerical data Beaumont adopted seven key performance indicators. The assertion made is that key performance indicators can be used to establish benchmarks for evaluation and comparison of the effectiveness and quality of radiation safety programs. Based on over a decade of data collection, and adoption of key performance indicators, this paper demonstrates one way to establish objective benchmarking for radiation safety programs in the health care environment.

Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management: a register study.

PubMed

Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens F; Bek, Toke; la Cour, Morten

2015-09-01

To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The use of citation indicators to identify and support high-quality research in Poland.

PubMed

Pilc, Andrzej

2008-01-01

In large, mostly English-speaking countries, where the "critical mass" of scientists working in different subfields of science is achieved, the peer review system may be sufficient to assess the quality of scientific research. However, in smaller countries, outside the Anglo-American circle, it is important to introduce different systems to identify research of high quality. In Poland, a parametric system for assessing the quality of research has been introduced. It was largely based on the impact factor of scientific journals. While the use of this indicator to assess research quality is highly questionable, the implementation of the system in the Polish reality is even worse. Therefore it is important to change and improve the system currently used by the Ministry of Science and Higher Education to both evaluate and, more importantly, finance science in Poland. Here, a system based on three factors, i.e. the impact factor, the institutional h-index, and the institutional number of citations, is proposed. The scientific quality of institutions in Division VI: Medical Sciences of the Polish Academy of Sciences were evaluated and the results were compared with the existing system. Moreover, a method to identify high-quality researchers and institutions at the national level based on the quantity of highly cited papers is shown. Additionally, an attempt to identify the highest quality Polish research on an international level is proposed. This is based on the number of individual citations, the individual h-index, the number of publications, and the priority of the discovery.

Re-evaluation of peroxide value as an indicator of the quality of edible oils.

PubMed

Shiozawa, Satoshi; Tanaka, Masaharu; Ohno, Katsutoshi; Nagao, Yasuhiro; Yamada, Toshihiro

2007-06-01

The oxidation of oils has important effects on the quality of oily foods, such as instant noodles. In particular, the generation of aldehydes, which accompanies the oxidation of oils, is one of the first factors to reduce food quality. We examined various indicators of oil quality during temperature-accelerated storage and found that peroxide value (POV) was highly correlated with the total concentration of major odorants. Moreover, the correlation of POV with the total concentration of five unsaturated aldehydes (t-2-heptenal, t-2-octenal, t-2-decenal, t-2-undecenal and t,t-2,4-decadienal) that show strong cytotoxicity was greater than the correlation of POV with the total concentration of major odorants. The maximum allowable concentration of the five aldehydes was calculated based on the 'no observed adverse-effect level' of the aldehyde that showed the highest cytotoxicity, t,t-2,4-decadienal, along with the human daily oil intake. We showed that it is useful to utilize POV as an indicator to control food quality and safety.

Application of indices Cp and Cpk to improve quality control capability in clinical biochemistry laboratories.

PubMed

Chen, Ming-Shu; Wu, Ming-Hsun; Lin, Chih-Ming

2014-04-30

The traditional criteria for acceptability of analytic quality may not be objective in clinical laboratories. To establish quality control procedures intended to enhance Westgard multi-rules for improving the quality of clinical biochemistry tests, we applied the Cp and Cpk quality-control indices to monitor tolerance fitting and systematic variation of clinical biochemistry test results. Daily quality-control data of a large Taiwanese hospital in 2009 were analyzed. The test items were selected based on an Olympus biochemistry machine and included serum albumin, aspartate aminotransferase, cholesterol, glucose and potassium levels. Cp and Cpk values were calculated for normal and abnormal levels, respectively. The tolerance range was estimated with data from 50 laboratories using the same instruments and reagents. The results showed a monthly trend of variation for the five items under investigation. The index values of glucose were lower than those of the other items, and their values were usually <2. In contrast to the Cp value for cholesterol, Cpk of cholesterol was lower than 2, indicating a systematic error that should be further investigated. This finding suggests a degree of variation or failure to meet specifications that should be corrected. The study indicated that Cp and Cpk could be applied not only for monitoring variations in quality control, but also for revealing inter-laboratory qualitycontrol capability differences.

Dashboard report on performance on select quality indicators to cancer care providers.

PubMed

Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

2016-01-01

Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

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

PubMed

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

2015-09-08

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

Quality of Life Indicators for Individuals with Intellectual Disabilities: Extending Current Practice

ERIC Educational Resources Information Center

Brown, Ivan; Hatton, Chris; Emerson, Eric

2013-01-01

Quality of life is a social construct that is measured by what are considered to be its most appropriate indicators. Quality of life measurement in intellectual disability reflects a variety of indicators, often grouped under life domains. Subjective and objective methods of measuring indicators each have strengths and drawbacks, but it is…

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed Central

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

2016-01-01

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

Methods of Statistical Control for Groundwater Quality Indicators

NASA Astrophysics Data System (ADS)

Yankovich, E.; Nevidimova, O.; Yankovich, K.

2016-06-01

The article describes the results of conducted groundwater quality control. Controlled quality indicators included the following microelements - barium, manganese, iron, mercury, iodine, chromium, strontium, etc. Quality control charts - X-bar chart and R chart - were built. For the upper and the lower threshold limits, maximum permissible concentration of components in water and the lower limit of their biologically significant concentration, respectively, were selected. The charts analysis has shown that the levels of microelements content in water at the area of study are stable. Most elements in the underground water are contained in concentrations, significant for human organisms consuming the water. For example, such elements as Ba, Mn, Fe have concentrations that exceed maximum permissible levels for drinking water.

Adherence to outpatient epilepsy quality indicators at a tertiary epilepsy center.

PubMed

Pourdeyhimi, R; Wolf, B J; Simpson, A N; Martz, G U

2014-10-01

Quality indicators for the treatment of people with epilepsy were published in 2010. This is the first report of adherence to all measures in routine care of people with epilepsy at a level 4 comprehensive epilepsy center in the US. Two hundred patients with epilepsy were randomly selected from the clinics of our comprehensive epilepsy center, and all visits during 2011 were abstracted for documentation of adherence to the eight quality indicators. Alternative measures were constructed to evaluate failure of adherence. Detailed descriptions of all equations are provided. Objective measures (EEG, imaging) showed higher adherence than counseling measures (safety). Initial visits showed higher adherence. Variations in the interpretation of the quality measure result in different adherence values. Advanced practice providers and physicians had different adherence patterns. No patient-specific patterns of adherence were seen. This is the first report of adherence to all the epilepsy quality indicators for a sample of patients during routine care in a level 4 epilepsy center in the US. Overall adherence was similar to that previously reported on similar measures. Precise definitions of adherence equations are essential for accurate measurement. Complex measures result in lower adherence. Counseling measures showed low adherence, possibly highlighting a difference between practice and documentation. Adherence to the measures as written does not guarantee high quality care. The current quality indicators have value in the process of improving quality of care. Future approaches may be refined to eliminate complex measures and incorporate features linked to outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Instrument Psychometrics: Parental Satisfaction and Quality Indicators of Perinatal Palliative Care.

PubMed

Wool, Charlotte

2015-10-01

Despite a life-limiting fetal diagnosis, prenatal attachment often occurs in varying degrees resulting in role identification by an individual as a parent. Parents recognize quality care and report their satisfaction when interfacing with health care providers. The aim was to test an instrument measuring parental satisfaction and quality indicators with parents electing to continue a pregnancy after learning of a life-limiting fetal diagnosis. A cross sectional survey design gathered data using a computer-mediated platform. Subjects were parents (n=405) who opted to continue a pregnancy affected by a life-limiting diagnosis. Factor analysis using principal component analysis with Varimax rotation was used to validate the instrument, evaluate components, and summarize the explained variance achieved among quality indicator items. The Prenatal Scale was reduced to 37 items with a three-component solution explaining 66.19% of the variance and internal consistency reliability of 0.98. The Intrapartum Scale included 37 items with a four-component solution explaining 66.93% of the variance and a Cronbach α of 0.977. The Postnatal Scale was reduced to 44 items with a six-component solution explaining 67.48% of the variance. Internal consistency reliability was 0.975. The Parental Satisfaction and Quality Indicators of Perinatal Palliative Care Instrument is a valid and reliable measure for parent-reported quality care and satisfaction. Use of this instrument will enable clinicians and researchers to measure quality indicators and parental satisfaction. The instrument is useful for assessing, analyzing, and reporting data on quality for care delivered during the prenatal, intrapartum, and postnatal periods.

Adherence to outpatient epilepsy quality indicators at a tertiary epilepsy center

PubMed Central

Pourdeyhimi, R.; Wolf, B.J.; Simpson, A.N.; Martz, G.U.

2014-01-01

Introduction Quality indicators for the treatment of people with epilepsy were published in 2010. This is the first report of adherence to all measures in routine care of people with epilepsy at a level 4 comprehensive epilepsy center in the US. Methods Two hundred patients with epilepsy were randomly selected from the clinics of our comprehensive epilepsy center, and all visits during 2011 were abstracted for documentation of adherence to the eight quality indicators. Alternative measures were constructed to evaluate failure of adherence. Detailed descriptions of all equations are provided. Results Objective measures (EEG, imaging) showed higher adherence than counseling measures (safety). Initial visits showed higher adherence. Variations in the interpretation of the quality measure result in different adherence values. Advanced practice providers and physicians had different adherence patterns. No patient-specific patterns of adherence were seen. Discussion This is the first report of adherence to all the epilepsy quality indicators for a sample of patients during routine care in a level 4 epilepsy center in the US. Overall adherence was similar to that previously reported on similar measures. Precise definitions of adherence equations are essential for accurate measurement. Complex measures result in lower adherence. Counseling measures showed low adherence, possibly highlighting a difference between practice and documentation. Adherence to the measures as written does not guarantee high quality care. Conclusion The current quality indicators have value in the process of improving quality of care. Future approaches may be refined to eliminate complex measures and incorporate features linked to outcomes. PMID:25171260

Biological indices of soil quality: an ecosystem case study of their use

Treesearch

Jennifer D. Knoepp; David C. Coleman; D.A. Crossley; James S. Clark

2000-01-01

Soil quality indices can help ensure that site productivity and soil function are maintained. Biological indices yield evidence of how a soil functions and interacts with the plants, animals, and climate that comprise an ecosystem. Soil scientists can identify and quantify both chemical and biological soil-quality indicators for ecosystems with a single main function,...

Extra-analytical quality indicators and laboratory performances.

PubMed

Sciacovelli, Laura; Aita, Ada; Plebani, Mario

2017-07-01

In the last few years much progress has been made in raising the awareness of laboratory medicine professionals about the effectiveness of quality indicators (QIs) in monitoring, and improving upon, performances in the extra-analytical phases of the Total Testing Process (TTP). An effective system for management of QIs includes the implementation of an internal assessment system and participation in inter-laboratory comparison. A well-designed internal assessment system allows the identification of critical activities and their systematic monitoring. Active participation in inter-laboratory comparison provides information on the performance level of one laboratory with respect to that of other participating laboratories. In order to guarantee the use of appropriate QIs and facilitate their implementation, many laboratories have adopted the Model of Quality Indicators (MQI) proposed by Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of IFCC, since 2008, which is the result of international consensus and continuous experimentation, and updating to meet new, constantly emerging needs. Data from participating laboratories are collected monthly and reports describing the statistical results and evaluating laboratory data, utilizing the Six Sigma metric, issued regularly. Although the results demonstrate that the processes need to be improved upon, overall the comparison with data collected in 2014 shows a general stability of quality levels and that an improvement has been achieved over time for some activities. The continuous monitoring of QI data allows identification all possible improvements, thus highlighting the value of participation in the inter-laboratory program proposed by WG-LEPS. The active participation of numerous laboratories will guarantee an ever more significant State-of-the-Art, promote the reduction of errors and improve quality of the TTP, thus guaranteeing patient safety. Copyright © 2017. Published by Elsevier Inc.

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

NASA Technical Reports Server (NTRS)

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

2012-01-01

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

Stability of physical activity, fitness components and diet quality indices.

PubMed

Mertens, E; Clarys, P; Mullie, P; Lefevre, J; Charlier, R; Knaeps, S; Huybrechts, I; Deforche, B

2017-04-01

Regular physical activity (PA), a high level of fitness and a high diet quality are positively associated with health. However, information about stability of fitness components and diet quality indices is limited. This study aimed to evaluate stability of those parameters. This study includes 652 adults (men=57.56 (10.28) years; women=55.90 (8.34) years at follow-up) who participated in 2002-2004 and returned for follow-up at the Policy Research Centre Leuven in 2012-2014. Minutes sport per day and Physical activity level (PAL) were calculated from the Flemish Physical Activity Computerized Questionnaire. Cardiorespiratory fitness (CRF), morphological fitness (MORF; body mass index and waist circumference) and metabolic fitness (METF) (blood cholesterol and triglycerides) were used as fitness components. Diet quality indices (Healthy Eating Index-2010 (HEI), Diet Quality Index (DQI), Mediterranean Diet Score (MDS)) were calculated from a diet record. Tracking coefficients were calculated using Pearson/Spearman correlation coefficients (r Pearson ) and intra-class correlation coefficients (r ICC ). In both men (r Pearson&ICC =0.51) and women (r Pearson =0.62 and r ICC =0.60) PAL showed good stability, while minutes sport remained stable in women (r Pearson&ICC =0.57) but less in men (r Pearson&ICC =0.45). Most fitness components remained stable (r⩾0.50) except some METF components in women. In general the diet quality indices and their components were unstable (r<0.50). PAL and the majority of the fitness components remained stable, while diet quality was unstable over 10 years. For unstable parameters such as diet quality measurements are needed at both time points in prospective research.

Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care

PubMed Central

2010-01-01

Background The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators. Objective To present a conceptual framework to develop comprehensive, robust, and transparent composite indicators of pediatric care quality, and to highlight aspects specific to quality measurement in children. Methods We reviewed the scientific literature on composite indicator development, health systems, and quality measurement in the pediatric healthcare setting. Frameworks were selected for explicitness and applicability to a hospital-based measurement system. Results We synthesized various frameworks into a comprehensive model for the development of composite indicators of quality of care. Among its key premises, the model proposes identifying structural, process, and outcome metrics for each of the Institute of Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity) and presents a step-by-step framework for embedding the quality of care measurement model into composite indicator development. Conclusions The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals. PMID:20181129

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

PubMed

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

2009-01-15

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

Indicators for the automated analysis of drug prescribing quality.

PubMed

Coste, J; Séné, B; Milstein, C; Bouée, S; Venot, A

1998-01-01

Irrational and inconsistent drug prescription has considerable impact on morbidity, mortality, health service utilization, and community burden. However, few studies have addressed the methodology of processing the information contained in these drug orders used to study the quality of drug prescriptions and prescriber behavior. We present a comprehensive set of quantitative indicators for the quality of drug prescriptions which can be derived from a drug order. These indicators were constructed using explicit a priori criteria which were previously validated on the basis of scientific data. Automatic computation is straightforward, using a relational database system, such that large sets of prescriptions can be processed with minimal human effort. We illustrate the feasibility and value of this approach by using a large set of 23,000 prescriptions for several diseases, selected from a nationally representative prescriptions database. Our study may result in direct and wide applications in the epidemiology of medical practice and in quality control procedures.

Toward the Next Generation of Air Quality Monitoring Indicators

NASA Technical Reports Server (NTRS)

Hsu, Angel; Reuben, Aaron; Shindell, Drew; deSherbinin, Alex; Levy, Marc

2013-01-01

This paper introduces an initiative to bridge the state of scientific knowledge on air pollution with the needs of policymakers and stakeholders to design the "next generation" of air quality indicators. As a first step this initiative assesses current monitoring and modeling associated with a number of important pollutants with an eye toward identifying knowledge gaps and scientific needs that are a barrier to reducing air pollution impacts on human and ecosystem health across the globe. Four outdoor air pollutants were considered e particulate matter, ozone, mercury, and Persistent Organic Pollutants (POPs) e because of their clear adverse impacts on human and ecosystem health and because of the availability of baseline data for assessment for each. While other papers appearing in this issue will address each pollutant separately, this paper serves as a summary of the initiative and presents recommendations for needed investments to provide improved measurement, monitoring, and modeling data for policyrelevant indicators. The ultimate goal of this effort is to enable enhanced public policy responses to air pollution by linking improved data and measurement methods to decision-making through the development of indicators that can allow policymakers to better understand the impacts of air pollution and, along with source attribution based on modeling and measurements, facilitate improved policies to solve it. The development of indicators represents a crucial next step in this process.

A Perceptually Weighted Rank Correlation Indicator for Objective Image Quality Assessment

NASA Astrophysics Data System (ADS)

Wu, Qingbo; Li, Hongliang; Meng, Fanman; Ngan, King N.

2018-05-01

In the field of objective image quality assessment (IQA), the Spearman's $\\rho$ and Kendall's $\\tau$ are two most popular rank correlation indicators, which straightforwardly assign uniform weight to all quality levels and assume each pair of images are sortable. They are successful for measuring the average accuracy of an IQA metric in ranking multiple processed images. However, two important perceptual properties are ignored by them as well. Firstly, the sorting accuracy (SA) of high quality images are usually more important than the poor quality ones in many real world applications, where only the top-ranked images would be pushed to the users. Secondly, due to the subjective uncertainty in making judgement, two perceptually similar images are usually hardly sortable, whose ranks do not contribute to the evaluation of an IQA metric. To more accurately compare different IQA algorithms, we explore a perceptually weighted rank correlation indicator in this paper, which rewards the capability of correctly ranking high quality images, and suppresses the attention towards insensitive rank mistakes. More specifically, we focus on activating `valid' pairwise comparison towards image quality, whose difference exceeds a given sensory threshold (ST). Meanwhile, each image pair is assigned an unique weight, which is determined by both the quality level and rank deviation. By modifying the perception threshold, we can illustrate the sorting accuracy with a more sophisticated SA-ST curve, rather than a single rank correlation coefficient. The proposed indicator offers a new insight for interpreting visual perception behaviors. Furthermore, the applicability of our indicator is validated in recommending robust IQA metrics for both the degraded and enhanced image data.

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

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

PubMed

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

2014-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2005-04-01

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

[Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].

PubMed

Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

2011-01-01

Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.

A 2-1-1 research collaboration: participant accrual and service quality indicators.

PubMed

Eddens, Katherine S; Alcaraz, Kassandra I; Kreuter, Matthew W; Rath, Suchitra; Greer, Regina

2012-12-01

In times of crises, 2-1-1 serves as a lifeline in many ways. These crises often cause a spike in call volume that can challenge 2-1-1's ability to meet its service quality standards. For researchers gathering data through 2-1-1s, a sudden increase in call volume might reduce accrual as 2-1-1 has less time to administer study protocols. Research activities imbedded in 2-1-1 systems may affect directly 2-1-1 service quality indicators. Using data from a 2-1-1 research collaboration, this paper examines the impact of crises on call volume to 2-1-1, how call volume affects research participant accrual through 2-1-1, and how research recruitment efforts affect 2-1-1 service quality indicators. t-tests were used to examine the effect of call volume on research participant accrual. Linear and logistic regressions were used to examine the effect of research participant accrual on 2-1-1 service quality indicators. Data were collected June 2010-December 2011; data were analyzed in 2012. Findings from this collaboration suggest that crises causing spikes in call volume adversely affect 2-1-1 service quality indicators as well as accrual of research participants. Administering a brief (2-3 minute) health risk assessment did not affect service quality negatively, but administering a longer (15-18 minute) survey had a modest adverse effect on these indicators. In 2-1-1 research collaborations, both partners need to understand the dynamic relationship among call volume, research accrual, and service quality and adjust expectations accordingly. If research goals include administering a longer survey, increased staffing of 2-1-1 call centers may be needed to avoid compromising service quality. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Using Aquatic Insects as Indicators of Water Quality

ERIC Educational Resources Information Center

Dyche, Steven E.

1977-01-01

Described is a science field activity that studies the presence of certain aquatic insects, like stoneflies, as indicators of water quality. Equipment, materials, and methods are listed in detail, including suggestions for building certain supplies. Results of previous studies on the Yellowstone River are included. (MA)

Methodology for analyzing environmental quality indicators in a dynamic operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard W; Wagner, Jennifer; Greeley, Damon; Clarke, James H; Abkowitz, Mark; Ostojic, John

2017-04-01

Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m 3 at the sterile field and 5-27 CFU/m 3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical

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

PubMed

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

2013-09-01

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

Social Indicators Research and Health-Related Quality of Life Research.

ERIC Educational Resources Information Center

Michalos, Alex C.

2004-01-01

The aim of this essay is to build a bridge between two intersecting areas of research, social indicators research on the one hand and health-related quality of life research on the other. The first substantive section of the paper introduces key concepts and definitions in the social indicators research tradition, e.g., social indicators,…

[Indicators of healthcare quality in day surgery (2010-2012)].

PubMed

Martínez Rodenas, F; Codina Grifell, J; Deulofeu Quintana, P; Garrido Corchón, J; Blasco Casares, F; Gibanel Garanto, X; Cuixart Vilamajó, L; de Haro Licer, J; Vazquez Dorrego, X

2014-01-01

Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Quality indicators for Transfusion Medicine in Spain: a survey among hospital transfusion services.

PubMed

Romon, Iñigo; Lozano, Miguel

2017-05-01

Transfusion services in the European Union must implement quality management systems to improve quality. Quality indicators (QI) play a key role in quality management because they can supply important information about the performance of the transfusion service, which can then be used for benchmarking. However, little is known about the actual use of QI in hospitals. We tried to ascertain the use and characteristics of QI in Spanish hospital transfusion services. We performed a survey among transfusion services in order to learn which QI they use. We classified indicators into categories and concepts, according to the steps of the transfusion process or the activities the indicators referred to. Seventy-six hospitals (17.9% of the hospitals actively transfusing in the country) reported 731 QI. Twenty-two of them (29%) were tertiary level hospitals. The number of indicators per hospital and by activity varied greatly. QI were assigned to some basic categories: transfusion process (23% of indicators), transfusion activity and stock management (22%), haemovigilance (20%), stem cell transplantation (9%), transfusion laboratory (9%), quality management system (8%), blood donation (3.4%), apheresis and therapeutic activities (2.5%) and immunohaematology of pregnancy (2%). Although most hospitals use QI in their quality management system and share a core group of indicators, we found a great dispersion in the number and characteristics of the indicators used. The use of a commonly agreed set of QI could be an aid to benchmarking among hospitals and to improving the transfusion process.

An empirical comparison of key statistical attributes among potential ICU quality indicators.

PubMed

Brown, Sydney E S; Ratcliffe, Sarah J; Halpern, Scott D

2014-08-01

Good quality indicators should have face validity, relevance to patients, and be able to be measured reliably. Beyond these general requirements, good quality indicators should also have certain statistical properties, including sufficient variability to identify poor performers, relative insensitivity to severity adjustment, and the ability to capture what providers do rather than patients' characteristics. We assessed the performance of candidate indicators of ICU quality on these criteria. Indicators included ICU readmission, mortality, several length of stay outcomes, and the processes of venous-thromboembolism and stress ulcer prophylaxis provision. Retrospective cohort study. One hundred thirty-eight U.S. ICUs from 2001-2008 in the Project IMPACT database. Two hundred sixty-eight thousand eight hundred twenty-four patients discharged from U.S. ICUs. None. We assessed indicators' (1) variability across ICU-years; (2) degree of influence by patient vs. ICU and hospital characteristics using the Omega statistic; (3) sensitivity to severity adjustment by comparing the area under the receiver operating characteristic curve (AUC) between models including vs. excluding patient variables, and (4) correlation between risk adjusted quality indicators using a Spearman correlation. Large ranges of among-ICU variability were noted for all quality indicators, particularly for prolonged length of stay (4.7-71.3%) and the proportion of patients discharged home (30.6-82.0%), and ICU and hospital characteristics outweighed patient characteristics for stress ulcer prophylaxis (ω, 0.43; 95% CI, 0.34-0.54), venous thromboembolism prophylaxis (ω, 0.57; 95% CI, 0.53-0.61), and ICU readmissions (ω, 0.69; 95% CI, 0.52-0.90). Mortality measures were the most sensitive to severity adjustment (area under the receiver operating characteristic curve % difference, 29.6%); process measures were the least sensitive (area under the receiver operating characteristic curve % differences

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

PubMed

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

2014-03-01

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

Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

PubMed

Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

2016-08-01

Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided

Evaluation of multiple water quality indices for drinking and irrigation purposes for the Karoon river, Iran.

PubMed

Aminiyan, Milad Mirzaei; Aitkenhead-Peterson, Jacqueline; Aminiyan, Farzad Mirzaei

2018-06-16

The main purpose of this study was to evaluate the water quality of the Karoon river, which is a main river in Iran country. For this purpose, hydrochemical analyses of a database that maintained by the Water Resources Authority of Khuzestan Province, Iran's Ministry of Energy, were carried out. These data were compared with the maximum permissible limit values recommended by World Health Organization and Food and Agriculture Organization water standards for drinking and agricultural purposes, respectively. Also in this regard, multiple indices of water quality were utilized. However, not all indices gave similar rankings for water quality. According to the USSL diagram and Kelly ratio, Karoon's water quality is not suitable for irrigation purposes due to high salinity and moderate alkalinity. However, the results of the magnesium hazard analysis suggested that water quality for irrigation is acceptable. A Piper diagram illustrated that the most dominant water types during the 15 years of the study were Na-Cl and Na-SO 4 . The mineral saturation index also indicated that Na-Cl is the dominant water type. The water quality for drinking purpose was evaluated using a Schoeller diagram and water quality index (WQI). According to the computed WQI ranging from 111.9 to 194.0, the Karoon's water in the Khuzestan plain can be categorized as "poor water" for drinking purposes. Based on hydrochemical characteristics, years 2000-2007 and 2008-2014 were categorized into two clusters illustrating a decline in water quality between the two time periods.

Indicators of quality of antenatal care: a pilot study.

PubMed

Vause, S; Maresh, M

1999-03-01

To pilot a list of indicators of quality of antenatal care across a range of maternity care settings. For each indicator to determine what is achieved in current clinical practice, to facilitate the setting of audit standards and calculation of appropriate sample sizes for audit. A multicentre retrospective observational study. Nine maternity units in the United Kingdom. 20,771 women with a singleton pregnancy, who were delivered between 1 August 1994 and 31 July 1995. Nine of the eleven suggested indicators were successfully piloted. Two indicators require further development. In seven of the nine hospitals external cephalic version was not commonly performed. There were wide variations in the proportions of women screened for asymptomatic bacteriuria. Screening of women from ethnic minorities for haemoglobinopathy was more likely in hospitals with a large proportion of non-caucasian women. A large number of Rhesus negative women did not have a Rhesus antibody check performed after 28 weeks of gestation and did not receive anti-D immunoglobulin after a potentially sensitising event during pregnancy. As a result of the study appropriate sample sizes for future audit could be calculated. Measuring the extent to which evidence-based interventions are used in routine clinical practice provides a more detailed picture of the strengths and weaknesses in an antenatal service than traditional outcomes such as perinatal mortality rates. Awareness of an appropriate sample size should prevent waste of time and resources on inconclusive audits.

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

PubMed

Aden, Bile; Allekotte, Silke; Mösges, Ralph

2016-12-01

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

Identification of sensitive indicators to assess the interrelationship between soil quality, management practices and human health

NASA Astrophysics Data System (ADS)

Zornoza, R.; Acosta, J. A.; Bastida, F.; Domínguez, S. G.; Toledo, D. M.; Faz, A.

2014-09-01

Soil quality (SQ) assessment has been a challenging issue since soils present high variability in properties and functions. This paper aims to increase understanding of SQ through review of SQ assessments in different scenarios providing evidence about the interrelationship between SQ, land use and human health. There is a general consensus that there is a need to develop methods to assess and monitor SQ for assuring sustainable land use with no prejudicial effects on human health. This review points out the importance of adopting indicators of different nature (physical, chemical and biological) to achieve a holistic image of SQ. Most authors use single indicators to assess SQ and its relationship with land uses, being the most used indicators soil organic carbon and pH. The use of nitrogen and nutrients content has resulted sensitive for agricultural and forest systems, together with physical properties such as texture, bulk density, available water and aggregate stability. These physical indicators have also been widely used to assess SQ after land use changes. The use of biological indicators is less generalized, being microbial biomass and enzyme activities the most selected indicators. Although most authors assess SQ using independent indicators, it is preferable to combine some of them into models to create a soil quality index (SQI), since it provides integrated information about soil processes and functioning. The majority of revised articles used the same methodology to establish a SQI, based on scoring and weighting of different soil indicators, selected by multivariate analyses. The use of multiple linear regressions has been successfully used under forest land use. Urban soil quality has been poorly assessed, with lack of adoption of SQIs. In addition, SQ assessments were human health indicators or exposure pathways are incorporated are practically inexistent. Thus, new efforts should be carried out to establish new methodologies not only to assess

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

PubMed

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

2017-10-01

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

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

PubMed

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

2015-06-01

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

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

NASA Astrophysics Data System (ADS)

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

2017-11-01

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

A test of vegetation-related indicators of wetland quality in the prairie pothole region

USGS Publications Warehouse

Kantrud, H.A.; Newton, W.E.

1996-01-01

This study was part of an effort by the U.S. Environmental Protection Agency to quantitatively assess the environmental quality or 'health' of wetland resources on regional and national scales. During a two-year pilot study, we tested selected indicators of wetland quality in the U.S. portion of the prairie pothole region (PPR). We assumed that the amount of cropland versus non-cropland (mostly grassland) in the plots containing these basins was a proxy for their quality. We then tested indicators by their ability to discriminate between wetlands at the extremes of that proxy. Amounts of standing dead vegetation were greater in zones of greater water permanence. Depth of litter was greater in zones of greater water permanence and in zones of basins in poor-quality watersheds. Amounts of unvegetated bottom were greater in basins in poor-quality watersheds; lesser amounts occurred in all wetlands during a wetter year. Greater amounts of open water occurred during a wetter year and in zones of greater water permanence. When unadjusted for areas (ha) of communities, plant taxon richness was higher in wet-meadow and shallow-marsh zones in good-quality watersheds than in similar zones in poor-quality watersheds. Wet-meadow zones in good-quality watersheds had greater numbers of native perennials than those in poor-quality watersheds. This relation held when we eliminated all communities in good-quality watersheds larger than the largest communities in poor-quality watersheds from the data set. We conclude that although amounts of unvegetated bottom and plant taxon richness in wet-meadow zones were useful indicators of wetland quality during our study, the search for additional such indicators should continue. The value of these indicators may change with the notoriously unstable hydrological conditions in the PPR. Most valuable would be indicators that could be photographed or otherwise remotely sensed and would remain relatively stable under various hydrological

MEASURING BASE-FLOW CHEMISTRY AS AN INDICATOR OF REGIONAL GROUND-WATER QUALITY IN THE MID-ATLANTIC COASTAL PLAIN

EPA Science Inventory

Water quality in headwater (first-order) streams of the Mid-Atlantic Coastal Plain during base flow in the winter and spring is related to land use, hydrogeology, and other natural and human influences. A random survey of water quality in 174 headwater streams in the Mid-Atlantic...

Identifying unintended consequences of quality indicators: a qualitative study.

PubMed

Lester, Helen E; Hannon, Kerin L; Campbell, Stephen M

2011-12-01

For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper describes an in-depth exploration of family physician, nurse and other primary-care practice staff views of the value of piloting with a particular focus on unintended consequences of 13 potential new QOF indicators. Fifty-seven family-practice professionals were interviewed in 24 representative practices across England. Almost all interviewees emphasised the value of piloting in terms of an opportunity to identify unintended consequences of potential QOF indicators in 'real world' settings with staff who deliver day-to-day care to patients. Four particular types of unintended consequences were identified: measure fixation, tunnel vision, misinterpretation and potential gaming. 'Measure fixation,' an inappropriate attention on isolated aspects of care, appeared to be the key unintended consequence. In particular, if the palliative care indicator had been introduced without piloting, this might have incentivised poorer care in a minority of practices with potential harm to vulnerable patients. It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150,000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money.

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

PubMed

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

2017-05-16

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

Faculty Perceptions of Online Teaching Effectiveness and Indicators of Quality.

PubMed

Frazer, Christine; Sullivan, Debra Henline; Weatherspoon, Deborah; Hussey, Leslie

2017-01-01

Online education programs in nursing are increasing rapidly. Faculty need to be competent in their role and possess the skills necessary to positively impact student outcomes. Existing research offers effective teaching strategies for online education; however, there may be some disconnect in the application of these strategies and faculty perceptions of associated outcomes. Focus groups were formed to uncover how nursing faculty in an online program define and describe teaching effectiveness and quality indicators in an asynchronous online environment. A semistructured interview format guided group discussion. Participants ( n = 11) included nurse educators from an online university with an average of 15 years of experience teaching in nursing academia and 6 years in an online environment. Teaching effectiveness, indicators of quality, and student success were three categories that emerged from the analysis of data. What materialized from the analysis was an overarching concept of a "dance" that occurs in the online environment. Effective online teachers facilitate, connect, lead, and work in synchrony with students to obtain indicators of quality such as student success, student improvement over time, and student application of knowledge to the professional role.

Faculty Perceptions of Online Teaching Effectiveness and Indicators of Quality

PubMed Central

Sullivan, Debra Henline; Weatherspoon, Deborah; Hussey, Leslie

2017-01-01

Online education programs in nursing are increasing rapidly. Faculty need to be competent in their role and possess the skills necessary to positively impact student outcomes. Existing research offers effective teaching strategies for online education; however, there may be some disconnect in the application of these strategies and faculty perceptions of associated outcomes. Focus groups were formed to uncover how nursing faculty in an online program define and describe teaching effectiveness and quality indicators in an asynchronous online environment. A semistructured interview format guided group discussion. Participants (n = 11) included nurse educators from an online university with an average of 15 years of experience teaching in nursing academia and 6 years in an online environment. Teaching effectiveness, indicators of quality, and student success were three categories that emerged from the analysis of data. What materialized from the analysis was an overarching concept of a “dance” that occurs in the online environment. Effective online teachers facilitate, connect, lead, and work in synchrony with students to obtain indicators of quality such as student success, student improvement over time, and student application of knowledge to the professional role. PMID:28326195

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

PubMed

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

2015-11-01

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

The Global Streamflow Indices and Metadata Archive (GSIM) - Part 2: Quality control, time-series indices and homogeneity assessment

NASA Astrophysics Data System (ADS)

Gudmundsson, Lukas; Do, Hong Xuan; Leonard, Michael; Westra, Seth

2018-04-01

This is Part 2 of a two-paper series presenting the Global Streamflow Indices and Metadata Archive (GSIM), which is a collection of daily streamflow observations at more than 30 000 stations around the world. While Part 1 (Do et al., 2018a) describes the data collection process as well as the generation of auxiliary catchment data (e.g. catchment boundary, land cover, mean climate), Part 2 introduces a set of quality controlled time-series indices representing (i) the water balance, (ii) the seasonal cycle, (iii) low flows and (iv) floods. To this end we first consider the quality of individual daily records using a combination of quality flags from data providers and automated screening methods. Subsequently, streamflow time-series indices are computed for yearly, seasonal and monthly resolution. The paper provides a generalized assessment of the homogeneity of all generated streamflow time-series indices, which can be used to select time series that are suitable for a specific task. The newly generated global set of streamflow time-series indices is made freely available with an digital object identifier at https://doi.pangaea.de/10.1594/PANGAEA.887470 and is expected to foster global freshwater research, by acting as a ground truth for model validation or as a basis for assessing the role of human impacts on the terrestrial water cycle. It is hoped that a renewed interest in streamflow data at the global scale will foster efforts in the systematic assessment of data quality and provide momentum to overcome administrative barriers that lead to inconsistencies in global collections of relevant hydrological observations.

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

EPA Science Inventory

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

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

PubMed

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

2016-12-01

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

Marital-role quality and stress-related psychobiological indicators.

PubMed

Barnett, Rosalind Chait; Steptoe, Andrew; Gareis, Karen C

2005-08-01

The quality of one's marital relationship is gaining recognition as a potential stressor associated with negative health outcomes. In this study, we estimated the relationship between marital-role quality and three psychobiological stress indicators (self-reported stress, cortisol levels, and ambulatory blood pressure). Participants were 105 middle-age adults (67 men, 38 women) who had previously taken part in the Whitehall psychobiology study. Ambulatory monitoring and saliva sampling were carried out over a working day, and marital relationships were assessed with the Marital/Partner Role Quality scales. We found that marital-role concerns (but not marital-role rewards) were related to all three psychobiological stress indicators; results did not vary by gender. Specifically, participants with more marital concerns reported greater stress throughout the day (p=.014), showed an attenuated cortisol increase following waking (p=.042) and a flatter cortisol slope over the day (p=.010), and had elevated ambulatory diastolic blood pressure over the middle of the workday (p=.004), with a similar trend in systolic pressure (p=.069). The results suggest that in addition to the carryover of work stress into domestic life that has been evident for many years, there are also influences of domestic strain on biological function over the working day and evening. Previous research suggests that a possible mechanism linking troubled marriages to health outcomes is depressed immune functioning. This study suggests a second mechanism-poorer stress-related biological response.

Process quality indicators in family medicine: results of an international comparison.

PubMed

Pavlič, Danica Rotar; Sever, Maja; Klemenc-Ketiš, Zalika; Švab, Igor

2015-12-02

The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care. The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level. None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation. A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians' characteristics.

Machine-Learning Based Channel Quality and Stability Estimation for Stream-Based Multichannel Wireless Sensor Networks.

PubMed

Rehan, Waqas; Fischer, Stefan; Rehan, Maaz

2016-09-12

Wireless sensor networks (WSNs) have become more and more diversified and are today able to also support high data rate applications, such as multimedia. In this case, per-packet channel handshaking/switching may result in inducing additional overheads, such as energy consumption, delays and, therefore, data loss. One of the solutions is to perform stream-based channel allocation where channel handshaking is performed once before transmitting the whole data stream. Deciding stream-based channel allocation is more critical in case of multichannel WSNs where channels of different quality/stability are available and the wish for high performance requires sensor nodes to switch to the best among the available channels. In this work, we will focus on devising mechanisms that perform channel quality/stability estimation in order to improve the accommodation of stream-based communication in multichannel wireless sensor networks. For performing channel quality assessment, we have formulated a composite metric, which we call channel rank measurement (CRM), that can demarcate channels into good, intermediate and bad quality on the basis of the standard deviation of the received signal strength indicator (RSSI) and the average of the link quality indicator (LQI) of the received packets. CRM is then used to generate a data set for training a supervised machine learning-based algorithm (which we call Normal Equation based Channel quality prediction (NEC) algorithm) in such a way that it may perform instantaneous channel rank estimation of any channel. Subsequently, two robust extensions of the NEC algorithm are proposed (which we call Normal Equation based Weighted Moving Average Channel quality prediction (NEWMAC) algorithm and Normal Equation based Aggregate Maturity Criteria with Beta Tracking based Channel weight prediction (NEAMCBTC) algorithm), that can perform channel quality estimation on the basis of both current and past values of channel rank estimation. In the end

Machine-Learning Based Channel Quality and Stability Estimation for Stream-Based Multichannel Wireless Sensor Networks

PubMed Central

Rehan, Waqas; Fischer, Stefan; Rehan, Maaz

2016-01-01

Wireless sensor networks (WSNs) have become more and more diversified and are today able to also support high data rate applications, such as multimedia. In this case, per-packet channel handshaking/switching may result in inducing additional overheads, such as energy consumption, delays and, therefore, data loss. One of the solutions is to perform stream-based channel allocation where channel handshaking is performed once before transmitting the whole data stream. Deciding stream-based channel allocation is more critical in case of multichannel WSNs where channels of different quality/stability are available and the wish for high performance requires sensor nodes to switch to the best among the available channels. In this work, we will focus on devising mechanisms that perform channel quality/stability estimation in order to improve the accommodation of stream-based communication in multichannel wireless sensor networks. For performing channel quality assessment, we have formulated a composite metric, which we call channel rank measurement (CRM), that can demarcate channels into good, intermediate and bad quality on the basis of the standard deviation of the received signal strength indicator (RSSI) and the average of the link quality indicator (LQI) of the received packets. CRM is then used to generate a data set for training a supervised machine learning-based algorithm (which we call Normal Equation based Channel quality prediction (NEC) algorithm) in such a way that it may perform instantaneous channel rank estimation of any channel. Subsequently, two robust extensions of the NEC algorithm are proposed (which we call Normal Equation based Weighted Moving Average Channel quality prediction (NEWMAC) algorithm and Normal Equation based Aggregate Maturity Criteria with Beta Tracking based Channel weight prediction (NEAMCBTC) algorithm), that can perform channel quality estimation on the basis of both current and past values of channel rank estimation. In the end

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2017-09-22

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

Work-Experience and Work-Study Programs for Students with Special Needs: Quality Indicators of Transition Services.

ERIC Educational Resources Information Center

Wisniewski, Lech A.; And Others

1991-01-01

This article proposes a continuum of employment training options for students with special needs and identifies program quality indicators in the areas of assessment and the Individual Education Plan; the employment training program; community-based settings; provisions for on-site training and evaluation; and interagency cooperation. (DB)

Survey of quality indicators in commercial dehydrated fruits.

PubMed

Megías-Pérez, Roberto; Gamboa-Santos, Juliana; Soria, Ana Cristina; Villamiel, Mar; Montilla, Antonia

2014-05-01

Physical and chemical quality parameters (dry matter, aw, protein, carbohydrates, vitamin C, 2-furoylmethyl amino acids, rehydration ratio and leaching loss) have been determined in 30 commercial dehydrated fruits (strawberry, blueberry, raspberry, cranberry, cherry, apple, grapefruit, mango, kiwifruit, pineapple, melon, coconut, banana and papaya). For comparison purposes, strawberry samples processed in the laboratory by freeze-drying and by convective drying were used as control samples. Overall quality of dehydrated fruits seemed to be greatly dependent on processing conditions and, in a cluster analysis, samples which were presumably subjected to osmotic dehydration were separated from the rest of fruits. These samples presented the lowest concentration of vitamin C and the highest evolution of Maillard reaction, as evidenced by its high concentration of 2-furoylmethyl amino acids. This is the first study on the usefulness of this combination of chemical and physical indicators to assess the overall quality of commercial dehydrated fruits. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

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

2018-02-01

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

Identification of sensitive indicators to assess the interrelationship between soil quality, management practices and human health

NASA Astrophysics Data System (ADS)

Zornoza, R.; Acosta, J. A.; Bastida, F.; Domínguez, S. G.; Toledo, D. M.; Faz, A.

2015-02-01

Soil quality (SQ) assessment has long been a challenging issue, since soils present high variability in properties and functions. This paper aims to increase the understanding of SQ through the review of SQ assessments in different scenarios providing evidence about the interrelationship between SQ, land use and human health. There is a general consensus that there is a need to develop methods to assess and monitor SQ for assuring sustainable land use with no prejudicial effects on human health. This review points out the importance of adopting indicators of different nature (physical, chemical and biological) to achieve a holistic image of SQ. Most authors use single indicators to assess SQ and its relationship with land uses - soil organic carbon and pH being the most used indicators. The use of nitrogen and nutrient content has resulted sensitive for agricultural and forest systems, together with physical properties such as texture, bulk density, available water and aggregate stability. These physical indicators have also been widely used to assess SQ after land use changes. The use of biological indicators is less generalized, with microbial biomass and enzyme activities being the most selected indicators. Although most authors assess SQ using independent indicators, it is preferable to combine some of them into models to create a soil quality index (SQI), since it provides integrated information about soil processes and functioning. The majority of revised articles used the same methodology to establish an SQI, based on scoring and weighting of different soil indicators, selected by means of multivariate analyses. The use of multiple linear regressions has been successfully used for forest land use. Urban soil quality has been poorly assessed, with a lack of adoption of SQIs. In addition, SQ assessments where human health indicators or exposure pathways are incorporated are practically inexistent. Thus, further efforts should be carried out to establish new

Quality indicators for blogs and podcasts used in medical education: modified Delphi consensus recommendations by an international cohort of health professions educators.

PubMed

Lin, Michelle; Thoma, Brent; Trueger, N Seth; Ankel, Felix; Sherbino, Jonathan; Chan, Teresa

2015-10-01

Quality assurance concerns about social media platforms used for education have arisen within the medical education community. As more trainees and clinicians use resources such as blogs and podcasts for learning, we aimed to identify quality indicators for these resources. A previous study identified 151 potentially relevant quality indicators for these social media resources. To identify quality markers for blogs and podcasts using an international cohort of health professions educators. A self-selected group of 44 health professions educators at the 2014 International Conference on Residency Education participated in a Social Media Summit during which a modified Delphi consensus study was conducted to determine which of the 151 quality indicators met the a priori ≥90% inclusion threshold. Thirteen quality indicators classified into the domains of credibility (n=8), content (n=4) and design (n=1) met the inclusion threshold. The quality indicators that were identified may serve as a foundation for further research on quality indicators of social media-based medical education resources and prompt discussion of their legitimacy as a form of educational scholarship. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Assessing groundwater quality for irrigation using indicator kriging method

NASA Astrophysics Data System (ADS)

Delbari, Masoomeh; Amiri, Meysam; Motlagh, Masoud Bahraini

2016-11-01

One of the key parameters influencing sprinkler irrigation performance is water quality. In this study, the spatial variability of groundwater quality parameters (EC, SAR, Na+, Cl-, HCO3 - and pH) was investigated by geostatistical methods and the most suitable areas for implementation of sprinkler irrigation systems in terms of water quality are determined. The study was performed in Fasa county of Fars province using 91 water samples. Results indicated that all parameters are moderately to strongly spatially correlated over the study area. The spatial distribution of pH and HCO3 - was mapped using ordinary kriging. The probability of concentrations of EC, SAR, Na+ and Cl- exceeding a threshold limit in groundwater was obtained using indicator kriging (IK). The experimental indicator semivariograms were often fitted well by a spherical model for SAR, EC, Na+ and Cl-. For HCO3 - and pH, an exponential model was fitted to the experimental semivariograms. Probability maps showed that the risk of EC, SAR, Na+ and Cl- exceeding the given critical threshold is higher in lower half of the study area. The most proper agricultural lands for sprinkler irrigation implementation were identified by evaluating all probability maps. The suitable areas for sprinkler irrigation design were determined to be 25,240 hectares, which is about 34 percent of total agricultural lands and are located in northern and eastern parts. Overall the results of this study showed that IK is an appropriate approach for risk assessment of groundwater pollution, which is useful for a proper groundwater resources management.

Study on an Air Quality Evaluation Model for Beijing City Under Haze-Fog Pollution Based on New Ambient Air Quality Standards

PubMed Central

Li, Li; Liu, Dong-Jun

2014-01-01

Since 2012, China has been facing haze-fog weather conditions, and haze-fog pollution and PM2.5 have become hot topics. It is very necessary to evaluate and analyze the ecological status of the air environment of China, which is of great significance for environmental protection measures. In this study the current situation of haze-fog pollution in China was analyzed first, and the new Ambient Air Quality Standards were introduced. For the issue of air quality evaluation, a comprehensive evaluation model based on an entropy weighting method and nearest neighbor method was developed. The entropy weighting method was used to determine the weights of indicators, and the nearest neighbor method was utilized to evaluate the air quality levels. Then the comprehensive evaluation model was applied into the practical evaluation problems of air quality in Beijing to analyze the haze-fog pollution. Two simulation experiments were implemented in this study. One experiment included the indicator of PM2.5 and was carried out based on the new Ambient Air Quality Standards (GB 3095-2012); the other experiment excluded PM2.5 and was carried out based on the old Ambient Air Quality Standards (GB 3095-1996). Their results were compared, and the simulation results showed that PM2.5 was an important indicator for air quality and the evaluation results of the new Air Quality Standards were more scientific than the old ones. The haze-fog pollution situation in Beijing City was also analyzed based on these results, and the corresponding management measures were suggested. PMID:25170682

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

PubMed

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

2018-06-01

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

A literature review of quantitative indicators to measure the quality of labor and delivery care.

PubMed

Tripathi, Vandana

2016-02-01

Strengthening measurement of the quality of labor and delivery (L&D) care in low-resource countries requires an understanding of existing approaches. To identify quantitative indicators of L&D care quality and assess gaps in indicators. PubMed, CINAHL Plus, and Embase databases were searched for research published in English between January 1, 1990, and October 31, 2013, using structured terms. Studies describing indicators for L&D care quality assessment were included. Those whose abstracts contained inclusion criteria underwent full-text review. Study characteristics, including indicator selection and data sources, were extracted via a standard spreadsheet. The structured search identified 1224 studies. After abstract and full-text review, 477 were included in the analysis. Most studies selected indicators by using literature review, clinical guidelines, or expert panels. Few indicators were empirically validated; most studies relied on medical record review to measure indicators. Many quantitative indicators have been used to measure L&D care quality, but few have been validated beyond expert opinion. There has been limited use of clinical observation in quality assessment of care processes. The findings suggest the need for validated, efficient consensus indicators of the quality of L&D care processes, particularly in low-resource countries. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Escherichia coli and fecal-coliform bacteria as indicators of recreational water quality

USGS Publications Warehouse

Francy, D.S.; Myers, Donna N.; Metzker, K.D.

1993-01-01

-regression analysis and analysis of covariance. Log-transformed E. coli and fecal-coliform concentrations were highly correlated in all data sets (r-values ranged from 0.929 to 0.984). Linear regression analysis on USGS and ORSANCO data sets showed that concentration of E. coli could be predicted from fecal-coliform concentration (coefficients of determination (R2) ranged from 0.863 to 0.970). Results of analysis of covariance (ANCOVA) indicated that the predictive equations among the three USGS data sets and two ORSANCO data sets were not significantly different and that the data could be pooled into two large data sets, one for USGS data and one for ORSANCO data. However, results of ANCOVA indicated that USGS and ORSANCO data could not be pooled into one large data set. Predictions of E. coli concentrations calculated for USGS And ORSANCO regression relations, based on fecal-coliform concentrations set to equal Ohio water-quality standards, further showed the differences in E. coli to fecal-coliform relations among data sets. For USGS data, a predicted geometric mean of 176 col/100 mL (number of colonies per 100 milliliters) was greater than the current geometric-mean E. coli standard for bathing water of 126 col/100mL. In contrast, for ORSANCO data, the predicted geometric mean of 101 col/100 mL was less than the current E. coli standard. The risk of illness associated with predicted E. coli concentrations for USGS and ORSANCO data was evaluated by use of the USEPA regression equation that predicts swimming-related gastroenteritis rates from E. coli concentrations.1 The predicted geometric-mean E. coli concentrations for bathing water of 176 col/100 mL for USGS data and 101 col/100 mL for ORSANCO data would allow 9.4 and 7.1 gastrointestinal illnesses per 1,000 swimmers, respectively. This prediction compares well with the illness rate of 8 individuals per 1,000 swimmers estimated by the USEPA for an E. coli concentration of 126 col/100 mL. Therefore, the

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

PubMed

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

2008-08-01

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

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

PubMed

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

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

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

PubMed

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

2014-04-01

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

Indicators to support the dynamic evaluation of air quality models

NASA Astrophysics Data System (ADS)

Thunis, P.; Clappier, A.

2014-12-01

Air quality models are useful tools for the assessment and forecast of pollutant concentrations in the atmosphere. Most of the evaluation process relies on the “operational phase” or in other words the comparison of model results with available measurements which provides insight on the model capability to reproduce measured concentrations for a given application. But one of the key advantages of air quality models lies in their ability to assess the impact of precursor emission reductions on air quality levels. Models are then used in a dynamic mode (i.e. response to a change in a given model input data) for which evaluation of the model performances becomes a challenge. The objective of this work is to propose common indicators and diagrams to facilitate the understanding of model responses to emission changes when models are to be used for policy support. These indicators are shown to be useful to retrieve information on the magnitude of the locally produced impacts of emission reductions on concentrations with respect to the “external to the domain” contribution but also to identify, distinguish and quantify impacts arising from different factors (different precursors). In addition information about the robustness of the model results is provided. As such these indicators might reveal useful as first screening methodology to identify the feasibility of a given action as well as to prioritize the factors on which to act for an increased efficiency. Finally all indicators are made dimensionless to facilitate the comparison of results obtained with different models, different resolutions, or on different geographical areas.

A Multilevel System of Quality Technology-Enhanced Learning and Teaching Indicators

ERIC Educational Resources Information Center

Law, Nancy; Niederhauser, Dale S.; Christensen, Rhonda; Shear, Linda

2016-01-01

In this paper we elaborate and extend the work of the EDUsummIT 2015 Thematic Working Group 7 (TWG7) by proposing a set of indicators on quality Technology-Enhanced Learning and Teaching (TEL&T). These indicators are intended as one component of a set of global indicators that could be used to monitor implementation of the Education 2030…

[Validation and adhesion to GESIDA quality indicators in patients with HIV infection].

PubMed

Riera, Melchor; Esteban, Herminia; Suarez, Ignacio; Palacios, Rosario; Lozano, Fernando; Blanco, Jose R; Valencia, Eulalia; Ocampo, Antonio; Amador, Concha; Frontera, Guillem; vonWichmann-de Miguel, Miguel Angel

2016-01-01

The objective of the study is to validate the relevant GESIDA quality indicators for HIV infection, assessing the reliability, feasibility and adherence to them. The reliability was evaluated using the reproducibility of 6 indicators in peer review, with the second observer being an outsider. The feasibility and measurement of the level of adherence to the 22 indicators was conducted with annual fragmented retrospective collection of information from specific databases or the clinical charts of the nine participating hospitals. Reliability was very high, with interobserver agreement levels higher than 95% in 5 of the 6 indicators. The median time to achieve the indicators ranged between 5 and 600minutes, but could be achieved progressively from specific databases, enabling obtaining them automatically. As regards adherence to the indicators related with the initial evaluation of the patients, instructions and suitability of the guidelines for ART, adherence to ART, follow-up in clinics, and achieve an undetectable HIV by PCR at week 48 of the ART. Indicators of quality related to the prevention of opportunistic infections and control of comorbidities, the standards set were not achieved, and significant heterogeneity was observed between hospitals. The GESIDA quality indicators of HIV infection enabled the relevant indicators to be feasibly and reliably measured, and should be collected in all the units that care for patients with HIV infection. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study.

PubMed

Bernardo, Miquel; de Dios, Consuelo; Pérez, Víctor; Ignacio, Emilio; Serrano, Manuel; Vieta, Eduard; Mira, José Joaquín; Guilabert, Mercedes; Roca, Miquel

To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

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

PubMed

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

2008-01-01

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

Evaluation of soil quality indicators in paddy soils under different crop rotation systems

NASA Astrophysics Data System (ADS)

Nadimi-Goki, Mandana; Bini, Claudio; Haefele, Stephan; Abooei, Monireh

2013-04-01

Evaluation of soil quality indicators in paddy soils under different crop rotation systems Soil quality, by definition, reflects the capacity to sustain plant and animal productivity, maintain or enhance water and air quality, and promote plant and animal health. Soil quality assessment is an essential issue in soil management for agriculture and natural resource protection. This study was conducted to detect the effects of four crop rotation systems (rice-rice-rice, soya-rice-rice, fallow-rice and pea-soya-rice) on soil quality indicators (soil moisture, porosity, bulk density, water-filled pore space, pH, extractable P, CEC, OC, OM, microbial respiration, active carbon) in paddy soils of Verona area, Northern Italy. Four adjacent plots which managed almost similarly, over five years were selected. Surface soil samples were collected from each four rotation systems in four times, during growing season. Each soil sample was a composite of sub-samples taken from 3 points within 350 m2 of agricultural land. A total of 48 samples were air-dried and passed through 2mm sieve, for some chemical, biological, and physical measurements. Statistical analysis was done using SPSS. Statistical results revealed that frequency distribution of most data was normal. The lowest CV% was related to pH. Analysis of variance (ANOVA) and comparison test showed that there are significant differences in soil quality indicators among crop rotation systems and sampling times. Results of multivariable regression analysis revealed that soil respiration had positively correlation coefficient with soil organic matter, soil moisture and cation exchange capacity. Overall results indicated that the rice rotation with legumes such as bean and soybean improved soil quality over a long time in comparison to rice-fallow rotation, and this is reflected in rice yield. Keywords: Soil quality, Crop Rotation System, Paddy Soils, Italy

Hospital quality measures: are process indicators associated with hospital standardized mortality ratios in French acute care hospitals?

PubMed

Ngantcha, Marcus; Le-Pogam, Marie-Annick; Calmus, Sophie; Grenier, Catherine; Evrard, Isabelle; Lamarche-Vadel, Agathe; Rey, Grégoire

2017-08-22

Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs). The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method. Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52-0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54-0.95]), 60 dpa HSMR (0.51 [0.39-0.67]) and 90 dpa HSMR (0.52 [0.40-0.68]). In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations

The relationship between different diet quality indices and severity of airflow obstruction among COPD patients

PubMed Central

Yazdanpanah, Leila; Paknahad, Zamzam; Moosavi, Ali Javad; Maracy, Mohammad Reza; Zaker, Mohammad Masoud

2016-01-01

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. Smoking is the number one cause of COPD; however, genetic, environmental and dietary factors contribute to the etiology of this disease. In this study, we assessed the association between three diet quality indices -the Healthy Eating Index-2005 (HEI-2005), the Healthy Eating Index-2010 (HEI-2010), and Mediterranean Diet Score (MED)- and the severity of disease in COPD patients. Methods: This cross-sectional study was performed at Rasul-e-Akram Hospital in Tehran on 121 COPD patients with the mean age of (SD) of 66.1(10.9) years. A pulmonary specialist diagnosed all participants based on a spirometry test. They were categorized into four groups (1, 2, 3, 4 stages of disease). Three diet quality indices, spirometry test and determination of disease severity were performed for all the participants. ANCOVA and Kruskal-Wallis test were used to assess the relationship between dietary quality indices and severity of the disease. The relationship between HEI-2010, HEI-2005, MED score, their components and lung function was assessed using a multiple linear regression analysis. All analyses were done using SPSS 18. Results: Reduction of the Healthy Eating Index-2010 and MED score were observed along with the increase in disease severity, but they were not significant. The relationship between the three diet quality indices and lung function showed a significant association between MED score and Forced expiratory volume in one second (FEV1), The Forced Vital Capacity (FVC) (β=2.9, 95% CI (1.1, 4.8), p=0.002), (β=2.8, 95% CI (0.9, 4.8), p=0.007), respectively. Conclusion: Mediterranean dietary pattern and obtaining a better score on HEI-2010 diet were associated with a better lung function test. PMID:27493924

Do quality indicators for general practice teaching practices predict good outcomes for students?

PubMed

Bartlett, Maggie; Potts, Jessica; McKinley, Bob

2016-07-01

Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching.

Performance Indicators and the Management of Quality in Education.

ERIC Educational Resources Information Center

Cuttance, Peter

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

Landscape-based Indicators

EPA Science Inventory

The report is based on data and experience gained through the GLNPO-funded Great Lakes Coastal Wetland Consortium (GLCWC) and the EPA-STAR funded Great Lakes Ecological Indicators Project (GLEI). EPA-MED author Trebitz and other MED personnel were collaborators on the GLEI proje...

Satellite-Derived NO2 as an Indicator of Urban Air Quality and Emissions

NASA Astrophysics Data System (ADS)

Holloway, T.; Penn, E.; Harkey, M.

2016-12-01

Nitrogen dioxide (NO2) is the satellite-derived constituent with the most direct connection to fossil fuel emissions. At present the Ozone Monitoring Instrument aboard the NASA Aura satellite offers the highest resolution NO2retrievals, and new missions under development (TropOMI, TEMPO, GEMS, Sentinel-4) offer the potential for improved data in coming years. We present results applying satellite-derived NO2data to characterize air quality and emissions in U.S. cities. We highlight research findings geared toward increasing the relevance of satellite data to evaluate urban-scale air quality issues. This work reflects activities under the NASA Air Quality Applied Sciences Team (AQAST), and emerging work under the NASA Health and Air Quality Applied Sciences Team (H-AQAST). Among our results is a characterization of the diurnal cycle of nitrogen oxides using ground-based observations and satellite data. In situ monitoring from the U.S. EPA Air Quality System (AQS) shows that most locations have two daily peaks in NO2 (morning and evening) and a single daily peak in NO (morning). Spaced-based observations from the ESA Global Ozone Monitoring Experiment-2 (GOME-2), with a mid-morning overpass, and the NASA OMI, with an early afternoon overpass, support a complementary analysis for characterizing diurnal variability in NO2. Both ground-based monitors and satellite data show a reduction in the amplitude of the diurnal NO2 cycle. In the Western U.S., satellite data showed evidence of higher NO2 in urban centers in the afternoon (OMI) and higher NO2 in suburban areas in the morning (GOME-2), consistent with diurnal traffic patterns associated with commuting. Some power plants in the Western U.S. showed an increase in NO2in the afternoon, consistent with peak power demand associated with building air conditioning use. We extend this city-focused analysis satellite-derived HCHO:NO2 ratios as an indicator of ozone production regime, comparing modeled and measured ratios

A no-reference video quality assessment metric based on ROI

NASA Astrophysics Data System (ADS)

Jia, Lixiu; Zhong, Xuefei; Tu, Yan; Niu, Wenjuan

2015-01-01

A no reference video quality assessment metric based on the region of interest (ROI) was proposed in this paper. In the metric, objective video quality was evaluated by integrating the quality of two compressed artifacts, i.e. blurring distortion and blocking distortion. The Gaussian kernel function was used to extract the human density maps of the H.264 coding videos from the subjective eye tracking data. An objective bottom-up ROI extraction model based on magnitude discrepancy of discrete wavelet transform between two consecutive frames, center weighted color opponent model, luminance contrast model and frequency saliency model based on spectral residual was built. Then only the objective saliency maps were used to compute the objective blurring and blocking quality. The results indicate that the objective ROI extraction metric has a higher the area under the curve (AUC) value. Comparing with the conventional video quality assessment metrics which measured all the video quality frames, the metric proposed in this paper not only decreased the computation complexity, but improved the correlation between subjective mean opinion score (MOS) and objective scores.

Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery

PubMed Central

Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson

2016-01-01

Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040

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

PubMed

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

2017-06-01

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

Adult Basic and Literacy Education Program: Revised Indicators of Program Quality, Fiscal Year 2004.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document lists the Ohio Department of Education's Adult Basic and Literacy Education revised indicators of program quality. A chart details the measures and performance standards for the following quality indicators: (1) students demonstrate progress toward attainment of literacy skills at levels of proficiency necessary to function on the…

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

PubMed

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

2011-12-01

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

[A measure of the efficiency of primary care in Barcelona (Spain) incorporating quality indicators].

PubMed

Romano, José; Choi, Álvaro

2016-01-01

To demonstrate the impact of the incorporation of quality indicators in assessing the technical efficiency of primary healthcare teams. The processes through which primary healthcare resources have been allocated since the onset of the financial crisis in 2008 have focussed on quantitative rather than qualitative indicators. This study applies data envelopment analysis (DEA) techniques to 58 primary healthcare teams from three different primary healthcare services from the province of Barcelona (Spain). We combine publicly available information from the regional government of Catalonia with data requested from the Catalan Health System Observatory. The analysis compares the results of three models, thereby allowing shifts in the efficiency of primary healthcare teams to be identified in terms of the (lack of) consideration for healthcare quality indicators. Only 16% of the primary healthcare teams were found to be efficient according to the baseline models, which only incorporated input and output quantity indicators. However, once proxies for healthcare quality are included in the analysis, this percentage increases to 58.6%. No meaningful differences in primary healthcare team efficiency were found between public and privately owned centres, between regional primary care services and organisational models, or between rural and urban teams. The results suggest the need to incorporate healthcare quality indicators as outputs when considering criteria for the streamlining of primary healthcare services. Failure to incorporate quality indicators is associated with various primary healthcare concepts. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

River Quality Investigations, Part 1: Some Diversity and Biotic Indices.

ERIC Educational Resources Information Center

Hewitt, G.

1991-01-01

The following indices for assessing river water quality are described: Shannon-Weiner Diversity Index, Sorenson Quotient of Similarity, Czekanowski's Index of Similarity, Trent Biotic Index, Chandler Score, and Biological Monitoring Working Party Score. Their advantages and disadvantages are outlined. (Author)

Novel indicators of recreational water quality and swimming-associated illness

EPA Science Inventory

In the United States and elsewhere, recreational water quality is monitored for fecal indicator bacteria to help prevent swimming-associated illnesses. Standard methods to measure these bacteria take at least 24 hours to obtain results. Molecular approaches such as quantitative p...

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

PubMed

Arkaravichien, Wiwat; Wongpratat, Apichaya; Lertsinudom, Sunee

2016-08-01

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

Droplet digital PCR-based EGFR mutation detection with an internal quality control index to determine the quality of DNA.

PubMed

Kim, Sung-Su; Choi, Hyun-Jeung; Kim, Jin Ju; Kim, M Sun; Lee, In-Seon; Byun, Bohyun; Jia, Lina; Oh, Myung Ryurl; Moon, Youngho; Park, Sarah; Choi, Joon-Seok; Chae, Seoung Wan; Nam, Byung-Ho; Kim, Jin-Soo; Kim, Jihun; Min, Byung Soh; Lee, Jae Seok; Won, Jae-Kyung; Cho, Soo Youn; Choi, Yoon-La; Shin, Young Kee

2018-01-11

In clinical translational research and molecular in vitro diagnostics, a major challenge in the detection of genetic mutations is overcoming artefactual results caused by the low-quality of formalin-fixed paraffin-embedded tissue (FFPET)-derived DNA (FFPET-DNA). Here, we propose the use of an 'internal quality control (iQC) index' as a criterion for judging the minimum quality of DNA for PCR-based analyses. In a pre-clinical study comparing the results from droplet digital PCR-based EGFR mutation test (ddEGFR test) and qPCR-based EGFR mutation test (cobas EGFR test), iQC index ≥ 0.5 (iQC copies ≥ 500, using 3.3 ng of FFPET-DNA [1,000 genome equivalents]) was established, indicating that more than half of the input DNA was amplifiable. Using this criterion, we conducted a retrospective comparative clinical study of the ddEGFR and cobas EGFR tests for the detection of EGFR mutations in non-small cell lung cancer (NSCLC) FFPET-DNA samples. Compared with the cobas EGFR test, the ddEGFR test exhibited superior analytical performance and equivalent or higher clinical performance. Furthermore, iQC index is a reliable indicator of the quality of FFPET-DNA and could be used to prevent incorrect diagnoses arising from low-quality samples.

Quality Indicators for Continuous Monitoring to Improve Maternal and Infant Health in Maternity Departments: A Modified Delphi Survey of an International Multidisciplinary Panel

PubMed Central

Boulkedid, Rym; Sibony, Olivier; Goffinet, François; Fauconnier, Arnaud; Branger, Bernard; Alberti, Corinne

2013-01-01

Objective Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals. Methodology and Main Findings An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators. Conclusion A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units. PMID:23577143

Risk-based indicators of Canadians' exposures to environmental carcinogens.

PubMed

Setton, Eleanor; Hystad, Perry; Poplawski, Karla; Cheasley, Roslyn; Cervantes-Larios, Alejandro; Keller, C Peter; Demers, Paul A

2013-02-12

Tools for estimating population exposures to environmental carcinogens are required to support evidence-based policies to reduce chronic exposures and associated cancers. Our objective was to develop indicators of population exposure to selected environmental carcinogens that can be easily updated over time, and allow comparisons and prioritization between different carcinogens and exposure pathways. We employed a risk assessment-based approach to produce screening-level estimates of lifetime excess cancer risk for selected substances listed as known carcinogens by the International Agency for Research on Cancer. Estimates of lifetime average daily intake were calculated using population characteristics combined with concentrations (circa 2006) in outdoor air, indoor air, dust, drinking water, and food and beverages from existing monitoring databases or comprehensive literature reviews. Intake estimates were then multiplied by cancer potency factors from Health Canada, the United States Environmental Protection Agency, and the California Office of Environmental Health Hazard Assessment to estimate lifetime excess cancer risks associated with each substance and exposure pathway. Lifetime excess cancer risks in excess of 1 per million people are identified as potential priorities for further attention. Based on data representing average conditions circa 2006, a total of 18 carcinogen-exposure pathways had potential lifetime excess cancer risks greater than 1 per million, based on varying data quality. Carcinogens with moderate to high data quality and lifetime excess cancer risk greater than 1 per million included benzene, 1,3-butadiene and radon in outdoor air; benzene and radon in indoor air; and arsenic and hexavalent chromium in drinking water. Important data gaps were identified for asbestos, hexavalent chromium and diesel exhaust in outdoor and indoor air, while little data were available to assess risk for substances in dust, food and beverages. The ability to

Using Performance-Based Risk-Sharing Arrangements to Address Uncertainty in Indication-Based Pricing.

PubMed

Yeung, Kai; Li, Meng; Carlson, Josh J

2017-10-01

The rise in pharmaceutical expenditures in recent years has increased health care payer interest in ensuring good value for the money. Indication-based pricing (IBP) sets separate, indication-specific prices paid to the manufacturer according to the expected efficacy of a drug in each of its indications. IBP allows payers to consistently pay for value across indications. While promising, a limitation of IBP as originally conceived is that efficacy estimates are typically based on clinical trial data, which may differ from real-world effectiveness. An outcomes guarantee is a type of performance-based risk-sharing arrangement that adjusts payments according to prospectively tracked outcomes. We suggest that an outcomes guarantee contract, which has been used by some payers, may be adapted to achieve indication-based prices supported by real-world effectiveness. To illustrate the potential of an outcomes guarantee to achieve indication-based prices aligned with real-world value, using a case study of trastuzumab for the treatment of metastatic breast and advanced gastric cancers. We estimated costs and outcomes under traditional IBP (i.e., expected value IBP) and outcomes guarantee frameworks and calculated incremental cost-effectiveness ratios (ICERs) comparing treatment with and without trastuzumab. Efficacy data came from pivotal trials, whereas effectiveness data came from observational studies. We adjusted trastuzumab prices in order to achieve target ICERs of $150,000 per quality-adjusted life-year under each framework and for each indication. To achieve the ICER target under traditional IBP, the unit price of trastuzumab using efficacy evidence was adjusted for metastatic breast and advanced gastric cancers from an average sales price of $9.17 per mg to $3.50 per mg and $0.93 per mg, respectively. Under an outcomes guarantee, the unit price of trastuzumab using effectiveness evidence was adjusted for metastatic breast cancer and advanced gastric cancer to $8

[Correlation between anthropometric indicators and sleep quality among Brazilian university students].

PubMed

de Vasconcelos, Hérica Cristina Alves; Fragoso, Luciana Vládia Carvalhêdo; Marinho, Niciane Bandeira Pessoa; de Araújo, Márcio Flávio Moura; de Freitas, Roberto Wagner Júnior Freire; Zanetti, Maria Lúcia; Damasceno, Marta Maria Coelho

2013-08-01

The current study investigated the correlation between anthropometric indicators and sleep quality among Brazilian university students using the Pittsburgh Sleep Quality Index. A cross-sectional assessment with 702 university students was conducted between March 2010 and June 2011. Results showed that cases of obesity were more frequent among students who were good sleepers. On the other hand, overweight and high cervical and abdominal circumference was most prominent among poor sleepers. Thus, apart from the damage caused by sleep disorders alone, additional risks due to the association between poor sleep quality and being overweight, central obesity, and increased cervical perimeter are highlighted.

The dissolved organic matter as a potential soil quality indicator in arable soils of Hungary.

PubMed

Filep, Tibor; Draskovits, Eszter; Szabó, József; Koós, Sándor; László, Péter; Szalai, Zoltán

2015-07-01

Although several authors have suggested that the labile fraction of soils could be a potential soil quality indicator, the possibilities and limitations of using the dissolved organic matter (DOM) fraction for this purpose have not yet been investigated. The objective of this study was to evaluate the hypothesis that DOM is an adequate indicator of soil quality. To test this, the soil quality indices (SQI) of 190 arable soils from a Hungarian dataset were estimated, and these values were compared to DOM parameters (DOC and SUVA254). A clear difference in soil quality was found between the soil types, with low soil quality for arenosols (average SQI 0.5) and significantly higher values for gleysols, vertisols, regosols, solonetzes and chernozems. The SQI-DOC relationship could be described by non-linear regression, while a linear connection was observed between SQI and SUVA. The regression equations obtained for the dataset showed only one relatively weak significant correlation between the variables, for DOC (R (2) = 0.157(***); n = 190), while non-significant relationships were found for the DOC and SUVA254 values. However, an envelope curve operated with the datasets showed the robust potential of DOC to indicate soil quality changes, with a high R (2) value for the envelope curve regression equation. The limitations to using the DOM fraction of soils as a quality indicator are due to the contradictory processes which take place in soils in many cases.

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

PubMed

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

2016-04-01

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

A novel approach in water quality assessment based on fuzzy logic.

PubMed

Gharibi, Hamed; Mahvi, Amir Hossein; Nabizadeh, Ramin; Arabalibeik, Hossein; Yunesian, Masud; Sowlat, Mohammad Hossein

2012-12-15

The present work aimed at developing a novel water quality index based on fuzzy logic, that is, a comprehensive artificial intelligence (AI) approach to the development of environmental indices for routine assessment of surface water quality, particularly for human drinking purposes. Twenty parameters were included based on their critical importance for the overall water quality and their potential impact on human health. To assess the performance of the proposed index under actual conditions, a case study was conducted at Mamloo dam, Iran, employing water quality data of four sampling stations in the water basin of the dam from 2006 to 2009. Results of this study indicated that the general quality of water in all the sampling stations over all the years of the study period is fairly low (yearly averages are usually in the range of 45-55). According to the results of ANOVA test, water quality did not significantly change over time in any of the sampling stations (P > 0.05). In addition, comparison of the outputs of the fuzzy-based proposed index proposed with those of the NSF water quality index (the WQI) and Canadian Water Quality Index (CWQI) showed similar results and were sensitive to changes in the level of water quality parameters. However, the index proposed by the present study produced a more stringent outputs compared to the WQI and CWQI. Results of the sensitivity analysis suggested that the index is robust against the changes in the rules. In conclusion, the proposed index seems to produce accurate and reliable results and can therefore be used as a comprehensive tool for water quality assessment, especially for the analysis of human drinking water. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-01-05

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

A Validation of Object-Oriented Design Metrics as Quality Indicators

NASA Technical Reports Server (NTRS)

Basili, Victor R.; Briand, Lionel C.; Melo, Walcelio

1997-01-01

This paper presents the results of a study in which we empirically investigated the suits of object-oriented (00) design metrics introduced in another work. More specifically, our goal is to assess these metrics as predictors of fault-prone classes and, therefore, determine whether they can be used as early quality indicators. This study is complementary to the work described where the same suite of metrics had been used to assess frequencies of maintenance changes to classes. To perform our validation accurately, we collected data on the development of eight medium-sized information management systems based on identical requirements. All eight projects were developed using a sequential life cycle model, a well-known 00 analysis/design method and the C++ programming language. Based on empirical and quantitative analysis, the advantages and drawbacks of these 00 metrics are discussed. Several of Chidamber and Kamerer's 00 metrics appear to be useful to predict class fault-proneness during the early phases of the life-cycle. Also, on our data set, they are better predictors than 'traditional' code metrics, which can only be collected at a later phase of the software development processes.

[Assessment of quality indicators in pediatric poisoning in an emergency service].

PubMed

Giménez Roca, C; Martínez Sánchez, L; Calzada Baños, Y; Trenchs Sainz de la Maza, V; Quintilla Martínez, J M; Luaces Cubells, C

2014-01-01

Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

[Evacuation plan of an intensive care unit: a new quality indicator?].

PubMed

Sánchez-Palacios, M; Lorenzo Torrent, R; Santana-Cabrera, L; Martín García, J A; Campos, S G; Carrasco de Miguel, V

2010-04-01

The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU. Copyright 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.

[Quality of care indicators for benign prostatic hyperplasia. A qualitative study].

PubMed

Navarro-Pérez, Jorge; Peiró, Salvador; Brotons-Muntó, Francisco; López-Alcina, Emilio; Real-Romaguera, Arcadio

2014-05-01

To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. Valencian School of Health Studies. Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. Some of the assessed indicators can be useful for incorporation into health information systems. Copyright © 2013 Elsevier España, S.L. All rights reserved.

UK key performance indicators and quality assurance standards for colonoscopy.

PubMed

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

2016-12-01

Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Quality Indicators for the Total Testing Process.

PubMed

Plebani, Mario; Sciacovelli, Laura; Aita, Ada

2017-03-01

ISO 15189:2012 requires the use of quality indicators (QIs) to monitor and evaluate all steps of the total testing process, but several difficulties dissuade laboratories from effective and continuous use of QIs in routine practice. An International Federation of Clinical Chemistry and Laboratory Medicine working group addressed this problem and implemented a project to develop a model of QIs to be used in clinical laboratories worldwide to monitor and evaluate all steps of the total testing process, and decrease error rates and improve patient services in laboratory testing. All laboratories are invited, at no cost, to enroll in the project and contribute to harmonized management at the international level. Copyright © 2016 Elsevier Inc. All rights reserved.

Soil quality assessment using GIS-based chemometric approach and pollution indices: Nakhlak mining district, Central Iran.

PubMed

Moore, Farid; Sheykhi, Vahideh; Salari, Mohammad; Bagheri, Adel

2016-04-01

This paper is a comprehensive assessment of the quality of soil in the Nakhlak mining district in Central Iran with special reference to potentially toxic metals. In this regard, an integrated approach involving geostatistical, correlation matrix, pollution indices, and chemical fractionation measurement is used to evaluate selected potentially toxic metals in soil samples. The fractionation of metals indicated a relatively high variability. Some metals (Mo, Ag, and Pb) showed important enrichment in the bioavailable fractions (i.e., exchangeable and carbonate), whereas the residual fraction mostly comprised Sb and Cr. The Cd, Zn, Co, Ni, Mo, Cu, and As were retained in Fe-Mn oxide and oxidizable fractions, suggesting that they may be released to the environment by changes in physicochemical conditions. The spatial variability patterns of 11 soil heavy metals (Ag, As, Cd, Co, Cr, Cu, Mo, Ni, Pb, Sb, and Zn) were identified and mapped. The results demonstrated that Ag, As, Cd, Mo, Cu, Pb, Sb, and Zn pollution are associated with mineralized veins and mining operations in this area. Further environmental monitoring and remedial actions are required for management of soil heavy metals in the study area. The present study not only enhanced our knowledge regarding soil pollution in the study area but also introduced a better technique to analyze pollution indices by multivariate geostatistical methods.

Soil quality indicator responses to row crop, grazed pasture, and agroforestry buffer management

USDA-ARS?s Scientific Manuscript database

Incorporation of trees and establishment of grass buffers within agroecosystems are management practices shown to enhance soil quality. Soil enzyme activities and water stable aggregates (WSA) have been identified as sensitive soil quality indicators to evaluate early responses to soil management. ...

Effect of participating in Taiwan Quality Indicator Project on hospital efficiency in Taiwan.

PubMed

Chu, Hsuan-Lien; Wang, Chen-Chin; Shiu, Shu Fen

2009-01-01

To examine the effect of participating in Taiwan Quality Indicator Project (TQIP) on hospital efficiency and investigate why hospitals participate in TQIP. Our sample consists of 417 private not-for-profit hospitals in Taiwan during the 2001-2007 period. A simultaneous-equation model was performed to examine if hospitals that participated in TQIP were more efficient than hospitals that did not and investigate which variables affected the probabilities of hospitals' participation in the project. Our findings indicate that participating hospitals are more efficient than hospitals not participating in TQIP. In addition, hospital efficiency, hospital size, teaching status, and hospital age are positively related to participation in the project. These empirical results can be used as supporting evidence of success in improving performance through creating quality for hospitals that have participated in the project and offer insights into the value and strengths of the project. In addition, in recent years, reimbursement systems worldwide have partly moved payment methods to a pay-for-performance mechanism. In an attempt to control costs and improve quality, the policy makers should consider participating in Quality Indicator Project (QIP) as being one of the criteria to be reimbursed for performance.

Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.

PubMed

Suija, Kadri; Kivisto, Katrin; Sarria-Santamera, Antonio; Kokko, Simo; Liseckiene, Ida; Bredehorst, Maren; Jaruseviciene, Lina; Papp, Renata; Oona, Marje; Kalda, Ruth

2015-02-01

The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records. Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators. Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Quality Indicator Survey: background, implementation, and widespread change.

PubMed

Lin, Michael K; Kramer, Andrew M

2013-01-01

The Quality Indicator Survey (QIS) is the most comprehensive regulatory change to the nursing home survey process since the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). In this article we describe the policy evolution that led to the QIS, summarize the QIS method and implementation, and profile the QIS survey results. Following over a decade of development, in 2007 the Centers for Medicare and Medicaid Services (CMS) began the national rollout of QIS. The intent was to improve consistency in the nursing home survey and to render the survey process more resident-centered and aligned with the intent of OBRA-87. We reviewed policy reports and firsthand accounts from the lead developer of the QIS methodology and leader of the national training contract for QIS. Changes in survey findings are profiled based on analysis of the publicly available Nursing Home Compare database from 2004 to 2010. Nineteen states implemented the QIS between 2007 and 2010, with nearly 20% of U.S. nursing homes receiving QIS surveys in 2010. Nursing homes surveyed with the QIS received more survey deficiencies on average than in the traditional survey; however, average numbers of deficiencies across states became more similar over the early implementation of QIS, with lower-than-average geographic areas experiencing increases and higher-than-average geographic areas experiencing decreases in survey deficiencies. The explicit and structured questioning of residents in the QIS is associated with increases in deficiencies related to choice, dignity, dental care, and nurse staffing. We describe ways in which the QIS affected the regulatory agencies, providers, and resident communities, although these effects are difficult to quantify. CMS's implementation of QIS is a significant step toward a more resident-centered, comprehensive, and consistent survey process. Substantial changes, however, are required not only among regulators but also among nursing homes. We argue that these new

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

PubMed

Li, Y; Zheng, G; Lin, H

2014-12-18

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

Total nutrient and sediment loads, trends, yields, and nontidal water-quality indicators for selected nontidal stations, Chesapeake Bay Watershed, 1985–2011

USGS Publications Warehouse

Langland, Michael J.; Blomquist, Joel D.; Moyer, Douglas; Hyer, Kenneth; Chanat, Jeffrey G.

2013-01-01

The U.S. Geological Survey, in cooperation with Chesapeake Bay Program (CBP) partners, routinely reports long-term concentration trends and monthly and annual constituent loads for stream water-quality monitoring stations across the Chesapeake Bay watershed. This report documents flow-adjusted trends in sediment and total nitrogen and phosphorus concentrations for 31 stations in the years 1985–2011 and for 32 stations in the years 2002–2011. Sediment and total nitrogen and phosphorus yields for 65 stations are presented for the years 2006–2011. A combined nontidal water-quality indicator (based on both trends and yields) indicates there are more stations classified as “improving water-quality trend and a low yield” than “degrading water-quality trend and a high yield” for total nitrogen. The same type of 2-way classification for total phosphorus and sediment results in equal numbers of stations in each indicator class.

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

PubMed

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

2017-05-01

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

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"].

PubMed

Nebot-Marzal, C M; Mira-Solves, J J; Guilabert-Mora, M; Pérez-Jover, V; Pablo-Comeche, D; Quirós-Morató, T; Cuesta Peredo, D

2014-01-01

To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud». The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

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

PubMed

Gajewski, Byron J; Dunton, Nancy

2013-04-01

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

Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

PubMed

Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano

2015-11-14

Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

Use of quality indicators in physical therapist practice: an observational study.

PubMed

Jette, Diane U; Jewell, Dianne V

2012-04-01

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited. The primary purpose of this study was to determine the use of quality indicators in physical therapist practice. This was an observational study. All members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use. Participants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%-51.3%) and use of standardized measures (5.5%-35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques. The survey was not assessed for test-retest reliability. A low response rate was a source of potential bias. The study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

Effects of Grazing and Fire Frequency on Floristic Quality and its Relationship to Indicators of Soil Quality in Tallgrass Prairie

NASA Astrophysics Data System (ADS)

Manning, George C.; Baer, Sara G.; Blair, John M.

2017-12-01

Fire and grazing are widely used to manage grasslands for conservation purposes, but few studies have evaluated the effects of these drivers on the conservation value of plant communities measured by the floristic quality index (FQI). Further, the influence of fire and grazing on soil properties and functions are difficult for land managers and restoration practitioners to assess. The objectives of this study were to: (1) quantify the independent and interactive effects of grazing and fire frequency on floristic quality in native tallgrass prairie to provide potential benchmarks for community assessment, and (2) to explore whether floristic quality can serve as an indicator of soil structure and function for more holistic ecosystem assessments. A factorial combination of fire frequencies (1-2, 4, and 20 years return intervals) and grazing (by bison or ungrazed) treatments were sampled for plant species composition, and for several indicators of soil quality in lowland tallgrass prairie. Floristic quality, diversity, and richness were higher in grazed than ungrazed prairie over all fire frequencies ( P < 0.05). Available inorganic N, microbial biomass N, total N, and soil bulk density were also higher in grazed prairie soil over all fire frequencies ( P < 0.05). Microbial biomass C, total organic C, and total soil N were positively correlated with FQI ( P < 0.05). This study shows that floristic quality and soil N pools are more strongly influenced by grazing than fire and that floristic quality can be an indicator of total soil C and N stocks in never cultivated lowland prairie.

Effects of Grazing and Fire Frequency on Floristic Quality and its Relationship to Indicators of Soil Quality in Tallgrass Prairie.

PubMed

Manning, George C; Baer, Sara G; Blair, John M

2017-12-01

Fire and grazing are widely used to manage grasslands for conservation purposes, but few studies have evaluated the effects of these drivers on the conservation value of plant communities measured by the floristic quality index (FQI). Further, the influence of fire and grazing on soil properties and functions are difficult for land managers and restoration practitioners to assess. The objectives of this study were to: (1) quantify the independent and interactive effects of grazing and fire frequency on floristic quality in native tallgrass prairie to provide potential benchmarks for community assessment, and (2) to explore whether floristic quality can serve as an indicator of soil structure and function for more holistic ecosystem assessments. A factorial combination of fire frequencies (1-2, 4, and 20 years return intervals) and grazing (by bison or ungrazed) treatments were sampled for plant species composition, and for several indicators of soil quality in lowland tallgrass prairie. Floristic quality, diversity, and richness were higher in grazed than ungrazed prairie over all fire frequencies (P < 0.05). Available inorganic N, microbial biomass N, total N, and soil bulk density were also higher in grazed prairie soil over all fire frequencies (P < 0.05). Microbial biomass C, total organic C, and total soil N were positively correlated with FQI (P < 0.05). This study shows that floristic quality and soil N pools are more strongly influenced by grazing than fire and that floristic quality can be an indicator of total soil C and N stocks in never cultivated lowland prairie.

An Evaluation of the Technical Adequacy of a Revised Measure of Quality Indicators of Transition

ERIC Educational Resources Information Center

Morningstar, Mary E.; Lee, Hyunjoo; Lattin, Dana L.; Murray, Angela K.

2016-01-01

This study confirmed the reliability and validity of the Quality Indicators of Exemplary Transition Programs Needs Assessment-2 (QI-2). Quality transition program indicators were identified through a systematic synthesis of transition research, policies, and program evaluation measures. To verify reliability and validity of the QI-2, we…

[Health information on the Internet and trust marks as quality indicators: vaccines case study].

PubMed

Mayer, Miguel Angel; Leis, Angela; Sanz, Ferran

2009-10-01

To find out the prevalence of quality trust marks present in websites and to analyse the quality of these websites displaying trust marks compared with those that do not display them, in order to put forward these trust marks as a quality indicator. Cross-sectional study. Internet. Websites on vaccines. Using "vacunas OR vaccines" as key words, the features of 40 web pages were analysed. These web pages were selected from the page results of two search engines, Google and Yahoo! Based on a total of 9 criteria, the average score of criteria fulfilled was 7 (95% CI 3.96-10.04) points for the web pages offered by Yahoo! and 7.3 (95% CI 3.86-10.74) offered by Google. Amongst web pages offered by Yahoo!, there were three with clearly inaccurate information, while there were four in the pages offered by Google. Trust marks were displayed in 20% and 30% medical web pages, respectively, and their presence reached statistical significance (P=0.033) when fulfilling the quality criteria compared with web pages where trust marks were not displayed. A wide variety of web pages was obtained by search engines and a large number of them with useless information. Although the websites analysed had a good quality, between 15% and 20% showed inaccurate information. Websites where trust marks were displayed had more quality than those that did not display one and none of them were included amongst those where inaccurate information was found.

Development of a Quality of Meals and Meal Service Set of Indicators for Residential Facilities for Elderly.

PubMed

Van Damme, N; Buijck, B; Van Hecke, A; Verhaeghe, S; Goossens, E; Beeckman, D

2016-01-01

To develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents' food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service. The indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group's expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care. A preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals. The 'quality of meals and meal service' set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice

Comparing Effects of Forestland conversion to Tea Farming on Soil Quality Indices

NASA Astrophysics Data System (ADS)

Gholoubi, A.; Emami, H.; Alizadeh, A.; Jones, S. B.

2017-12-01

The effect of land use type on soil function within an ecosystem can be assessed and monitored using soil quality indices. The research examined effects of land use change from natural forest to tea farming (with the same physiography and parent materials) on soil properties in different regions of the Guilan province, northern Iran. Two universally-accepted methods of soil quality evaluation were used to understand soil conditions in these two land uses. Thirty-six soil samples (0 -30 cm) were randomly collected from six sites with 3 replications. The soil quality of forestland and tea farms was determined using the cumulative rating (CR) index and the Cornell Comprehensive Assessment of Soil Health (CASH) scoring functions. Effects of Land use change on soil quality or health were significant (P <0.01) using both methods. In the CR method, a relative weighting factor (RWF) from 1 to 5 was assigned each key soil property. The results of both methods for all regions showed that the forestland use was more sustainable (lower CR and higher CASH score) than tea farm soils. forestland use affected most soil properties and thus their scores in both evaluation methods. Soil organic carbon and pH were the most important indicators reduced by land use change at all locations. There were significant correlations between these indicators and other soil chemical, physical and biological factors affected by changing forestland use.

78 FR 5810 - AHRQ Standing Workgroup for Quality Indicator Measure Specification

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... AHRQ Quality Indicators (QIs), their technical specifications, and associated methodological issues.... The time- limited workgroup is more restricted to specific clinical or methodological issues, while..., data enhancements, and methodological advances. The standing workgroup may potentially provide guidance...

Indicator-based water sustainability assessment - a review.

PubMed

Juwana, I; Muttil, N; Perera, B J C

2012-11-01

In the past few decades, there have been extensive efforts on measuring sustainability. One example is the development of assessment tools based on sustainability indicators. Several individuals and organisations have suggested various indices for assessing sustainability. This paper focuses on the review of water sustainability assessment using the indicator-based approach. It discusses major definitions of sustainable development that have been proposed and more specific concepts of sustainability based on sustainability principles and criteria. It then proceeds with the review of existing definitions, principles and guidelines on sustainable water resource management. The paper then explores elements of indicator-based water sustainability assessment. These elements include the selection of components and indicators, obtaining sub-index values, weighting schemes for components and indicators, aggregation of components and indicators, robustness analysis of the index, and interpretation of the final index value. These six elements are explored considering four existing water sustainability indices and two other sustainability indices that are thought to be useful for the development and use of water sustainability indices. The review presented in this paper on indicator-based water sustainability assessment can provide significant inputs to water stakeholders worldwide for using existing indices, for customising existing indices for their applications, and for developing new water sustainability indices. These indices can provide information on current conditions of water resources, including identifying all factors contributing to the improvement of water resources. This information can be used to communicate the current status of existing water resources to the wider community. Also, the water sustainability indices can be used to assist decision makers to prioritise issues, challenges and programmes related to water resource management. Copyright © 2012

[Correspondence analysis between traditional commercial specifications and quantitative quality indices of Notopterygii Rhizoma et Radix].

PubMed

Jiang, Shun-Yuan; Sun, Hong-Bing; Sun, Hui; Ma, Yu-Ying; Chen, Hong-Yu; Zhu, Wen-Tao; Zhou, Yi

2016-03-01

This paper aims to explore a comprehensive assessment method combined traditional Chinese medicinal material specifications with quantitative quality indicators. Seventy-six samples of Notopterygii Rhizoma et Radix were collected on market and at producing areas. Traditional commercial specifications were described and assigned, and 10 chemical components and volatile oils were determined for each sample. Cluster analysis, Fisher discriminant analysis and correspondence analysis were used to establish the relationship between the traditional qualitative commercial specifications and quantitative chemical indices for comprehensive evaluating quality of medicinal materials, and quantitative classification of commercial grade and quality grade. A herb quality index (HQI) including traditional commercial specifications and chemical components for quantitative grade classification were established, and corresponding discriminant function were figured out for precise determination of quality grade and sub-grade of Notopterygii Rhizoma et Radix. The result showed that notopterol, isoimperatorin and volatile oil were the major components for determination of chemical quality, and their dividing values were specified for every grade and sub-grade of the commercial materials of Notopterygii Rhizoma et Radix. According to the result, essential relationship between traditional medicinal indicators, qualitative commercial specifications, and quantitative chemical composition indicators can be examined by K-mean cluster, Fisher discriminant analysis and correspondence analysis, which provide a new method for comprehensive quantitative evaluation of traditional Chinese medicine quality integrated traditional commodity specifications and quantitative modern chemical index. Copyright© by the Chinese Pharmaceutical Association.

78 FR 22883 - AHRQ Standing Workgroup for Quality Indicator Measure Specification

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... Quality Indicators (QIs), their technical specifications, and associated methodological issues. The...-limited workgroup is more restricted to specific clinical or methodological issues, while the standing... enhancements, and methodological advances. The standing workgroup may potentially provide guidance for the...

Receiver Operating Characteristic Curve Analysis of Beach Water Quality Indicator Variables

PubMed Central

Morrison, Ann Michelle; Coughlin, Kelly; Shine, James P.; Coull, Brent A.; Rex, Andrea C.

2003-01-01

Receiver operating characteristic (ROC) curve analysis is a simple and effective means to compare the accuracies of indicator variables of bacterial beach water quality. The indicator variables examined in this study were previous day's Enterococcus density and antecedent rainfall at 24, 48, and 96 h. Daily Enterococcus densities and 15-min rainfall values were collected during a 5-year (1996 to 2000) study of four Boston Harbor beaches. The indicator variables were assessed for their ability to correctly classify water as suitable or unsuitable for swimming at a maximum threshold Enterococcus density of 104 CFU/100 ml. Sensitivity and specificity values were determined for each unique previous day's Enterococcus density and antecedent rainfall volume and used to construct ROC curves. The area under the ROC curve was used to compare the accuracies of the indicator variables. Twenty-four-hour antecedent rainfall classified elevated Enterococcus densities more accurately than previous day's Enterococcus density (P = 0.079). An empirically derived threshold for 48-h antecedent rainfall, corresponding to a sensitivity of 0.75, was determined from the 1996 to 2000 data and evaluated to ascertain if the threshold would produce a 0.75 sensitivity with independent water quality data collected in 2001 from the same beaches. PMID:14602593

The Validity of Higher-Order Questions as a Process Indicator of Educational Quality

ERIC Educational Resources Information Center

Renaud, Robert D.; Murray, Harry G.

2007-01-01

One way to assess the quality of education in post-secondary institutions is through the use of performance indicators. Studies that have compared currently popular process indicators (e.g., library size, percentage of faculty with PhD) found that after controlling for incoming student ability, these process indicators tend to be weakly associated…

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

NASA Astrophysics Data System (ADS)

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

2017-03-01

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

SCORE study: quality indicators for rheumatology nursing clinics.

PubMed

Muñoz-Fernández, Santiago; Aguilar, Ma Dolores; Almodóvar, Raquel; Cano-García, Laura; Fortea, Sandra; Alcañiz-Escandell, Cristina Patricia; Rodríguez, José R; Cebrián, Laura; Lázaro, Pablo

2017-03-01

Nursing clinics in rheumatology (NCR) are organizational care models that provide care centred within the scope of nurses abilities. To analyse patients differences in the knowledge of the disease, adherence to the treatment, quality indicators of the Rheumatology Departments included quality perceived by the patients with and without NCR. National multicenter observational prospective cohort study 1 year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; (3) its own appointment schedule, and (4) phone. Variables included were (baseline and 12 months) Batalla, Haynes-Sackett, Morisky-Green and quality perceived tests. In addition, another specific questionnaire was drawn up to collect the healthcare, teaching and research activities of each Rheumatology Department. A total of 393 patients were included; 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 ± 11.8 vs 56 ± 13.5 years). Significant differences in favour of the NCR group were found in Haynes-Sackett (p = 0.033) and Morisky-Green (p = 0.03) tests in the basal visit. Significant differences were found in questions about "the courtesy and/or kindness received by the nurse", being "good or very good" in greater proportion in the NCR group. The publications from the last 5 years were significantly higher in the NCR group in both, national (p = 0.04) and international (p = 0.03) journals. A higher research activity and quality perceived by the patients are observed in the Rheumatology Departments with NCR.

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

USGS Publications Warehouse

Baron, Jill S.

2005-01-01

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

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

ERIC Educational Resources Information Center

Royer, Paula Nassif; Kegan, Daniel

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

Evaluation of quality indicators and disease damage in childhood-onset systemic lupus erythematosus patients.

PubMed

Harris, Julia G; Maletta, Kristyn I; Kuhn, Evelyn M; Olson, Judyann C

2017-02-01

The aim of this study was to describe compliance with select quality indicators and assess organ-specific dysfunction in a childhood-onset systemic lupus erythematosus population by using a validated damage index and to evaluate associations between compliance with quality indicators and disease damage. A retrospective chart review was performed on patients diagnosed with systemic lupus erythematosus prior to age 18 followed at a single center in the USA from 1999 to 2012 (n = 75). Data regarding quality indicators and outcome variables, including the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were collected. The median disease duration was 3.8 years. The proportion of patients or patient-years in which care complied with the proposed quality measures was 94.4% for hydroxychloroquine use, 84.3% for vitamin D recommendation,75.8% for influenza vaccination (patient-years), 67.2% for meningococcal vaccination, 49.0% for ophthalmologic examination (patient-years), 31.7% for pneumococcal vaccination, and 28.6% for bone mineral density evaluation. Disease damage was present in 41.3% of patients at last follow-up, with an average damage index score of 0.81. Disease damage at last follow-up was associated with minority race/ethnicity (p = 0.008), bone mineral density evaluation (p = 0.035), and vitamin D recommendation (p = 0.018). Adherence to quality indicators in a childhood-onset systemic lupus erythematosus population is varied, and disease damage is prevalent. This study highlights the importance of quality improvement initiatives aimed at optimizing care delivery to reduce disease damage in pediatric lupus patients.

[Quality criteria and indicators of women's health care].

PubMed

Mandú, Edir Nei Teixeira

2005-04-01

In this article, quality criteria and indicators of the basic care of the woman's health are presented with emphasis on the sexual and reproductive health that can be used in the management of supervision practices. In its elaboration, formulations regarding the evaluating practice, the managerial work, the full care to the woman's health (sexual and reproductive) are taken into consideration, besides proposals of the Health Ministry for monitoring the attention to this specific group. It focuses mainly on care and vigilance actions as to the women's health and on organizational and managerial aspects of such care.

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory.

PubMed

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Cláudio; Tavares, Suelene Brito do Nascimento; de Souza, Nadja Lindany Alves; Amaral, Rita Goreti

2014-09-01

To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.

Dynamic Assessment of Water Quality Based on a Variable Fuzzy Pattern Recognition Model

PubMed Central

Xu, Shiguo; Wang, Tianxiang; Hu, Suduan

2015-01-01

Water quality assessment is an important foundation of water resource protection and is affected by many indicators. The dynamic and fuzzy changes of water quality lead to problems for proper assessment. This paper explores a method which is in accordance with the water quality changes. The proposed method is based on the variable fuzzy pattern recognition (VFPR) model and combines the analytic hierarchy process (AHP) model with the entropy weight (EW) method. The proposed method was applied to dynamically assess the water quality of Biliuhe Reservoir (Dailan, China). The results show that the water quality level is between levels 2 and 3 and worse in August or September, caused by the increasing water temperature and rainfall. Weights and methods are compared and random errors of the values of indicators are analyzed. It is concluded that the proposed method has advantages of dynamism, fuzzification and stability by considering the interval influence of multiple indicators and using the average level characteristic values of four models as results. PMID:25689998

Dynamic assessment of water quality based on a variable fuzzy pattern recognition model.

PubMed

Xu, Shiguo; Wang, Tianxiang; Hu, Suduan

2015-02-16

Water quality assessment is an important foundation of water resource protection and is affected by many indicators. The dynamic and fuzzy changes of water quality lead to problems for proper assessment. This paper explores a method which is in accordance with the water quality changes. The proposed method is based on the variable fuzzy pattern recognition (VFPR) model and combines the analytic hierarchy process (AHP) model with the entropy weight (EW) method. The proposed method was applied to dynamically assess the water quality of Biliuhe Reservoir (Dailan, China). The results show that the water quality level is between levels 2 and 3 and worse in August or September, caused by the increasing water temperature and rainfall. Weights and methods are compared and random errors of the values of indicators are analyzed. It is concluded that the proposed method has advantages of dynamism, fuzzification and stability by considering the interval influence of multiple indicators and using the average level characteristic values of four models as results.

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

PubMed

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

2017-09-01

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

Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project).

PubMed

Woitha, Kathrin; Van Beek, Karen; Ahmed, Nisar; Jaspers, Birgit; Mollard, Jean M; Ahmedzai, Sam H; Hasselaar, Jeroen; Menten, Johan; Vissers, Kris; Engels, Yvonne

2014-02-01

Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. To develop and validate a set of structure and process indicators for palliative care settings in Europe. A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator). The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.

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

PubMed

Bonanno, Giuseppe; Lo Giudice, Rosa

2010-04-01

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

Evaluation of Preanalytical Quality Indicators by Six Sigma and Pareto`s Principle.

PubMed

Kulkarni, Sweta; Ramesh, R; Srinivasan, A R; Silvia, C R Wilma Delphine

2018-01-01

Preanalytical steps are the major sources of error in clinical laboratory. The analytical errors can be corrected by quality control procedures but there is a need for stringent quality checks in preanalytical area as these processes are done outside the laboratory. Sigma value depicts the performance of laboratory and its quality measures. Hence in the present study six sigma and Pareto principle was applied to preanalytical quality indicators to evaluate the clinical biochemistry laboratory performance. This observational study was carried out for a period of 1 year from November 2015-2016. A total of 1,44,208 samples and 54,265 test requisition forms were screened for preanalytical errors like missing patient information, sample collection details in forms and hemolysed, lipemic, inappropriate, insufficient samples and total number of errors were calculated and converted into defects per million and sigma scale. Pareto`s chart was drawn using total number of errors and cumulative percentage. In 75% test requisition forms diagnosis was not mentioned and sigma value of 0.9 was obtained and for other errors like sample receiving time, stat and type of sample sigma values were 2.9, 2.6, and 2.8 respectively. For insufficient sample and improper ratio of blood to anticoagulant sigma value was 4.3. Pareto`s chart depicts out of 80% of errors in requisition forms, 20% is contributed by missing information like diagnosis. The development of quality indicators, application of six sigma and Pareto`s principle are quality measures by which not only preanalytical, the total testing process can be improved.

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

NASA Astrophysics Data System (ADS)

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

2017-05-01

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

An examination of water quality indicators in swim sites located in the upper Los Angeles River Watershed

NASA Astrophysics Data System (ADS)

Lee, C. M.; Morris, K.; Fingland, N. K.; Johnstone, K.; Pendleton, L.; Ponce, A.; Tang, C.; Griffith, J. F.; Steele, N. L.

2013-12-01

Multiple sites in the upper Los Angeles River watershed were sampled during summer 2012 and measured for Escherichia coli, enterococci, and Clostridium perfringens (vegetative cells and spores) using culture-based analyses and preserved for quantitative polymerase chain reaction (qPCR) analysis. The objective of this work includes the characterization of how well indicators correlated with each other, with respect to background levels and to 'spikes' from background, possibly indicative of a pollution input, environmental/physicochemical parameters, as well as in the context of recreational water quality standards. The 2nd objective of this work was to evaluate the economic impact of implementing qPCR at our study sites for rapid water quality monitoring. None of the species of indicators correlated well with each other (R2 < 0.1) across sites and dates when the sample set was examined in its entirety, though C. perfringens vegetative cells and spores were moderately correlated (R2 = 0.31, p = 0.07). The observation of concentration 'spikes' against background levels, suggesting a potential input of contamination, were observed on holiday sampling days and will be examined further. In general, the number of swimmers present was not linked with indicator concentrations; however, incidence of water quality exceedances (for E. coli 235 CFU or MPN/100 mL sample) were more likely to occur on the weekend or holidays (for E. coli, , suggesting that the presence/absence of swimmers may be an important variable at our sites. Clostridium perfringens may be a useful indicator at our study sites, as a comparison of vegetative to endospore forms of this organism may be used to understand how recently a contamination event or input occurred.

Consensus on Quality Indicators of Postgraduate Medical E-Learning: Delphi Study

PubMed Central

Walsh, Kieran; Westerman, Michiel; Scheele, Fedde

2018-01-01

Background The progressive use of e-learning in postgraduate medical education calls for useful quality indicators. Many evaluation tools exist. However, these are diversely used and their empirical foundation is often lacking. Objective We aimed to identify an empirically founded set of quality indicators to set the bar for “good enough” e-learning. Methods We performed a Delphi procedure with a group of 13 international education experts and 10 experienced users of e-learning. The questionnaire started with 57 items. These items were the result of a previous literature review and focus group study performed with experts and users. Consensus was met when a rate of agreement of more than two-thirds was achieved. Results In the first round, the participants accepted 37 items of the 57 as important, reached no consensus on 20, and added 15 new items. In the second round, we added the comments from the first round to the items on which there was no consensus and added the 15 new items. After this round, a total of 72 items were addressed and, of these, 37 items were accepted and 34 were rejected due to lack of consensus. Conclusions This study produced a list of 37 items that can form the basis of an evaluation tool to evaluate postgraduate medical e-learning. This is, to our knowledge, the first time that quality indicators for postgraduate medical e-learning have been defined and validated. The next step is to create and validate an e-learning evaluation tool from these items. PMID:29699970

Southern P indices, water quality data, and modeling results: a comparison

USDA-ARS?s Scientific Manuscript database

Phosphorus (P) indices in the south frequently produce different results for similar conditions. After collecting data from benchmark sites throughout the south (6 Arkansas, 1 Georgia, 2 Mississippi, 4 North Carolina, 4 Oklahoma, and 4 Texas site/treatment water quality and land treatment data sets...

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

PubMed

Carinci, F; Van Gool, K; Mainz, J; Veillard, J; Pichora, E C; Januel, J M; Arispe, I; Kim, S M; Klazinga, N S

2015-04-01

To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. International group of countries participating to OECD projects. Members of the OECD HCQI expert group. A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Direct detection of male quality can facilitate the evolution of female choosiness and indicators of good genes: Evolution across a continuum of indicator mechanisms.

PubMed

Dhole, Sumit; Stern, Caitlin A; Servedio, Maria R

2018-04-01

The evolution of mating displays as indicators of male quality has been the subject of extensive theoretical and empirical research for over four decades. Research has also addressed the evolution of female mate choice favoring such indicators. Yet, much debate still exists about whether displays can evolve through the indirect benefits of female mate choice. Here, we use a population genetic model to investigate how the extent to which females can directly detect male quality influences the evolution of female choosiness and male displays. We use a continuum framework that incorporates indicator mechanisms that are traditionally modeled separately. Counter to intuition, we find that intermediate levels of direct detection of male quality can facilitate, rather than impede, the evolution of female choosiness and male displays in broad regions of this continuum. We examine how this evolution is driven by selective forces on genetic quality and on the display, and find that direct detection of male quality results in stronger indirect selection favoring female choosiness. Our results imply that displays maybe more likely to evolve when female choosiness has already evolved to discriminate perceptible forms of male quality. They also highlight the importance of considering general female choosiness, as well as preference, in studies of "good genes." © 2018 The Author(s). Evolution © 2018 The Society for the Study of Evolution.

Identifying Consistent and Coherent Dimensions of Nursing Home Quality: Exploratory Factor Analysis of Quality Indicators.

PubMed

Xu, Dongjuan; Kane, Robert L; Shippee, Tetyana; Lewis, Teresa M

2016-12-01

There is a general belief that the markers of nursing home quality do not aggregate easily. Identifying consistent and coherent dimensions of quality that usefully summarize the multiplicity of nursing home quality measures is an important goal. It would simplify interpretation and help consumers, their families and advocates to choose nursing facilities. This study uses quality indicators (QIs) from a state nursing home report card to explore the dimensionality of quality in nursing homes and to determine whether aggregation at the resident versus facility level yields the same underlying dimensions. Cross-sectional study. 382 Medicare- and/or Medicaid-certified nursing homes in Minnesota. Residents admitted to the nursing homes during 2011-2012. 16 QIs obtained from the Minimum Data Set 3.0 assessment instrument between 2011 and 2012 were used in the exploratory factor analysis. Factor analysis results suggest four main factors or dimensions to characterize facility performance: continence care (including 4 QIs), restraints and behavioral symptoms (including 3 QIs), care for specific conditions (including 6 QIs), and physical functioning (including 3 QIs). The resident-level and facility-level results generally agreed for 11 QIs. Nursing home quality of care can be captured in summary measures, which can be used by consumers, providers and researchers. Reporting at the resident or facility level will depend on the purpose. These summary measures can be used by policy-makers to identify and reward high-performing facilities and by families to choose nursing facilities for care. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

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

PubMed

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

2018-06-01

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

Stream salamanders as indicators of stream quality in Maryland, USA

USGS Publications Warehouse

Southerland, M.T.; Jung, R.E.; Baxter, D.P.; Chellman, I.C.; Mercurio, G.; Volstad, J.H.

2004-01-01

Biological indicators are critical to the protection of small, headwater streams and the ecological values they provide. Maryland and other state monitoring programs have determined that fish indicators are ineffective in small streams, where stream salamanders may replace fish as top predators. Because of their life history, physiology, abundance, and ubiquity, stream salamanders are likely representative of biological integrity in these streams. The goal of this study was to determine whether stream salamanders are effective indicators of ecological conditions across biogeographic regions and gradients of human disturbance. During the summers of 2001 and 2002, we intensively surveyed for stream salamanders at 76 stream sites located west of the Maryland Coastal Plain, sites also monitored by the Maryland Biological Stream Survey (MBSS) and City of Gaithersburg. We found 1,584 stream salamanders, including all eight species known in Maryland, using two 15 ? 2 m transects and two 4 m2 quadrats that spanned both stream bank and channel. We performed removal sampling on transects to estimate salamander species detection probabilities, which ranged from 0.67-0.85. Stepwise regressions identified 15 of 52 non-salamander variables, representing water quality, physical habitat, land use, and biological conditions, which best predicted salamander metrics. Indicator development involved (1) identifying reference (non-degraded) and degraded sites (using percent forest, shading, riparian buffer width, aesthetic rating, and benthic macroinvertebrate and fish indices of biotic integrity); (2) testing 12 candidate salamander metrics (representing species richness and composition, abundance, species tolerance, and reproductive function) for their ability to distinguish reference from degraded sites; and (3) combining metrics into an index that effectively discriminated sites according to known stream conditions. Final indices for Highlands, Piedmont, and Non-Coastal Plain

A potential to monitor nutrients as an indicator of rangeland quality using space borne remote sensing

NASA Astrophysics Data System (ADS)

Ramoelo, A.; Cho, M. A.; Madonsela, S.; Mathieu, R.; van der Korchove, R.; Kaszta, Z.; Wolf, E.

2014-02-01

Global change consisting of land use and climate change could have huge impacts on food security and the health of various ecosystems. Leaf nitrogen (N) is one of the key factors limiting agricultural production and ecosystem functioning. Leaf N can be used as an indicator of rangeland quality which could provide information for the farmers, decision makers, land planners and managers. Leaf N plays a crucial role in understanding the feeding patterns and distribution of wildlife and livestock. Assessment of this vegetation parameter using conventional methods at landscape scale level is time consuming and tedious. Remote sensing provides a synoptic view of the landscape, which engenders an opportunity to assess leaf N over wider rangeland areas from protected to communal areas. Estimation of leaf N has been successful during peak productivity or high biomass and limited studies estimated leaf N in dry season. The objective of this study is to monitor leaf N as an indicator of rangeland quality using WorldView 2 satellite images in the north-eastern part of South Africa. Series of field work to collect samples for leaf N were undertaken in the beginning of May (end of wet season) and July (dry season). Several conventional and red edge based vegetation indices were computed. Simple regression was used to develop prediction model for leaf N. Using bootstrapping, indicator of precision and accuracy were analyzed to select a best model for the combined data sets (May and July). The may model for red edge based simple ratio explained over 90% of leaf N variations. The model developed from the combined data sets with normalized difference vegetation index explained 62% of leaf N variation, and this is a model used to estimate and map leaf N for two seasons. The study demonstrated that leaf N could be monitored using high spatial resolution with the red edge band capability.

Feasibility of 48 quality indicators in ambulatory care in Germany: a cross-sectional observational study.

PubMed

de Cruppé, Werner; Kleudgen, Susanne; Diel, Franziska; Burgdorf, Friederike; Geraedts, Max

2015-01-01

The National Association of Statutory Health Insurance Physicians develops quality indicators (QIs) for ambulatory care in Germany. This study explores the feasibility of a total of 48 QIs. Cross-sectional observational study with primary data collection in writing from medical practices in 10 specialist fields of outpatient care. "Feasibility" covers 7 criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. A questionnaire consisting of 10 questions was used to evaluate these feasibility criteria for each indicator. Survey results were subjected to descriptive analysis. The analyzed sample comprises 103 participants who have been working as practice-based physicians for an average of 13 years. 40% only keep electronic medical records and 2% only paper records, and the rest uses both. The rating of QIs in the field-specific QI sets shows the following mean values: 67% of the participants consider the QIs assigned to them as corresponding to their practice care mandate. Data on these QIs deemed to be applicable are collected by 94% of respondents, documented by 91%, and by 51% electronically. 58% of the data required for the denominator, and 38% for the numerator are retrievable from the practice management system. The time required to access data on a QI is more than 30minutes for 84% of respondents, and 67% consider the effort involved as unacceptable. The rating received was 61% for the relevance of QIs to the assessment of a practitioner's own quality of health care, 69% for the estimated reliability of data collection, and 58% for the acceptance of being evaluated via QIs. In order to improve the feasibility of QI-based practice assessments it will be necessary to a) fine-tune the selection of QIs for the respective groups of specialist, b) to promote the use of computerized practice management systems, and c) integrate effective and user-friendly retrieval functions

A vision-based weld quality evaluation system

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

Barnett, R.J.; Cook, G.E.; Strauss, A.M.

1996-12-31

Inspection of the appearance of weld beads is an integral part of the overall welding process. Lack of satisfactory appearance in itself may be sufficient grounds for part rejection or the lack of satisfactory appearance may be used as an indirect indicator of more substantive problems such as poor fusion or subsurface cracks. In all cases the inspection process tends to be both time and labor intensive. The present research uses a video system and appropriate image capture and processing to determine the quality of the weld based upon surface appearance. This relative quality rating was compared to similar ratingsmore » performed by human inspectors and was found to give very good correlation. The system was implemented for the Gas Tungsten Arc Welding (GTAW) and Gas Metal Arc Welding (GMAW) processes.« less

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

PubMed

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

2014-03-01

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

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

NASA Astrophysics Data System (ADS)

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

2012-12-01

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

Quality assessment of remote sensing image fusion using feature-based fourth-order correlation coefficient

NASA Astrophysics Data System (ADS)

Ma, Dan; Liu, Jun; Chen, Kai; Li, Huali; Liu, Ping; Chen, Huijuan; Qian, Jing

2016-04-01

In remote sensing fusion, the spatial details of a panchromatic (PAN) image and the spectrum information of multispectral (MS) images will be transferred into fused images according to the characteristics of the human visual system. Thus, a remote sensing image fusion quality assessment called feature-based fourth-order correlation coefficient (FFOCC) is proposed. FFOCC is based on the feature-based coefficient concept. Spatial features related to spatial details of the PAN image and spectral features related to the spectrum information of MS images are first extracted from the fused image. Then, the fourth-order correlation coefficient between the spatial and spectral features is calculated and treated as the assessment result. FFOCC was then compared with existing widely used indices, such as Erreur Relative Globale Adimensionnelle de Synthese, and quality assessed with no reference. Results of the fusion and distortion experiments indicate that the FFOCC is consistent with subjective evaluation. FFOCC significantly outperforms the other indices in evaluating fusion images that are produced by different fusion methods and that are distorted in spatial and spectral features by blurring, adding noise, and changing intensity. All the findings indicate that the proposed method is an objective and effective quality assessment for remote sensing image fusion.