Ohio Step Up to Quality: 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 Ohio's Step Up to Quality 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) Indicators for Family…

Miami-Dade Quality Counts: 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 Miami-Dade's Quality Counts 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) Indicators for…

Indiana Paths to Quality: 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 Indiana's Paths to Quality 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) Indicators for…

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)

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.

[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.

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

PubMed Central

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

2013-01-01

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

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

PubMed Central

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

2015-01-01

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

Quality of osteoarthritis care in family medicine – A cross-sectional study.

PubMed

Račić, Maja; Tošić, Milena; Mašić, Srdjan

2016-01-01

Effective treatments for osteoarthritis are available, yet little is known about the quality of primary care in the Republic of Srpska for this disabling condition. The main objective of this study was to analyze the overall quality of osteoarthritis treatment in a family medicine setting, as well as to explore whether the achievement of quality indicators was associated with particular patient characteristics and severity of osteoarthritis. The cross-sectional study included 120 patients with confirmed hand, knee, and hip osteoarthritis, recruited at seven family practices in the town of Ugljevik, Republic of Srpska, Bosnia and Herzegovina. Data were extracted from a patient questionnaire on quality indicators, as well as from their electronic and paper records, to assess care against 14 indicators. The included quality indicators were based on the Arthritis Foundation’s Quality Indicator set for Osteoarthritis. Summary achievement rates for hip, knee, or hand osteoarthritis, as well as for the total sample, were calculated. The mean achievement rate for all 14 quality indicators obtained from medical records was 74%, and 77% obtained from patient interview. The quality indicators concerning referral for weight reduction (23%) and pharmacological treatment (24%) had the lowest achievement rates, whereas the highest achievement rates were related to physical examination (100%), pain and functional assessment (100%), and education (90.8%). Patients physical functioning was significantly associated with the quality indicator achievement rate (p = 0.001). Pharmacological therapy and the referral of osteoarthritis patients in need of weight reduction seem to have the greatest potential for improvement in primary health care.

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.

Environmental indicators of biofuel sustainability : What about context?

EPA Science Inventory

Indicators of the environmental sustainability of biofuel production, distribution, and use should be selected, measured, and interpreted with respect to the context in which they are used. These indicators include measures of soil quality, water quality and quantity, greenhouse...

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

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

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

Quality Indicators for Single-Case Research on Social Skill Interventions for Children with Autistic Spectrum Disorder

ERIC Educational Resources Information Center

Wang, Shin-Yi; Parrila, Rauno

2008-01-01

In this paper, we describe a quality checklist that parents, teachers, clinicians, and policy-makers with basic research skills can use to systematically evaluate the methodological quality of single-case studies on social skill training of children with autistic spectrum disorder (ASD). We provide a rationale for included quality indicators, and…

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.

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.

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.

Natural language processing in an intelligent writing strategy tutoring system.

PubMed

McNamara, Danielle S; Crossley, Scott A; Roscoe, Rod

2013-06-01

The Writing Pal is an intelligent tutoring system that provides writing strategy training. A large part of its artificial intelligence resides in the natural language processing algorithms to assess essay quality and guide feedback to students. Because writing is often highly nuanced and subjective, the development of these algorithms must consider a broad array of linguistic, rhetorical, and contextual features. This study assesses the potential for computational indices to predict human ratings of essay quality. Past studies have demonstrated that linguistic indices related to lexical diversity, word frequency, and syntactic complexity are significant predictors of human judgments of essay quality but that indices of cohesion are not. The present study extends prior work by including a larger data sample and an expanded set of indices to assess new lexical, syntactic, cohesion, rhetorical, and reading ease indices. Three models were assessed. The model reported by McNamara, Crossley, and McCarthy (Written Communication 27:57-86, 2010) including three indices of lexical diversity, word frequency, and syntactic complexity accounted for only 6% of the variance in the larger data set. A regression model including the full set of indices examined in prior studies of writing predicted 38% of the variance in human scores of essay quality with 91% adjacent accuracy (i.e., within 1 point). A regression model that also included new indices related to rhetoric and cohesion predicted 44% of the variance with 94% adjacent accuracy. The new indices increased accuracy but, more importantly, afford the means to provide more meaningful feedback in the context of a writing tutoring system.

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

Colorado Qualistar. 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 Colorado's Qualistar 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) Indicators for Family…

Pennsylvania Keystone STARS: 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 Pennsylvania's Keystone STARS 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) Indicators for…

Minnesota Parent Aware: 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 Minnesota's Parent Aware 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) Indicators for Family…

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

Quality of clinical and economic evidence in dossier formulary submissions.

PubMed

Colmenero, Fernando; Sullivan, Sean D; Palmer, Jennifer A; Brauer, Carmen A; Bungay, Kathleen; Watkins, John; Neumann, Peter J

2007-07-01

To investigate the quality and completeness of clinical and economic data in dossiers submitted by drug companies to a health plan using Academy of Managed Care Pharmacy guidelines (the Format) for formulary submissions. We reviewed the quality of economic analyses in dossiers submitted to Premera Blue Cross Health Plan (Mountlake Terrace, Washington; enrollment 1.6 million) between January 2002 and September 2005. For dossiers submitted in 2003, we examined the clinical studies included. Dossiers were audited with a data collection form to judge the types of clinical studies used to support labeled and off-label indications, and the quality and transparency of economic analyses. We compared economic analyses for high-cost (30-day treatment cost > $1000) versus low-cost products, and for "innovative" versus "me-too" drugs. Evidence to support off-label indications often was included in 2003 dossiers, but the information was less extensive and of poorer quality than data for labeled indications. Of 115 dossiers submitted between 2002 and 2005, 53 (46%) included economic analyses. The economic analyses had low levels of compliance with standards: only 43% performed sensitivity analysis; 38% stated the study perspective; 37% discussed relevant treatment alternatives; 20% stated assumptions clearly; and 18% mentioned caveats to conclusions. Economic analyses of high-cost products and innovative products had higher compliance with recommended practices. Drug companies are submitting dossiers of evidence to formulary committees. Dossiers often included clinical data to support off-label indications, but concerns persist about their quality. About half of dossiers included economic analyses, but these analyses had relatively low levels of compliance with recommended practices.

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: venous thromboembolism prophylaxis, 3.4%; stress ulcer prophylaxis, 2.1%). None of the 10 indicators was clearly and consistently correlated with a majority of the other nine indicators. No indicator performed optimally across assessments. Future research should seek to define and operationalize quality in a way that is relevant to both patients and providers.

Methodological quality of behavioural weight loss studies: a systematic review

PubMed Central

Lemon, S. C.; Wang, M. L.; Haughton, C. F.; Estabrook, D. P.; Frisard, C. F.; Pagoto, S. L.

2018-01-01

Summary This systematic review assessed the methodological quality of behavioural weight loss intervention studies conducted among adults and associations between quality and statistically significant weight loss outcome, strength of intervention effectiveness and sample size. Searches for trials published between January, 2009 and December, 2014 were conducted using PUBMED, MEDLINE and PSYCINFO and identified ninety studies. Methodological quality indicators included study design, anthropometric measurement approach, sample size calculations, intent-to-treat (ITT) analysis, loss to follow-up rate, missing data strategy, sampling strategy, report of treatment receipt and report of intervention fidelity (mean = 6.3). Indicators most commonly utilized included randomized design (100%), objectively measured anthropometrics (96.7%), ITT analysis (86.7%) and reporting treatment adherence (76.7%). Most studies (62.2%) had a follow-up rate >75% and reported a loss to follow-up analytic strategy or minimal missing data (69.9%). Describing intervention fidelity (34.4%) and sampling from a known population (41.1%) were least common. Methodological quality was not associated with reporting a statistically significant result, effect size or sample size. This review found the published literature of behavioural weight loss trials to be of high quality for specific indicators, including study design and measurement. Identified for improvement include utilization of more rigorous statistical approaches to loss to follow up and better fidelity reporting. PMID:27071775

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

ERIC Educational Resources Information Center

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

2004-01-01

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

Kentucky STARS for KIDS NOW: 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 Kentucky's STARS for KIDS NOW 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) Indicators for…

Are university rankings useful to improve research? A systematic review.

PubMed

Vernon, Marlo M; Balas, E Andrew; Momani, Shaher

2018-01-01

Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

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

PubMed

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

2013-12-01

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

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 point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators. PMID:25884623

Reliability and validity assessment of administrative databases in measuring the quality of rectal cancer management.

PubMed

Corbellini, Carlo; Andreoni, Bruno; Ansaloni, Luca; Sgroi, Giovanni; Martinotti, Mario; Scandroglio, Ildo; Carzaniga, Pierluigi; Longoni, Mauro; Foschi, Diego; Dionigi, Paolo; Morandi, Eugenio; Agnello, Mauro

2018-01-01

Measurement and monitoring of the quality of care using a core set of quality measures are increasing in health service research. Although administrative databases include limited clinical data, they offer an attractive source for quality measurement. The purpose of this study, therefore, was to evaluate the completeness of different administrative data sources compared to a clinical survey in evaluating rectal cancer cases. Between May 2012 and November 2014, a clinical survey was done on 498 Lombardy patients who had rectal cancer and underwent surgical resection. These collected data were compared with the information extracted from administrative sources including Hospital Discharge Dataset, drug database, daycare activity data, fee-exemption database, and regional screening program database. The agreement evaluation was performed using a set of 12 quality indicators. Patient complexity was a difficult indicator to measure for lack of clinical data. Preoperative staging was another suboptimal indicator due to the frequent missing administrative registration of tests performed. The agreement between the 2 data sources regarding chemoradiotherapy treatments was high. Screening detection, minimally invasive techniques, length of stay, and unpreventable readmissions were detected as reliable quality indicators. Postoperative morbidity could be a useful indicator but its agreement was lower, as expected. Healthcare administrative databases are large and real-time collected repositories of data useful in measuring quality in a healthcare system. Our investigation reveals that the reliability of indicators varies between them. Ideally, a combination of data from both sources could be used in order to improve usefulness of less reliable 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.

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.

Family Impacts among Children with Autism Spectrum Disorder: The Role of Health Care Quality

PubMed Central

Zuckerman, Katharine E.; Lindly, Olivia J.; Bethell, Christina D.; Kuhlthau, Karen

2014-01-01

Objectives To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN+ASD), CSHCN with functional limitations (CSHCN+FL), and CSHCN lacking these conditions (other CSHCN). To test whether high health care quality was associated with reduced family impacts among CSHCN+ASD. Methods Data from the 2009-2010 National Survey of CSHCN were used to compare 3025 CSHCN+ASD, 6505 CSHCN+FL, and 28 296 other CSHCN. Weighted multivariate logistic regression analyses examined six age-relevant, federally-defined health care quality indicators and five family financial and employment impact indicators. Two composite measures were additionally used: (1) receipt of care that met all age-relevant quality indicators; and (2) had ≥ two of the five adverse family impacts. Results Across all health care quality indicators CSHCN+ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN+ASD had worse health care quality than other CSHCN, including CSHCN+FL. CSHCN+ASD also had high rates of adverse family impact, with over half experiencing two or more adverse impacts. Rates of adverse family impact were higher in CSHCN+ASD than other CSHCN, including CSHCN+FL. Among CSHCN+ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN+ASD whose health care did not meet federal quality standards. Conclusions CSHCN+ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN+FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN+ASD. PMID:24976352

Nutritional factors and hypospadias risks

PubMed Central

Carmichael, Suzan L.; Ma, Chen; Feldkamp, Marcia L.; Munger, Ronald G.; Olney, Richard S.; Botto, Lorenzo D.; Shaw, Gary M.; Correa, Adolfo

2012-01-01

SUMMARY We examined whether hypospadias was associated with several aspects of the diet, including intake of animal products, intake of several nutrients and food groups related to a vegetarian diet and estrogen metabolism, and diet quality. The study included deliveries from 1997 to 2005 that were part of the National Birth Defects Prevention Study. Diet was assessed by food frequency questionnaire during maternal telephone interviews, and two diet quality indices were developed based on existing indices. Analyses included 1,250 cases with second or third degree hypospadias (urethra opened at the penile shaft, scrotum or perineum) and 3,118 male, liveborn, non-malformed controls. All odds ratios (ORs) and 95% confidence intervals (CI) were estimated from logistic regression models that included several potential confounders, including energy intake. Intake of animal products was not associated with hypospadias; e.g., the adjusted OR for any versus no intake of meat was 1.0 (95% CI 0.6, 1.6). Frequency of intake of meat or other animal products was also not associated with hypospadias, nor was intake of iron or several nutrients that are potentially related to estrogen metabolism. Diet quality was also not associated with hypospadias; the ORs for diet quality in the highest versus lowest quartile for the two diet quality indices were 1.0 (95% CI 0.6, 1.6) and 0.9 (95% CI 0.7, 1.1). In conclusion, this large study does not support an association of a vegetarian diet or worse diet quality with hypospadias. PMID:22686387

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.

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

PubMed

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

2015-02-01

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

[Evaluation of external quality assurance in accordance with sect. 137 SGB V at the Carl Gustav Carus university hospital in Dresden].

PubMed

Petzold, Thomas; Steinwitz, Adrienne; Schmitt, Jochen; Eberlein-Gonska, Maria

2013-01-01

Obligatory external quality assurance is an established method used to ensure the quality of inpatient care in Germany. The comprehensive approach is unique in international comparison. In addition to the statutory requirement, the health insurance funds require this form of external quality control in order to foster quality-based competition between hospitals. Ever since its introduction, healthcare providers have scrutinised the effects of the mandatory use of this survey. The study was based on all patients in the University Hospital Dresden, for whom a quality assurance sheet (n = 45,639) had to be recorded between 2003 and 2011. The documentation of these sheets was carried out by specially trained personnel. For each performance area, the duration of the documentation quality sheets was assessed, and a descriptive analysis of all quality assurance sheets was conducted. In the presence of statistical significance the so-called "Structured Dialogues" were analysed. Over the whole period, 167 statistically noticeable problems occurred. Nine of these have been rated as noticeable problems in medical quality by the specialised working groups of the project office quality assurance (PGSQS) at the Saxon State Medical Association (SLÄK). The remaining 158 statistical anomalies included 25 documentation errors; 96 were classified as statistically significant, and only 37 were marked to indicate that re-observation by the PGSQS was required. The total effort estimate for the documentation of quality assurance sheets was approximately 1,420 working days in the observation period. As far as the quality of patient care is concerned, the results can be considered positive because only a small number of quality indicators indicate noticeable qualitative problems. This statement is based primarily on the comparison of the groups of Saxony and Germany, which are included in the quality report of external quality assurance in accordance with sect. 137 SGB V. The majority of noticeable statistical problems were due to documentation errors. Other noticeable statistical problems that are medically indicated, but without effect on the extramural care to patients, recurrently occur with the respective quality indicators. Examples include the postoperative mobility indicators of the implementation of endoprostheses which cannot be used to draw conclusions about patient outcomes. Information on the quality of life as well as the post-hospital course of disease would be important in this context, but is still lacking. The use of external quality assurance data in accordance with sect. 137 SGB V for evaluation research has so far been handled quite restrictively. Thus, in-depth analyses on the quality of treatment cannot be derived. Copyright © 2013. Published by Elsevier GmbH.

[Quality indicators in the acute coronary syndrome for the analysis of the pre- and in-hospital care process].

PubMed

Felices-Abad, F; Latour-Pérez, J; Fuset-Cabanes, M P; Ruano-Marco, M; Cuñat-de la Hoz, J; del Nogal-Sáez, F

2010-01-01

We present a map of 27 indicators to measure the care quality given to patients with acute coronary syndrome attended in the pre- and hospital area. This includes technical process indicators (registration of care intervals, performance of electrocardiogram, monitoring and vein access, assessment of prognostic risk, hemorrhage and in-hospital mortality, use of reperfusion techniques and performance of echocardiograph), pharmacological process indicators (platelet receptors inhibition, anticoagulation, thrombolysis, beta-blockers, angiotensin converting inhibitors and lipid lowering drugs) and outcomes indicators (quality scales of the care given and mortality). Copyright © 2010 Elsevier España, S.L. y SEMICYUC. All rights reserved.

The Food and Nutrition Care Indicators (FANCI): Experts’ views on quality indicators for food and nutrition services in assisted living facilities for elders

USDA-ARS?s Scientific Manuscript database

This study assessed the views of 153 national experts in nutrition, health and aging services in ALFs, including gerontological nutrition (39%), food services (14%), aging and disability (22%), geriatric medicine (9%) and assisted living (16%) on the practices that serve as indicators of the quality...

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-03-24

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

Evidence-based practice: a quality indicator analysis of peer-tutoring in adapted physical education.

PubMed

Kalef, Laura; Reid, Greg; Macdonald, Cathy

2013-09-01

The purpose of the research was to conduct a quality indicator analysis of studies investigating peer-tutoring for students with a disability in adapted physical education. An electronic search was conducted among English journals published from 1960 to November 2012. Databases included ERIC, PsycINFO, and SPORTDiscus. Fifteen research studies employing group-experimental (Gersten et al., 2005) or single-subject designs (Horner et al., 2005) met inclusion criteria. Each study was assessed for the presence and clarity of quality indicators. Group designs met an average of 62.5% essential and 69% desirable indicators. An average of 80% of indicators was present for single-subject designs. Results suggest claims of peer-tutoring being an evidence-based practice are premature. Recommendations for clarifying and applying the quality indicators are offered. Copyright © 2013 Elsevier Ltd. All rights reserved.

Quality indicators for hip fracture patients: a scoping review protocol

PubMed Central

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

2014-01-01

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

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

PubMed

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

2014-10-21

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

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

PubMed

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

2012-08-01

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

Defining quality of care.

PubMed

Campbell, S M; Roland, M O; Buetow, S A

2000-12-01

This paper defines quality of health care. We suggest that there are two principal dimensions of quality of care for individual patients; access and effectiveness. In essence, do users get the care they need, and is the care effective when they get it? Within effectiveness, we define two key components--effectiveness of clinical care and effectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to individual patients and we suggest that quality of care is a concept that is at its most meaningful when applied to the individual user of health care. However, care for individuals must placed in the context of providing health care for populations which introduces additional notions of equity and efficiency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the differences between US and UK measures of quality. Using a conceptual framework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included.

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.

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

PubMed

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

2017-05-16

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

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.

Are university rankings useful to improve research? A systematic review

PubMed Central

Momani, Shaher

2018-01-01

Introduction Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. Methods A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. Results A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. Discussion No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and “luxury” indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance. PMID:29513762

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.

Virginia Star Quality Initiative: 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 Virginia's Star Quality Initiative 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) Indicators…

Mississippi Quality Step System: 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 Mississippi's Quality Step System 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) Application…

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.

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

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.

Quality Indicators for Multidisciplinary Team Functioning in Community-Based Children’s Mental Health Services

PubMed Central

Kutash, Krista; Acri, Mary; Pollock, Michele; Armusewicz, Kelsey; Hoagwood, Kimberly Eaton

2014-01-01

The current study examined the organizational social context in 21 community-based programs serving youth at-risk for out-of-home care due to emotional or behavioral disorders and their families and program performance on five quality indicators of team functioning in teams that included a family support specialist. Results indicate that programs with higher performance on structures to facilitate teamwork, informal communication mechanisms among team members, and the ability to integrate family support specialists as equal members of the team showed more positive organizational functioning. Implications for the role of quality indicators in health care reform efforts are discussed. PMID:23873037

Effects of backpacker use, pack stock trail use, and pack stock grazing on water-quality indicators, including nutrients, E. coli, hormones, and pharmaceuticals, in Yosemite National Park, USA

USGS Publications Warehouse

Forrester, Harrison; Clow, David W.; Roche, James W.; Heyvaert, Alan C.; Battaglin, William A.

2017-01-01

We investigated how visitor-use affects water quality in wilderness in Yosemite National Park. During the summers of 2012–2014, we collected and analyzed surface-water samples for water-quality indicators, including fecal indicator bacteria Escherichia coli, nutrients (nitrogen, phosphorus, carbon), suspended sediment concentration, pharmaceuticals, and hormones. Samples were collected upstream and downstream from different types of visitor use at weekly to biweekly intervals and during summer storms. We conducted a park-wide synoptic sampling campaign during summer 2014, and sampled upstream and downstream from meadows to evaluate the mitigating effect of meadows on water quality. At pack stock stream crossings, Escherichia coli concentrations were greater downstream from crossings than upstream (median downstream increase in Escherichia coli of three colony forming units 100 mL−1), with the greatest increases occurring during storms (median downstream increase in Escherichia coli of 32 CFU 100 mL−1). At backpacker use sites, hormones, and pharmaceuticals (e.g., insect repellent) were detected at downstream sites, and Escherichia coli concentrations were greater at downstream sites (median downstream increase in Escherichia coli of 1 CFU 100 mL−1). Differences in water quality downstream vs. upstream from meadows grazed by pack stock were not detectable for most water-quality indicators, however, Escherichia coli concentrations decreased downstream, suggesting entrapment and die-off of fecal indicator bacteria in meadows. Our results indicate that under current-use levels pack stock trail use and backpacker use are associated with detectable, but relatively minor, effects on water quality, which are most pronounced during storms.

Effects of Backpacker Use, Pack Stock Trail Use, and Pack Stock Grazing on Water-Quality Indicators, Including Nutrients, E. coli, Hormones, and Pharmaceuticals, in Yosemite National Park, USA

NASA Astrophysics Data System (ADS)

Forrester, Harrison; Clow, David; Roche, James; Heyvaert, Alan; Battaglin, William

2017-09-01

We investigated how visitor-use affects water quality in wilderness in Yosemite National Park. During the summers of 2012-2014, we collected and analyzed surface-water samples for water-quality indicators, including fecal indicator bacteria Escherichia coli, nutrients (nitrogen, phosphorus, carbon), suspended sediment concentration, pharmaceuticals, and hormones. Samples were collected upstream and downstream from different types of visitor use at weekly to biweekly intervals and during summer storms. We conducted a park-wide synoptic sampling campaign during summer 2014, and sampled upstream and downstream from meadows to evaluate the mitigating effect of meadows on water quality. At pack stock stream crossings, Escherichia coli concentrations were greater downstream from crossings than upstream (median downstream increase in Escherichia coli of three colony forming units 100 mL-1), with the greatest increases occurring during storms (median downstream increase in Escherichia coli of 32 CFU 100 mL-1). At backpacker use sites, hormones, and pharmaceuticals (e.g., insect repellent) were detected at downstream sites, and Escherichia coli concentrations were greater at downstream sites (median downstream increase in Escherichia coli of 1 CFU 100 mL-1). Differences in water quality downstream vs. upstream from meadows grazed by pack stock were not detectable for most water-quality indicators, however, Escherichia coli concentrations decreased downstream, suggesting entrapment and die-off of fecal indicator bacteria in meadows. Our results indicate that under current-use levels pack stock trail use and backpacker use are associated with detectable, but relatively minor, effects on water quality, which are most pronounced during storms.

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.

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…

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.

Has compliance with CLIA requirements really improved quality in US clinical laboratories?

PubMed

Ehrmeyer, Sharon S; Laessig, Ronald H

2004-08-02

The Clinical Laboratory Improvement Amendments of 1988 (CLIA'88) mandate universal requirements for all U.S. clinical laboratory-testing sites. The intent of CLIA'88 is to ensure quality testing through a combination of minimum quality practices that incorporate total quality management concepts. These regulations do not contain established, objective indicators or measures to assess quality. However, there is an implicit assumption that compliance with traditionally accepted good laboratory practices--following manufacturers' directions, routinely analysing quality control materials, applying quality assurance principles, employing and assessing competent testing personnel, and participating in external quality assessment or proficiency testing (PT)--will result in improved test quality. The CLIA'88 regulations do include PT performance standards, which intentionally or unintentionally, define intra-laboratory performance. Passing PT has become a prime motivation for improving laboratory performance; it can also be used as an objective indicator to assess whether compliance to CLIA has improved intra-laboratory quality. Data from 1994 through 2002 indicate that the percentage of laboratories passing PT has increased. In addition to PT performance, subjective indicators of improved quality--frequency of inspection deficiencies, the number of government sanctions for non-compliance, and customer satisfaction--were evaluated. The results from these subjective indicators are more difficult to interpret but also seem to show improved quality in US clinical laboratories eleven years post-CLIA'88.

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

PubMed Central

2015-01-01

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

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

PubMed

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

2015-01-01

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

[Development and validation of quality standards for colonoscopy].

PubMed

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

2010-01-30

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

Tennessee Star-Quality Child Care 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 Tennessee's Star-Quality Child Care 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)…

New Hampshire Quality Rating System: 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 New Hampshire's Quality Rating System 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)…

Algal Attributes: An Autecological Classification of Algal Taxa Collected by the National Water-Quality Assessment Program

USGS Publications Warehouse

Porter, Stephen D.

2008-01-01

Algae are excellent indicators of water-quality conditions, notably nutrient and organic enrichment, and also are indicators of major ion, dissolved oxygen, and pH concentrations and stream microhabitat conditions. The autecology, or physiological optima and tolerance, of algal species for various water-quality contaminants and conditions is relatively well understood for certain groups of freshwater algae, notably diatoms. However, applications of autecological information for water-quality assessments have been limited because of challenges associated with compiling autecological literature from disparate sources, tracking name changes for a large number of algal species, and creating an autecological data base from which algal-indicator metrics can be calculated. A comprehensive summary of algal autecological attributes for North American streams and rivers does not exist. This report describes a large, digital data file containing 28,182 records for 5,939 algal taxa, generally species or variety, collected by the U.S. Geological Survey?s National Water-Quality Assessment (NAWQA) Program. The data file includes 37 algal attributes classified by over 100 algal-indicator codes or metrics that can be calculated easily with readily available software. Algal attributes include qualitative classifications based on European and North American autecological literature, and semi-quantitative, weighted-average regression approaches for estimating optima using regional and national NAWQA data. Applications of algal metrics in water-quality assessments are discussed and national quartile distributions of metric scores are shown for selected indicator metrics.

The Linear Programming to evaluate the performance of Oral Health in Primary Care.

PubMed

Colussi, Claudia Flemming; Calvo, Maria Cristina Marino; Freitas, Sergio Fernando Torres de

2013-01-01

To show the use of Linear Programming to evaluate the performance of Oral Health in Primary Care. This study used data from 19 municipalities of Santa Catarina city that participated of the state evaluation in 2009 and have more than 50,000 habitants. A total of 40 indicators were evaluated, calculated using the Microsoft Excel 2007, and converted to the interval [0, 1] in ascending order (one indicating the best situation and zero indicating the worst situation). Applying the Linear Programming technique municipalities were assessed and compared among them according to performance curve named "quality estimated frontier". Municipalities included in the frontier were classified as excellent. Indicators were gathered, and became synthetic indicators. The majority of municipalities not included in the quality frontier (values different of 1.0) had lower values than 0.5, indicating poor performance. The model applied to the municipalities of Santa Catarina city assessed municipal management and local priorities rather than the goals imposed by pre-defined parameters. In the final analysis three municipalities were included in the "perceived quality frontier". The Linear Programming technique allowed to identify gaps that must be addressed by city managers to enhance actions taken. It also enabled to observe each municipal performance and compare results among similar municipalities.

Adult education and the quality of life

NASA Astrophysics Data System (ADS)

Tuijnman, Albert

1990-09-01

The purpose of this study is to investigate the complementary role of adult education in influencing people's objective and subjective quality of life. The analytical strategy used to achieve this end is to estimate parameters in a path model which includes both objective indicators such as occupational status and earned income, and subjective indicators such as job satisfaction and perceived personal wellbeing. The investigation builds on Swedish data and employs the LISREL method in the fitting of the model to the data. The results indicate that adult education positively influences objective indicators of the quality of life. Even though adult education is found to relate to measures of perceived personal wellbeing, the hypothesis that it also influences the way men assess their life situation and evaluate their subjective quality of life cannot be confirmed.

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

Evidence-based quality indicators for stroke rehabilitation.

PubMed

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

2012-01-01

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

Microbiological quality of natural waters.

PubMed

Borrego, J J; Figueras, M J

1997-12-01

Several aspects of the microbiological quality of natural waters, especially recreational waters, have been reviewed. The importance of the water as a vehicle and/or a reservoir of human pathogenic microorganisms is also discussed. In addition, the concepts, types and techniques of microbial indicator and index microorganisms are established. The most important differences between faecal streptococci and enterococci have been discussed, defining the concept and species included. In addition, we have revised the main alternative indicators used to measure the water quality.

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.

Socioeconomic dynamics of water quality in the Egyptian Nile

NASA Astrophysics Data System (ADS)

Malik, Maheen; Nisar, Zainab; Karakatsanis, Georgios

2016-04-01

The Nile River remains the most important source of freshwater for Egypt as it accounts for nearly all of the country's drinking and irrigation water. About 95% of the total population is accounted to live along the Banks of the Nile(1). Therefore, water quality deterioration in addition to general natural scarcity of water in the region(2) is the main driver for carrying out this study. What further aggravates this issue is the water conflict in the Blue Nile region. The study evaluates different water quality parameters and their concentrations in the Egyptian Nile; further assessing the temporal dynamics of water quality in the area with (a) the Environmental Kuznets Curve (EKC)(3) and (b) the Jevons Paradox (JP)(4) in order to identify water quality improvements or degradations using selected socioeconomic variables(5). For this purpose various environmental indicators including BOD, COD, DO, Phosphorus and TDS were plotted against different economic variables including Population, Gross Domestic Product (GDP), Annual Fresh Water Withdrawal and Improved Water Source. Mathematically, this was expressed by 2nd and 3rd degree polynomial regressions generating the EKC and JP respectively. The basic goal of the regression analysis is to model and highlight the dynamic trend of water quality indicators in relation to their established permissible limits, which will allow the identification of optimal future water quality policies. The results clearly indicate that the dependency of water quality indicators on socioeconomic variables differs for every indicator; while COD was above the permissible limits in all the cases despite of its decreasing trend in each case, BOD and phosphate signified increasing concentrations for the future, if they continue to follow the present trend. This could be an indication of rebound effect explained by the Jevons Paradox i.e. water quality deterioration after its improvement, either due to increase of population or intensification of economic activities related to these indicators. Keywords: Water quality dynamics, Environmental Kuznets Curve (EKC), Jevons Paradox (JP), economic variables, polynomial regressions, environmental indicators, permissible limit References: (1)Evans, A. (2007). River of Life River Nile. (2)Egypt's Water Crisis - Recipe for Disaster. (2016). [Blog] EcoMENA- Echoing Sustainability. (3)Alstine, J. and Neumayer, E. (2010). The Environmental Kuznets Curve. (4)Garrett, T. (2014). Rebound, Backfire, and the Jevons Paradox. [Blog] (5)Data.worldbank.org

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.

Louisiana Quality Start Child Care Rating System: 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 Louisiana's Quality Start Child Care Rating System 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;…

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.

The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis.

PubMed

Salyers, Michelle P; Bonfils, Kelsey A; Luther, Lauren; Firmin, Ruth L; White, Dominique A; Adams, Erin L; Rollins, Angela L

2017-04-01

Healthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of this relationship. This meta-analysis examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and the quality (perceived quality, patient satisfaction) and safety of healthcare. Publications were identified through targeted literature searches in Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, and ProQuest Dissertations & Theses through March of 2015. Two coders extracted data to calculate effect sizes and potential moderators. We calculated Pearson's r for all independent relationships between burnout and quality measures, using a random effects model. Data were assessed for potential impact of study rigor, outliers, and publication bias. Eighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = -0.26, 95 % CI [-0.29, -0.23]) and safety (r = -0.23, 95 % CI [-0.28, -0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients. Moderators for the quality relationship included dimension of burnout, unit of analysis, and quality data source. Moderators for the relationship between burnout and safety were safety indicator type, population, and country. Rigor of the study was not a significant moderator. This is the first study to systematically, quantitatively analyze the links between healthcare provider burnout and healthcare quality and safety across disciplines. Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators, and perceptions of safety. Though the effects are small to medium, the findings highlight the importance of effective burnout interventions for healthcare providers. Moderator analyses suggest contextual factors to consider for future study.

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

PubMed

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

2017-01-01

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

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.

Soil Quality Indicator: a new concept

NASA Astrophysics Data System (ADS)

Barão, Lúcia; Basch, Gottlieb

2017-04-01

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

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

USGS Publications Warehouse

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

2008-01-01

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

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

PubMed

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

2018-05-01

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

The role of depression, anxiety, stress and adherence to treatment in dialysis patients’ health-related quality of life: a systematic review of the literature.

PubMed

García-Llana, Helena; Remor, Eduardo; Del Peso, Gloria; Selgas, Rafael

2014-01-01

Health-related quality of life (HRQOL) has been widely studied in the field of dialysis patients. However, there are few studies that include relationships of psychosocial variables and adherence to treatment with HRQOL. The aim of this review is to systematically synthesise available information on the role that psychological variables (depression, anxiety and stress) and adherence to treatment have on HRQOL of dialysis patients through a systematic narrative review. We selected studies that included and related, in their results psychological variables (at least one of the following: depression, anxiety or perceived stress), adherence to treatment and HRQOL in adults on dialysis due to advanced chronic kidney disease (ACKD). The studies included had to incorporate standardised instruments into their assessment protocol. We searched the MEDLINE and PsycINFO databases from January 2002 to August 2012. Thirty-eight studies were included in this review and we assessed their methodological quality. The review revealed that 100% of the studies identified a negative association between indicators of anxiety, depression and stress and HRQL, indicating that these variables are risk factors for quality of life. Adherence to treatment was associated with psychological factors and HRQOL in 8% (N=3) of the studies included and has been demonstrated to be a protective factor for quality of life in 66% of studies (2 of 3) that included this variable. Considering the effect of these variables on HRQOL, it is important to screen for early indicators of anxiety, stress and depression or difficulties in complying with treatment in the ACKD population on dialysis. This will allow preventive interventions to be carried out before HRQOL deteriorates.

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.

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

PubMed

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

2017-01-01

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

[Pay for performance in dental care: A systematic narrative review of quality P4P models in dental care].

PubMed

Chenot, Regine

2017-11-01

Pay for performance (P4P) links reimbursement to the achievement of quality objectives. Experiences with P4P instruments and studies on their effects are available for the inpatient sector. A systematic narrative review brings together findings concerning the use and the effects of P4P, especially in dental care. A systematic literature search in PubMed and the Cochrane Library for reimbursement models using quality indicators provided 77 publications. Inclusion criteria were: year of publication not older than 2007, dental sector, models of quality-oriented remuneration, quality of care, quality indicators. 27 publications met the inclusion criteria and were evaluated with regard to the instruments and effects of P4P. The database search was supplemented by a free search on the Internet as well as a search in indicator databases and portals. The results of the included studies were extracted and summarized narratively. 27 studies were included in the review. Performance-oriented remuneration is an instrument of quality competition. In principle, P4P is embedded in an existing remuneration system, i.e., it does not occur in isolation. In the United States, England and Scandinavia, models are currently being tested for quality-oriented remuneration in dental care, based on quality indicators. The studies identified by the literature search are very heterogeneous and do not yield comparable endpoints. Difficulties are seen in the reproducibility of the quality of dental care with regard to certain characteristics which still have to be defined as quality-promoting properties. Risk selection cannot be ruled out, which may have an impact on structural quality (access to care, coordination). There were no long-term effects of P4P on the quality of care. In the short and medium term, adverse effects on the participants' motivation as well as shifting effects towards the private sector are described. A prerequisite for the functioning of P4P is the definition of clear targets and measuring parameters. Furthermore, evidence-based quality indicators have to be developed that validly depict quality differences. It is yet unknown whether P4P will have long-term effects or whether the quality of dental care will increase. Copyright © 2017. Published by Elsevier GmbH.

Environmental quality program review

NASA Technical Reports Server (NTRS)

1979-01-01

The transcript of discussions held following formal presentations during sessions 4 and 5 of the program review are presented. Topics covered include global and regional tropospheric research and water quality. Plans for continued study are indicated.

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.

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

PubMed Central

2012-01-01

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

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.

A new four-step hierarchy method for combined assessment of groundwater quality and pollution.

PubMed

Zhu, Henghua; Ren, Xiaohua; Liu, Zhizheng

2017-12-28

A new four-step hierarchy method was constructed and applied to evaluate the groundwater quality and pollution of the Dagujia River Basin. The assessment index system is divided into four types: field test indices, common inorganic chemical indices, inorganic toxicology indices, and trace organic indices. Background values of common inorganic chemical indices and inorganic toxicology indices were estimated with the cumulative-probability curve method, and the results showed that the background values of Mg 2+ (51.1 mg L -1 ), total hardness (TH) (509.4 mg L -1 ), and NO 3 - (182.4 mg L -1 ) are all higher than the corresponding grade III values of Quality Standard for Groundwater, indicating that they were poor indicators and therefore were not included in the groundwater quality assessment. The quality assessment results displayed that the field test indices were mainly classified as grade II, accounting for 60.87% of wells sampled. The indices of common inorganic chemical and inorganic toxicology were both mostly in the range of grade III, whereas the trace organic indices were predominantly classified as grade I. The variabilities and excess ratios of the indices were also calculated and evaluated. Spatial distributions showed that the groundwater with poor quality indices was mainly located in the northeast of the basin, which was well-connected with seawater intrusion. Additionally, the pollution assessment revealed that groundwater in well 44 was classified as "moderately polluted," wells 5 and 8 were "lightly polluted," and other wells were classified as "unpolluted."

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 are completed, the indicator set can be used to guide meal and meal service quality improvement projects in collaboration with kitchen staff and health care professionals. These improvement projects will help to improve food intake and reduce the risk of malnutrition among elders living in residential facilities.

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

PubMed

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

2015-01-01

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

40 CFR 257.22 - Ground-water monitoring systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... defined in § 257.5(b)) that: (1) Represent the quality of background ground water that has not been affected by leakage from a unit. A determination of background quality may include sampling of wells that... at other wells will provide an indication of background ground-water quality that is as...

Social Work Education and Avoidable Ignorance

ERIC Educational Resources Information Center

Gambrill, Eileen

2014-01-01

The quality of professional education affects the quality of services offered to clients. Examples of avoidable ignorance that dilute the quality of education social workers receive are suggested, indicating that we have not been honest and energetic brokers of knowledge and ignorance. Related reasons are suggested, including a reluctance to take…

River Pollution: Part II. Biological Methods for Assessing Water Quality.

ERIC Educational Resources Information Center

Openshaw, Peter

1984-01-01

Discusses methods used in the biological assessment of river quality and such indicators of clean and polluted waters as the Trent Biotic Index, Chandler Score System, and species diversity indexes. Includes a summary of a river classification scheme based on quality criteria related to water use. (JN)

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... patient safety by using quality indicators or performance measures associated with improved health... that includes care and services furnished in the ASC. (b) Standard: Program data. (1) The program must...

Quality assessment of urban environment

NASA Astrophysics Data System (ADS)

Ovsiannikova, T. Y.; Nikolaenko, M. N.

2015-01-01

This paper is dedicated to the research applicability of quality management problems of construction products. It is offered to expand quality management borders in construction, transferring its principles to urban systems as economic systems of higher level, which qualitative characteristics are substantially defined by quality of construction product. Buildings and structures form spatial-material basis of cities and the most important component of life sphere - urban environment. Authors justify the need for the assessment of urban environment quality as an important factor of social welfare and life quality in urban areas. The authors suggest definition of a term "urban environment". The methodology of quality assessment of urban environment is based on integrated approach which includes the system analysis of all factors and application of both quantitative methods of assessment (calculation of particular and integrated indicators) and qualitative methods (expert estimates and surveys). The authors propose the system of indicators, characterizing quality of the urban environment. This indicators fall into four classes. The authors show the methodology of their definition. The paper presents results of quality assessment of urban environment for several Siberian regions and comparative analysis of these results.

Difference of performance in response to disease admissions between daily time air quality indices and those derived from average and entropy functions.

PubMed

Lai, Li-Wei; Cheng, Wan-Li

2017-06-01

Daily time air quality indices, which can reflect air quality in 1 day, are suitable for identifying daily exposure during conditions of poor air quality. The aim of this study is to compare the main effectiveness of four daily time indices in representing variation in the number of disease admissions. These indices include pollution standard index (PSI), air quality index (AQI) and their respective indices derived from mean and entropy functions: MEPSI and MEAQI. The hourly concentrations of fine particulate matter less than 10 μm in diameter (PM 10 ), PM 2.5 , O 3 , CO, NO 2 and SO 2 from 1 January 2006 to 31 December 2010 were obtained from 14 air quality monitoring stations owned by the Environmental Protection Administration (EPA) in the Kaoping region, Taiwan.Instead of circulatory system disease admissions, the indices were correlative with the number of respiratory disease admissions with correlative coefficients of 0.49 to 0.56 (P < 0.05). The daily time air quality indices derived from mean and entropy functions improved their performance of reactive range and air pollution identification. The reactive range of MEPSI and MEAQI was 1.4-3 times that of the original indices. The MEPSI and MEAQI increased identification from 40 to 180 in index scale and revealed one to two additional categories of public health effect information. In comparison with other indices, MEAQI is more effective for application to pollution events with multiple air pollutants.

Colonoscopy quality assurance in Ontario: Systematic review and clinical practice guideline

PubMed Central

Tinmouth, Jill; Kennedy, Erin B; Baron, David; Burke, Mae; Feinberg, Stanley; Gould, Michael; Baxter, Nancy; Lewis, Nancy

2014-01-01

Colonoscopy is fundamental to the diagnosis and management of digestive diseases and plays a key role in colorectal cancer (CRC) screening and diagnosis. Therefore, it is important to ensure that colonoscopy is of high quality. The present guidance document updates the evidence and recommendations in Cancer Care Ontario’s 2007 Colonoscopy Standards, and was conducted under the aegis of the Program in Evidence-Based Care. It is intended to support quality improvement for colonoscopies for all indications, including follow-up to a positive fecal occult blood test, screening for individuals who have a family history of CRC and those at average risk, investigation for symptomatic patients, and surveillance of those with a history of adenomatous polyps or CRC. A systematic review was performed to evaluate the existing evidence concerning the following three key aspects of colonoscopy: physician endoscopist training and maintenance of competency; institutional quality assurance parameters; and colonoscopy quality indicators and auditable outcomes. Where appropriate, indicators were designated quality indicators (where there was sufficient evidence to recommend a specific target) and auditable outcomes (insufficient evidence to recommend a specific target, but which should be monitored for quality assurance purposes). The guidance document may be used to support colonoscopy quality assurance programs to improve the quality of colonoscopy regardless of indication. Improvements in colonoscopy quality are anticipated to improve important outcomes in digestive diseases, such as reduction of the incidence of and mortality from CRC. PMID:24839621

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

PubMed

Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.

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.

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

PubMed

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

2016-02-19

Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations' websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies, including 2 stakeholder meetings, publication and presentation at conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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.

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.

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

PubMed

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

2017-05-01

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

Hospital quality of care: does information technology matter? The relationship between information technology adoption and quality of care.

PubMed

Menachemi, Nir; Chukmaitov, Askar; Saunders, Charles; Brooks, Robert G

2008-01-01

Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption. To explore the relationship between IT adoption and quality of care in acute-care hospitals. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality. Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy. Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.

40 CFR 257.22 - Ground-water monitoring systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... aquifer (as defined in § 257.5(b)) that: (1) Represent the quality of background ground water that has not been affected by leakage from a unit. A determination of background quality may include sampling of...) Sampling at other wells will provide an indication of background ground-water quality that is as...

Looking for High Quality Accreditation in Higher Education in Colombia

ERIC Educational Resources Information Center

Pérez Gama, Jesús Alfonso; Vega Vega, Anselmo

2017-01-01

We look for the High Quality Accreditation of tertiary education in two ways: one, involving large amount of information, including issues such as self-assessment, high quality, statistics, indicators, surveys, and field work (process engineering), during several periods of time; and the second, in relation to the information contained there about…

40 CFR 257.22 - Ground-water monitoring systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... aquifer (as defined in § 257.5(b)) that: (1) Represent the quality of background ground water that has not been affected by leakage from a unit. A determination of background quality may include sampling of...) Sampling at other wells will provide an indication of background ground-water quality that is as...

[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.

[Infection prevention in Dutch hospitals; results say more than process indicators].

PubMed

Bonten, Marc J M; Friedrich, Alexander; Kluytmans, Jan A J W; Vandenbroucke-Grauls, Christina M J E; Voss, Andreas; Vos, Margreet C

2014-01-01

The Dutch Health Care Inspectorate investigated the preparedness of Dutch hospitals for the emergence of antibiotic resistance, and concluded that hospitals are not well prepared and are insufficiently aware that infection prevention is a prerequisite for patient safety. These conclusions are based on observations of process indicators of current practice guidelines, without including the available outcome indicators that demonstrate the persistently low incidence of infections with antibiotic resistant bacteria in Dutch hospitals. The conclusions may have negative effects on the quality of infection prevention in Dutch hospitals. Therefore, it is advisable to use outcome indicators rather than process indicators to evaluate the quality of infection prevention.

Monitoring marine recreational water quality using multiple microbial indicators in an urban tropical environment

PubMed Central

Shibata, Tomoyuki; Solo-Gabriele, Helena M.; Fleming, Lora E.; Elmir, Samir

2008-01-01

The microbial water quality at two beaches, Hobie Beach and Crandon Beach, in Miami-Dade County, Florida, USA was measured using multiple microbial indicators for the purpose of evaluating correlations between microbes and for identifying possible sources of contamination. The indicator microbes chosen for this study (enterococci, Escherichia coli, fecal coliform, total coliform and C. perfringens) were evaluated through three different sampling efforts. These efforts included daily measurements at four locations during a wet season month and a dry season month, spatially intensive water sampling during low- and high-tide periods, and a sand sampling effort. Results indicated that concentrations did not vary in a consistent fashion between one indicator microbe and another. Daily water quality frequently exceeded guideline levels at Hobie Beach for all indicator microbes except for fecal coliform, which never exceeded the guideline. Except for total coliform, the concentrations of microbes did not change significantly between seasons in spite of the fact that the physical–chemical parameters (rainfall, temperature, pH, and salinity) changed significantly between the two monitoring periods. Spatially intense water sampling showed that the concentrations of microbes were significantly different with distance from the shoreline. The highest concentrations were observed at shoreline points and decreased at offshore points. Furthermore, the highest concentrations of indicator microbe concentrations were observed at high tide, when the wash zone area of the beach was submerged. Beach sands within the wash zone tested positive for all indicator microbes, thereby suggesting that this zone may serve as the source of indicator microbes. Ultimate sources of indicator microbes to this zone may include humans, animals, and possibly the survival and regrowth of indicator microbes due to the unique environmental conditions found within this zone. Overall, the results of this study indicated that the concentrations of indicator microbes do not necessarily correlate with one another. Exceedence of water quality guidelines, and thus the frequency of beach advisories, depends upon which indicator microbe is chosen. PMID:15261551

The Role of Reliability, Vulnerability and Resilience in the Management of Water Quality Systems

NASA Astrophysics Data System (ADS)

Lence, B. J.; Maier, H. R.

2001-05-01

The risk based performance indicators reliability, vulnerability and resilience provide measures of the frequency, magnitude and duration of the failure of water resources systems, respectively. They have been applied primarily to water supply problems, including the assessment of the performance of reservoirs and water distribution systems. Applications to water quality case studies have been limited, although the need to consider the length and magnitude of violations of a particular water quality standard has been recognized for some time. In this research, the role of reliability, vulnerability and resilience in water quality management applications is investigated by examining their significance as performance measures for water quality systems and assessing their potential for assisting in decision making processes. The importance of each performance indicator is discussed and a framework for classifying such systems, based on the relative significance of each of these indicators, is introduced and illustrated qualitatively with various case studies. Quantitative examples drawn from both lake and river water quality modeling exercises are then provided.

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.

Supplier selection based on complex indicator of finished products quality

NASA Astrophysics Data System (ADS)

Chernikova, Anna; Golovkina, Svetlana; Kuzmina, Svetlana; Demenchenok, Tatiana

2017-10-01

In the article the authors consider possible directions of solving problems when selecting a supplier for deliveries of raw materials and materials of an industrial enterprise, possible difficulties are analyzed and ways of their solution are suggested. Various methods are considered to improve the efficiency of the supplier selection process based on the analysis of the paper bags supplier selection process for the needs of the construction company. In the article the calculation of generalized indicators and complex indicator, which should include single indicators, formed in groups that reflect different aspects of quality, is presented.

Does Satisfaction Reflect the Technical Quality of Mental Health Care?

PubMed Central

Edlund, Mark J; Young, Alexander S; Kung, Fuan Yue; Sherbourne, Cathy D; Wells, Kenneth B

2003-01-01

Objective To analyze the relationship between satisfaction and technical quality of care for common mental disorders. Data Source A nationally representative telephone survey of 9,585 individuals conducted in 1997–1998. Study Design Using multinomial logistic regression techniques we investigated the association between a five-level measure of satisfaction with the mental health care available for personal or emotional problems and two quality indicators. The first measure, appropriate technical quality, was defined as use of either appropriate counseling or psychotropic medications during the prior year for a probable depressive or anxiety disorder. The second, active treatment, indicated whether the respondent had received treatment for a psychiatric disorder in the past year. Covariates included measures of physical and mental health and sociodemographic indicators. Principal Findings Appropriate technical quality of care was significantly associated with higher levels of satisfaction. The strength of the association was moderate. Conclusions Satisfaction is associated with technical quality of care. However, profiling quality of care with satisfaction will likely require large samples and case-mix adjustment, which may be more difficult for plans or provider groups to implement than measuring technical indicators. More importantly, satisfaction is not the same as technical quality, and our results suggest that at this time they cannot be made to approach each other closely enough to eliminate either. PMID:12785565

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.

The impact of learned resourcefulness on quality of life in type II diabetic patients: a cross-sectional correlational study.

PubMed

Huang, Chiung-Yu; Perng, Shoa-Jen; Chen, Hisu-Fung; Lai, Chien-Yu

2008-12-01

It is well recognized that patients with diabetes encounter a host of daily self-care issues, including controlling blood sugar and preventing and managing complications, which impact significantly upon quality of life. Studies have indicated that learned resourcefulness has a potentially positive effect in dealing with psychosocial and health problems. The purpose of this study was to test the relationship between learned resourcefulness and quality of life in type II diabetic patients. The mediating and moderating effects of learned resourcefulness on the relationship between metabolic control and quality of life of diabetic patients was also examined. This cross-sectional and correlational study included a convenience sample of 131 type II diabetic patients recruited from three hospitals in southern Taiwan. Data were collected through questionnaires, which included the Rosenbaum's Self Control Schedule and World Health Organization's Quality of Life (Short Version). Multiple regression techniques were used to analyze outcome predictors. Study findings include identification of a mediating effect of learned resourcefulness between metabolic control and quality of life. While most DM patients were not satisfied with their health, we found that those with greater learned resourcefulness enjoyed a better quality of life. Learned resourcefulness, gender, and HbA1C explained 35.2% of variance in DM patient quality of life. Male diabetic patients enjoyed a better quality of life than females, even though levels of learned resourcefulness between the two groups were not significantly different. Results indicate that poor metabolic control of diabetic patients has a detrimental effect on quality of life, and when diabetic patients use more self-control skills, they may achieve better quality of life. Results suggest that nurses who use cognitive behavior coping strategies (resourcefulness) may help diabetic patients achieve better metabolic control and promote better quality of life.

Parallels between Objective Indicators and Subjective Perceptions of Quality of Life: A Study of Metropolitan and County Areas in Taiwan

ERIC Educational Resources Information Center

Liao, Pei-shan

2009-01-01

This study explores the consistency between objective indicators and subjective perceptions of quality of life in a ranking of survey data for cities and counties in Taiwan. Data used for analysis included the Statistical Yearbook of Hsiens and Municipalities and the Survey on Living Conditions of Citizens in Taiwan, both given for the year 2000.…

The quality of primary care provided to the elderly in Israel.

PubMed

Podell, Rachel; Shriqui, Vered Kaufman; Sagy, Yael Wolff; Manor, Orly; Ben-Yehuda, Arie

2018-06-04

In view of increasing global and local trends in population ageing and the high healthcare utilization rates among the elderly, this study assesses the quality of primary care provided to the elderly population in Israel. It examines changes in quality over time, how quality varies across sub-groups of the elderly, and how quality in Israel compares with other countries. Data originate from the National Program for Quality Indicators in Community Healthcare (QICH), which operates in full collaboration with Israel's four HMOs. The study population included all elderly Israeli residents aged 65 years or older during 2002-2015 (N = 879,671 residents in 2015). Seven elderly-specific quality indicators from within the QICH framework were included: influenza and pneumococcal vaccinations, benzodiazepine overuse, long-acting benzodiazepine use, body weight documentation, weight loss and underweight. In addition, two non-age specific quality indicators relating to diabetes mellitus were included: the rate of HbA1C documentation and uncontrolled diabetes. Data were collected from patient electronic medical records (EMR) in accordance with each HMO, and aggregated by three variables: gender, age, and socio-economic position (SEP). During the measurement period, vaccination rates significantly increased (Influenza: from 42.0% in 2002 to 63.2% in 2015; and pneumococcal vaccination: from 25.8% in 2005 to 77.0% in 2015). Body weight documentation (in 65-74 year old persons) increased from only 16.3% in 2003 to 80.9% in 2015. The rate of underweight (BMI < 23 kg/m 2 ) and significant weight-loss (10% or more of their body weight) was only measured in 2015. The overall rate of benzodiazepine overuse remained steady from 2011 to 2015 at around 5%, while the rate of long-acting benzodiazepine use decreased from 3.8% in 2011 to 2.4% in 2015. The rate of HbA1c documentation for elderly diabetics was higher than for non-elderly diabetics in 2015 (92.2% vs 87.9%). The rate of uncontrolled diabetes was lower for the elderly than the non-elderly population in 2015 (6.9% vs. 15.7%). Gender disparities were observed across all measures, after age stratification, with worse indicator rates among females compared to males. SEP-disparities were not consistent across measures. In all indicators except benzodiazepine overuse, Israel showed a higher quality of care for the elderly in comparison with the international healthcare community. Overall, the quality of care received by elderly Israelis has improved substantially since measurements first began; yet, females receive lower quality care than males. Monitoring results of primary care quality indicators can contribute to population's successful aging; both chronic conditions at earlier ages (e.g. diabetes), and short-term hazardous conditions such as the use of potentially harmful medications and weight loss should be evaluated.

Redox processes and water quality of selected principal aquifer systems

USGS Publications Warehouse

McMahon, P.B.; Chapelle, F.H.

2008-01-01

Reduction/oxidation (redox) conditions in 15 principal aquifer (PA) systems of the United States, and their impact on several water quality issues, were assessed from a large data base collected by the National Water-Quality Assessment Program of the USGS. The logic of these assessments was based on the observed ecological succession of electron acceptors such as dissolved oxygen, nitrate, and sulfate and threshold concentrations of these substrates needed to support active microbial metabolism. Similarly, the utilization of solid-phase electron acceptors such as Mn(IV) and Fe(III) is indicated by the production of dissolved manganese and iron. An internally consistent set of threshold concentration criteria was developed and applied to a large data set of 1692 water samples from the PAs to assess ambient redox conditions. The indicated redox conditions then were related to the occurrence of selected natural (arsenic) and anthropogenic (nitrate and volatile organic compounds) contaminants in ground water. For the natural and anthropogenic contaminants assessed in this study, considering redox conditions as defined by this framework of redox indicator species and threshold concentrations explained many water quality trends observed at a regional scale. An important finding of this study was that samples indicating mixed redox processes provide information on redox heterogeneity that is useful for assessing common water quality issues. Given the interpretive power of the redox framework and given that it is relatively inexpensive and easy to measure the chemical parameters included in the framework, those parameters should be included in routine water quality monitoring programs whenever possible.

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.

Mammogram image quality as a potential contributor to disparities in breast cancer stage at diagnosis: an observational study

PubMed Central

2013-01-01

Background In an ongoing study of racial/ethnic disparities in breast cancer stage at diagnosis, we consented patients to allow us to review their mammogram images, in order to examine the potential role of mammogram image quality on this disparity. Methods In a population-based study of urban breast cancer patients, a single breast imaging specialist (EC) performed a blinded review of the index mammogram that prompted diagnostic follow-up, as well as recent prior mammograms performed approximately one or two years prior to the index mammogram. Seven indicators of image quality were assessed on a five-point Likert scale, where 4 and 5 represented good and excellent quality. These included 3 technologist-associated image quality (TAIQ) indicators (positioning, compression, sharpness), and 4 machine associated image quality (MAIQ) indicators (contrast, exposure, noise and artifacts). Results are based on 494 images examined for 268 patients, including 225 prior images. Results Whereas MAIQ was generally high, TAIQ was more variable. In multivariable models of sociodemographic predictors of TAIQ, less income was associated with lower TAIQ (p < 0.05). Among prior mammograms, lower TAIQ was subsequently associated with later stage at diagnosis, even after adjusting for multiple patient and practice factors (OR = 0.80, 95% CI: 0.65, 0.99). Conclusions Considerable gains could be made in terms of increasing image quality through better positioning, compression and sharpness, gains that could impact subsequent stage at diagnosis. PMID:23621946

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

PubMed

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

2018-06-01

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

Good-quality social care for people with Parkinson’s disease: a qualitative study

PubMed Central

Kennedy, Fiona; Stocks, Amanda-Jayne; McDonnell, Ann; Ramaswamy, Bhanu; Wood, Brendan; Whitfield, Malcolm

2016-01-01

Objectives The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being. Design Qualitative case study methodology, interview and framework analysis techniques were used. Setting: community locations in the north and midlands of England. Participants Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner. Findings Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the ‘Impact Gap’ developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. ‘Parkinson's aware’ social care was seen to generate psychological, physical and social benefits that were inter-related. Conclusions The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early detection of and signposting to social care. PMID:26883233

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.

Quality of Life Indicators in the U.S. Metropolitan Areas, 1970 (Summary).

ERIC Educational Resources Information Center

Liu, Ben-Chieh

The empirical results of a 1970 study designed to assess the quality of life in 243 metropolitan areas are provided in this booklet. The quality of life components include 123 variables related to overall economic, political, environmental, health and education, and social conditions. The booklet is divided into five sections which explain the…

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

ERIC Educational Resources Information Center

Arkansas State Dept. of Higher Education, Little Rock.

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

Delaware Stars for Early Success. 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 Delaware's Stars for Early Success 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) Indicators…

Vermont STep Ahead Recognition System: 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 Vermont's STep Ahead Recognition System (STARS) 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 All Child Care Programs;…

North Carolina Star Rated License System: 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 North Carolina's Star Rated License System 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)…

Selection for inpatient rehabilitation after acute stroke: a systematic review of the literature.

PubMed

Hakkennes, Sharon J; Brock, Kim; Hill, Keith D

2011-12-01

To identify patient-related factors that have been found to correlate with functional outcomes post acute stroke to guide clinical decision making with regard to rehabilitation admission after acute stroke. We systematically searched the scientific literature between 1966 and January 2010. The primary source of studies was the electronic databases Medline, CINAHL, and Embase. The search was supplemented with citation tracking. Two reviewers independently applied the inclusion criteria to identify relevant articles from the citations obtained through the literature search. Eligible studies included systematic reviews of prognostic indicators, studies of prognostic indicators of acute discharge disposition, and studies of rehabilitation admission criteria after acute stroke. Of the 8895 studies identified, 83 articles, representing 79 studies, were included in the review. One reviewer extracted the data relating to the participants, prognostic indicators, and outcomes. A second reviewer independently checked data extracted with disagreement resolved by a third reviewer. Quality of included studies was assessed for internal and external validity. Of the 79 studies, 26 were systematic reviews of prognostic indicators of functional level and/or discharge disposition, 48 were studies of prognostic indicators of acute discharge disposition, and 6 were studies of rehabilitation selection criteria. The methodologic quality of the included studies was generally poor. Age, cognition, functional level after stroke, and, to a lesser extent, continence were found to have a consistent association with outcome across all 3 research areas. In addition, stroke severity was also associated with acute discharge disposition, final discharge disposition, and functional level. Sex and side of stroke appeared to have no association across all 3 of the research areas. This review highlights a number of important prognostic indicators and rehabilitation selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation after stroke, although the quality of many studies is low. Further high quality studies and reviews of prognostic indicators and clinician decision making with regards to rehabilitation acceptance are required. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test.

PubMed

Ohtera, Shosuke; Kanazawa, Natsuko; Ozasa, Neiko; Ueshima, Kenji; Nakayama, Takeo

2017-01-27

Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice. This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan. 10 professionals in cardiac rehabilitation for the consensus panel. In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively). A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation. 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/.

The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population.

PubMed

Hilsden, Robert J; Dube, Catherine; Heitman, Steven J; Bridges, Ronald; McGregor, S Elizabeth; Rostom, Alaa

2015-11-01

Although several quality indicators of colonoscopy have been defined, quality assurance activities should be directed at the measurement of quality indicators that are predictive of key screening colonoscopy outcomes. The goal of this study was to examine the association among established quality indicators and the detection of screen-relevant lesions (SRLs), adverse events, and postcolonoscopy cancers. Historical cohort study. Canadian colorectal cancer screening center. A total of 18,456 asymptomatic men and women ages 40 to 74, at either average risk or increased risk for colorectal cancer because of a family history, who underwent a screening colonoscopy from 2008 to 2010. Using univariate and multivariate analyses, we explored the association among procedural quality indicators and 3 colonoscopy outcomes: detection of SRLs, adverse events, and postcolonoscopy cancers. The crude rates of SRLs, adverse events, and postcolonoscopy cancers were 240, 6.44, and .54 per 1000 colonoscopies, respectively. Several indicators, including endoscopist withdrawal time (OR, 1.3; 95% CI, 1.2-1.4) and cecal intubation rate (OR, 13.9; 95% CI, 1.9-96.9), were associated with the detection of SRLs. No quality indicator was associated with the risk of adverse events. Endoscopist average withdrawal time over 6 minutes (OR, .12; 95% CI, .002-.85) and SRL detection rate over 20% (OR, .17; 95% CI, .03-.74) were associated with a reduced risk of postcolonoscopy cancers. Single-center study. Quality assurance programs should prioritize the measurement of endoscopist average withdrawal time and adenoma (SRL) detection rate. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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.

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

PubMed

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

2007-01-01

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

Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance.

PubMed

Venara, A; Toqué, L; Barbieux, J; Cesbron, E; Ridereau-Zins, C; Lermite, E; Hamy, A

2015-09-01

The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease. This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction. Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention. Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[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.

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

PubMed

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

2018-04-01

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

[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.

[Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation].

PubMed

Giraldes, Maria do Rosário

2008-01-01

To proceed to the evaluation of the efficiency and quality in the NHS, based in methodologies of evaluation of management, indicators of benchmarking and indicators of process and outcome. The 1980 and 1990 decades have seen the proliferation of all forms of process indicators as a way to control health services. It is not a coincidence that the increase in managed care has been accompanied by an explosion of process indicators, as it has happened in the health system of the USA. More recently the attention has turned away from measures of performance, which measure the process (what has been done) to those which measure outcomes (what was the result). Quality indicators have been developed in Europe, first to be used in hospitals, but also to be used in primary health care. Conceptually the justification for the introduction of process indicators comes from the principle that their use will reinforce a modification in the quality of the proceedings, which will give origin to better outcomes as well at population level, as resource saving. Outcome indicators compared with process indicators in health care shows that process indicators have the advantage of being more sensitive than outcome indicators to differences in the quality. Optimizing health care quality has the objective of establishing a quantitative relationship between the quality of the health services and cost-effectiveness. To identify quality indicators and benchmarking and to implement plans to measure the quality of health care. In a study made in a group of senior GP, in the UK, with the objective of determining which process indicators better reflect the quality of the services in primary health care services a Delphi method was used. Only seven indicators were chosen by 75% of the respondents: the percentage of eligible patients receiving cervical screening; the percentage of generic prescribing; the percentage of eligible patients receiving childhood immunization; the percentage of eligible patients receiving influenza vaccinations; ability to see GP within 48 hours; percentage prescribing antibacterial drugs; primary care management (diabetes and asthma). The main characteristics of health indicators are: acceptability--The acceptability of the data collected using a measure will depend upon the extent to which the findings are acceptable to both those being assessed and those undertaking the assessment; feasibility--information about the quality of services is often driven by data availability rather than by epidemiological and clinical considerations. Quality measurement cannot be achieved without accurate and consistent information systems; reliability--indicators should be used to compare organisations/practitioners with similar organisations/practitioners; sensitivity to change--quality measures must be capable of detecting changes in quality of care in order to discriminate between and within subjects; validity--there has been little methodological scrutiny of the validity of consensus methods. Outcome indicators are not good performance indicators in health care. Which causes the variation in outcomes between deliverers of primary health care services are the observed differences due to differences in users, due to age, sex, co-morbidity, severity and socio-economic situation. The Medical Outcomes Study, published in 1989, has brought, for the first time, subjective indicators, based in the evaluation of users, as an important outcome indicator. Clinical indicators are those that are more associated with the outcomes. A few studies exist of the effects of management indicators in outcomes. Several indicators, however, reflect norms related with the local of work. The use of a Composite Indicator presents advantages. In England it has been used a Composite Indicator of process indicators in 302 organizations of primary health care, in 2001-2002. This study has used a mathematical model to select the best indicators which allow the evaluation of performance. It has concluded that the use of a Composite Indicator is of easy construction, interpretation, and acceptable and that has validity. Giraldes (2007) has done an evaluation of health centres in a perspective of management and quality of deliver using a Composite Indicator of Efficiency and Quality. It includes the efficiency indicators concerned with the main activities of the health centre, preventive activities, curative activities and drugs, by main pharmaco therapeutic groups, and auxiliary means of diagnosis (analysis, X Ray, ecographies and CAT by user, weighted according to the relevance of the expenditure in total expenditure). The Composite Quality Indicator includes 12 performance and 5 outcome indicators. From the 10 best health centres in an efficiency and quality perspective 3 are from the Porto Sub-Region (Negrelos, Rebordosa and Paredes) and 2 from the Braga Sub-Region (Vila Verde and Vila Nova de Famalicão I), Leiria (Pedrogão Grande and Batalha), and Vila Real (Mesão Frio and Sabrosa), while 1 belongs to the Aveiro Sub-Region (Sever do Vouga). The more efficient health centres are from the Aveiro Sub-Region, followed by Braga, Porto, and Lisboa. Sub-Regions with very similar values. Giraldes (2007) has made an evaluation of the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc.) and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered; process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of cesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care. Those indicators have been aggregated, by a mean. The Composite Indicator of Efficiency and Quality is the mean of the Composite Indicator of Efficiency and the Composite Indicator of Quality, having this one been converted in inverse base.

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

USGS Publications Warehouse

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

2004-01-01

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

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

PubMed

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

2018-04-01

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

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

PubMed Central

2011-01-01

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

Structural Indicators on Graduate Employability in Europe--2016. Eurydice Report

ERIC Educational Resources Information Center

Riiheläinen, Jari Matti

2017-01-01

This publication presents some structural indicators on graduate employability in 40 European education and training systems. It examines whether countries use regular labour market forecasting to improve the employability of graduates; moreover, other indicators include the involvement of employers in external quality assurance procedures,…

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.

Quality of care and quality of life of people with dementia living at green care farms: a cross-sectional study.

PubMed

de Boer, Bram; Hamers, Jan P H; Zwakhalen, Sandra M G; Tan, Frans E S; Verbeek, Hilde

2017-07-19

Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia. A cross-sectional design was used. Three types of nursing homes were included: (1) green care farms; (2) regular small-scale living facilities; (3) traditional nursing homes. All participating nursing homes were non-profit, collectively funded nursing homes in the south of the Netherlands. One hundred and fifteen residents with a formal diagnosis of dementia were included in the study. Data on quality of care was gathered and consisted of outcome indicators (e.g. falling incidents, pressure ulcers), structure indicators (e.g. hours per resident per day), and process indicators (e.g. presence, accessibility and content of protocols on care delivery). Furthermore, questionnaires on cognition, dependence in activities of daily living, quality of life, social engagement, neuropsychiatric symptoms, agitation, and depression were used. Data showed that quality of care was comparable across settings. No large differences were found on clinical outcome measures, hours per resident per day, or process indicators. Higher quality of life scores were reported for residents of green care farms in comparison with residents of traditional nursing homes. They scored significantly higher on the Quality of Life - Alzheimer's disease Scale (p < 0.05, ES = 0.8) indicating a better quality of life. In addition, residents of green care farms scored higher on three quality of life domains of the Qualidem: positive affect, social relations and having something to do (p < 0.05, ES > 0.7). No differences with regular small-scale living facilities were found. Green care farms seem to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments.

Quality of Streams in Johnson County, Kansas, and Relations to Environmental Variables, 2003-07

USGS Publications Warehouse

Rasmussen, Teresa J.; Poulton, Barry C.; Graham, Jennifer L.

2009-01-01

The quality of streams and relations to environmental variables in Johnson County, northeastern Kansas, were evaluated using water, streambed sediment, land use, streamflow, habitat, algal periphyton (benthic algae), and benthic macroinvertebrate data. Water, streambed sediment, and macroinvertebrate samples were collected in March 2007 during base flow at 20 stream sites that represent 11 different watersheds in the county. In addition, algal periphyton samples were collected twice (spring and summer 2007) at one-half of the sites. Environmental data including water and streambed-sediment chemistry data (primarily nutrients, fecal-indicator bacteria, and organic wastewater compounds), land use, streamflow, and habitat data were used in statistical analyses to evaluate relations between biological conditions and variables that may affect them. This report includes an evaluation of water and streambed-sediment chemistry, assessment of habitat conditions, comparison of biological community attributes (such as composition, diversity, and abundance) among sampling sites, placement of sampling sites into impairment categories, evaluation of biological data relative to environmental variables, and evaluation of changes in biological communities and effects of urbanization. This evaluation is useful for understanding factors that affect stream quality, for improving water-quality management programs, and for documenting changing conditions over time. The information will become increasingly important for protecting streams in the future as urbanization continues. Results of this study indicate that the biological quality at nearly all biological sampling sites in Johnson County has some level of impairment. Periphyton taxa generally were indicative of somewhat degraded conditions with small to moderate amounts of organic enrichment. Camp Branch in the Blue River watershed was the only site that met State criteria for full support of aquatic life in 2007. Since 2003, biological quality improved at one rural sampling site, possibly because of changes in wastewater affecting the site, and declined at three urban sites possibly because of the combined effects of ongoing development. Rural streams in the western and southern parts of the county, with land-use conditions similar to those found at the State reference site (Captain Creek), continue to support some organisms normally associated with healthy streams. Several environmental factors contribute to biological indicators of stream quality. The primary factor explaining biological quality at sites in Johnson County was the amount of urbanization upstream in the watershed. Specific conductance of stream water, which is a measure of dissolved solids in water and is determined primarily by the amount of groundwater contributing to streamflow, the amount of urbanization, and discharges from wastewater and industrial sites, was strongly negatively correlated with biological stream quality as indicated by macroinvertebrate metrics. Concentration of polycyclic aromatic hydrocarbons (PAHs) in streambed sediment also was negatively correlated with biological stream quality. Individual habitat variables that most commonly were positively correlated with biological indicators included stream sinuosity, buffer length, and substrate cover diversity. Riffle substrate embeddedness and sediment deposition commonly were negatively correlated with favorable metric scores. Statistical analysis indicated that specific conductance, impervious surface area (a measure of urbanization), and stream sinuosity explained 85 percent of the variance in macroinvertebrate communities. Management practices affecting environmental variables that appear to be most important for Johnson County streams include protection of stream corridors, measures that reduce the effects of impervious surfaces associated with urbanization, reduction of dissolved solids in stream water, reduction of PAHs entering streams and

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

PubMed

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

2007-08-01

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

The effects of RN staffing hours on nursing home quality: a two-stage model.

PubMed

Lee, Hyang Yuol; Blegen, Mary A; Harrington, Charlene

2014-03-01

Based on structure-process-outcome approach, this study examined the association of registered nurse (RN) staffing hours and five quality indicators, including two process measures (catheter use and antipsychotic drug use) and three outcome measures (pressure ulcers, urinary tract infections, and weight loss). We used data on resident assessments, RN staffing, organizational characteristics, and market factors to examine the quality of 195 nursing homes operating in a rural state of United States - Colorado. Two-stage least squares regression models were performed to address the endogenous relationships between RN staffing and the outcome-related quality indicators, and ordinary least squares regression was used for the process-related ones. This analysis focused on the relationship of RN staffing to nursing home quality indicators, controlling for organizational characteristics, resources, resident casemix, and market factors with clustering to control for geographical differences. Higher RN hours were associated with fewer pressure ulcers, but RN hours were not related to the other quality indicators. The study finding shows the importance of understanding the role of 'nurse staffing' under nursing home care, as well as the significance of associated/contextual factors with nursing home quality even in a small rural state. Copyright © 2013 Elsevier Ltd. All rights reserved.

Choices in recreational water quality monitoring: new opportunities and health risk trade-offs.

PubMed

Nevers, Meredith B; Byappanahalli, Muruleedhara N; Whitman, Richard L

2013-04-02

With the recent release of new recreational water quality monitoring criteria, there are more options for regulatory agencies seeking to protect beachgoers from waterborne pathogens. Included are methods that can reduce analytical time, providing timelier estimates of water quality, but the application of these methods has not been examined at most beaches for expectation of health risk and management decisions. In this analysis, we explore health and monitoring outcomes expected at Lake Michigan beaches using protocols for indicator bacteria including culturable Escherichia coli (E. coli; EC), culturable enterococci (ENT), and enterococci as analyzed by qPCR (QENT). Correlations between method results were generally high, except at beaches with historically high concentrations of EC. The "beach action value" was exceeded most often when using EC or ENT as the target indicator; QENT exceeded the limit far less frequently. Measured water quality between years was varied. Although methods with equivalent health expectation have been established, the lack of relationship among method outcomes and annual changes in mean indicator bacteria concentrations complicates the decision-making process. The monitoring approach selected by beach managers may be a combination of available tools that maximizes timely health protection, cost efficiency, and collaboration among beach jurisdictions.

[The OPTIMISE study (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment]. Results for Luxembourg].

PubMed

Michel, G

2012-01-01

The OPTIMISE study (NCT00681850) has been run in six European countries, including Luxembourg, to prospectively assess the effect of benchmarking on the quality of primary care in patients with type 2 diabetes, using major modifiable vascular risk factors as critical quality indicators. Primary care centers treating type 2 diabetic patients were randomized to give standard care (control group) or standard care with feedback benchmarked against other centers in each country (benchmarking group). Primary endpoint was percentage of patients in the benchmarking group achieving pre-set targets of the critical quality indicators: glycated hemoglobin (HbAlc), systolic blood pressure (SBP) and low-density lipoprotein (LDL) cholesterol after 12 months follow-up. In Luxembourg, in the benchmarking group, more patients achieved target for SBP (40.2% vs. 20%) and for LDL-cholesterol (50.4% vs. 44.2%). 12.9% of patients in the benchmarking group met all three targets compared with patients in the control group (8.3%). In this randomized, controlled study, benchmarking was shown to be an effective tool for improving critical quality indicator targets, which are the principal modifiable vascular risk factors in diabetes type 2.

Choices in recreational water quality monitoring: new opportunities and health risk trade-offs

USGS Publications Warehouse

Nevers, Meredith B.; Byappanahalli, Muruleedhara N.; Whitman, Richard L.

2013-01-01

With the recent release of new recreational water quality monitoring criteria, there are more options for regulatory agencies seeking to protect beachgoers from waterborne pathogens. Included are methods that can reduce analytical time, providing timelier estimates of water quality, but the application of these methods has not been examined at most beaches for expectation of health risk and management decisions. In this analysis, we explore health and monitoring outcomes expected at Lake Michigan beaches using protocols for indicator bacteria including culturable Escherichia coli (E. coli; EC), culturable enterococci (ENT), and enterococci as analyzed by qPCR (QENT). Correlations between method results were generally high, except at beaches with historically high concentrations of EC. The “beach action value” was exceeded most often when using EC or ENT as the target indicator; QENT exceeded the limit far less frequently. Measured water quality between years was varied. Although methods with equivalent health expectation have been established, the lack of relationship among method outcomes and annual changes in mean indicator bacteria concentrations complicates the decision-making process. The monitoring approach selected by beach managers may be a combination of available tools that maximizes timely health protection, cost efficiency, and collaboration among beach jurisdictions.

Groundwater quality data from the National Water-Quality Assessment Project, May 2012 through December 2013

USGS Publications Warehouse

Arnold, Terri L.; Desimone, Leslie A.; Bexfield, Laura M.; Lindsey, Bruce D.; Barlow, Jeannie R.; Kulongoski, Justin T.; Musgrove, MaryLynn; Kingsbury, James A.; Belitz, Kenneth

2016-06-20

Groundwater-quality data were collected from 748 wells as part of the National Water-Quality Assessment Project of the U.S. Geological Survey National Water-Quality Program from May 2012 through December 2013. The data were collected from four types of well networks: principal aquifer study networks, which assess the quality of groundwater used for public water supply; land-use study networks, which assess land-use effects on shallow groundwater quality; major aquifer study networks, which assess the quality of groundwater used for domestic supply; and enhanced trends networks, which evaluate the time scales during which groundwater quality changes. Groundwater samples were analyzed for a large number of water-quality indicators and constituents, including major ions, nutrients, trace elements, volatile organic compounds, pesticides, and radionuclides. These groundwater quality data are tabulated in this report. Quality-control samples also were collected; data from blank and replicate quality-control samples are included in this report.

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

DTIC Science & Technology

1992-09-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

New Mexico Look for the STARS--AIM HIGH: 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 New Mexico's Look for the STARS--AIM HIGH 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)…

Los Angeles County Steps to Excellence Project: 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 Los Angeles County's Steps to Excellence Project 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;…

Water quality, hydrology, and the effects of changes in phosphorus loading to Pike Lake, Washington County, Wisconsin, with special emphasis on inlet-to-outlet short-circuiting

USGS Publications Warehouse

Rose, William J.; Robertson, Dale M.; Mergener, Elizabeth A.

2004-01-01

Simulations using water-quality models within the Wisconsin Lake Model Suite (WiLMS) indicated Pike Lake's response to 13 different phosphorus-loading scenarios. These scenarios included a base 'normal' year (2000) for which lake water quality and loading were known, six different percentage increases or decreases in phosphorus loading from controllable sources, and six different loading scenarios corresponding to specific management actions. Model simulations indicate that a 50-percent reduction in controllable loading sources would be needed to achieve a mesotrophic classification with respect to phosphorus, chlorophyll a, and Secchi depth (an index of water clarity). Model simulations indicated that short-circuiting of phosphorus from the inlet to the outlet was the main reason the water quality of the lake is good relative to the amount of loading from the Rubicon River and that changes in the percentage of inlet-to-outlet short-circuiting have a significant influence on the water quality of the lake.

How to Assess Quality of Research in Iran, From Input to Impact? Introduction of Peer-Based Research Evaluation Model in Iran.

PubMed

Ebadifar, Asghar; Baradaran Eftekhari, Monir; Owlia, Parviz; Habibi, Elham; Ghalenoee, Elham; Bagheri, Mohammad Reza; Falahat, Katayoun; Eltemasi, Masoumeh; Sobhani, Zahra; Akhondzadeh, Shahin

2017-11-01

Research evaluation is a systematic and objective process to measure relevance, efficiency and effectiveness of research activities, and peer review is one of the most important tools for assessing quality of research. The aim of this study was introducing research evaluation indicators based on peer reviewing. This study was implemented in 4 stages. A list of objective-oriented evaluation indicators were designed in 4 axes, including; governance and leadership, structure, knowledge production and research impact. The top 10% medical sciences research centers (RCs) were evaluated based on peer review. Adequate equipment and laboratory instruments, high quality research publication and national or international cooperation were the main strengths in medical sciences RCs and the most important weaknesses included failure to adhere to strategic plans, parallel actions in similar fields, problems in manpower recruitment, knowledge translation & exchange (KTE) in service providers and policy makers' levels. Peer review evaluation can improve the quality of research.

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 which included the sustainable management taken into account. A parametric t-test was used to determine the comprehensive significance of the average SI for a given indicator. Reduced tillage increased DOC and POXC in the 0-10 cm of soil (SI=1.19 and 1.18 respectively) compared to conventional tillage. Organic fertilization increased DOC and POXC in the 0-10 cm compared to mineral fertilization (SI=1.43 and 1.41) and compared to no fertilizer applications (SI=1.27 and 1.17). DOC was slightly more sensitive than POXC, however, the t-test resulted to be significant only for POXC. Preliminary tests revealed a significant correlation between POXC and DOC (Spearman ρ=0.53, p<0.001). POXC was more strongly correlated with TOC (ρ=0.8, p<0.001), soil respiration (ρ=0.5, p<0.001) and total nematode number (ρ=0.25, p<0.001), than DOC (ρ=0.37, p<0.001; ρ=0.28, p<0.001; ρ=0.04, p=0.5, respectively). These preliminary results could indicate the better suitability of POXC as soil quality indicator compared to DOC. Further analyses will be implemented to elucidate these relations (including DOC quality parameters and hot water extractable carbon). In the coming months, nematode community composition and abundance of specific groups will be assessed with molecular techniques (sequencing and qPCR). Together, the results will permit to assess the feasibility of the implementation of novel indicators to monitor the effects of agricultural management on soil functions.

Delivering Quality and Choice. How Performance Indicators Help and How Performance Indicators Hinder. Research Report

ERIC Educational Resources Information Center

Perry, Adrian; Simpson, Matthew

2006-01-01

This document reports on a research project held in 2005, which looked to see how performance indicators related to area needs. It shows the results of research across four Learning and Skills Council (LSC) areas, with contributions also from national stakeholders and other witnesses. Findings include: (1) Performance indicators are regarded as…

[Satisfaction and perceived quality of people insured by the Social Health Protection in Mexico. Methodological foundations].

PubMed

Saturno-Hernández, Pedro J; Gutiérrez-Reyes, Juan Pablo; Vieyra-Romero, Waldo Ivan; Romero-Martínez, Martín; O'Shea-Cuevas, Gabriel Jaime; Lozano-Herrera, Javier; Tavera-Martínez, Sonia; Hernández-Ávila, Mauricio

2016-01-01

To describe the conceptual framework and methods for implementation and analysis of the satisfaction survey of the Mexican System for Social Protection in Health. We analyze the methodological elements of the 2013, 2014 and 2015 surveys, including the instrument, sampling method and study design, conceptual framework, and characteristics and indicators of the analysis. The survey captures information on perceived quality and satisfaction. Sampling has national and State representation. Simple and composite indicators (index of satisfaction and rate of reported quality problems) are built and described. The analysis is completed using Pareto diagrams, correlation between indicators and association with satisfaction by means of multivariate models. The measurement of satisfaction and perceived quality is a complex but necessary process to comply with regulations and to identify strategies for improvement. The described survey presents a design and rigorous analysis focused on its utility for improving.

America's Children in Brief: Key National Indicators of Well-Being

MedlinePlus

... Conceptual Framework Structure of the Report Changes to This Year's Report Race and Ethnicity and Poverty Status Statistical ... made to improve the quality and breadth of this year's report, including changes to the following indicators: Child ...

Determinants of social quality and their regional disparities: an integrated approach for health equity in South Korea.

PubMed

Jung, Minsoo

2014-01-01

Quality of life was originally included in the concept of social quality (SQ), which refers to the possibility of manifesting the life chance possessed by each individual and the consequences resulting from restricting such possibility. Social quality describes how favorable the socioenvironmental components are that impact the possibility of an individual's life. Despite the close relationship between community capacity and SQ, the components and regional disparities of SQ have not yet been examined. This study identified community-based distribution and disparities of SQ in South Korea, including health indicators. Standardized methods of SQ were used to examine the interrelationships among institutional capacity, citizen capacity, and their associations with population-based health indicators. Under the principles of conceptual suitability, reliability, clarity, comparability, and changeability, a total of 18 SQ indicators were collected, then transformed by European Social Survey standardization and Geographical Information System computation. In the results, the hidden structure that determined the distribution of the SQ indicators was the financial independence and average length of residence. Financial independence indicated the size of the budget that each local community controls was out of the total budget. The average length of residence showed a reverse-U-shape relation to the mutual supports of the residents. The regional distribution of the SQ indicators largely differed from the local economic index or health indicators. Disparities in SQ indicators are likely to arise from the degree of urbanization and the degree of citizens' cohesiveness. Therefore, it is necessary to analyze in-depth cases of both local government with high SQ indicators in all fields and those with low SQ indicators in all fields. In addition, there is a need to elucidate the structural causes and backgrounds that produce disparities in SQ, thus lowering disparities among regions, and to develop policies that will promote the overall and continuous improvement of SQ.

Strategic Orientation and Nursing Home Response to Public Reporting of Quality Measures: An Application of the Miles and Snow Typology

PubMed Central

Zinn, Jacqueline S; Spector, William D; Weimer, David L; Mukamel, Dana B

2008-01-01

Objective To assess whether differences in strategic orientation of nursing homes as identified by the Miles and Snow typology are associated with differences in their response to the publication of quality measures on the Nursing Home Compare website. Data Sources Administrator survey of a national 10 percent random sample (1,502 nursing homes) of all facilities included in the first publication of the Nursing Home Compare report conducted in May–June 2004; 724 responded, yielding a response rate of 48.2 percent. Study Design The dependent variables are dichotomous, indicating whether or not action was taken and the type of action taken. Four indicator variables were created for each of the four strategic types: Defender, Analyzer, Prospector, and Reactor. Other variables were included in the seven logistic regression models to control for factors other than strategic type that could influence nursing home response to public disclosure of their quality of care. Data Collection/Extraction Methods Survey data were merged with data on quality measures and organizational characteristics from the first report (November 2002). Principal Findings About 43 percent of surveyed administrators self-typed as Defenders, followed by Analyzers (33 percent), and Prospectors (19 percent). The least self-selected strategic type was the Reactor (6.6 percent). In general, results of the regression models indicate differences in response to quality measure publication by strategic type, with Prospectors and Analyzers more likely, and Reactors less likely, to respond than Defenders. Conclusions While almost a third of administrators took no action at all, our results indicate that whether, when, and how nursing homes reacted to publication of federally reported quality measures is associated with strategic orientation. PMID:18370969

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.

Using High Resolution Commercial Satellite Imagery to Quantify Spatial Features of Urban Areas and their Relationship to Quality of Life Indicators in Accra, Ghana

NASA Astrophysics Data System (ADS)

Sandborn, A.; Engstrom, R.; Yu, Q.

2014-12-01

Mapping urban areas via satellite imagery is an important task for detecting and anticipating land cover and land use change at multiple scales. As developing countries experience substantial urban growth and expansion, remotely sensed based estimates of population and quality of life indicators can provide timely and spatially explicit information to researchers and planners working to determine how cities are changing. In this study, we use commercial high spatial resolution satellite imagery in combination with fine resolution census data to determine the ability of using remotely sensed data to reveal the spatial patterns of quality of life in Accra, Ghana. Traditionally, spectral characteristics are used on a per-pixel basis to determine land cover; however, in this study, we test a new methodology that quantifies spatial characteristics using a variety of spatial features observed in the imagery to determine the properties of an urban area. The spatial characteristics used in this study include histograms of oriented gradients, PanTex, Fourier transform, and line support regions. These spatial features focus on extracting structural and textural patterns of built-up areas, such as homogeneous building orientations and straight line indices. Information derived from aggregating the descriptive statistics of the spatial features at both the fine-resolution census unit and the larger neighborhood level are then compared to census derived quality of life indicators including information about housing, education, and population estimates. Preliminary results indicate that there are correlations between straight line indices and census data including available electricity and literacy rates. Results from this study will be used to determine if this methodology provides a new and improved way to measure a city structure in developing cities and differentiate between residential and commercial land use zones, as well as formal versus informal housing areas.

Case-mix adjustment for diabetes indicators: a systematic review.

PubMed

Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

2016-02-01

Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

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

PubMed

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

2013-01-01

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

Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale.

PubMed

Ten Have, Elsbeth C M; Nap, Raoul E; Tulleken, Jaap E

2013-10-01

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of leadership training on the quality of IDRs in the ICU. A nonrandomized intervention study was conducted in four ICUs for adults. The intervention was a 1-day training session in a simulation environment and workplace-based feedback sessions. Measurement included 28 videotaped IDRs (total, 297 patient presentations) that were assessed with 10 essential quality indicators of the validated IDR Assessment Scale. Participants were 19 intensivists who previously had no formal training in leading IDRs. They were subdivided by cluster sampling into a control group (ten experienced intensivists) and intervention group (nine intensive care fellows). Mann-Whitney U test was used to compare results between control and intervention groups. Baseline measurements of control and intervention groups revealed two indicators that differed significantly. The frequency of yes ratings for the intervention group significantly increased for seven of the ten indicators from before to after intervention. The frequency of yes ratings after training was significantly greater in the intervention than control groups for eight of the ten essential quality indicators. The leadership training improved the quality of the IDRs performed in the ICUs. This may improve quality and safety of patient care.

[Quality of care in nursing homes: a review of literature regarding structure, process and outcome indicators related to the risk of malnutrition].

PubMed

Lorini, C; Mencacci, M; Bonaccorsi, G

2012-01-01

The admissions and the demands for entering nursing homes (NHs) are gradually increasing. Focusing on the quality of care in NHs, the risk of protein- calorie malnutrition has a key role. The purpose of this paper is to select and describe structure, process of care and outcome indicators, as well as individual risk factors (confounders), related to malnutrition in NHs. We have analyzed scientific articles found in MEDLINE, published from 2000 to 2011, identified through four different string selections. 505 articles have been collected, 17 of whom were chosen because they included specific malnutrition indicators in the framework of quality of care indicators. Three papers specifically deal with malnutrition as one of the elements of the quality of care in NHs linked to structure, processes and outcome. From this review, it clearly emerges that scientific articles addressing malnutrition as one of the requirements of healthcare quality in NHs are scarce, compared with a rather large number of publications concerning the prevalence and/or the description of interventions related to--and made to solve or reduce--malnutrition already in place. It is therefore necessary to spread the culture and the approach of nutritional risk analysis within the systems aimed at evaluating the quality of care in NHs, by selecting and monitoring appropriate malnutrition indicators.

Classroom Quality at Pre-kindergarten and Kindergarten and Children’s Social Skills and Behavior Problems

PubMed Central

Broekhuizen, Martine L.; Mokrova, Irina L.; Burchinal, Margaret R.; Garrett-Peters, Patricia T.

2016-01-01

Focusing on the continuity in the quality of classroom environments as children transition from preschool into elementary school, this study examined the associations between classroom quality in pre-kindergarten and kindergarten and children’s social skills and behavior problems in kindergarten and first grade. Participants included 1175 ethnically-diverse children (43% African American) living in low-wealth rural communities of the US. Results indicated that children who experienced higher levels of emotional and organizational classroom quality in both pre-kindergarten and kindergarten demonstrated better social skills and fewer behavior problems in both kindergarten and first grade comparing to children who did not experience higher classroom quality. The examination of the first grade results indicated that the emotional and organizational quality of pre-kindergarten classrooms was the strongest predictor of children’s first grade social skills and behavior problems. The study results are discussed from theoretical, practical, and policy perspectives. PMID:26949286

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.

Determinants of perceived sleep quality in normal sleepers.

PubMed

Goelema, M S; Regis, M; Haakma, R; van den Heuvel, E R; Markopoulos, P; Overeem, S

2017-09-20

This study aimed to establish the determinants of perceived sleep quality over a longer period of time, taking into account the separate contributions of actigraphy-based sleep measures and self-reported sleep indices. Fifty participants (52 ± 6.6 years; 27 females) completed two consecutive weeks of home monitoring, during which they kept a sleep-wake diary while their sleep was monitored using a wrist-worn actigraph. The diary included questions on perceived sleep quality, sleep-wake information, and additional factors such as well-being and stress. The data were analyzed using multilevel models to compare a model that included only actigraphy-based sleep measures (model Acti) to a model that included only self-reported sleep measures to explain perceived sleep quality (model Self). In addition, a model based on the self-reported sleep measures and extended with nonsleep-related factors was analyzed to find the most significant determinants of perceived sleep quality (model Extended). Self-reported sleep measures (model Self) explained 61% of the total variance, while actigraphy-based sleep measures (model Acti) only accounted for 41% of the perceived sleep quality. The main predictors in the self-reported model were number of awakenings during the night, sleep onset latency, and wake time after sleep onset. In the extended model, the number of awakenings during the night and total sleep time of the previous night were the strongest determinants of perceived sleep quality, with 64% of the variance explained. In our cohort, perceived sleep quality was mainly determined by self-reported sleep measures and less by actigraphy-based sleep indices. These data further stress the importance of taking multiple nights into account when trying to understand perceived sleep quality.

Managing quality and compliance.

PubMed

McNeil, Alice; Koppel, Carl

2015-01-01

Critical care nurses assume vital roles in maintaining patient care quality. There are distinct facets to the process including standard setting, regulatory compliance, and completion of reports associated with these endeavors. Typically, multiple niche software applications are required and user interfaces are varied and complex. Although there are distinct quality indicators that must be tracked as well as a list of serious or sentinel events that must be documented and reported, nurses may not know the precise steps to ensure that information is properly documented and actually reaches the proper authorities for further investigation and follow-up actions. Technology advances have permitted the evolution of a singular software platform, capable of monitoring quality indicators and managing all facets of reporting associated with regulatory compliance.

Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

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

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

PubMed

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

2006-07-01

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

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.

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

PubMed

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

2017-10-01

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

District of Columbia Going for the Gold Tiered Rate Reimbursement System. 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 District of Columbia's Going for the Gold Tiered Rate Reimbursement Systemp repared 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…

Effect of land cover, stream discharge, and precipitation on water quality in Puerto Rico

NASA Astrophysics Data System (ADS)

Hall, J. S.; Uriarte, M.

2017-12-01

In 2015, Puerto Rico experienced one of the worst droughts in its history, causing widespread water rationing and sparking concerns for future resources. The drought represents precipitation extremes that provide valuable insight into the effects of land cover (LC), on modulating discharge and water quality indices at varying spatial scales. We used data collected from 38 water quality and 55 precipitation monitoring stations in Puerto Rico from 2005 to 2016, paired with a 2010 land cover map to (1) determine whether temporal variability in discharge, precipitation, or antecedent precipitation was a better predictor of water quality, (2) find the spatial scale where LC has the greatest impact on water quality, and (3) quantify impacts of LC on water quality indices, including dissolved oxygen (mg/L), total nitrogen (mg/L), phosphorous (mg/L), turbidity (NTRU), fecal coliforms (colony units/100mL) and instantaneous discharge (ft3/s). The resulting linear mixed effects models account for between 36-68% of the variance in water quality. Preliminary results indicate that phosphorous and nitrogen were best predicted from instantaneous stream discharge, the log of discharge was the better predictor for turbidity and fecal coliforms, and summed 2 and 14-day antecedent precipitation indices were better predictors for dissolved oxygen and discharge, respectively. Increased urban and pasture area reliably decreased water quality in relation to forest cover, while agriculture and wetlands had little or mixed effects. Turbidity and nitrogen responded to a watershed level LC, while phosphorous, fecal coliforms, and discharge responded to LC in 60 m riparian buffers at the watershed scale. Our results indicate that LC modulates changing precipitation regimes and the ensuing impacts on water quality at a range of spatial scales.

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

PubMed

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

2014-05-16

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

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

ERIC Educational Resources Information Center

Winston, Nessa; Pareja Eastaway, Montserrat

2008-01-01

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

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 only contain nutrients, include the components fruits and vegetables; additional attributes are legumes or pulses, nuts and seeds. Meat and meat products, namely red and processed meat, poultry, and milk and dairy products are also included in many scores. Other foods contained in some DQIs e.g. MDS are olive oil and fish. Nowadays, there is interest in defining more than DQIs, healthy life indices (HLIs), which give information on behaviours associated with specific patterns and beyond dietary habits they include physical activity, rest and selected socio-cultural habits. The Mediterranean Lifestyle (MEDLIFE) index has been recently created based on the current Spanish Mediterranean food guide pyramid and it includes both the assessment of food consumption directly related to the Mediterranean diet, physical activity and rest and other relevant cultural information. However, a global HLI should consider, based on the Iberoamerican Nutrition Foundation (FINUT) Pyramid of Healthy Lifestyles, in addition to food groups and nutrients, selected items on food safety e.g. consumption rate of proceed foods, food handling, preparation and storage and access to drinking water, selected food habits, including alcoholic beverage and salt consumption patterns, purchase of seasonal and local foods, home cooking and conviviality, as well as patterns of physical activity, sedentary and rest habits and some selected sociocultural habits, particularly those related to food selection, religious beliefs and socializing with friends. Copyright AULA MEDICA EDICIONES 2015. Published by AULA MEDICA. All rights reserved.

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

PubMed

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

2007-01-01

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

[Care quality: reliability and usefulness of observation data in bench marking nursing homes and homes for the aged in the Netherlands].

PubMed

Frijters, Dinnus; Gerritsen, Debby; Steverink, Nardi

2003-02-01

Before including quality of care indicators in the Benchmark of Nursing Homes and Homes for the Aged in the Netherlands the reliability of the patient data collection, and usefulness had to be established. The patient data items were derived from the Resident Assessment Instruments (RAI) and a questionnaire on social interaction in elderly people. Three nursing homes and three homes for the aged participated in the test with 550 patients. 279 x 2 assessments were collected by independent raters for an inter rater reliability test; 259 x 2 by the same rater for a reliability test-retest; and 24 by a single rater. The scores on paired assessment forms were compared with the weighted Kappa agreement test. The test results allowed 10 of the 13 quality indicators from RAI to be retained. In addition new quality indicators could be defined on 'giving attention' and 'unrespectful addressing'. We estimate on the basis of a questionnaire for the raters that on average 9 to 12 minutes per patient are needed to collect and enter data for the resulting 12 quality indicators.

A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

PubMed

St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

2017-01-01

A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

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.

Evaluating Water Quality in the Lovros River (Greece), Using Biotic Indices based on Invertebrate Communities.

ERIC Educational Resources Information Center

Koussouris, Theodore; And Others

1990-01-01

Presented is a survey of a river including physiochemical measurements and river fauna observations. It is shown that the self-purification gradient of river water quality and the possible ecological disturbances due to pollutants entering the river create an unpredictable pattern of recovery. (CW)

Conditions of Children in California

ERIC Educational Resources Information Center

Policy Analysis for California Education, Berkeley, CA.

Although many California children are growing up in circumstances favoring school performance, many others are inhibited by poor health, poverty, low-quality child care, and other factors external to schools. This report assembles a set of indicators depicting California children's quality of life. Data are included on physical and mental health,…

Quality Indicators for California Community College Job Placement Programs.

ERIC Educational Resources Information Center

Mount San Antonio Community Coll. District, Walnut, CA.

Designed to help California community colleges in assessing their job placement services, identifying strengths and needs for improvement, and establishing priorities for the future, this color-coded guide lists specific tasks and responsibilities within the four essential functional areas of job placement programs and includes quality indicators…

Comparison of a wire belt conveyor and cross auger conveyor for conveying burr cotton on a stripper harvester

USDA-ARS?s Scientific Manuscript database

Cotton fiber quality begins to degrade naturally with the opening of the boll, and mechanical harvesting processes are perceived to exacerbate fiber degradation. Previous research indicates that stripper-harvested cotton generally has lower fiber quality including on average lower micronaire, length...

LQAS usefulness in an emergency department.

PubMed

de la Orden, Susana Granado; Rodríguez-Rieiro, Cristina; Sánchez-Gómez, Amaya; García, Ana Chacón; Hernández-Fernández, Tomás; Revilla, Angel Abad; Escribano, Dolores Vigil; Pérez, Paz Rodríguez

2008-01-01

This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.

Does adding clinical data to administrative data improve agreement among hospital quality measures?

PubMed

Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann

2017-09-01

Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.

Historical water-quality data from the Harlem River, New York

USGS Publications Warehouse

Fisher, Shawn C.

2016-04-22

Data specific to the Harlem River, New York, have been summarized and are presented in this report. The data illustrate improvements in the quality of water for the past 65 years and emphasize the importance of a continuous water-quality record for establishing trends in environmental conditions. Although there is a paucity of sediment-quality data, the New York City Department of Environmental Protection (NYCDEP) Bureau of Wastewater Treatment has maintained a water-quality monitoring network in the Harlem River (and throughout the harbor of New York City) to which 61 combined sewer outfalls discharge effluent. In cooperation with the NYCDEP, the U.S. Geological Survey evaluated water-quality data collected by the NYCDEP dating back to 1945, which indicate trends in water quality and reveal improvement following the 1972 passage of the Clean Water Act. These improvements are indicated by the steady increase in median dissolved oxygen concentrations and an overall decrease in fecal indicator bacteria concentrations starting in the late 1970s. Further, the magnitude of the highest fecal indicator bacteria concentrations (that is, the 90th percentile) in samples collected from the Harlem River have decreased significantly over the past four decades. Other parameters of water quality used to gauge the health of a water body include total suspended solids and nutrient (inorganic forms of nitrogen and phosphorus) concentrations—mean concentrations for these indicators have also decreased in the past decades. The limited sediment data available for one sample in the Harlem River indicate concentrations of copper, zinc, and lead are above sediment-quality thresholds set by the New York State Department of Environmental Conservation. However, more data are needed to better understand the changes in both sediment and water quality in the Harlem River, both as the tide cycles and during precipitation events. As a partner in the Urban Waters Federal Partnership, the U.S. Geological Survey has worked to address the chronic water-quality concerns of the Harlem River by compiling relevant data and studies, which is an important component for understanding and rectifying water-quality problems within a watershed.

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.

A research review of quality assessment for software

NASA Technical Reports Server (NTRS)

1991-01-01

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

Data from exploratory sampling of groundwater in selected oil and gas areas of coastal Los Angeles County and Kern and Kings Counties in southern San Joaquin Valley, 2014–15: California oil, gas, and groundwater project

USGS Publications Warehouse

Dillon, David B.; Davis, Tracy A.; Landon, Matthew K.; Land, Michael T.; Wright, Michael T.; Kulongoski, Justin T.

2016-12-09

Exploratory sampling of groundwater in coastal Los Angeles County and Kern and Kings Counties of the southern San Joaquin Valley was done by the U.S. Geological Survey from September 2014 through January 2015 as part of the California State Water Resources Control Board’s Water Quality in Areas of Oil and Gas Production Regional Groundwater Monitoring Program. The Regional Groundwater Monitoring Program was established in response to the California Senate Bill 4 of 2013 mandating that the California State Water Resources Control Board design and implement a groundwater-monitoring program to assess potential effects of well-stimulation treatments on groundwater resources in California. The U.S. Geological Survey is in cooperation with the California State Water Resources Control Board to collaboratively implement the Regional Groundwater Monitoring Program through the California Oil, Gas, and Groundwater Project. Many researchers have documented the utility of different suites of chemical tracers for evaluating the effects of oil and gas development on groundwater quality. The purpose of this exploratory sampling effort was to determine whether tracers reported in the literature could be used effectively in California. This reconnaissance effort was not designed to assess the effects of oil and gas on groundwater quality in the sampled areas. A suite of water-quality indicators and geochemical tracers were sampled at groundwater sites in selected areas that have extensive oil and gas development. Groundwater samples were collected from a total of 51 wells, including 37 monitoring wells at 17 multiple-well monitoring sites in coastal Los Angeles County and 5 monitoring wells and 9 water-production wells in southern San Joaquin Valley, primarily in Kern and Kings Counties. Groundwater samples were analyzed for field waterquality indicators; organic constituents, including volatile and semi-volatile organic compounds and dissolved organic carbon indicators; naturally present inorganic constituents, including trace elements, nutrients, major and minor ions, and iron species; naturally present stable and radioactive isotopes; dissolved noble gases; dissolved standard and hydrocarbon gases, δ13C of methane, ethane, and δ2 H of methane. In total, 249 constituents and water-quality indicators were measured. Four types of quality-control samples (blanks, replicates, matrix spikes, and surrogates spiked in environmental and blank samples) were collected at approximately 10 percent of the wells. The quality-control data were used to determine whether the groundwater-sample data were of sufficient quality for the measured analytes to be used as potential indicators of oil and gas effects. The data from the 51 groundwater samples and from the quality-control samples are presented in this report.

Sleep Complaints in Older Blacks: Do Demographic and Health Indices Explain Poor Sleep Quality and Duration?

PubMed Central

Gamaldo, Alyssa A.; Gamaldo, Charlene E.; Allaire, Jason C.; Aiken-Morgan, Adrienne T.; Salas, Rachel E.; Szanton, Sarah; Whitfield, Keith E.

2014-01-01

Objective: To examine the relationship between measures of sleep quality and the presence of commonly encountered comorbid and sociodemographic conditions in elderly Black subjects. Method: Analyses included participants from the Baltimore Study of Black Aging (BSBA; n = 450; mean age 71.43 years; SD 9.21). Pittsburgh Sleep Quality Index (PSQI) measured overall sleep pattern and quality. Self-reported and objective measures of physical and mental health data and demographic information were collected for all participants. Results: Sociodemographic and comorbid health factors were significantly associated with sleep quality. Results from regression analyses revealed that older age, current financial strain, interpersonal problems, and stress were unique predictors of worse sleep quality. Sleep duration was significantly correlated with age, depressive affect, interpersonal problems, and stress; only age was a unique significant predictor. While participants 62 years or younger had worse sleep quality with increasing levels of stress, there was no significant relationship between sleep quality and stress for participants 81 years and older. Conclusions: Several potential mechanisms may explain poor sleep in urban, community dwelling Blacks. Perceived stressors, including current financial hardship or hardship experienced for an extended time period throughout the lifespan, may influence sleep later in life. Citation: Gamaldo AA, Gamaldo CE, Allaire JC, Aiken-Morgan AT, Salas RE, Szanton S, Whitfield KE. Sleep complaints in older blacks: do demographic and health indices explain poor sleep quality and duration? J Clin Sleep Med 2014;10(7):725-731. PMID:25024649

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

PubMed

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

2015-01-01

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

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

PubMed

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

2006-09-01

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

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

Water quality, hydrology, and invertebrate communities of three remnant wetlands in Missouri, 1995-97

USGS Publications Warehouse

Heimann, David C.; Femmer, Suzanne R.

1998-01-01

This report presents the results of a study conducted by the U.S. Geological Survey in cooperation with the Missouri Department of Natural Resources from December 1995 through May 1997 to describe the water quality, hydrologic, and invertebrate characteristics of three remnant wetlands. These data may be used to help develop selected water-quality standards for wetlands in Missouri. Wetlands monitored in this study include Spile Lake, Vernon County; Little Bean Marsh, Platte County; and Forker Oxbow, Linn County, Missouri. Extremes in physicochemical properties in these wetlands were greatly affected by thermal stratification, hydrologic fluctuations, biological activity, and ice formation. The wetlands had dissolved-oxygen concentrations below the 5-milligrams-per-liter State water-quality standard from 40 to 60 percent of a selected 1-year period, corresponding to periods of thermal stratification. Hydrologic fluctuations were common as the water-surface elevation changes in these systems ranged up to 12 feet during the course of the study. Photosynthesis and respiration are likely causes of diurnal fluctuations in pH and dissolved oxygen throughout the study period, but particularly in the summer months. Periods of ice formation were short lived in the wetlands, but corresponded with maximum values of specific conductance and dissolved oxygen in all three systems. Analyses of invertebrate results using the Jaccard Coefficient of Community Similarity indicated mixed results. Woody snag sample results showed little similarities between sites, while sweep net sample results indicated similarities existed. Most of the families detected at these sites are considered organic tolerant as indicated by the Hilsenhoff Biotic Index. Analysis of the dominant taxon indicates that one or two invertebrate families that are tolerant to organic enrichment generally dominate the wetlands. The hydrologic, water quality, and invertebrate information analyzed in this study indicate that while there are similarities among wetlands, these are unique systems. The statistical comparisons between water-quality constituents in wetlands and streams indicate dissimilarities are common. Including the presence of thermal stratification in these wetlands, the exclusions and modifications in State standards that are applied to lakes and reservoirs also may be applicable.

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.

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

PubMed

Thatte, Nandita; Choi, Yoonjoung

2015-04-01

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

Chesapeake Bay Program Water Quality Database

EPA Pesticide Factsheets

The Chesapeake Information Management System (CIMS), designed in 1996, is an integrated, accessible information management system for the Chesapeake Bay Region. CIMS is an organized, distributed library of information and software tools designed to increase basin-wide public access to Chesapeake Bay information. The information delivered by CIMS includes technical and public information, educational material, environmental indicators, policy documents, and scientific data. Through the use of relational databases, web-based programming, and web-based GIS a large number of Internet resources have been established. These resources include multiple distributed on-line databases, on-demand graphing and mapping of environmental data, and geographic searching tools for environmental information. Baseline monitoring data, summarized data and environmental indicators that document ecosystem status and trends, confirm linkages between water quality, habitat quality and abundance, and the distribution and integrity of biological populations are also available. One of the major features of the CIMS network is the Chesapeake Bay Program's Data Hub, providing users access to a suite of long- term water quality and living resources databases. Chesapeake Bay mainstem and tidal tributary water quality, benthic macroinvertebrates, toxics, plankton, and fluorescence data can be obtained for a network of over 800 monitoring stations.

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

NASA Technical Reports Server (NTRS)

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

2010-01-01

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

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs.

PubMed

Dy, Sydney M; Al Hamayel, Nebras Abu; Hannum, Susan M; Sharma, Ritu; Isenberg, Sarina R; Kuchinad, Kamini; Zhu, Junya; Smith, Katherine; Lorenz, Karl A; Kamal, Arif H; Walling, Anne M; Weaver, Sallie J

2017-12-01

Although critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality. Development of a survey tool to assess palliative care team perspectives on facilitators and barriers to quality measurement and improvement in palliative care programs. We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and frontline practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. We developed a final survey using these results. The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics, and process of implementation. Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs, and quality issues. This novel, adaptable instrument assesses palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of the survey's construct validity and how survey results correlate with findings from program quality initiatives. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Expert study to select indicators of the occurrence of emerging mycotoxin hazards.

PubMed

Kandhai, M C; Booij, C J H; Van der Fels-Klerx, H J

2011-01-01

This article describes a Delphi-based expert judgment study aimed at the selection of indicators to identify the occurrence of emerging mycotoxin hazards related to Fusarium spp. in wheat supply chains. A panel of 29 experts from 12 European countries followed a holistic approach to evaluate the most important indicators for different chain stages (growth, transport and storage, and processing) and their relative importance. After three e-mailing rounds, the experts reached consensus on the most important indicators for each of the three stages: wheat growth, transport and storage, and processing. For wheat growth, these indicators include: relative humidity/rainfall, crop rotation, temperature, tillage practice, water activity of the kernels, and crop variety/cultivar. For the transport and storage stage, they include water activity in the kernels, relative humidity, ventilation, temperature, storage capacity, and logistics. For wheat processing, indicators include quality data, fraction of the cereal used, water activity in the kernels, quality management and traceability systems, and carryover of contamination. The indicators selected in this study can be used in an identification system for the occurrence of emerging mycotoxin hazards in wheat supply chains. Such a system can be used by risk managers within governmental (related) organizations and/or the food and feed industry in order to react proactively to the occurrence of these emerging mycotoxins. © 2010 Society for Risk Analysis.

Empirical examination of the indicator 'pediatric gastroenteritis hospitalization rate' based on administrative hospital data in Italy.

PubMed

Lenzi, Jacopo; Luciano, Lorenza; McDonald, Kathryn Mack; Rosa, Simona; Damiani, Gianfranco; Corsello, Giovanni; Fantini, Maria Pia

2014-02-11

Awareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data to identify admissions that could be avoided through high-quality outpatient care. Building on this approach, the purpose of this study is to perform an empirical examination of the 'pediatric gastroenteritis admission rate' indicator in Italy, under the assumption that lower admission rates are associated with better management at the primary care level and with overall better quality of care for children. Following the AHRQ process for evaluating quality indicators, we examined age exclusion/inclusion criteria, selection of diagnostic codes, hospitalization type, and methodological issues for the 'pediatric gastroenteritis admission rate'. The regional variability of hospitalizations was analyzed for Italian children aged 0-17 years discharged between January 1, 2009 and December 31, 2011. We considered hospitalizations for the following diagnoses: non-bacterial gastroenteritis, bacterial gastroenteritis and dehydration (along with a secondary diagnosis of gastroenteritis). The data source was the hospital discharge records database. All rates were stratified by age. In the study period, there were 61,130 pediatric hospitalizations for non-bacterial gastroenteritis, 5,940 for bacterial gastroenteritis, and 38,820 for dehydration. In <1-year group, the relative risk of hospitalization for non-bacterial gastroenteritis was 24 times higher than in adolescents, then it dropped to 14.5 in 1- to 4-year-olds and to 3.2 in 5- to 9-year-olds. At the national level, the percentage of admissions for bacterial gastroenteritis was small compared with non-bacterial, while including admissions for dehydration revealed a significant variability in diagnostic coding among regions that affected the regional performance of the indicator. For broadest application, we propose a 'pediatric gastroenteritis admission rate' that consists of including bacterial gastroenteritis and dehydration diagnoses in the numerator, as well as infants aged <3 months. We also suggest adjusting for age and including day hospital admissions. Future evaluation by a clinical panel at the national level might be helpful to determine appropriate application for such measures, and make recommendations to policy makers.

Animals as indicators of ecosystem responses to air emissions

USGS Publications Warehouse

Newman, James R.; Schreiber, R. Kent

1984-01-01

With existing and proposed air-quality regulations, ecological disasters resulting from air emissions such as those observed at Copperhill, Tennessee, and Sudbury, Ontario, are unlikely. Current air-quality standards, however, may not protect ecosystems from subacute and chronic exposure to air emissions. The encouragement of the use of coal for energy production and the development of the fossil-fuel industries, including oil shales, tar sands, and coal liquification, point to an increase and spread of fossil-fuel emissions and the potential to influence a number of natural ecosystems. This paper reviews the reported responses of ecosystems to air-borne pollutants and discusses the use of animals as indicators of ecosystem responses to these pollutants. Animal species and populations can act as important indicators of biotic and abiotic responses of aquatic and terrestrial ecosystems. These responses can indicate long-term trends in ecosystem health and productivity, chemical cycling, genetics, and regulation. For short-term trends, fish and wildlife also serve as monitors of changes in community structure, signaling food-web contamination, as well as providing a measure of ecosystem vitality. Information is presented to show not only the importance of animals as indicators of ecosystem responses to air-quality degradation, but also their value as air-pollution indices, that is, as air-quality-related values (AQRV), required in current air-pollution regulation.

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

PubMed

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

2007-11-01

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

Comparison Between Impact Factor, Eigenfactor Metrics, and SCimago Journal Rank Indicator of Pediatric Neurology Journals.

PubMed

Kianifar, Hamidreza; Sadeghi, Ramin; Zarifmahmoudi, Leili

2014-04-01

Impact Factor (IF) as a major journal quality indicator has a series of shortcomings including effect of self-citation, review articles, total number of articles, etc. In this study, we compared 4 journals quality indices ((IF), Eigenfactor Score (ES), Article Influence Score (AIS) and SCImago Journal Rank indicator (SJR)) in the specific Pediatric Neurology journals. All ISI and Scopus indexed specific Pediatric Neurology journals were compared regarding their 2011 IF, ES, AIS and SJR. Fourteen pediatric Neurology journals were identified, 3 of which were only Scopus indexed and the others were both ISI and Scopus indexed. High correlation was found between IF and AIS (0.850). Correlations between IF and other indices were not that high. Self-citation, total article number and review articles were related to the IF and other indices as well as their ranks. English language and citation to non citable item didn't have any effect on pediatric neurology journals ranks. Although all the above mentioned indicators can be used interchangeably, using all considered indices is a more appropriate way than using only IF for quality assessment of pediatric neurology journals.

Comparison Between Impact Factor, Eigenfactor Metrics, and SCimago Journal Rank Indicator of Pediatric Neurology Journals

PubMed Central

Kianifar, Hamidreza; Sadeghi, Ramin; Zarifmahmoudi, Leili

2014-01-01

Background: Impact Factor (IF) as a major journal quality indicator has a series of shortcomings including effect of self-citation, review articles, total number of articles, etc. In this study, we compared 4 journals quality indices ((IF), Eigenfactor Score (ES), Article Influence Score (AIS) and SCImago Journal Rank indicator (SJR)) in the specific Pediatric Neurology journals. Methods: All ISI and Scopus indexed specific Pediatric Neurology journals were compared regarding their 2011 IF, ES, AIS and SJR. Results: Fourteen pediatric Neurology journals were identified, 3 of which were only Scopus indexed and the others were both ISI and Scopus indexed. High correlation was found between IF and AIS (0.850). Correlations between IF and other indices were not that high. Self-citation, total article number and review articles were related to the IF and other indices as well as their ranks. English language and citation to non citable item didn’t have any effect on pediatric neurology journals ranks. Conclusion: Although all the above mentioned indicators can be used interchangeably, using all considered indices is a more appropriate way than using only IF for quality assessment of pediatric neurology journals. PMID:24825934

Using ecological indicators and a decision support system for integrated ecological assessment at two national park units in the Mid-Atlantic region, U.S.A.

USGS Publications Warehouse

Mahan, Carolyn G.; Young, John A.; Miller, Bruce; Saunders, Michael C.

2014-01-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)—national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks’ conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a −1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape—we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Using ecological indicators and a decision support system for integrated ecological assessment at two national park units in the mid-Atlantic region, USA.

PubMed

Mahan, Carolyn G; Young, John A; Miller, Bruce J; Saunders, Michael C

2015-02-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)-national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks' conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a -1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape-we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Using Ecological Indicators and a Decision Support System for Integrated Ecological Assessment at Two National Park Units in the Mid-Atlantic Region, USA

NASA Astrophysics Data System (ADS)

Mahan, Carolyn G.; Young, John A.; Miller, Bruce J.; Saunders, Michael C.

2015-02-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)—national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks' conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a -1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape—we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Redundancies in "H" Index Variants and the Proposal of the Number of Top-Cited Papers as an Attractive Indicator

ERIC Educational Resources Information Center

Bornmann, Lutz

2012-01-01

Ruscio, Seaman, D'Oriano, Stremlo, and Mahalchik (this issue) evaluate 22 bibliometric indicators, including conventional measures, like the number of publications, the "h" index, and many "h" index variants. To assess the quality of the indicators, their well-justified criteria encompass conceptual, empirical, and practical…

Does adoption of electronic health records improve the quality of care management in France? Results from the French e-SI (PREPS-SIPS) study.

PubMed

Plantier, Morgane; Havet, Nathalie; Durand, Thierry; Caquot, Nicolas; Amaz, Camille; Biron, Pierre; Philip, Irène; Perrier, Lionel

2017-06-01

Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France. This retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics. The models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology. These results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units. Copyright © 2017 Elsevier B.V. All rights reserved.

A 2-1-1 Research Collaboration

PubMed Central

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

2012-01-01

Background 2-1-1 serves as a lifeline in times of crises. These crises often cause a spike in call volume that can challenge 2-1-1’s ability to meet their 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 directly affect 2-1-1 service quality indicators. Purpose 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. Methods 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. Results 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 negatively affect service quality, but administering a longer (15–18 minute) survey had a modest adverse effect on these indicators. Conclusions In 2-1-1 research collaborations, both partners need to understand the dynamic relationship between 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. PMID:23157769

SEDIMENT ANALYSIS - LANDSCAPE INDICATORS FOR PESTICIDES STUDY FOR MID-ATLANTIC COASTAL STREAMS (LIPS-MACS)

EPA Science Inventory

Nonpoint-source pollution, including pesticides and toxics, is the largest threat facing aquatic resources today. Understanding how pesticides applied to agricultural fields and suburban lawns reach and influence stream water quality is the focus of the Landscape Indicators for ...

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

EPA Science Inventory

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

Relating landscape characteristics to non-point source pollution in mine waste-located watersheds using geospatial techniques.

PubMed

Xiao, Huaguo; Ji, Wei

2007-01-01

Landscape characteristics of a watershed are important variables that influence surface water quality. Understanding the relationship between these variables and surface water quality is critical in predicting pollution potential and developing watershed management practices to eliminate or reduce pollution risk. To understand the impacts of landscape characteristics on water quality in mine waste-located watersheds, we conducted a case study in the Tri-State Mining District which is located in the conjunction of three states (Missouri, Kansas and Oklahoma). Severe heavy metal pollution exists in that area resulting from historical mining activities. We characterized land use/land cover over the last three decades by classifying historical multi-temporal Landsat imagery. Landscape metrics such as proportion, edge density and contagion were calculated based on the classified imagery. In-stream water quality data over three decades were collected, including lead, zinc, iron, cadmium, aluminum and conductivity which were used as key water quality indicators. Statistical analyses were performed to quantify the relationship between landscape metrics and surface water quality. Results showed that landscape characteristics in mine waste-located watersheds could account for as much as 77% of the variation of water quality indicators. A single landscape metric alone, such as proportion of mine waste area, could be used to predict surface water quality; but its predicting power is limited, usually accounting for less than 60% of the variance of water quality indicators.

Quality differentials and reproductive health service utilisation determinants in India.

PubMed

Anand, Sandip; Sinha, R K

2010-01-01

This paper seeks to establish relationships between women's reproductive health service use, assessed longitudinally and by facility type, with service quality perceptions related to public or private health facilities. The study was mainly secondary and quantitative in nature. It included analysing data collected by the International Institute for Population Sciences (IIPS) and The Johns Hopkins University (JHU) as a follow-up study to the 1998-1999 National Family Health Survey (NFHS-2). The follow-up survey was carried out in Tamil Nadu, Maharashtra, Bihar and Jharkhand. In 2002-2003, these four states were selected to capture socio-economic and demographic variations. Analysis includes composite indices and logistic regression analysis. A scale was constructed to measure utilisation levels. Dimensions include: service proximity, doctor availability, waiting time, medicines, facility cleanliness, dignified treatment, privacy, service affordability and treatment effectiveness. Findings indicate that doctor availability, waiting time, cleanliness, privacy and affordability at private health facilities enhance the probability that a health facility will be used for any reproductive health purpose. At the combined states level, medicine availability and treatment effectiveness at public health facilities enhances service use. The major limitation is that the study includes only selected Indian states. The findings may enhance Indian service-quality policy. The paper's main contribution is that seemingly for the first time in India, healthcare service use has been measured longitudinally and then explained through service quality variables by comparing public and private health facilities.

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

USGS Publications Warehouse

Angermeier, P.L.; Davideanu, G.

2004-01-01

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

The health-nutrition dimension: a methodological approach to assess the nutritional sustainability of typical agro-food products and the Mediterranean diet.

PubMed

Azzini, Elena; Maiani, Giuseppe; Turrini, Aida; Intorre, Federica; Lo Feudo, Gabriella; Capone, Roberto; Bottalico, Francesco; El Bilali, Hamid; Polito, Angela

2018-08-01

The aim of this paper is to provide a methodological approach to evaluate the nutritional sustainability of typical agro-food products, representing Mediterranean eating habits and included in the Mediterranean food pyramid. For each group of foods, suitable and easily measurable indicators were identified. Two macro-indicators were used to assess the nutritional sustainability of each product. The first macro-indicator, called 'business distinctiveness', takes into account the application of different regulations and standards regarding quality, safety and traceability as well as the origin of raw materials. The second macro-indicator, called 'nutritional quality', assesses product nutritional quality taking into account the contents of key compounds including micronutrients and bioactive phytochemicals. For each indicator a 0-10 scoring system was set up, with scores from 0 (unsustainable) to 10 (very sustainable), with 5 as a sustainability benchmark value. The benchmark value is the value from which a product can be considered sustainable. A simple formula was developed to produce a sustainability index. The proposed sustainability index could be considered a useful tool to describe both the qualitative and quantitative value of micronutrients and bioactive phytochemical present in foodstuffs. This methodological approach can also be applied beyond the Mediterranean, to food products in other world regions. © 2018 Society of Chemical Industry. © 2018 Society of Chemical Industry.

[Cross-sectoral quality assurance in ambulatory care].

PubMed

Albrecht, Martin; Loos, Stefan; Otten, Marcus

2013-01-01

Overcoming rigid sectoral segmentation in healthcare has also become a health policy target in quality assurance. With the Act to Enhance Competition in Statutory Health Insurance (GKV-WSG) coming into effect, quality assurance measures are to be designed in a cross-sectoral fashion for in- and outpatient sectors equally. An independent institution is currently mandated to develop specific quality indicators for eleven indications. For three of these operating tests have already been commissioned by the Federal Joint Committee. This article depicts the major results of a feasibility study, including a compliance cost estimate, for the aforementioned indications of cross-sectoral quality assurance (cQA). In conclusion, a number of both practical and conceptual basic challenges are still to be resolved prior to the full implementation of cQA, such as a sufficient specification to activate documentation requirements and an inspection system capable of separating actual quality problems from documentary deficits. So far, a comprehensive cost-utility analysis of cQA has not been provided, in particular with comparison to existing QA systems. In order to optimise cost and utility of cQA an evidence-based approach is required for both the extension of cQA areas and for QA provisions. Copyright © 2013. Published by Elsevier GmbH.

Environmental toxicology and risk assessment: Standardization of biomarkers for endocrine disruption and environmental assessment: Eighth volume. Special technical publication 1364

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

Henshel, D.S.; Black, M.C.; Harrass, M.C.

1999-07-01

This conference was held April 20--22, 1998 in Atlanta, Georgia. The purpose of this conference was to provide a multidisciplinary forum for exchange of state-of-the-art information on biological markers in toxicology and risk assessment, including endocrine disrupter screening assays. Attention is focused on the following: aquatic toxicology; behavioral toxicology; biochemical indicators; developmental indicators; endocrine indicators; biodegradation and fate of chemicals; quality assurance and quality control within laboratory and field studies; risk assessment and communication, and harmonization of standards development. Individual papers have been processed separately for inclusion in the appropriate data bases.

Effects of Early Leader-Member Exchange Perceptions on Academic Outcomes

ERIC Educational Resources Information Center

Jacques, Paul H.; Garger, John; Thomas, Michael; Vracheva, Veselina

2012-01-01

This study tested a series of hypotheses linking college support and quality of student-instructor relations with outcomes including student efficacy, social connectedness with peers, expectancies and academic performance. Early quality of exchanges with the instructor using Leader-Member Exchange theory was found to be a key indicator of academic…

Gender Ideologies, Marital Roles, and Marital Quality in Taiwan

ERIC Educational Resources Information Center

Xu, Xiaohe; Lai, Shu-Chuan

2004-01-01

This study uses the multidimensional measures included in the 1996 Taiwan Social Change Survey to examine the effects of gender ideologies and marital role sharing on marital quality among married Taiwanese men and women as reporting spouses. The authors' quantitative analyses indicate that (a) there is little direct relationship between gender…

Predicting redwood productivity using biophysical data, spatial statistics and site quality indices

Treesearch

John-Pascal Berrill; Kevin L. O’Hara; Shawn Headley

2017-01-01

Coast redwood (Sequoia sempervirens (D. Don) Endl.) height growth and basal area growth are sensitive to variations in site quality. Site factors known to be correlated with redwood stand growth and yield include topographic variables such as position on slope, exposure, and the composite variable: topographic relative moisture index. Species...

34 CFR 356.30 - What selection criteria are used for this program?

Code of Federal Regulations, 2012 CFR

2012-07-01

...— (a) Quality and level of formal education, previous work experience, and recommendations of present or former supervisors or colleagues that include an indication of the applicant's ability to work creatively in scientific research; and (b) The quality of a research proposal of no more than 12 pages...

Urbanization in Pearl River Delta area in past 20 years: remote sensing of impact on water quality

NASA Astrophysics Data System (ADS)

Wang, Yunpeng; Fan, Fenglei; Zhang, Jinqu; Xia, Hao; Ye, Chun

2004-11-01

The Pearl River Delta of Guangdong province in China is one of the world"s largest growths in urbanization for the past 20 years. The objective of this research is to explore the relationship between urbanization and water quality in this area. Present and past remote sensing data including MSS< TM/ETM and ASTER are used to research the urbanization and its impact on water quality. Land use and water quality information are extracted from remote sensing data. Data of population, industrial and agricultural productivity indices are integrated with the thematic maps derived from remote sensing data by GIS method. Spatial analysis methods are applied on these data and the results indicate that population, waste water both from household and industrial and chemical fertilizer consumptions are main controls of the regional water quality and environment.

New Perspectives in Monitoring Drinking Water Microbial Quality

PubMed Central

Figueras, Ma José; Borrego, Juan J.

2010-01-01

The safety of drinking water is evaluated by the results obtained from faecal indicators during the stipulated controls fixed by the legislation. However, drinking-water related illness outbreaks are still occurring worldwide. The failures that lead to these outbreaks are relatively common and typically involve preceding heavy rain and inadequate disinfection processes. The role that classical faecal indicators have played in the protection of public health is reviewed and the turning points expected for the future explored. The legislation for protecting the quality of drinking water in Europe is under revision, and the planned modifications include an update of current indicators and methods as well as the introduction of Water Safety Plans (WSPs), in line with WHO recommendations. The principles of the WSP approach and the advances signified by the introduction of these preventive measures in the future improvement of dinking water quality are presented. The expected impact that climate change will have in the quality of drinking water is also critically evaluated. PMID:21318002

Using Caffeine as a Water Quality Indicator in the Ambient Monitoring Program for Third Fork Creek Watershed, Durham, North Carolina

PubMed Central

Spence, Porché L

2015-01-01

Caffeine has been suggested as a chemical indicator for domestic wastewater in freshwater systems, although it is not included in water quality monitoring programs. The Third Fork Creek watershed in Durham, NC, is highly urbanized, with a history of receiving untreated wastewater from leaking and overflowing sanitary sewers. The poor water quality originating in the Third Fork Creek watershed threatens its intended uses and jeopardizes drinking water, aquatic life, and recreational activities provided by Jordan Lake. Organic waste contaminants have been detected in both Third Fork Creek watershed and Jordan Lake; however, the sampling periods were temporary, resulting in a few samples collected during nonstorm periods. It is recommended that (1) the concentration of caffeine and other organic waste contaminants are determined during storm and nonstorm periods and (2) caffeine is monitored regularly with traditional water quality indicators to evaluate the health of Third Fork Creek watershed. PMID:26157335

What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges.

PubMed

Meier, Frederick A; Badrick, Tony C; Sikaris, Kenneth A

2018-02-17

For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal risk assessment, rather than competing with economic value, enhances it.

Water-Quality Characteristics for Selected Sites Within the Milwaukee Metropolitan Sewerage District Planning Area, Wisconsin, February 2004-September 2005

USGS Publications Warehouse

Thomas, Judith C.; Lutz, Michelle A.; Bruce, Jennifer L.; Graczyk, David J.; Richards, Kevin D.; Krabbenhoft, David P.; Westenbroek, Stephen M.; Scudder, Barbara C.; Sullivan, Daniel J.; Bell, Amanda H.

2007-01-01

The Milwaukee Metropolitan Sewerage District (MMSD) Corridor Study is a three-phase project designed to improve the understanding of water resources in the MMSD planning area to assist managers and policy makers in their decisions. Phase I of the Study involved the compilation of existing data from multiple agencies into a single database. These data were analyzed to identify spatial, temporal, and technological gaps in the planning area, and were used to develop Phase II of the Study. Phase II, the subject of this report, involved an intensive data-collection effort by the U.S. Geological Survey (USGS) in cooperation with MMSD (from February, 2004, through September, 2005). This phase addressed the data gaps identified in Phase I and completed a baseline assessment of water quality for selected stream and harbor sites in the MMSD planning area. This baseline assessment included evaluations of surface-water chemistry and microbial concentrations in the streams and harbor sites; additionally, stream sites were evaluated for discharge, sediment chemistry, fish-tissue chemistry, habitat, and the quality of biological communities (including fish, macroinvertebrates, and algae). In all, data were collected at 15 stream and 6 harbor sites within the MMSD planning area, including manual sampling and analysis for more than 220 water-quality properties and constituents at all 21 sites, stream-discharge data for 14 stream sites, and automated water-quality sampling at 4 stream sites. A bioassessment during autumn 2004 included collection of biologic-community data and stream-habitat data at wadeable streams. Quartiles of Phase II aggregate bioassessment rankings were used to divide the 14 wadeable stream sites into four groups to investigate relations between bioassessment data and site characteristic and water-quality data. Quartile numbers reflect relative water quality: quartile 1 contained sites where the bioassessment data indicated the least-degraded water quality among those sampled, and quartile 4 contained sites that indicated the most-degraded water quality. Quartiles contained the following stream sites: Quartile 1: Milwaukee River near Cedarburg, Milwaukee River at Milwaukee, Jewel Creek, and Menomonee River at Menomonee Falls; Quartile 2: Willow Creek, Root River near Franklin, and Root River at Grange Avenue; Quartile 3: Menomonee River at Wauwatosa, Oak Creek, and Little Menomonee River; and Quartile 4: Honey Creek, Underwood Creek, Lincoln Creek, and Kinnickinnic River. Site characteristics (in this case, drainage area and land use) and selected water-quality data were summarized based on the four bioassessment quartiles to determine if there were relations with the aggregate bioassessment rankings. In general, sites having the largest drainage basins with the lowest proportion of urban land use were in quartile 1, and the smallest drainage basins with the highest proportion of urban land use were in quartile 4. Major ions, indicator organisms, and wastewater compounds generally had the lowest overall results in quartile 1 and highest overall results in quartile 4, with intermediate results in quartiles 2 and 3. Results for other constituent types (nutrients, mercury, pathogenic organisms, and bed sediment) were mixed, with results for some constituents decreasing from quartile 1 to quartile 4. Where sufficient Phase I data were available, summary statistics (including medians) for chemical and biological data were calculated, allowing some comparisons to be made between Phase I and Phase II data. Comparisons between Phase I and Phase II results indicated a variety of changes with respect to water quality. Concentrations of chloride, nitrate, chlorophyll a, total phosphorus in water; arsenic in bed sediment; and fish Index of Biotic Integrity ratings generally indicated declines in water quality. However, concentrations of total nitrogen, suspended sediment, and fecal coliform in water; some trace eleme

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.

From phenotyping towards breeding strategies: using in vivo indicator traits and genetic markers to improve meat quality in an endangered pig breed.

PubMed

Biermann, A D M; Yin, T; König von Borstel, U U; Rübesam, K; Kuhn, B; König, S

2015-06-01

In endangered and local pig breeds of small population sizes, production has to focus on alternative niche markets with an emphasis on specific product and meat quality traits to achieve economic competiveness. For designing breeding strategies on meat quality, an adequate performance testing scheme focussing on phenotyped selection candidates is required. For the endangered German pig breed 'Bunte Bentheimer' (BB), no breeding program has been designed until now, and no performance testing scheme has been implemented. For local breeds, mainly reared in small-scale production systems, a performance test based on in vivo indicator traits might be a promising alternative in order to increase genetic gain for meat quality traits. Hence, the main objective of this study was to design and evaluate breeding strategies for the improvement of meat quality within the BB breed using in vivo indicator traits and genetic markers. The in vivo indicator trait was backfat thickness measured by ultrasound (BFiv), and genetic markers were allele variants at the ryanodine receptor 1 (RYR1) locus. In total, 1116 records of production and meat quality traits were collected, including 613 in vivo ultrasound measurements and 713 carcass and meat quality records. Additionally, 700 pigs were genotyped at the RYR1 locus. Data were used (1) to estimate genetic (co)variance components for production and meat quality traits, (2) to estimate allele substitution effects at the RYR1 locus using a selective genotyping approach and (3) to evaluate breeding strategies on meat quality by combining results from quantitative-genetic and molecular-genetic approaches. Heritability for the production trait BFiv was 0.27, and 0.48 for backfat thickness measured on carcass. Estimated heritabilities for meat quality traits ranged from 0.14 for meat brightness to 0.78 for the intramuscular fat content (IMF). Genetic correlations between BFiv and IMF were higher than estimates based on carcass backfat measurements (0.39 v. 0.25). The presence of the unfavorable n allele was associated with increased electric conductivity, paler meat and higher drip loss. The allele substitution effect on IMF was unfavorable, indicating lower IMF when the n allele is present. A breeding strategy including the phenotype (BFiv) combined with genetic marker information at the RYR1 locus from the selection candidate, resulted in a 20% increase in accuracy and selection response when compared with a breeding strategy without genetic marker information.

Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

PubMed

Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

2016-01-01

The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

PubMed

Jenkins, Kathy J; Koch Kupiec, Jennifer; Owens, Pamela L; Romano, Patrick S; Geppert, Jeffrey J; Gauvreau, Kimberlee

2016-05-20

The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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

USGS Publications Warehouse

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

2008-01-01

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

The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients.

PubMed

Carels, Robert A

2004-02-01

Congestive heart failure significantly compromises quality of life by contributing to severe physical, role, and social functioning impairment as well as increased psychological distress. Previous research examining quality of life in CHF patients has typically been conducted using global self-report instruments that may exceed a patient's ability to accurately recall their experiences. This investigation examines the impact of disease severity, functional status, and level of depression on daily quality of life (i.e., mean level and variability) in CHF patients during a 2-week monitoring period. Indices of quality of life included emotional and physical quality of life, social support and conflict, positive and negative mood, and coping responses. Fifty-eight patients with CHF participated in the investigation. Depressive symptoms were positively associated with a number of quality of life indices (i.e., physical and emotional quality of life, social support and conflict, mood, and coping behaviours). Left ventricular ejection fraction and functional impairment had a much weaker association with quality of life. These findings suggest that depressive symptoms may have a greater impact on quality of life in CHF patients than severity of cardiac dysfunction or functional impairment.

Water quality of arctic rivers in Finnish Lapland.

PubMed

Niemi, Jorma

2010-02-01

The water quality monitoring data of eight rivers situated in the Finnish Lapland above the Arctic Circle were investigated. These rivers are icebound annually for about 200 days. They belong to the International River Basin District founded according to the European Union Water Framework Directive and shared with Norway. They are part of the European river monitoring network that includes some 3,400 river sites. The water quality monitoring datasets available varied between the rivers, the longest comprising the period 1975-2003 and the shortest 1989-2003. For each river, annual medians of eight water quality variables were calculated. In addition, medians and fifth and 95th percentiles were calculated for the whole observation periods. The medians indicated good river water quality in comparison to other national or foreign rivers. However, the river water quality oscillated widely. Some rivers were in practice in pristine state, whereas some showed slight human impacts, e.g., occasional high values of hygienic indicator bacteria.

Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda.

PubMed

Nisingizwe, Marie Paul; Iyer, Hari S; Gashayija, Modeste; Hirschhorn, Lisa R; Amoroso, Cheryl; Wilson, Randy; Rubyutsa, Eric; Gaju, Eric; Basinga, Paulin; Muhire, Andrew; Binagwaho, Agnès; Hedt-Gauthier, Bethany

2014-01-01

Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period. The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level. Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios. Conclusion and policy implications: Our findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data.

Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda

PubMed Central

Nisingizwe, Marie Paul; Iyer, Hari S.; Gashayija, Modeste; Hirschhorn, Lisa R.; Amoroso, Cheryl; Wilson, Randy; Rubyutsa, Eric; Gaju, Eric; Basinga, Paulin; Muhire, Andrew; Binagwaho, Agnès; Hedt-Gauthier, Bethany

2014-01-01

Background Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period. Methods The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level. Results Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios. Conclusion and policy implications Our findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data. PMID:25413722

Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments.

PubMed

Schnitker, Linda M; Martin-Khan, Melinda; Burkett, Ellen; Beattie, Elizabeth R A; Jones, Richard N; Gray, Len C

2015-03-01

The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated. © 2015 by the Society for Academic Emergency Medicine.

Improving Elementary School Quality Through the Use of a Social-Emotional and Character Development Program: A Matched-Pair, Cluster-Randomized, Controlled Trial in Hawai’i

PubMed Central

Snyder, Frank J.; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J.; Flay, Brian R.

2012-01-01

BACKGROUND School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai’i trial included 20 racially/ethnically diverse schools and was conducted from 2002–2003 through 2005–2006. METHODS School-level archival data, collected by the Hawai’i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. RESULTS Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. CONCLUSIONS School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. PMID:22142170

Improving elementary school quality through the use of a social-emotional and character development program: a matched-pair, cluster-randomized, controlled trial in Hawai'i.

PubMed

Snyder, Frank J; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J; Flay, Brian R

2012-01-01

School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools and was conducted from 2002-2003 through 2005-2006. School-level archival data, collected by the Hawai'i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. © 2011, American School Health Association.

Quality measurement in diabetes care.

PubMed

Leas, Brian F; Berman, Bettina; Kash, Kathryn M; Crawford, Albert G; Toner, Richard W; Goldfarb, Neil I; Nash, David B

2009-10-01

This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes.

Selecting pesticides for inclusion in drinking water quality guidelines on the basis of detection probability and ranking.

PubMed

Narita, Kentaro; Matsui, Yoshihiko; Iwao, Kensuke; Kamata, Motoyuki; Matsushita, Taku; Shirasaki, Nobutaka

2014-02-01

Pesticides released into the environment may pose both ecological and human health risks. Governments set the regulations and guidelines for the allowable levels of active components of pesticides in various exposure sources, including drinking water. Several pesticide risk indicators have been developed using various methodologies, but such indicators are seldom used for the selection of pesticides to be included in national regulations and guidelines. The aim of the current study was to use risk indicators for the selection of pesticides to be included in regulations and guidelines. Twenty-four risk indicators were created, and a detection rate was defined to judge which indicators were the best for selection. The combination of two indicators (local sales of a pesticide for the purposes of either rice farming or other farming, divided by the guideline value and annual precipitation, and amended with the scores from the physical and chemical properties of the pesticide) gave the highest detection rates. In this case study, this procedure was used to evaluate 134 pesticides that are currently unregulated in the Japanese Drinking Water Quality Guidelines, from which 44 were selected as pesticides to be added to the primary group in the guidelines. The detection probability of the 44 pesticides was more than 72%. Among the 102 pesticides currently in the primary group, 17 were selected for withdrawal from the group. © 2013.

Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres.

PubMed

Katsarava, Zaza; Gouveia, Raquel Gil; Jensen, Rigmor; Gaul, Charly; Schramm, Sara; Schoppe, Anja; Steiner, Timothy J

2015-01-01

Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages.

78 FR 52929 - Scientific Information Request on Imaging Tests for the Diagnosis and Staging of Pancreatic...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-27

... improve the quality of this review. AHRQ is conducting this comparative effectiveness review pursuant to..., study period, design, methodology, indication and diagnosis, proper use instructions, inclusion and... including a study number, the study period, design, methodology, indication and diagnosis, proper use...

Levels of Indicator Development for Education for Sustainable Development

ERIC Educational Resources Information Center

Rode, Horst; Michelsen, Gerd

2008-01-01

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

The Relationship between Quantitative and Qualitative Measures of Writing Skills.

ERIC Educational Resources Information Center

Howerton, Mary Lou P.; And Others

The relationships of quantitative measures of writing skills to overall writing quality as measured by the E.T.S. Composition Evaluation Scale (CES) were examined. Quantitative measures included indices of language productivity, vocabulary diversity, spelling, and syntactic maturity. Power of specific indices to account for variation in overall…

Science & Engineering Indicators 2016. National Science Board

ERIC Educational Resources Information Center

National Science Foundation, 2016

2016-01-01

"Science and Engineering Indicators" (SEI) is first and foremost a volume of record comprising high-quality quantitative data on the U.S. and international science and engineering enterprise. SEI includes an overview and seven chapters that follow a generally consistent pattern. The chapter titles are as follows: (1) Elementary and…

Lichen indicator [Section 4

Treesearch

Paul L. Patterson; Susan Will-Wolf; Marie T. Trest

2009-01-01

Lichens are very responsive to environmental stressors in forests, including changes in forest structure, air quality, and climate. Each lichen species on a plot is an indicator of how lichen communities respond to ecological conditions. Individual lichen species occur erratically and even common species are often absent from plots with suitable habitat. The combined...

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

PubMed

Patterson, C H

1989-10-01

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

Comparison of an enhanced versus a written feedback model on the management of Medicare inpatients with venous thrombosis.

PubMed

Hayes, R; Bratzler, D; Armour, B; Moore, L; Murray, C; Stevens, B R; Radford, M; Fitzgerald, D; Elward, K; Ballard, D J

2001-03-01

A multistate randomized study conducted under the Health Care Financing Administration's (HCFA's) Health Care Quality Improvement Program (HCQIP) offered the opportunity to compare the effect of a written feedback intervention (WFI) with that of an enhanced feedback intervention (EFI) on improving the anticoagulant management of Medicare beneficiaries who present to the hospital with venous thromboembolic disease. Twenty-nine hospitals in five states were randomly assigned to receive written hospital-specific feedback (WFI) of feedback enhanced by the participation of a trained physician, quality improvement tools, and an Anticoagulant Management of Venous Thrombosis (AMVT) project liaison (EFI). Differences in the performance of five quality indicators between baseline and remeasurement were assessed. Quality managers were interviewed to determine perceptions of project implementation. No significant differences in the change from baseline to remeasurement were found between the two intervention groups. Significant improvement in one indicator and significant decline in two indicators were found for one or both groups. Yet 59% of all quality managers perceived the AMVT project as being successful to very successful, and more EFI quality managers perceived success than did WFI managers (71% versus 40%). In the majority of EFI hospitals, physician liaisons played an important role in project implementation. Study results indicated that the addition of a physician liaison, quality improvement tools, and a project liaison did not provide incremental value to hospital-specific feedback for improving quality of care. Future studies with larger sample sizes, lengthier follow-up periods, and interventions that include more of the elements shown to affect practice behavior change are needed to identify an optimal feedback model for use by external quality management organizations.

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

PubMed Central

Flores-Hernández, Sergio; Saturno-Hernández, Pedro J.; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

2015-01-01

Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care. PMID:26230991

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012).

PubMed

Flores-Hernández, Sergio; Saturno-Hernández, Pedro J; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

2015-01-01

The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

Internet Service Cognition and Use, and Their Promotion of Quality of Life in Taiwan

ERIC Educational Resources Information Center

Liang, Te-Hsin

2011-01-01

The "e-Taiwan Program" implemented by Taiwan government is aimed at showing the e-advantage in people's life and bring about essential benefits. This research follows the e-Life indicators of the Quality of Life measurement system developed by "e-Taiwan Program", which including four major dimensions of e-Daily Life,…

Perceived Parent-Child Relational Qualities and Parental Behavioral and Psychological Control in Chinese Adolescents in Hong Kong

ERIC Educational Resources Information Center

Shek, Daniel T. L.

2006-01-01

Chinese secondary school students (N = 3,017) were asked to respond to instruments measuring their perceived parent-child relational qualities (parental trust of the child, child's trust of parents, child's readiness to communicate with parents, and child's satisfaction with parental control), parental behavioral control (including indicators of…

What We Know--and Don't Know--About Water Quality at Stream Crossings

Treesearch

Steven E. Taylor; Robert B. Rummer; Kyung H. Yoo; Richard A. Welch; Jason D. Thompson

1999-01-01

Forest road stream crossings including fords, culverts, and bridges, are primary contributors of sediment to forest streams. Information on the water quality impacts form each type for crossings is limited, but the available literature indicates that signicifacent amounts of sediment are produced during installation fo fords and culverts; construction and use of...

Changes in Quality of Life in Visually Impaired Patients after Low-Vision Rehabilitation

ERIC Educational Resources Information Center

Renieri, Giulia; Pitz, Susanne; Pfeiffer, Norbert; Beutel, Manfred E.; Zwerenz, Rudiger

2013-01-01

The objective of the study was to assess the impact of low-vision aids on quality of life. Interviews included a modified version of the National Eye Institute Visual Functioning Questionnaire (Modified German NEI VFQ-25), the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination Blind, and Indicators of the Rehabilitation…

Social Anxiety and Adolescents' Friendships: The Role of Social Withdrawal

ERIC Educational Resources Information Center

Biggs, Bridget K.; Vernberg, Eric M.; Wu, Yelena P.

2012-01-01

Research indicates social anxiety is associated with lower friendship quality, but little is known about the underlying mechanisms. This 2-month longitudinal study examined social withdrawal as a mediator of the social anxiety-friendship quality link in a sample of 214 adolescents (M[subscript age] = 13.1 years, SD = 0.73) that included an…

Summary and Evaluation of the Quality of Stormwater in Denver, Colorado, October 2001 to October 2005

USGS Publications Warehouse

Bossong, Clifford R.; Fleming, Andrea C.

2008-01-01

Stormwater in the Denver area was sampled by the U.S. Geological Survey, in cooperation with the Urban Drainage and Flood Control District, in a network of five monitoring stations - three on the South Platte River and two on tributary streams, beginning in October 2001 and continuing through October 11, 2005. Composite samples of stormwater were analyzed at the U.S. Geological Survey National Water Quality Laboratory during water years 2003-2005 and the Metro Wastewater Reclamation District Laboratory during water year 2002 for water-quality properties such as pH, specific conductance, hardness, and residue on evaporation at 105 degrees Celsius; and for constituents such as major ions (calcium, chloride, fluoride, magnesium, potassium, sodium, and sulfate) in 2005, organic carbon and nutrients, including ammonia, nitrite plus nitrate, ammonia plus organic nitrogen, phosphorus, and orthophosphate; and for metals, including total and dissolved phases of copper, lead, manganese, and zinc. Samples analyzed for bacteriological indicators such as Escherichia coli and fecal coliform collected during selected storms also were analyzed at the Metro Wastewater Reclamation Laboratory. Discrete samples collected during selected storms were analyzed at the U.S. Geological Survey National Water Quality Laboratory for a suite of water-quality properties and constituents similar to those analyzed in the composite samples but that did not include determinations for total phases of metals. Streamflow characteristics associated with 176 composite stormwater samples indicate that most samples were collected from hydrographs classified as falling or event hydrographs and that only a few samples were collected from rising hydrographs. Results from laboratory analyses of the composite samples indicate spatial patterns in which concentrations for some constituents increase with contributing drainage area in the South Platte River and Sand Creek, but no well-defined relation with the amount of urban land cover was identified using data available from the U.S. Geological Survey National Land Cover data. Results from 22 discrete samples collected during two storms and used to obtain composited results with various weighting methods indicate that correlation coefficients between time-weighted and volume-weighted concentrations were generally at least 0.65, indicating a strong direct correlation between the two weighting methods for the stations involved in this study. In addition, the central tendency for relative percent differences between the time- and volume-weighting methods typically has an absolute value of about 10 or less, indicating good agreement for these weighting methods for data collected as part of this study. Comparison of stormwater results to numeric standards for streams developed by the Colorado Department of Public Health and Environment on the basis of use classifications indicates that, for water-quality properties and constituents other than bacteriological indicators, there were very few exceptions to numeric standards. Bacteriological indicators, however, such as Escherichia coli and fecal coliform consistently exceeded numeric standards in all bacteriological samples. An evaluation of laboratory results from composite samples on the basis of annual means indicates the presence of some simple upward and downward temporal trends in concentrations. In general, for annual means of results for all stations, hardness, ammonia plus organic nitrogen, total phosphorus, most dissolved metals (lead, manganese, and zinc), and all total metals (copper, lead, manganese, and zinc) all indicate annual means that decrease each year, or downward trends. Some trends were indicated only at individual stations in the network rather than at all stations. Ammonia as nitrogen at Union, Denver, and Henderson, orthophosphate at Sand Creek, and nitrite plus nitrate at Denver and Henderson all indicate decreasing annual means, or downward tr

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.

Detecting Long-term Trend of Water Quality Indices of Dong-gang River, Taiwan Using Quantile Regression

NASA Astrophysics Data System (ADS)

Yang, D.; Shiau, J.

2013-12-01

ABSTRACT BODY: Abstract Surface water quality is an essential issue in water-supply for human uses and sustaining healthy ecosystem of rivers. However, water quality of rivers is easily influenced by anthropogenic activities such as urban development and wastewater disposal. Long-term monitoring of water quality can assess whether water quality of rivers deteriorates or not. Taiwan is a population-dense area and heavily depends on surface water for domestic, industrial, and agricultural uses. Dong-gang River is one of major resources in southern Taiwan for agricultural requirements. The water-quality data of four monitoring stations of the Dong-gang River for the period of 2000-2012 are selected for trend analysis. The parameters used to characterize water quality of rivers include biochemical oxygen demand (BOD), dissolved oxygen (DO), suspended solids (SS), and ammonia nitrogen (NH3-N). These four water-quality parameters are integrated into an index called river pollution index (RPI) to indicate the pollution level of rivers. Although widely used non-parametric Mann-Kendall test and linear regression exhibit computational efficiency to identify trends of water-quality indices, limitations of such approaches include sensitive to outliers and estimations of conditional mean only. Quantile regression, capable of identifying changes over time of any percentile values, is employed in this study to detect long-term trend of water-quality indices for the Dong-gang River located in southern Taiwan. The results show that Dong-gang River 4 stations from 2000 to 2012 monthly long-term trends in water quality.To analyze s Dong-gang River long-term water quality trends and pollution characteristics. The results showed that the bridge measuring ammonia Long-dong, BOD5 measure in that station on a downward trend, DO, and SS is on the rise, River Pollution Index (RPI) on a downward trend. The results form Chau-Jhou station also ahowed simialar trends .more and more near the upstrean Hing-she station raise vivestok Sing-She stations are that ammonia on a upward trend, BOD5 no significant change in trend, DO, and SS is on the rise, river pollution index (RPI) a slight downward trend. Dong-gang River Basin , but the progress of sewer construction in slow. To reduce pollation in this river effort shoul be made regulatory reform on livestock waste control and acceleration of sewer construction. Keywords: quantile regression analysis, BOD5, RPI

Chapter A7. Biological Indicators

USGS Publications Warehouse

Myers, Donna N.; Wilde, Franceska D.

2003-01-01

The National Field Manual for the Collection of Water-Quality Data (National Field Manual) provides guidelines and standard procedures for U.S. Geological Survey (USGS) personnel who collect data used to assess the quality of the Nation's surface-water and ground-water resources. This chapter of the manual includes procedures for the (1) determination of biochemical oxygen demand using a 5-day bioassay test; (2) collection, identification, and enumeration of fecal indicator bacteria; (3) collection of samples and information on two laboratory methods for fecal indicator viruses (coliphages); and (4) collection of samples for protozoan pathogens. Each chapter of the National Field Manual is published separately and revised periodically. Newly published and revised chapters are posted on the World Wide Web on the USGS page 'National Field Manual for the Collection of Water-Quality Data.' The URL for this page is http://pubs.water.usgs.gov/twri9A/ (accessed November 25, 2003).

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.

Measures of fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions: A systematic review of measure quality.

PubMed

Walton, Holly; Spector, Aimee; Tombor, Ildiko; Michie, Susan

2017-11-01

Understanding the effectiveness of complex, face-to-face health behaviour change interventions requires high-quality measures to assess fidelity of delivery and engagement. This systematic review aimed to (1) identify the types of measures used to monitor fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions and (2) describe the reporting of psychometric and implementation qualities. Electronic databases were searched, systematic reviews and reference lists were hand-searched, and 21 experts were contacted to identify articles. Studies that quantitatively measured fidelity of delivery of, and/or engagement with, a complex, face-to-face health behaviour change intervention for adults were included. Data on interventions, measures, and psychometric and implementation qualities were extracted and synthesized using narrative analysis. Sixty-six studies were included: 24 measured both fidelity of delivery and engagement, 20 measured fidelity of delivery, and 22 measured engagement. Measures of fidelity of delivery included observation (n = 17; 38.6%), self-report (n = 15; 34%), quantitatively rated qualitative interviews (n = 1; 2.3%), or multiple measures (n = 11; 25%). Measures of engagement included self-report (n = 18; 39.1%), intervention records (n = 11; 24%), or multiple measures (n = 17; 37%). Fifty-one studies (77%) reported at least one psychometric or implementation quality; 49 studies (74.2%) reported at least one psychometric quality, and 17 studies (25.8%) reported at least one implementation quality. Fewer than half of the reviewed studies measured both fidelity of delivery of, and engagement with complex, face-to-face health behaviour change interventions. More studies reported psychometric qualities than implementation qualities. Interpretation of intervention outcomes from fidelity of delivery and engagement measurements may be limited due to a lack of reporting of psychometric and implementation qualities. Statement of contribution What is already known on this subject? Evidence of fidelity and engagement is needed to understand effectiveness of complex interventions Evidence of fidelity and engagement are rarely reported High-quality measures are needed to measure fidelity and engagement What does this study add? Evidence that indicators of quality of measures are reported in some studies Evidence that psychometric qualities are reported more frequently than implementation qualities A recommendation for intervention evaluations to report indicators of quality of fidelity and engagement measures. © 2017 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

BACTERIAL MORTALITY DUE TO SOLAR RADIATION, COMPARING EXPERIMENTAL AND STATISTICAL EVIDENCE

EPA Science Inventory

Many researchers report that sunlight is a primary stressor of beach indicator bacteria. Some water quality models include code that quantifies the effect of radiation on bacterial decay. For example, the EPA Visual Plumes model includes two coliform and one enterococcus submodel...

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

PubMed

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

2016-02-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

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.

[Quality level assessment of lowly efficient Tamarix chinensis secondary shrubs in Laizhou Bay of Yellow River Delta].

PubMed

Xia, Jiang-Bao; Liu, Yu-Ting; Zhu, Jin-Fang; Xu, Jing-Wei; Lu, Zhao-Hua; Liu, Jing-Tao; Liu, Qing

2013-06-01

Taking the Tamarix chinensis secondary shrubs in Laizhou Bay of Yellow River Delta as test objects, and by using synthetic factor method, this paper studied the main factors causing the lowly efficiency of T. chinensis secondary shrubs as well as the main parameters for the classification of lowly efficient T. chinensis secondary shrubs. A total of 24 indices including shrubs growth and soil physical and chemical properties were selected to determine the main affecting factors and parameters in evaluating and classifying the lowly efficient shrubs. There were no obvious correlations between the indices reflecting the shrubs growth and soil quality, and thus, only using shrub growth index to reflect the lowly efficiency level of T. chinensis was not enough, and it would be necessary to combine with soil quality factors to make a comprehensive evaluation. The principal factors reflecting the quality level of lowly efficient T. chinensis shrubs included soil salt content and moisture content, stand age, single tree's aboveground stem, leaf biomass, and basal diameter, followed by soil density, porosity, and soil nutrient status. The lowly efficient T. chinensis shrubs in the Bay could be classified into five types, namely, shrub with growth potential, slightly low quality shrub, moderately lowly efficient shrub, moderately low quality and lowly efficient shrub, and seriously low quality and lowly efficient shrub. The main features, low efficiency causes, and management measures of these shrubs were discussed based on the mean cluster value.

The Effects of Perceived Quality on Behavioral Economic Demand for Marijuana: A Web-Based Experiment

PubMed Central

Vincent, Paula C.; Collins, R. Lorraine; Liu, Liu; Yu, Jihnhee; De Leo, Joseph A.; Earleywine, Mitch

2016-01-01

Background Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including “demand” for marijuana, varied as a function of its perceived quality. Methods Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. Results We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., Pmax, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. Conclusions This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products. PMID:27951424

The effects of perceived quality on behavioral economic demand for marijuana: A web-based experiment.

PubMed

Vincent, Paula C; Collins, R Lorraine; Liu, Liu; Yu, Jihnhee; De Leo, Joseph A; Earleywine, Mitch

2017-01-01

Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality. Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., P max , elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Building Bridges to a Brighter Tomorrow: A Systematic Evidence Review of Interventions That Prepare Adolescents for Adulthood.

PubMed

Burrus, Barri B; Krieger, Kathleen; Rutledge, Regina; Rabre, Alexander; Axelson, Sarah; Miller, Audra; White, LeBretia; Jackson, Christine

2018-02-01

Data suggest that adverse social determinants during adolescence can set in motion a lifetime of poor social and health outcomes. Vulnerable youths are at particularly high risk in this regard. To identify and assess the current evidence base for adolescent-focused interventions designed to influence adulthood preparation that could affect longer-term social determinants. Using a systematic review methodology, we conducted an initial assessment of intervention evaluations targeting 6 adulthood preparation subject (APS) areas to assess the quality and character of the evidence base. The review is specific to evaluated interventions that address at least 1 of the 6 APS areas: healthy relationships, adolescent development, financial literacy, parent-child communication, educational and career success, and healthy life skills. The inclusion criteria were as follows: (1) published in English in an independent, peer-reviewed journal; (2) conducted in developed, English-speaking countries; (3) implemented an intervention that addressed at least 1 of the 6 APS areas, delivered in an in-person setting; (4) included youths at the 5th- through 12th-grade levels or aged 10 to 18 years at some point during intervention implementation; (5) included an evaluation component with a comparison group and baseline and follow-up measures; (6) included behavioral measures as outcomes; and (7) reported statistical significance levels for the behavioral outcome measures. We developed an abstraction form to capture details from each article, including key details of the intervention, such as services, implementer characteristics, and timing; adulthood preparation foci; evaluation design, methods, and key behavioral measures; and results, including key statistically significant results for behavior-based outcome measures. We assessed study quality by using several key factors, including randomization, baseline equivalence of treatment and control groups, attrition, and confounding factors. We characterized the quality of evidence as high, moderate, or low on the basis of the described design and execution of the research. Our assessment included only information stated explicitly in the manuscript. A total of 36 independent intervention evaluations met the criteria for inclusion. Of these, 27 (75%) included significant findings for behavioral outcomes related to adulthood preparation. Quality was mixed across studies. Of the 36 studies reviewed, 27 used a randomized controlled design (15 group randomization, 12 individual randomization), whereas the others used observational pre-post designs. Ten studies used mixed-methods approaches. Most (n = 32) studies used self-report questionnaires at baseline with a follow-up questionnaire, and 14 studies included multiple follow-up points. Of the studies reviewed, 7 studies received a high-quality rating, indicating no significant issues identified within our quality criteria. We rated 23 studies as moderate quality, indicating methodological challenges within 1 of the quality criteria categories. The most common reasons studies were down-rated were poor baseline equivalency across treatment groups (or no discussion of baseline equivalency) and high levels of attrition. Finally, 6 studies received a low-quality rating because of methodological challenges across multiple quality domains. The studies broadly represented the APS areas. We identified no systematic differences in study quality across the APS areas. Although some of the intervention results indicate behavioral changes that may be linked to adulthood preparation skills, many of the extant findings are derived from moderate- or poor-quality studies. Additional work is needed to build the evidence base by using methodologically rigorous implementation and evaluation designs and execution. Public Health Implications. Interventions designed to help adolescents better prepare for adulthood may have the potential to affect their longer-term social determinants of health and well-being. More theory-driven approaches and rigorously evaluated interventions could strengthen the evidence base and improve the effectiveness of these adulthood preparation interventions.

Building Bridges to a Brighter Tomorrow: A Systematic Evidence Review of Interventions That Prepare Adolescents for Adulthood

PubMed Central

Krieger, Kathleen; Rutledge, Regina; Rabre, Alexander; Axelson, Sarah; Miller, Audra; White, LeBretia; Jackson, Christine

2018-01-01

Background. Data suggest that adverse social determinants during adolescence can set in motion a lifetime of poor social and health outcomes. Vulnerable youths are at particularly high risk in this regard. Objectives. To identify and assess the current evidence base for adolescent-focused interventions designed to influence adulthood preparation that could affect longer-term social determinants. Search Methods. Using a systematic review methodology, we conducted an initial assessment of intervention evaluations targeting 6 adulthood preparation subject (APS) areas to assess the quality and character of the evidence base. The review is specific to evaluated interventions that address at least 1 of the 6 APS areas: healthy relationships, adolescent development, financial literacy, parent–child communication, educational and career success, and healthy life skills. Selection Criteria. The inclusion criteria were as follows: (1) published in English in an independent, peer-reviewed journal; (2) conducted in developed, English-speaking countries; (3) implemented an intervention that addressed at least 1 of the 6 APS areas, delivered in an in-person setting; (4) included youths at the 5th- through 12th-grade levels or aged 10 to 18 years at some point during intervention implementation; (5) included an evaluation component with a comparison group and baseline and follow-up measures; (6) included behavioral measures as outcomes; and (7) reported statistical significance levels for the behavioral outcome measures. Data Collection and Analysis. We developed an abstraction form to capture details from each article, including key details of the intervention, such as services, implementer characteristics, and timing; adulthood preparation foci; evaluation design, methods, and key behavioral measures; and results, including key statistically significant results for behavior-based outcome measures. We assessed study quality by using several key factors, including randomization, baseline equivalence of treatment and control groups, attrition, and confounding factors. We characterized the quality of evidence as high, moderate, or low on the basis of the described design and execution of the research. Our assessment included only information stated explicitly in the manuscript. Main Results. A total of 36 independent intervention evaluations met the criteria for inclusion. Of these, 27 (75%) included significant findings for behavioral outcomes related to adulthood preparation. Quality was mixed across studies. Of the 36 studies reviewed, 27 used a randomized controlled design (15 group randomization, 12 individual randomization), whereas the others used observational pre–post designs. Ten studies used mixed-methods approaches. Most (n = 32) studies used self-report questionnaires at baseline with a follow-up questionnaire, and 14 studies included multiple follow-up points. Of the studies reviewed, 7 studies received a high-quality rating, indicating no significant issues identified within our quality criteria. We rated 23 studies as moderate quality, indicating methodological challenges within 1 of the quality criteria categories. The most common reasons studies were down-rated were poor baseline equivalency across treatment groups (or no discussion of baseline equivalency) and high levels of attrition. Finally, 6 studies received a low-quality rating because of methodological challenges across multiple quality domains. The studies broadly represented the APS areas. We identified no systematic differences in study quality across the APS areas. Author’s Conclusions. Although some of the intervention results indicate behavioral changes that may be linked to adulthood preparation skills, many of the extant findings are derived from moderate- or poor-quality studies. Additional work is needed to build the evidence base by using methodologically rigorous implementation and evaluation designs and execution. Public Health Implications. Interventions designed to help adolescents better prepare for adulthood may have the potential to affect their longer-term social determinants of health and well-being. More theory-driven approaches and rigorously evaluated interventions could strengthen the evidence base and improve the effectiveness of these adulthood preparation interventions. PMID:29443561

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.

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

PubMed

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

2017-01-05

The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centred approach. In this paper, we outline our scoping review protocol to systematically review published and unpublished literature specific to patient-centred quality indicators that have been implemented and evaluated across various care settings. Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. We will search electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts), grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. 2 reviewers will independently screen all abstracts and full-text studies for inclusion. We will include any study which focuses on quality indicators in the context of PCC. All bibliographic data, study characteristics and indicators will be collected and analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. The scoping review will synthesise patient-centred quality indicators and their characteristics as described in the literature. This review will be the first step to formally identify what quality indicators have been used to evaluate PCC across the healthcare continuum, and will be used to inform a stakeholder consensus process exploring the development of a generic set of patient-centred quality indicators applicable to multiple care settings. The results will be disseminated through a peer-reviewed publication, conference presentations and a one-day stakeholder meeting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

PubMed

van Doorn-Klomberg, Arna L; Braspenning, Jozé C C; Wolters, René J; Bouma, Margriet; Wensing, Michel

2014-11-04

Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). A comparative observational study with two cohorts was performed. We included 138 Dutch family practices that participated in the national accreditation program for primary care. A first cohort of 69 practices was measured at start and completion of a 3-year accreditation program. A second cohort of 69 practices was included and measured simultaneously with the final measurement of the first cohort. In separate multilevel regression analyses, we compared both within-group changes in the first cohort and between-groups differences at follow-up (first cohort) and start (second cohort). Outcome measures consisted of 24 systematically developed indicators of quality of care in targeted chronic diseases. In the within-group comparison, we found improvements on 6 indicators related to diabetes (feet examination, cholesterol measurement, lipid lowering medication prescription) and COPD (spirometry performance, stop smoking advice). In the between-groups comparison we found that first cohort practices performed better on 4 indicators related to diabetes (cholesterol outcome) and CVD (blood pressure outcome, smoke status registration, glucose measurement). Improvements of the quality of primary care for patients with chronic diseases were found, but few could be attributed to the accreditation program. Further development of accreditation is needed to enhance its effectiveness on chronic disease management.

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

PubMed

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

2012-08-01

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

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

Water quality in the Schuylkill River, Pennsylvania: the potential for long-lead forecasts

NASA Astrophysics Data System (ADS)

Block, P. J.; Peralez, J.

2012-12-01

Prior analysis of pathogen levels in the Schuylkill River has led to a categorical daily forecast of water quality (denoted as red, yellow, or green flag days.) The forecast, available to the public online through the Philadelphia Water Department, is predominantly based on the local precipitation forecast. In this study, we explore the feasibility of extending the forecast to the seasonal scale by associating large-scale climate drivers with local precipitation and water quality parameter levels. This advance information is relevant for recreational activities, ecosystem health, and water treatment (energy, chemicals), as the Schuylkill provides 40% of Philadelphia's water supply. Preliminary results indicate skillful prediction of average summertime water quality parameters and characteristics, including chloride, coliform, turbidity, alkalinity, and others, using season-ahead oceanic and atmospheric variables, predominantly from the North Atlantic. Water quality parameter trends, including historic land use changes along the river, association with climatic variables, and prediction models will be presented.

Spatial and temporal variations of water quality in Cao-E River of eastern China.

PubMed

Chen, Ding-jiang; Lu, Jun; Yuan, Shao-feng; Jin, Shu-quan; Shen, Ye-na

2006-01-01

Evaluation and analysis of water quality variations were performed with integrated consideration of water quality parameters, hydrological-meteorologic and anthropogenic factors in Cao-E River, Zhejiang Province of China. Cao-E River system has been polluted and the water quality of some reaches are inferior to Grade V according to National Surface Water Quality Standard of China (GB2002). However, mainly polluted indices of each tributary and mainstream are different. Total nitrogen (TN) and total phosphorus (TP) in the water are the main polluted indices for mainstream that varies from 1.52 to 45.85 mg/L and 0.02 to 4.02 mg/L, respectively. TN is the main polluted indices for Sub-watershed I, II, IV and V (0.76 to 18.27 mg/L). BOD5 (0.36 to 289.5 mg/L), CODMn (0.47 to 78.86 mg/L), TN (0.74 to 31.09 mg/L) and TP (0 to 3.75 mg/L) are the main polluted indices for Sub-watershed III. There are tow pollution types along the river including nonpoint source pollution and point source pollution types. Remarkably temporal variations with a few spatial variations occur in nonpoint pollution type reaches (including mainstream, Sub-watershed I and II) that mainly drained by arable field and/or dispersive rural dwelling district, and the maximum pollutant concentration appears in flooding seasons. It implied that the runoff increases the pollutant concentration of the water in the nonpoint pollution type reaches. On the other hand, remarkably spatial variations occur in the point pollution type reaches (include Sub-watershed III, IV and V) and the maximum pollutant concentration appears in urban reaches. The runoff always decreases the pollutant concentration of the river water in the seriously polluted reaches that drained by industrial point sewage. But for the point pollution reaches resulted from centralized town domestic sewage pipeline and from frequent shipping and digging sands, rainfall always increased the concentration of pollutant (TN) in the river water too. Pollution controls were respectively suggested for these tow types according to different pollution causes.

Friends Also Matter: Examining Friendship Adjustment Indices as Moderators of Anxious-Withdrawal and Trajectories of Change in Psychological Maladjustment

ERIC Educational Resources Information Center

Markovic, Andrea; Bowker, Julie C.

2017-01-01

The present study evaluated whether 3 indices of friendship adjustment (mutual friendship involvement, friendship stability, friendship quality) are important, but overlooked, moderators of the impact of anxious-withdrawal on trajectories of psychological maladjustment during early adolescence. Participants included 271 young adolescents (51%…

Assessing the Impact of Urban Runoff in Recreational Beaches in South Carolina and Florida Using Culturable and QPCR Fecal Indicator

EPA Science Inventory

Urban/suburban runoff carries a variety of pollutants that often includes bacterial pathogens and indicators of fecal contamination. The objective of this study was to assess the microbial water quality of recreational beaches impacted solely by urban runoff through the use of cu...

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.

Does Accreditation Matter? School Readiness Rates for Accredited versus Nonaccredited Child Care Facilities in Florida's Voluntary Pre-Kindergarten Program

ERIC Educational Resources Information Center

Winterbottom, Christian; Piasta, Shayne B.

2015-01-01

Accreditation is a widely accepted indicator of quality in early education and includes many of the components cited in broad conceptualizations of quality. The purpose of this study was to examine whether kindergarten readiness rates differed between Florida child care facilities that were and were not accredited by any relevant national…

Understanding the role of personality in explaining associations between marital quality and parenting

PubMed Central

Ganiban, Jody M.; Ulbricht, Jennifer A.; Spotts, Erica L.; Lichtenstein, Paul; Reiss, David; Hansson, Kjell; Neiderhiser, Jenae M.

2010-01-01

This study examined the contributions of personality to the emotional and behavior dynamics of families. Analyses assessed the degrees to which personality accounts for associations between marital quality and parenting, and mediates genetic contributions to these relationships. Participants included 318 male and 544 female same-sex twin pairs from the Twin and Offspring Study in Sweden. All twins completed self-report measures of marital quality and personality (anxiousness, aggression, sociability). Composite measures of parent negativity and warmth were derived from the twins' and their adolescent children's ratings of the twins' disciplinary styles and the emotional tone of the parent-child relationship. Observational ratings of marital quality and parenting were also obtained for a subset of twins. Analyses indicated that personality characteristics explain 33% to 42% of the covariance between reported marital quality and parenting, and 26% to 28% of the covariance between observed marital quality and parenting. For both sets of analyses personality accounted for more than half of the genetic contributions to covariance between marital quality and parenting. Results indicate that personality significantly contributes to associations between marital quality and parenting, and that personality is an important path through which genetic factors contribute to family relationships. PMID:19803601

Bibliography, indices, and data sources of water-related studies, upper Colorado River basin, Colorado and Utah, 1872-1995

USGS Publications Warehouse

Bauch, N.J.; Apodaca, L.E.

1995-01-01

As part of the U.S. Geological Survey's National Water-Quality Assessment Program, current water-quality conditions in the Upper Colorado River Basin in Colorado and Utah are being assessed. This report is an initial effort to identify and compile information on water-related studies previously conducted in the basin and consists of a bibliography, coauthor and subject indices, and sources of available water-related data. Computerized literature searches of scientific data bases were carried out to identify past water-related studies in the basin, and government agencies and private organizations were contacted regarding their knowledge or possession of water-related publications and data. Categories of information in the bibliography include: aquatic biology, climate, energy development, geology, land use, limnology, runoff, salinity, surface- and ground-water hydrology, water chemistry, water quality and quantity, and water use and management. The approximately 1,400 indexed references date from 1872 through February 1995 and include books, journal articles, maps, and reports. In many instances, an abstract has been provided for a given reference. Sources of water-related data in the basin are included in a table.

Valuing recreational fishing quality at rivers and streams

NASA Astrophysics Data System (ADS)

Melstrom, Richard T.; Lupi, Frank; Esselman, Peter C.; Stevenson, R. Jan

2015-01-01

This paper describes an economic model that links the demand for recreational stream fishing to fish biomass. Useful measures of fishing quality are often difficult to obtain. In the past, economists have linked the demand for fishing sites to species presence-absence indicators or average self-reported catch rates. The demand model presented here takes advantage of a unique data set of statewide biomass estimates for several popular game fish species in Michigan, including trout, bass and walleye. These data are combined with fishing trip information from a 2008-2010 survey of Michigan anglers in order to estimate a demand model. Fishing sites are defined by hydrologic unit boundaries and information on fish assemblages so that each site corresponds to the area of a small subwatershed, about 100-200 square miles in size. The random utility model choice set includes nearly all fishable streams in the state. The results indicate a significant relationship between the site choice behavior of anglers and the biomass of certain species. Anglers are more likely to visit streams in watersheds high in fish abundance, particularly for brook trout and walleye. The paper includes estimates of the economic value of several quality change and site loss scenarios.

Perspectives on Home Care Quality

PubMed Central

Kane, Rosalie A.; Kane, Robert L.; Illston, Laurel H.; Eustis, Nancy N.

1994-01-01

Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized “enabling” criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID:10140158

Voice symptoms and voice-related quality of life in college students.

PubMed

Merrill, Ray M; Tanner, Kristine; Merrill, Joseph G; McCord, Matthew D; Beardsley, Melissa M; Steele, Brittanie A

2013-08-01

The purpose of this study was to examine the prevalence of voice disorders in college students and their effect on the students as shown by quality-of-life indicators. A cross-sectional survey was completed by 545 college students in 2012. The survey included 10 questions from the Voice-Related Quality of Life (V-RQOL), selected voice symptoms, and quality-of-life indicators of functional health and well-being based on the Short Form 36-item Health Survey (SF-36). Twenty-nine percent of the college students (mean age, 22.7 years) reported a history of a voice disorder. Hoarseness was the most prevalent voice symptom, but was not correlated with V-RQOL scores. A wobbly or shaky voice, throat dryness, vocal fatigue, and vocal effort explained a significant amount of variance on the social-emotional and physical domains of the V-RQOL index (p < 0.05). Voice symptoms limited emotional and physical functioning as indicated by SF-36 scores. Voice disorders significantly influence psychosocial and physical functioning in college students. These findings have important implications for voice-care services in this population.

Urban environment and well-being: cross-cultural studies on Perceived Residential Environment Quality Indicators (PREQIs).

PubMed

Bonaiuto, Marino; Fornara, Ferdinando; Alves, Susana; Ferreira, Ines; Mao, Yanhui; Moffat, Eva; Piccinin, Gloria; Rahimi, Leila

2015-09-01

Architectural and environmental psychology literature has shown the importance of urban design in provoking stress feelings or enhancing well-being and quality of life. The aim of this contribution is to show the main results of a set of cross-cultural survey studies concerning the perceived quality of urban features at the neighbourhood level. A questionnaire was used including the extended or the short version of the 11 scales measuring Perceived Residential Environment Quality Indicators (PREQIs), which cover architectural, social, functional, and contextual aspects. Both versions of PREQIs showed a similar factorial structure and a good (or at least acceptable) reliability across different geographical contexts, even though some differences emerged in those countries that are more distant from the Western linguistic and cultural milieu. The development of tools like PREQIs should increase a "user-centred" vision on urban issues.

Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Part 1.

PubMed

Redfern, S; Norman, I

1999-07-01

The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 includes the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and the conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. Congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis.

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing.

PubMed

González-Chordá, Víctor Manuel; Maciá-Soler, María Loreto

2015-01-01

to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. prospective longitudinal study conducted in a population of 60 secondyear Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teachinglearning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care.

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

PubMed Central

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

2015-01-01

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

Remote Sensing of Water Quality in the Niger River Basin

NASA Astrophysics Data System (ADS)

Mueller, C.; Palacios, S. L.; Milesi, C.; Schmidt, C.; Baney, O. N.; Mitchell, Å. R.; Kislik, E.; Palmer-Moloney, L. J.

2015-12-01

An overarching goal of the National Geospatial Intelligence Agency (NGA) Anticipatory Analytics- -GEOnarrative program is to establish water linkages with energy, food, and climate and to understand how these linkages relate to national security and stability. Recognizing that geopolitical stability is tied to human health, agricultural productivity, and natural ecosystems' vitality, NGA partnered with NASA Ames Research Center to use satellite remote sensing to assess water quality in West Africa, specifically the Niger River Basin. Researchers from NASA Ames used MODIS and Landsat imagery to apply two water quality indices-- the Floating Algal Index (FAI) and the Turbidity Index (TI)--to large rivers, lakes and reservoirs within the Niger Basin. These indices were selected to evaluate which observations were most suitable for monitoring water quality in a region where coincident in situ measurements are not available. In addition, the FAI and TI indices were derived using data from the Hyperspectral Imagery for the Coastal Ocean (HICO) sensor for Lake Erie in the United States to determine how increased spectral resolution and in-situ measurements would improve the ability to measure the spatio-temporal variations in water quality. Results included the comparison of outputs from sensors with different spectral and spatial resolution characteristics for water quality monitoring. Approaches, such as the GEOnarrative, that incorporate water quality will enable analysts and decision-makers to recognize the current and potentially future impacts of changing water quality on regional security and stability.

Exploring Rating Quality in Rater-Mediated Assessments Using Mokken Scale Analysis

PubMed Central

Wind, Stefanie A.; Engelhard, George

2015-01-01

Mokken scale analysis is a probabilistic nonparametric approach that offers statistical and graphical tools for evaluating the quality of social science measurement without placing potentially inappropriate restrictions on the structure of a data set. In particular, Mokken scaling provides a useful method for evaluating important measurement properties, such as invariance, in contexts where response processes are not well understood. Because rater-mediated assessments involve complex interactions among many variables, including assessment contexts, student artifacts, rubrics, individual rater characteristics, and others, rater-assigned scores are suitable candidates for Mokken scale analysis. The purposes of this study are to describe a suite of indices that can be used to explore the psychometric quality of data from rater-mediated assessments and to illustrate the substantive interpretation of Mokken-based statistics and displays in this context. Techniques that are commonly used in polytomous applications of Mokken scaling are adapted for use with rater-mediated assessments, with a focus on the substantive interpretation related to individual raters. Overall, the findings suggest that indices of rater monotonicity, rater scalability, and invariant rater ordering based on Mokken scaling provide diagnostic information at the level of individual raters related to the requirements for invariant measurement. These Mokken-based indices serve as an additional suite of diagnostic tools for exploring the quality of data from rater-mediated assessments that can supplement rating quality indices based on parametric models. PMID:29795883

Effects of stock use and backpackers on water quality in wilderness in Sequoia and Kings Canyon National Parks, USA.

PubMed

Clow, David W; Forrester, Harrison; Miller, Benjamin; Roop, Heidi; Sickman, James O; Ryu, Hodon; Domingo, Jorge Santo

2013-12-01

During 2010-2011, a study was conducted in Sequoia and Kings Canyon National Parks (SEKI) to evaluate the influence of pack animals (stock) and backpackers on water quality in wilderness lakes and streams. The study had three main components: (1) a synoptic survey of water quality in wilderness areas of the parks, (2) paired water quality sampling above and below several areas with differing types and amounts of visitor use, and (3) intensive monitoring at six sites to document temporal variations in water quality. Data from the synoptic water quality survey indicated that wilderness lakes and streams are dilute and have low nutrient and Escherichia coli concentrations. The synoptic survey sites were categorized as minimal use, backpacker-use, or mixed use (stock and backpackers), depending on the most prevalent type of use upstream from the sampling locations. Sites with mixed use tended to have higher concentrations of most constituents (including E. coli) than those categorized as minimal-use (P ≤ 0.05); concentrations at backpacker-use sites were intermediate. Data from paired-site sampling indicated that E. coli, total coliform, and particulate phosphorus concentrations were greater in streams downstream from mixed-use areas than upstream from those areas (P ≤ 0.05). Paired-site data also indicated few statistically significant differences in nutrient, E. coli, or total coliform concentrations in streams upstream and downstream from backpacker-use areas. The intensive-monitoring data indicated that nutrient and E. coli concentrations normally were low, except during storms, when notable increases in concentrations of E. coli, nutrients, dissolved organic carbon, and turbidity occurred. In summary, results from this study indicate that water quality in SEKI wilderness generally is good, except during storms; and visitor use appears to have a small, but statistically significant influence on stream water quality.

Effects of Stock Use and Backpackers on Water Quality in Wilderness in Sequoia and Kings Canyon National Parks, USA

NASA Astrophysics Data System (ADS)

Clow, David W.; Forrester, Harrison; Miller, Benjamin; Roop, Heidi; Sickman, James O.; Ryu, Hodon; Domingo, Jorge Santo

2013-12-01

During 2010-2011, a study was conducted in Sequoia and Kings Canyon National Parks (SEKI) to evaluate the influence of pack animals (stock) and backpackers on water quality in wilderness lakes and streams. The study had three main components: (1) a synoptic survey of water quality in wilderness areas of the parks, (2) paired water quality sampling above and below several areas with differing types and amounts of visitor use, and (3) intensive monitoring at six sites to document temporal variations in water quality. Data from the synoptic water quality survey indicated that wilderness lakes and streams are dilute and have low nutrient and Escherichia coli concentrations. The synoptic survey sites were categorized as minimal use, backpacker-use, or mixed use (stock and backpackers), depending on the most prevalent type of use upstream from the sampling locations. Sites with mixed use tended to have higher concentrations of most constituents (including E. coli) than those categorized as minimal-use ( P ≤ 0.05); concentrations at backpacker-use sites were intermediate. Data from paired-site sampling indicated that E. coli, total coliform, and particulate phosphorus concentrations were greater in streams downstream from mixed-use areas than upstream from those areas ( P ≤ 0.05). Paired-site data also indicated few statistically significant differences in nutrient, E. coli, or total coliform concentrations in streams upstream and downstream from backpacker-use areas. The intensive-monitoring data indicated that nutrient and E. coli concentrations normally were low, except during storms, when notable increases in concentrations of E. coli, nutrients, dissolved organic carbon, and turbidity occurred. In summary, results from this study indicate that water quality in SEKI wilderness generally is good, except during storms; and visitor use appears to have a small, but statistically significant influence on stream water quality.

Effects of stock use and backpackers on water quality in wilderness in Sequoia and Kings Canyon National Parks, USA

USGS Publications Warehouse

Clow, David W.; Forrester, Harrison; Miller, Benjamin; Roop, Heidi; Sickman, James O.; Ryu, Hodon; Santo Domingo, Jorge

2013-01-01

During 2010-2011, a study was conducted in Sequoia and Kings Canyon National Parks (SEKI) to evaluate the influence of pack animals (stock) and backpackers on water quality in wilderness lakes and streams. The study had three main components: (1) a synoptic survey of water quality in wilderness areas of the parks, (2) paired water-quality sampling above and below several areas with differing types and amounts of visitor use, and (3) intensive monitoring at six sites to document temporal variations in water quality. Data from the synoptic water-quality survey indicated that wilderness lakes and streams are dilute and have low nutrient and Escherichia coli (E. coli) concentrations. The synoptic survey sites were categorized as minimal use, backpacker use, or mixed use (stock and backpackers), depending on the most prevalent type of use upstream from the sampling locations. Sites with mixed use tended to have higher concentrations of most constituents (including E.coli) than those categorized as minimal-use (p≤0.05); concentrations at backpacker-use sites were intermediate. Data from paired-site sampling indicated that E.coli, total coliform, and particulate phosphorus concentrations were greater in streams downstream from mixed-use areas than upstream from those areas (p≤0.05). Paired-site data also indicated few statistically significant differences in nutrient, E. coli, or total coliform concentrations in streams upstream and downstream from backpacker-use areas. The intensive-monitoring data indicated that nutrient and E. coli concentrations normally were low, except during storms, when notable increases in concentrations of E.coli, nutrients, dissolved organic carbon, and turbidity occurred. In summary, results from this study indicate that water quality in SEKI wilderness generally is good, except during storms; and visitor use appears to have a small, but statistically significant influence on stream water quality.

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.

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review.

PubMed

Miteniece, Elina; Pavlova, Milena; Rechel, Bernd; Groot, Wim

2017-03-01

Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care. Copyright © 2017 Elsevier Ltd. All rights reserved.

2004 Children's Health Protection Advisory Committee Meeting Agendas

EPA Pesticide Factsheets

Objectives for the three meetings in 2004 include discussing schools-related work, mercury regulation, the Food Quality Protection Act, Children's Health Indicators, early life exposure to carcinogens, and smart growth.

Assessment of soil pollution based on total petroleum hydrocarbons and individual oil substances.

PubMed

Pinedo, J; Ibáñez, R; Lijzen, J P A; Irabien, Á

2013-11-30

Different oil products like gasoline, diesel or heavy oils can cause soil contamination. The assessment of soils exposed to oil products can be conducted through the comparison between a measured concentration and an intervention value (IV). Several national policies include the IV based on the so called total petroleum hydrocarbons (TPH) measure. However, the TPH assessment does not indicate the individual substances that may produce contamination. The soil quality assessment can be improved by including common hazardous compounds as polycyclic aromatic hydrocarbons (PAHs) and aromatic volatile hydrocarbons like benzene, toluene, ethylbenzene and xylenes (BTEX). This study, focused on 62 samples collected from different sites throughout The Netherlands, evaluates TPH, PAH and BTEX concentrations in soils. Several indices of pollution are defined for the assessment of individual variables (TPH, PAH, B, T, E, and X) and multivariables (MV, BTEX), allowing us to group the pollutants and simplify the methodology. TPH and PAH concentrations above the IV are mainly found in medium and heavy oil products such as diesel and heavy oil. On the other hand, unacceptable BTEX concentrations are reached in soils contaminated with gasoline and kerosene. The TPH assessment suggests the need for further action to include lighter products. The application of multivariable indices allows us to include these products in the soil quality assessment without changing the IV for TPH. This work provides useful information about the soil quality assessment methodology of oil products in soils, focussing the analysis into the substances that mainly cause the risk. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2018-01-01

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

The Risk of Bias in Randomized Trials in General Dentistry Journals.

PubMed

Hinton, Stephanie; Beyari, Mohammed M; Madden, Kim; Lamfon, Hanadi A

2015-01-01

The use of a randomized controlled trial (RCT) research design is considered the gold standard for conducting evidence-based clinical research. In this present study, we aimed to assess the quality of RCTs in dentistry and create a general foundation for evidence-based dentistry on which to perform subsequent RCTs. We conducted a systematic assessment of bias of RCTs in seven general dentistry journals published between January 2011 and March 2012. We extracted study characteristics in duplicate and assessed each trial's quality using the Cochrane Risk of Bias tool. We compared risk of bias across studies graphically. Among 1,755 studies across seven journals, we identified 67 RCTs. Many included studies were conducted in Europe (39%), with an average sample size of 358 participants. These studies included 52% female participants and the maximum follow-up period was 13 years. Overall, we found a high percentage of unclear risk of bias among included RCTs, indicating poor quality of reporting within the included studies. An overall high proportion of trials with an "unclear risk of bias" suggests the need for better quality of reporting in dentistry. As such, key concepts in dental research and future trials should focus on high-quality reporting.

Low-Tech Education Threatens the High-Tech Future.

ERIC Educational Resources Information Center

Business Week, 1983

1983-01-01

Indicating that the quality of scientific/technical education in the United States has been slipping since the brief surge of attention in the decade following Sputnik, discusses the need for upgrading science/technical education. Includes efforts currently under way, including financial support by industry and donations of equipment and computers…

Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association.

PubMed

Shaw, Leslee J; Blankstein, Ron; Jacobs, Jill E; Leipsic, Jonathon A; Kwong, Raymond Y; Taqueti, Viviany R; Beanlands, Rob S B; Mieres, Jennifer H; Flamm, Scott D; Gerber, Thomas C; Spertus, John; Di Carli, Marcelo F

2017-12-01

The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality. © 2017 American Heart Association, Inc.

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.

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Physical and biological factors influencing environmental sources of fecal indicator bacteria in surface water

USGS Publications Warehouse

Whitman, Richard L.; Nevers, Meredith B.; Przybyla-Kelly, Katarzyna; Byappanahalli, Muruleedhara N.; Sadowsky, Michael J.; Whitman, Richard L.

2011-01-01

This paper describes the environmental populations of faecal indicator bacteria, and the processes by which these populations become nonpoint sources and influence nearshore water quality. The different possible sources of these indicator bacteria are presented. These include groundwater, springs and seeps, aquatic sediments, beach sand, birds, Cladophora and plant wrack. Also discussed are the environmental factors (moisture, sunlight, temperature and salinity) influencing their survival.

[Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program].

PubMed

Pérez-Cuevas, Ricardo; Jasso Gutiérrez, Luis; Doubova, Svetlana; Flores Hernández, Sergio; Mantilla Trollé, Clara; González Guerra, Eduardo; Muñoz Hernández, Onofre

Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

[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.

Moss and vascular plant indices in Ohio wetlands have similar environmental predictors

USGS Publications Warehouse

Stapanian, Martin A.; Schumacher, William; Gara, Brian; Adams, Jean V.; Viau, Nick

2016-01-01

Mosses and vascular plants have been shown to be reliable indicators of wetland habitat delineation and environmental quality. Knowledge of the best ecological predictors of the quality of wetland moss and vascular plant communities may determine if similar management practices would simultaneously enhance both populations. We used Akaike's Information Criterion to identify models predicting a moss quality assessment index (MQAI) and a vascular plant index of biological integrity based on floristic quality (VIBI-FQ) from 27 emergent and 13 forested wetlands in Ohio, USA. The set of predictors included the six metrics from a wetlands disturbance index (ORAM) and two landscape development intensity indices (LDIs). The best single predictor of MQAI and one of the predictors of VIBI-FQ was an ORAM metric that assesses habitat alteration and disturbance within the wetland, such as mowing, grazing, and agricultural practices. However, the best single predictor of VIBI-FQ was an ORAM metric that assessed wetland vascular plant communities, interspersion, and microtopography. LDIs better predicted MQAI than VIBI-FQ, suggesting that mosses may either respond more rapidly to, or recover more slowly from, anthropogenic disturbance in the surrounding landscape than vascular plants. These results supported previous predictive studies on amphibian indices and metrics and a separate vegetation index, indicating that similar wetland management practices may result in qualitatively the same ecological response for three vastly different wetland biological communities (amphibians, vascular plants, and mosses).

How healthcare organizations use the Internet to market quality achievements.

PubMed

Revere, Lee; Robinson, Leroy

2010-01-01

The increasingly competitive environment is having a strong bearing on the strategic marketing practices of hospitals. The Internet is a fairly new marketing tool, and it has the potential to dramatically influence healthcare consumers. This exploratory study investigates how hospitals use the Internet as a tool to market the quality of their services. Significant evidence exists that customers use the Internet to find information about potential healthcare providers, including information concerning quality. Data were collected from a random sample of 45 U.S. hospitals from the American Hospital Association database. The data included hospital affiliation, number of staffed beds, accreditation status, Joint Commission quality awards, and number of competing hospitals. The study's findings show that system-affiliated hospitals do not provide more, or less, quality information on their websites than do non-system-affiliated hospitals. The findings suggest that the amount of quality information provided on a hospital website is not dependent on hospital size. Research provides evidence that hospitals with more Joint Commission awards promote their quality accomplishments more so than their counterparts that earned fewer Joint Commission awards. The findings also suggest that the more competitors in a marketplace the more likely a hospital is to promote its quality as a potential differential advantage. The study's findings indicate that a necessary element of any hospital's competitive strategy should be to include the marketing of its quality on the organization's website.

Depression, anxiety and quality of life in suicide survivors: a comparison of close and distant relationships.

PubMed

Mitchell, Ann M; Sakraida, Teresa J; Kim, Yookyung; Bullian, Leann; Chiappetta, Laurel

2009-02-01

The study's purpose was to describe and compare depression, anxiety, and quality of life, by degree of relationship, between closely related and distantly related survivors (persons close to the suicide victim, or "suicide survivors"; N = 60) during the acute phase of bereavement (within 1 month of the death). The close relationship category included spouses, parents, children, and siblings, whereas the distant relationship category included in-laws, aunts/uncles, and nieces/nephews. Analysis of covariance examined differences between the two groups on the symptom measures. Results indicate that, after controlling for age and gender effects, closely related survivors had significantly higher mean levels of depression and anxiety and had lower levels of mental health quality of life. There were no statistically significant differences on the physical health quality of life subscale.

Identifying Watershed Regions Sensitive to Soil Erosion and Contributing to Lake Eutrophication--A Case Study in the Taihu Lake Basin (China).

PubMed

Lin, Chen; Ma, Ronghua; He, Bin

2015-12-24

Taihu Lake in China is suffering from severe eutrophication partly due to non-point pollution from the watershed. There is an increasing need to identify the regions within the watershed that most contribute to lake water degradation. The selection of appropriate temporal scales and lake indicators is important to identify sensitive watershed regions. This study selected three eutrophic lake areas, including Meiliang Bay (ML), Zhushan Bay (ZS), and the Western Coastal region (WC), as well as multiple buffer zones next to the lake boundary as the study sites. Soil erosion intensity was designated as a watershed indicator, and the lake algae area was designated as a lake quality indicator. The sensitive watershed region was identified based on the relationship between these two indicators among different lake divisions for a temporal sequence from 2000 to 2012. The results show that the relationship between soil erosion modulus and lake quality varied among different lake areas. Soil erosion from the two bay areas was more closely correlated with water quality than soil erosion from the WC region. This was most apparent at distances of 5 km to 10 km from the lake, where the r² was as high as 0.764. Results indicate that soil erosion could be used as an indicator for identifying key watershed protection areas. Different lake areas need to be considered separately due to differences in geographical features, land use, and the corresponding effects on lake water quality.

Identifying Watershed Regions Sensitive to Soil Erosion and Contributing to Lake Eutrophication—A Case Study in the Taihu Lake Basin (China)

PubMed Central

Lin, Chen; Ma, Ronghua; He, Bin

2015-01-01

Taihu Lake in China is suffering from severe eutrophication partly due to non-point pollution from the watershed. There is an increasing need to identify the regions within the watershed that most contribute to lake water degradation. The selection of appropriate temporal scales and lake indicators is important to identify sensitive watershed regions. This study selected three eutrophic lake areas, including Meiliang Bay (ML), Zhushan Bay (ZS), and the Western Coastal region (WC), as well as multiple buffer zones next to the lake boundary as the study sites. Soil erosion intensity was designated as a watershed indicator, and the lake algae area was designated as a lake quality indicator. The sensitive watershed region was identified based on the relationship between these two indicators among different lake divisions for a temporal sequence from 2000 to 2012. The results show that the relationship between soil erosion modulus and lake quality varied among different lake areas. Soil erosion from the two bay areas was more closely correlated with water quality than soil erosion from the WC region. This was most apparent at distances of 5 km to 10 km from the lake, where the r2 was as high as 0.764. Results indicate that soil erosion could be used as an indicator for identifying key watershed protection areas. Different lake areas need to be considered separately due to differences in geographical features, land use, and the corresponding effects on lake water quality. PMID:26712772

Public perceptions of key performance indicators of healthcare in Alberta, Canada.

PubMed

Northcott, Herbert C; Harvey, Michael D

2012-06-01

To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. The province of Alberta, Canada during the years 1996-2004. Four thousand adults randomly selected each survey year. Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

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

PubMed

Subert, Jan; Cižmárik, Jozef

2013-04-01

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

Inside the Black Box of Audit and Feedback: a Laboratory Study to Explore Determinants of Improvement Target Selection by Healthcare Professionals in Cardiac Rehabilitation.

PubMed

Gude, Wouter T; van der Veer, Sabine N; van Engen-Verheul, Mariëtte M; de Keizer, Nicolette F; Peek, Niels

2015-01-01

Audit and feedback (A&F) is widely used to aid healthcare professionals in improving clinical performance, but there is little understanding of the underlying mechanism that determines its effectiveness. The aim of this paper is to investigate the process by which healthcare professionals select indicators as improvement targets based on A&F. We performed a laboratory study among 41 healthcare professionals in the context of a web-based A&F intervention designed to improve the quality of cardiac rehabilitation care in the Netherlands. Feedback was provided on eighteen quality indicators, including a score and a colour (representing a recommendation for selection (red and yellow) or non-selection (green)). Indicators with more room for improvement were more likely to be selected, although this varied substantially between participants. In more than a quarter of the cases, participants did not select indicators with obvious room for improvement (yellow or red colour), or selected indicators without apparent room for improvement (green colour). We conclude that personal preferences and beliefs concerning quality and performance targets may dilute the efficiency of A&F.

GETTING READY: RESULTS OF A RANDOMIZED TRIAL OF A RELATIONSHIP-FOCUSED INTERVENTION ON THE PARENT-INFANT RELATIONSHIP IN RURAL EARLY HEAD START.

PubMed

Knoche, Lisa L; Sheridan, Susan M; Clarke, Brandy L; Edwards, Carolyn Pope; Marvin, Christine A; Cline, Keely D; Kupzyk, Kevin A

2012-09-01

The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent-infant relationship for families enrolled in Early Head Start home-based programming. Two-hundred thirty-four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high-school diploma. Brief, semistructured parent-child interaction tasks were videotaped every 4 months over a16-month intervention period. Observational codes of parent-infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children's autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children's learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home-based programming for families of infants and toddlers.

GETTING READY: RESULTS OF A RANDOMIZED TRIAL OF A RELATIONSHIP-FOCUSED INTERVENTION ON THE PARENT–INFANT RELATIONSHIP IN RURAL EARLY HEAD START

PubMed Central

KNOCHE, LISA L.; SHERIDAN, SUSAN M.; CLARKE, BRANDY L.; EDWARDS, CAROLYN POPE; MARVIN, CHRISTINE A.; CLINE, KEELY D.; KUPZYK, KEVIN A.

2014-01-01

The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent–infant relationship for families enrolled in Early Head Start home-based programming. Two-hundred thirty-four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high-school diploma. Brief, semistructured parent–child interaction tasks were videotaped every 4 months over a16-month intervention period. Observational codes of parent–infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children’s autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children’s learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home-based programming for families of infants and toddlers. PMID:24644374

[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.

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

PubMed

Moss, Andrew; Brodie, Jon; Furnas, Miles

2005-01-01

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

Development of a method for comprehensive water quality forecasting and its application in Miyun reservoir of Beijing, China.

PubMed

Zhang, Lei; Zou, Zhihong; Shan, Wei

2017-06-01

Water quality forecasting is an essential part of water resource management. Spatiotemporal variations of water quality and their inherent constraints make it very complex. This study explored a data-based method for short-term water quality forecasting. Prediction of water quality indicators including dissolved oxygen, chemical oxygen demand by KMnO 4 and ammonia nitrogen using support vector machine was taken as inputs of the particle swarm algorithm based optimal wavelet neural network to forecast the whole status index of water quality. Gubeikou monitoring section of Miyun reservoir in Beijing, China was taken as the study case to examine effectiveness of this approach. The experiment results also revealed that the proposed model has advantages of stability and time reduction in comparison with other data-driven models including traditional BP neural network model, wavelet neural network model and Gradient Boosting Decision Tree model. It can be used as an effective approach to perform short-term comprehensive water quality prediction. Copyright © 2016. Published by Elsevier B.V.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

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.

Benthic invertebrates of fixed sites in the western Lake Michigan drainages, Wisconsin and Michigan, 1993-95

USGS Publications Warehouse

Lenz, Bernard N.; Rheaume, S.J.

2000-01-01

This report describes the variability in family-level benthic-invertebrate population data and the reliability of the data as a water-quality indicator for 11 fixed surface-water sites in the Western Lake Michigan Drainages study area of the National Water-Quality Assessment Program. Benthic-invertebrate-community measures were computed for the following: number of individuals, Hilsenhoff’s Family-Level Biotic Index, number and percent EPT (Ephemeroptera, Plecoptera, and Tricoptera), Margalef’s Diversity Index, and mean tolerance value. Relations between these measures and environmental setting, habitat, and of chemical water quality are examined. Benthic-invertebrate communities varied greatly among fixed sites and within individual streams among multiple-reach and multiple-year sampling. The variations between multiple reaches and years were sometimes larger than those found between different fixed sites. Factors affecting benthic invertebrates included both habitat and chemical quality. Generally, fixed-site streams with the highest diversity, greatest number of benthic invertebrates, and those at which community measures indicated the best water quality also had the best habitat and chemical quality. Variations among reaches are most likely related to differences in habitat. Variations among years are most likely related to climatic changes, which create variations in flow and/or chemical quality. The variability in the data analyzed in this study shows how benthic invertebrates are affected by differences in both habitat and water quality, making them useful indicators of stream health; however, a single benthic-invertebrate sample alone cannot be relied upon to accurately describe water quality of the streams in this study. Benthic-invertebrate data contributed valuable information on the biological health of the 11 fixed sites when used as one of several data sources for assessing water quality.

Evaluating laboratory key performance using quality indicators in Alexandria University Hospital Clinical Chemistry Laboratories.

PubMed

Rizk, Mostafa M; Zaki, Adel; Hossam, Nermine; Aboul-Ela, Yasmin

2014-12-01

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement (March-May 2012); an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement (June 2012); and phase II, which included data collection for evaluation of the process after improvement (July 2012-September 2012). In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items (P<0.001) with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error (TE) exceeded total error allowable (TEa), with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of (5.11%), whereas in phase II it was reduced to 2.48% (P<0.001).For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement (P<0.001). The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor (8.24%), wrong patient identification (1.0%), lack of reporting by lab doctor (1.11%), and finally, lack of reporting by the lab technician (1.03%). Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories.

Brief alcohol intervention trials conducted by higher prestige authors and published in higher impact factor journals are cited more frequently.

PubMed

Tanner-Smith, Emily E; Polanin, Joshua R

2016-07-01

To examine the relationships between study quality, author prestige, journal impact factors, and citation rates of trials and to examine whether journal impact factors mediated the relationships between study quality and author prestige on citation rates. We used bibliometric data from 128 controlled trials included in a recent meta-analysis on brief alcohol interventions for adolescents and young adults. We obtained the number of citations from ISI Web of Knowledge and Google Scholar; journal impact factors were obtained from ISI Web of Knowledge. Linear regression models were used to examine the direct and indirect effects of interest. The results indicated that studies were published in journals with higher impact factors when first authors had higher h-indices and studies were funded, but this was largely because those studies were of higher quality. Studies were cited more frequently when first authors had higher h-indices and studies were funded, even after adjusting for study quality proxies. The observed associations between study quality and author prestige on citation rates were also partly mediated through journal impact factors. We conclude that studies conducted by more established authors and reported in more prestigious journal outlets are more likely to be cited by other scholars, even after controlling for various proxies of study quality. Copyright © 2016 Elsevier Inc. All rights reserved.

Brief Alcohol Intervention Trials Conducted by Higher Prestige Authors and Published in Higher Impact Factor Journals are Cited More Frequently

PubMed Central

Tanner-Smith, Emily E.; Polanin, Joshua R.

2016-01-01

Objective To examine the relationships between study quality, author prestige, journal impact factors, and citation rates of trials; and to examine whether journal impact factors mediated the relationships between study quality and author prestige on citation rates. Study Design and Setting We used bibliometric data from 128 controlled trials included in a recent meta-analysis on brief alcohol interventions (BAIs) for adolescents and young adults. We obtained the number of citations from ISI Web of Knowledge and Google Scholar; journal impact factors were obtained from ISI Web of Knowledge. Linear regression models were used to examine the direct and indirect effects of interest. Results The results indicated that studies were published in journals with higher impact factors when first authors had higher h-indices and studies were funded, but this was largely because those studies were of higher quality. Studies were cited more frequently when first authors had higher h-indices and studies were funded, even after adjusting for study quality proxies. The observed associations between study quality and author prestige on citation rates were also partly mediated through journal impact factors. Conclusion We conclude that studies conducted by more established authors and reported in more prestigious journal outlets are more likely to be cited by other scholars, even after controlling for various proxies of study quality. PMID:26854420

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

PubMed

Farrokh-Eslamlou, Hamidreza; Aghlmand, Siamak; Eslami, Mohammad; Homer, Caroline S E

2014-04-01

We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). The adapted WHO's DMT has the potential to improve the quality of FP services.

Mobility Device Quality Affects Participation Outcomes for People With Disabilities: A Structural Equation Modeling Analysis.

PubMed

Magasi, Susan; Wong, Alex; Miskovic, Ana; Tulsky, David; Heinemann, Allen W

2018-01-01

To test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling. Survey, cross-sectional study, and model testing. Clinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital. Community-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke. Not applicable. The Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected. Respondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users. Mobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Critical appraisal of the Vienna consensus: performance indicators for assisted reproductive technology laboratories.

PubMed

Lopez-Regalado, María Luisa; Martínez-Granados, Luis; González-Utor, Antonio; Ortiz, Nereyda; Iglesias, Miriam; Ardoy, Manuel; Castilla, Jose A

2018-05-24

The Vienna consensus, based on the recommendations of an expert panel, has identified 19 performance indicators for assisted reproductive technology (ART) laboratories. Two levels of reference values are established for these performance indicators: competence and benchmark. For over 10 years, the Spanish embryology association (ASEBIR) has participated in the definition and design of ART performance indicators, seeking to establish specific guidelines for ART laboratories to enhance quality, safety and patient welfare. Four years ago, ASEBIR took part in an initiative by AENOR, the Spanish Association for Standardization and Certification, to develop a national standard in this field (UNE 17900:2013 System of quality management for assisted reproduction laboratories), extending the former requirements, based on ISO 9001, to include performance indicators. Considering the experience acquired, we discuss various aspects of the Vienna consensus and consider certain discrepancies in performance indicators between the consensus and UNE 179007:2013, and analyse the definitions, methodology and reference values used. Copyright © 2018. Published by Elsevier Ltd.

[EARLY IN-HOSPITAL MORTALITY IN INTERNAL MEDICINE WARDS (WITHIN 24 HOURS): A POTENTIAL QUALITY INDICATOR OR A VARIABLE AFFECTED BY MULTIPLE FACTORS?

PubMed

Niv, Yaron; Berkov, Evgeny; Kanter, Pazit; Abrahmson, Evgeny; Gabbay, Uri

2017-04-01

To evaluate in-hospital mortality rate within 24 hours in internal medicine wards and to evaluate if it may be used as quality indicator. In-hospital mortality rate is an outcome measure which apparently reflects quality of care. There are debates on whether it may be considered a quality indicator since it is difficult to compare different case-mixes between hospitals. Research on mortality within 24 hours had not been published. An historical prospective study was conducted including the entire internal wards admissions to the Rabin Medical Center between 1/7/14 and 30/6/15. We evaluated inhospital deaths and 7 days post discharge deaths. We focused on deaths within 24 hours, patients' characteristics, the primary diagnosis (which we assumed is the cause of death) and co-morbidity. The analysis includes descriptive statistics and mortality rates performed with SPSS version 22. Overall, 25,414 patients were admitted to internal wards during the study period. There were 1,620 in-hospitals deaths (6.37%) among which 164 deaths occurred within 24 hours (0.65%), which is 10.1% of in-hospital deaths. These patients were very old (median 82), many were residents of nursing homes and nearly all were brought to the hospital by ambulance. The most frequent primary diagnoses were sepsis (24%), pneumonia (22%), metastatic cancer (10%) and acute neurologic event (5%). The results exclude excessive inhospital mortality within 24 hours. The patients' characteristics enable researchers to assume that these deaths were expected and not preventable. There is no excessive mortality within 24 hours, the deaths were expected and a seasonal modifying effect was evident. All this and the different case mix in between hospitals suggest that early in-hospital mortality seems inadequate as a quality measure.

Elucidating hydraulic fracturing impacts on groundwater quality using a regional geospatial statistical modeling approach.

PubMed

Burton, Taylour G; Rifai, Hanadi S; Hildenbrand, Zacariah L; Carlton, Doug D; Fontenot, Brian E; Schug, Kevin A

2016-03-01

Hydraulic fracturing operations have been viewed as the cause of certain environmental issues including groundwater contamination. The potential for hydraulic fracturing to induce contaminant pathways in groundwater is not well understood since gas wells are completed while isolating the water table and the gas-bearing reservoirs lay thousands of feet below the water table. Recent studies have attributed ground water contamination to poor well construction and leaks in the wellbore annulus due to ruptured wellbore casings. In this paper, a geospatial model of the Barnett Shale region was created using ArcGIS. The model was used for spatial analysis of groundwater quality data in order to determine if regional variations in groundwater quality, as indicated by various groundwater constituent concentrations, may be associated with the presence of hydraulically fractured gas wells in the region. The Barnett Shale reservoir pressure, completions data, and fracture treatment data were evaluated as predictors of groundwater quality change. Results indicated that elevated concentrations of certain groundwater constituents are likely related to natural gas production in the study area and that beryllium, in this formation, could be used as an indicator variable for evaluating fracturing impacts on regional groundwater quality. Results also indicated that gas well density and formation pressures correlate to change in regional water quality whereas proximity to gas wells, by itself, does not. The results also provided indirect evidence supporting the possibility that micro annular fissures serve as a pathway transporting fluids and chemicals from the fractured wellbore to the overlying groundwater aquifers. Copyright © 2015 Elsevier B.V. All rights reserved.

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.

Comparison of national mental health quality assessment programs across the globe.

PubMed

Parameswaran, Sharat; Spaeth-Rublee, Brigitta; Huynh, Phuong Trang; Pincus, Harold Alan

2012-10-01

This study by the International Initiative for Mental Health Leadership Clinical Leaders Project sought to describe ongoing or soon-to-be-established national-level mental health quality measurement programs in 12 participating countries, in order to understand the nature and structure of these programs. A survey was distributed to representatives from the participating countries (Australia, Canada, England, Germany, Ireland, Japan, the Netherlands, New Zealand, Norway, Scotland, Taiwan, and the United States). Data included descriptions of qualifying programs and the organizations responsible for them, quality indicators used, entities assessed, sources and means of the programs' data collection, the level at which data are reported, and how the data are used. Participants were asked to identify which quality domains and subdomains were represented by indicators in each program. Results were analyzed with descriptive statistics. Thirty-eight programs were identified. Most programs were administered by governmental organizations, focused on hospital care, and used encounter or utilization databases as sources of information. Programs used different methods to identify indicators. Program data were used for various purposes. A wide range of domains of quality were represented in the programs reported, although most commonality was seen in domains associated with high-acuity care, with fewer programs assessing recovery-related domains. This study found wide variation among established quality assessment programs, which may reflect a focus on local priorities. The goal of this project is to work toward establishing an international framework for mental health quality assessment and thus a means to compare key measures of performance across countries.

Strategies for monitoring the bacteriological quality of water supply in distribution systems

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

Geldreich, E.E.; Goodrich, J.A.; Clark, R.M.

1989-01-01

Monitoring strategies for characterizing the bacteriological quality of water in the distribution system require a complete understanding of a variety of interrelated aspects that include treated water quality, water-supply retention in storage and infrastructure deterioration in the distribution system. A study of field data from several water-supply utilities was used to highlight some innovative interpretations of compliance monitoring data. Major perceptions include: The use of a 5% coliform frequency of occurrence limit highlights compliance significance in those situations where there are clusters of positive samples containing less than 4 coliforms per 100 mL. Unfortunately, this presence/absence concept does not providemore » any indication of the magnitude of a contamination event.« less

Effect of different cooking methods on minerals, vitamins and nutritional quality indices of kutum roach (Rutilus frisii kutum).

PubMed

Hosseini, Hedayat; Mahmoudzadeh, Maryam; Rezaei, Masoud; Mahmoudzadeh, Leila; Khaksar, Ramin; Khosroshahi, Nader Karimian; Babakhani, Aria

2014-04-01

In this study, the influence of four cooking methods (baking, boiling, microwaving and frying) was evaluated on the nutritional value of kutum roach. Proximate, fatty acid composition, vitamin and mineral contents and also nutritional quality indices (NQI) of kutum roach were investigated before and after cooking treatment. All treated samples showed increase in protein, ash and lipid contents and decrease in the content of total omega-3 fatty acids (n-3) in comparison to raw fish fillets (control group). Cooking methods had no significant effect on omega-6 fatty acids (n-6) except for frying that increased it. Nonetheless, all of the cooking methods reduced vitamin B1, A and D contents. Boiling significantly decreased mineral contents including Na, K, P and Zn. Considering the overall nutritional quality indices, vitamin and mineral contents, baking is the best cooking method among other applied methods. Copyright © 2013 Elsevier Ltd. All rights reserved.

Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review.

PubMed

D'Antoni, Donatella; Smith, Louise; Auyeung, Vivian; Weinman, John

2017-09-22

Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices, being exposed to health messages that reduced both concern about air pollution and perceived susceptibility, as well as perceived lack of self-efficacy/locus of control, reliance on sensory cues and lack of time. We found frequent suboptimal adherence rates to health advice accompanying air quality alerts. Several psychosocial facilitators and barriers of adherence were identified. To maximise their health effects, health advice needs to target these specific psychosocial factors.

Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality.

PubMed

Wheeler, Benedict W; Lovell, Rebecca; Higgins, Sahran L; White, Mathew P; Alcock, Ian; Osborne, Nicholas J; Husk, Kerryn; Sabel, Clive E; Depledge, Michael H

2015-04-30

Many studies suggest that exposure to natural environments ('greenspace') enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that "greenspace" is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents. This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics. Positive associations were observed between good health prevalence and the density of the greenspace types, "broadleaf woodland", "arable and horticulture", "improved grassland", "saltwater" and "coastal", after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of "saltwater". Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators. The findings indicate that the type, quality and context of 'greenspace' should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

['Clinical auditing', a novel tool for quality assessment in surgical oncology].

PubMed

van Leersum, Nicoline J; Kolfschoten, Nikki E; Klinkenbijl, Jean H G; Tollenaar, Rob A E M; Wouters, Michel W J M

2011-01-01

To determine whether systematic audit and feedback of information about the process and outcomes improve the quality of surgical care. Systematic literature review. Embase, PubMed, and Web of Science databases were searched for publications on 'quality assessment' and 'surgery'. The references of the publications found were examined as well. Publications were included in the review if the effect of auditing on the quality of surgical care had been investigated. In the databases 2415 publications were found. After selection, 28 publications describing the effect of auditing, whether or not combined with a quality improvement project, on guideline adherence or indications of outcomes of care were included. In 21 studies, a statistically significant positive effect of auditing was reported. In 5 studies a positive effect was found, but this was either not significant or statistical significance was not determined. In 2 studies no effect was observed. 5 studies compared the combination of auditing with a quality improvement project with auditing alone; 4 of these reported an additional effect of the quality improvement project. Audit and feedback of quality information seem to have a positive effect on the quality of surgical care. The use of quality information from audits for the purpose of a quality improvement project can enhance the positive effect of the audit.

Home Health Agency Performance in the United States: 2011–15

PubMed Central

Wang, Yun; Spatz, Erica S.; Tariq, Maliha; Angraal, Suveen; Krumholz, Harlan M.

2017-01-01

OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care. PMID:28960228

[Quality assessment in anesthesia].

PubMed

Kupperwasser, B

1996-01-01

Quality assessment (assurance/improvement) is the set of methods used to measure and improve the delivered care and the department's performance against pre-established criteria or standards. The four stages of the self-maintained quality assessment cycle are: problem identification, problem analysis, problem correction and evaluation of corrective actions. Quality assessment is a measurable entity for which it is necessary to define and calibrate measurement parameters (indicators) from available data gathered from the hospital anaesthesia environment. Problem identification comes from the accumulation of indicators. There are four types of quality indicators: structure, process, outcome and sentinel indicators. The latter signal a quality defect, are independent of outcomes, are easier to analyse by statistical methods and closely related to processes and main targets of quality improvement. The three types of methods to analyse the problems (indicators) are: peer review, quantitative methods and risks management techniques. Peer review is performed by qualified anaesthesiologists. To improve its validity, the review process should be explicited and conclusions based on standards of practice and literature references. The quantitative methods are statistical analyses applied to the collected data and presented in a graphic format (histogram, Pareto diagram, control charts). The risks management techniques include: a) critical incident analysis establishing an objective relationship between a 'critical' event and the associated human behaviours; b) system accident analysis, based on the fact that accidents continue to occur despite safety systems and sophisticated technologies, checks of all the process components leading to the impredictable outcome and not just the human factors; c) cause-effect diagrams facilitate the problem analysis in reducing its causes to four fundamental components (persons, regulations, equipment, process). Definition and implementation of corrective measures, based on the findings of the two previous stages, are the third step of the evaluation cycle. The Hawthorne effect is an outcome improvement, before the implementation of any corrective actions. Verification of the implemented actions is the final and mandatory step closing the evaluation cycle.

Optimal type 2 diabetes mellitus management: the randomised controlled OPTIMISE benchmarking study: baseline results from six European countries.

PubMed

Hermans, Michel P; Brotons, Carlos; Elisaf, Moses; Michel, Georges; Muls, Erik; Nobels, Frank

2013-12-01

Micro- and macrovascular complications of type 2 diabetes have an adverse impact on survival, quality of life and healthcare costs. The OPTIMISE (OPtimal Type 2 dIabetes Management Including benchmarking and Standard trEatment) trial comparing physicians' individual performances with a peer group evaluates the hypothesis that benchmarking, using assessments of change in three critical quality indicators of vascular risk: glycated haemoglobin (HbA1c), low-density lipoprotein-cholesterol (LDL-C) and systolic blood pressure (SBP), may improve quality of care in type 2 diabetes in the primary care setting. This was a randomised, controlled study of 3980 patients with type 2 diabetes. Six European countries participated in the OPTIMISE study (NCT00681850). Quality of care was assessed by the percentage of patients achieving pre-set targets for the three critical quality indicators over 12 months. Physicians were randomly assigned to receive either benchmarked or non-benchmarked feedback. All physicians received feedback on six of their patients' modifiable outcome indicators (HbA1c, fasting glycaemia, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), LDL-C and triglycerides). Physicians in the benchmarking group additionally received information on levels of control achieved for the three critical quality indicators compared with colleagues. At baseline, the percentage of evaluable patients (N = 3980) achieving pre-set targets was 51.2% (HbA1c; n = 2028/3964); 34.9% (LDL-C; n = 1350/3865); 27.3% (systolic blood pressure; n = 911/3337). OPTIMISE confirms that target achievement in the primary care setting is suboptimal for all three critical quality indicators. This represents an unmet but modifiable need to revisit the mechanisms and management of improving care in type 2 diabetes. OPTIMISE will help to assess whether benchmarking is a useful clinical tool for improving outcomes in type 2 diabetes.

Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS)

PubMed Central

Noest, Stefan; Ludt, Sabine; Klingenberg, Anja; Glassen, Katharina; Heiss, Friederike; Ose, Dominik; Rochon, Justine; Bozorgmehr, Kayvan; Wensing, Michel; Szecsenyi, Joachim

2014-01-01

Objective The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors. Design Mixed-methods design including focus groups, pretests and field test. Setting The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors. Participants For the field test, 589 questionnaires were distributed to patients via 47 general practices. Main Measurements Descriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care. Results The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics ‘Indication’, including shared-decision-making (6 items, 24.5–62.9%) and ‘Discharge and Transition’ (10 items; 20.7–48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8–9.3%) confirmed a high acceptance by patients. Conclusions The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement. PMID:24758750

What You Can Learn from the 1979 Pacemakers.

ERIC Educational Resources Information Center

Brasler, Wayne

1980-01-01

Indicates that prizewinning school publications differ from good publications in having three qualities: wide-ranging content reflecting organized, creative approaches to coverage; intelligence and sensitivity in content; and thoughtful design. Includes illustrations from prizewinners. (TJ)

Geochemical evolution processes and water-quality observations based on results of the National Water-Quality Assessment Program in the San Antonio segment of the Edwards aquifer, 1996-2006

USGS Publications Warehouse

Musgrove, MaryLynn; Fahlquist, Lynne; Houston, Natalie A.; Lindgren, Richard J.; Ging, Patricia B.

2010-01-01

As part of the National Water-Quality Assessment Program, the U.S. Geological Survey collected and analyzed groundwater samples during 1996-2006 from the San Antonio segment of the Edwards aquifer of central Texas, a productive karst aquifer developed in Cretaceous-age carbonate rocks. These National Water-Quality Assessment Program studies provide an extensive dataset of groundwater geochemistry and water quality, consisting of 249 groundwater samples collected from 136 sites (wells and springs), including (1) wells completed in the shallow, unconfined, and urbanized part of the aquifer in the vicinity of San Antonio (shallow/urban unconfined category), (2) wells completed in the unconfined (outcrop area) part of the regional aquifer (unconfined category), and (3) wells completed in and springs discharging from the confined part of the regional aquifer (confined category). This report evaluates these data to assess geochemical evolution processes, including local- and regional-scale processes controlling groundwater geochemistry, and to make water-quality observations pertaining to sources and distribution of natural constituents and anthropogenic contaminants, the relation between geochemistry and hydrologic conditions, and groundwater age tracers and travel time. Implications for monitoring water-quality trends in karst are also discussed. Geochemical and isotopic data are useful tracers of recharge, groundwater flow, fluid mixing, and water-rock interaction processes that affect water quality. Sources of dissolved constituents to Edwards aquifer groundwater include dissolution of and geochemical interaction with overlying soils and calcite and dolomite minerals that compose the aquifer. Geochemical tracers such as magnesium to calcium and strontium to calcium ratios and strontium isotope compositions are used to evaluate and constrain progressive fluid-evolution processes. Molar ratios of magnesium to calcium and strontium to calcium in groundwater typically increase along flow paths; results for samples of Edwards aquifer groundwater show an increase from shallow/urban unconfined, to unconfined, to confined groundwater categories. These differences are consistent with longer residence times and greater extents of water-rock interaction controlling fluid compositions as groundwater evolves from shallow unconfined groundwater to deeper confined groundwater. Results for stable isotopes of hydrogen and oxygen indicate specific geochemical processes affect some groundwater samples, including mixing with downdip saline water, mixing with recent recharge associated with tropical cyclonic storms, or mixing with recharge water than has undergone evaporation. The composition of surface water recharging the aquifer, as well as mixing with downdip water from the Trinity aquifer or the saline zone, also might affect water quality. A time-series record (1938-2006) of discharge at Comal Springs, one of the major aquifer discharge points, indicates an upward trend for nitrate and chloride concentrations, which likely reflects anthropogenic activities. A small number of organic contaminants were routinely or frequently detected in Edwards aquifer groundwater samples. These were the pesticides atrazine, its degradate deethylatrazine, and simazine; the drinking-water disinfection byproduct chloroform; and the solvent tetrachloroethene. Detection of these contaminants was most frequent in samples of the shallow/urban unconfined groundwater category and least frequent in samples of the unconfined groundwater category. Results indicate that the shallow/urban unconfined part of the aquifer is most affected by anthropogenic contaminants and the unconfined part of the aquifer is the least affected. The high frequency of detection for these anthropogenic contaminants aquifer-wide and in samples of deep, confined groundwater indicates that the entire aquifer is susceptible to water-quality changes as a result of anthropogenic activities. L

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).

Quality and safety training in primary care: making an impact.

PubMed

Byrne, John M; Hall, Susan; Baz, Sam; Kessler, Todd; Roman, Maher; Patuszynski, Mark; Thakkar, Kruti; Kashner, T Michael

2012-12-01

Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P  =  .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects. Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.

Quality and reporting of diagnostic accuracy studies in TB, HIV and malaria: evaluation using QUADAS and STARD standards.

PubMed

Fontela, Patricia Scolari; Pant Pai, Nitika; Schiller, Ian; Dendukuri, Nandini; Ramsay, Andrew; Pai, Madhukar

2009-11-13

Poor methodological quality and reporting are known concerns with diagnostic accuracy studies. In 2003, the QUADAS tool and the STARD standards were published for evaluating the quality and improving the reporting of diagnostic studies, respectively. However, it is unclear whether these tools have been applied to diagnostic studies of infectious diseases. We performed a systematic review on the methodological and reporting quality of diagnostic studies in TB, malaria and HIV. We identified diagnostic accuracy studies of commercial tests for TB, malaria and HIV through a systematic search of the literature using PubMed and EMBASE (2004-2006). Original studies that reported sensitivity and specificity data were included. Two reviewers independently extracted data on study characteristics and diagnostic accuracy, and used QUADAS and STARD to evaluate the quality of methods and reporting, respectively. Ninety (38%) of 238 articles met inclusion criteria. All studies had design deficiencies. Study quality indicators that were met in less than 25% of the studies included adequate description of withdrawals (6%) and reference test execution (10%), absence of index test review bias (19%) and reference test review bias (24%), and report of uninterpretable results (22%). In terms of quality of reporting, 9 STARD indicators were reported in less than 25% of the studies: methods for calculation and estimates of reproducibility (0%), adverse effects of the diagnostic tests (1%), estimates of diagnostic accuracy between subgroups (10%), distribution of severity of disease/other diagnoses (11%), number of eligible patients who did not participate in the study (14%), blinding of the test readers (16%), and description of the team executing the test and management of indeterminate/outlier results (both 17%). The use of STARD was not explicitly mentioned in any study. Only 22% of 46 journals that published the studies included in this review required authors to use STARD. Recently published diagnostic accuracy studies on commercial tests for TB, malaria and HIV have moderate to low quality and are poorly reported. The more frequent use of tools such as QUADAS and STARD may be necessary to improve the methodological and reporting quality of future diagnostic accuracy studies in infectious diseases.

Quality and Reporting of Diagnostic Accuracy Studies in TB, HIV and Malaria: Evaluation Using QUADAS and STARD Standards

PubMed Central

Fontela, Patricia Scolari; Pant Pai, Nitika; Schiller, Ian; Dendukuri, Nandini; Ramsay, Andrew; Pai, Madhukar

2009-01-01

Background Poor methodological quality and reporting are known concerns with diagnostic accuracy studies. In 2003, the QUADAS tool and the STARD standards were published for evaluating the quality and improving the reporting of diagnostic studies, respectively. However, it is unclear whether these tools have been applied to diagnostic studies of infectious diseases. We performed a systematic review on the methodological and reporting quality of diagnostic studies in TB, malaria and HIV. Methods We identified diagnostic accuracy studies of commercial tests for TB, malaria and HIV through a systematic search of the literature using PubMed and EMBASE (2004–2006). Original studies that reported sensitivity and specificity data were included. Two reviewers independently extracted data on study characteristics and diagnostic accuracy, and used QUADAS and STARD to evaluate the quality of methods and reporting, respectively. Findings Ninety (38%) of 238 articles met inclusion criteria. All studies had design deficiencies. Study quality indicators that were met in less than 25% of the studies included adequate description of withdrawals (6%) and reference test execution (10%), absence of index test review bias (19%) and reference test review bias (24%), and report of uninterpretable results (22%). In terms of quality of reporting, 9 STARD indicators were reported in less than 25% of the studies: methods for calculation and estimates of reproducibility (0%), adverse effects of the diagnostic tests (1%), estimates of diagnostic accuracy between subgroups (10%), distribution of severity of disease/other diagnoses (11%), number of eligible patients who did not participate in the study (14%), blinding of the test readers (16%), and description of the team executing the test and management of indeterminate/outlier results (both 17%). The use of STARD was not explicitly mentioned in any study. Only 22% of 46 journals that published the studies included in this review required authors to use STARD. Conclusion Recently published diagnostic accuracy studies on commercial tests for TB, malaria and HIV have moderate to low quality and are poorly reported. The more frequent use of tools such as QUADAS and STARD may be necessary to improve the methodological and reporting quality of future diagnostic accuracy studies in infectious diseases. PMID:19915664

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

EPA Pesticide Factsheets

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

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

PubMed

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

2015-04-21

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

[Potential for the survey of quality indicators based on a national emergency department registry : A systematic literature search].

PubMed

Hörster, A C; Kulla, M; Brammen, D; Lefering, R

2018-06-01

Emergency department processes are often key for successful treatment. Therefore, collection of quality indicators is demanded. A basis for the collection is systematic, electronic documentation. The development of paper-based documentation into an electronic and interoperable national emergency registry is-besides the establishment of quality management for emergency departments-a target of the AKTIN project. The objective of this research is identification of internationally applied quality indicators. For the investigation of the current status of quality management in emergency departments based on quality indicators, a systematic literature search of the database PubMed, the Cochrane Library and the internet was performed. Of the 170 internationally applied quality indicators, 25 with at least two references are identified. A total of 10 quality indicators are ascertainable by the data set. An enlargement of the data set will enable the collection of seven further quality indicators. The implementation of data of care behind the emergency processes will provide eight additional quality indicators. This work was able to show that the potential of a national emergency registry for the establishment of quality indicators corresponds with the international systems taken into consideration and could provide a comparable collection of quality indicators.

Flaw detection and evaluation

DOEpatents

Wilks, Robert S.; Sturges, Jr., Robert H.

1983-01-01

The invention provides a method of and apparatus for optically inspecting nuclear fuel pellets for surface flaws. The inspection system includes a prism and lens arrangement for scanning the surface of each pellet as the same is rotated. The resulting scan produces data indicative of the extent and shape of each flaw which is employed to generate a flaw quality index for each detected flaw. The flaw quality indexes from all flaws are summed and compared with an acceptable surface quality index. The result of the comparison is utilized to control the acceptance or rejection of the pellet.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

PubMed Central

de Albuquerque, Denilson Campos; de Souza, João David; Bacal, Fernando; Rohde, Luiz Eduardo Paim; Bernardez-Pereira, Sabrina; Berwanger, Otavio; Almeida, Dirceu Rodrigues

2015-01-01

Background Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. PMID:26131698

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes.

PubMed

Albuquerque, Denilson Campos de; Neto, João David de Souza; Bacal, Fernando; Rohde, Luiz Eduardo Paim; Bernardez-Pereira, Sabrina; Berwanger, Otavio; Almeida, Dirceu Rodrigues

2015-06-01

Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

Physician level reporting of surgical and pathology performance indicators: a regional study to assess feasibility and impact on quality.

PubMed

McFadyen, Craig; Lankshear, Sara; Divaris, Dimitrios; Berry, Mark; Hunter, Amber; Srigley, John; Irish, Jonathan

2015-02-01

There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels. Individual provider level reporting was implemented within a provincial health region involving 56 clinicians (general surgeons, surgical oncologists, urologists and pathologists). The 2 surgical pathology indicators chosen were colorectal cancer (CRC) lymph node retrieval rate and pT2 prostate cancer margin positivity rate. Surgical resections for all prostate and colorectal cancer performed between Jan. 1, 2011, and Mar. 30, 2012, were included. We used a pre- and postsurvey design to obtain physician perceptions and focus groups with program leadership to determine organizational impact. Survey results showed that respondents felt the data provided in the reports were valid (67%), consistent with expectations (70%), maintained confidentiality (80%) and were not used in a punitive manner (77%). During the study period the pT2 prostate margin positivity rate decreased from 57.1% to 27.5%. For the CRC lymph node retrieval rate indicator, high baseline performance was maintained. We developed a robust process for providing physicians with confidential, individualized surgical and pathology quality indicator reports. Our results reinforce the importance of individual physician feedback as a strategy for improving and sustaining quality in surgical and diagnostic oncology.

The Effect of Aromatherapy on Sleep Quality of Elderly People Residing in a Nursing Home.

PubMed

Faydalı, Saide; Çetinkaya, Funda

Sleep is important for health and quality of life in the elderly, and sleep disturbances are reported to be associated with many of the adverse medical conditions. This research was carried out to evaluate the effect of inhalation of lavender oil on sleep quality of nursing home residents. A questionnaire was used to evaluate sociodemographic characteristics and sleeping properties of the 30 volunteers, enrolled. Pittsburgh Sleep Quality Index was applied as a pre- and posttest to measure sleep quality of individuals who inhaled lavender oil drops on the pillows every evening for a week before sleeping. Before and after aromatherapy, the mean Pittsburgh Sleep Quality Index score of the nursing home residents was (Equation is included in full-text article.)= 6.0 ± 5.1 and (Equation is included in full-text article.)= 2.6 ± 3.4, respectively, whereas statistically significant difference was not observed for independent variables. Cronbach α reliability coefficient of the Pittsburgh Sleep Quality Index scale was found to be 0.816. The results indicated an improvement of sleep quality of nursing home residents after the application of aromatherapy with lavender oil.

Traditional and nontraditional evaluations of student outcomes in a practical final examination of veterinary radiology.

PubMed

Koskinen, Heli I

2010-01-01

The Faculty of Veterinary Medicine at the University of Helsinki recognized the lack of systems to measure the quality of education. At the department level, this meant lack of systems to measure the quality of students' outcomes. The aim of this article was to compare the quality of outcomes of a final examination in veterinary radiology by calculating the correlations between traditional (quantitative scores traditionally given by veterinary teachers) and nontraditional (qualitative Structure of the Observed Learning Outcome, or SOLO, method) grading results. Evaluation of the quality of the questions is also included. The results indicate that SOLO offers criteria for quality evaluation, especially for questions. A correlation of 0.60 (p<0.01) existed between qualitative and quantitative estimations, and a correlation of 0.79 (p<0.01) existed between evaluators, both using traditional scores. Two suggestions for a better system to evaluate quality in the future: First, development of problem-solving skills during the learning process should also be assessed. Second, both the scoring of factual correctness of answers (knowledge) and the grammatical structure of an answer and the quality of presentation should be included in the quality evaluation process.

Key Facts about Children in Utah. Children and Families at Risk: A Status Report of Our Children, 1994.

ERIC Educational Resources Information Center

Utah Children, Salt Lake City.

The Utah KIDS COUNT program provides information about child well-being to enhance discussions on securing better futures for children. Indicators of children's quality of life are chosen to reflect a range of influences on children, conditions across developmental stages, and comparisons across time. Ten indicators examined included: (1) low…

Assessing soil compaction on Forest Inventory & Analysis phase 3 field plots using a pocket penetrometer

Treesearch

Michael C. Amacher; Katherine P. O' Neill

2004-01-01

Soil compaction is an important indicator of soil quality, yet few practical methods are available to quantitatively measure this variable. Although an assessment of the areal extent of soil compaction is included as part of the soil indicator portion of the Forest Inventory & Analysis (FIA) program, no quantitative measurement of the degree of soil compaction...

Station descriptions and availability of discharge and water-quality data through 1985 for eastern Montana stream sites not included in the National Water Data Exchange Program

USGS Publications Warehouse

Groskinsky Link, B. L.; Cary, L.E.

1988-01-01

Stations were selected to monitor water discharge and water quality of streams in eastern Montana. This report describes the stations and indicates the availability of hydrologic data through 1985. Included are stations that are operated by organizations that do not belong to the National Water Data Exchange (NAWDEX) program operated by the U.S. Geological Survey. Each station description contains a narration of the station 's history including location, drainage area, elevation, operator, period of record, type of equipment and instruments used at the station, and data availability. The data collected at each station have been identified according to type: water discharge, chemical quality, and suspended sediment. Descriptions are provided for 113 stations. These data have potential uses in characterizing small hydrologic basins, as well as other uses. A map of eastern Montana shows the location of the stations selected. (USGS)

Return on investment in healthcare leadership development programs.

PubMed

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

2018-02-05

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

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey

PubMed Central

Zelefsky, Michael J.; Lee, W. Robert; Zietman, Anthony; Khalid, Najma; Crozier, Cheryl; Owen, Jean; Wilson, J. Frank

2012-01-01

Purpose To test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and non-academic US institutions. Methods and Materials 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures, such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results 167 patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16–23 MV. For intermediate- plus high-risk patients (n=181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n=9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85/354), weekly electronic portal imaging was obtained as verification films without daily target localization and the remaining 76% were treated with daily localization of the target using various methods. Conclusions Adherence to defined quality indicators was observed in a majority of patients. ≈90% of high-risk patients are treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients receive prescription doses >=75 Gy, consistent with the published results of randomized trials. PMID:23471563

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey.

PubMed

Zelefsky, Michael J; Lee, W Robert; Zietman, Anthony; Khalid, Najma; Crozier, Cheryl; Owen, Jean; Wilson, J Frank

2013-01-01

To test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and non-academic US institutions. 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures, such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. 167 patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n=181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n=9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85/354), weekly electronic portal imaging was obtained as verification films without daily target localization and the remaining 76% were treated with daily localization of the target using various methods. Adherence to defined quality indicators was observed in a majority of patients. ≈90% of high-risk patients are treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients receive prescription doses >=75 Gy, consistent with the published results of randomized trials.

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.

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 procedures. The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing 1

PubMed Central

González-Chordá, Víctor Manuel; Maciá-Soler, María Loreto

2015-01-01

Abstract Objective: to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. Method: prospective longitudinal study conducted in a population of 60 secondyear Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. Results: nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). Conclusion: the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teachinglearning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care. PMID:26444173

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.

Assessment of physical and chemical indicators of sandy soil quality for sustainable crop production

NASA Astrophysics Data System (ADS)

Lipiec, Jerzy; Usowicz, Boguslaw

2017-04-01

Sandy soils are used in agriculture in many regions of the world. The share of sandy soils in Poland is about 55%. The aim of this study was to assess spatial variability of soil physical and chemical properties affecting soil quality and crop yields in the scale of field (40 x 600 m) during three years of different weather conditions. The experimental field was located on the post glacial and acidified sandy deposits of low productivity (Szaniawy, Podlasie Region, Poland). Physical soil quality indicators included: content of sand, silt, clay and water, bulk density and those chemical: organic carbon, cation exchange capacity, acidity (pH). Measurements of the most soil properties were done at spring and summer each year in topsoil and subsoil layer in 150 points. Crop yields were evaluated in places close to measuring points of the soil properties. Basic statistics including mean, standard deviation, skewness, kurtosis minimal, maximal and correlations between the soil properties and crop yields were calculated. Analysis of spatial dependence and distribution for each property was performed using geostatistical methods. Mathematical functions were fitted to the experimentally derived semivariograms that were used for mapping the soil properties and crop yield by kriging. The results showed that the largest variations had clay content (CV 67%) and the lowest: sand content (5%). The crop yield was most negatively correlated with sand content and most positively with soil water content and cation exchange capacity. In general the exponential semivariogram models fairly good matched to empirical data. The range of semivariogram models of the measured indicators varied from 14 m to 250 m indicate high and moderate spatial variability. The values of the nugget-to-sill+nugget ratios showed that most of the soil properties and crop yields exhibited strong and moderate spatial dependency. The kriging maps allowed identification of low yielding sub-field areas that correspond with low soil organic carbon and cation exchange capacity and high content of sand. These areas are considered as management zones to improve crop productivity and soil properties responsible for soil quality and functions. We conclude that soil organic carbon, cation exchange capacity and pH should be included as indicators of soil quality in sandy soils. The study was funded by HORIZON 2020, European Commission, Programme H2020-SFS-2015-2: Soil Care for profitable and sustainable crop production in Europe, project No. 677407 (SoilCare, 2016-2021).

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.

Toward youth self-report of health and quality of life in population monitoring.

PubMed

Topolski, Tari D; Edwards, Todd C; Patrick, Donald L

2004-01-01

This paper addresses population monitoring of youth health and quality of life, including the concepts used, methodological and practical criteria for indicators, and existing surveys and measures. Current population surveys of youth generally focus on poor health, such as disability or health-risk behaviors. Although these are important end points, indicators of illness or risk do not reflect the health or life perspective of the majority of youth who do not experience health problems. The measures used to monitor youth health should be appropriate and sensitive to future needs and capture the perspectives of youths. Two potential concepts for this "scorecard" are self-perceived health and quality of life, which have been shown to be useful in adults. For youth, the quality of life framework seems particularly relevant as it incorporates both positive and negative aspects of health and well-being and also captures salient aspects of health other than physical health, such as sense of self, social relationships, environment and culture, and life satisfaction.

Analysis of selected water-quality data for surface water in St. Tammany Parish, Louisiana, April-August 1995

USGS Publications Warehouse

Demcheck, Dennis K.

1996-01-01

Physical and chemical-related properties, concentrations of chemical constituents, which included major ions and nutrients, and concentrations of fecal-coliform bacteria were determined for 17 sites on 11 streams in St. Tammany Parish, Louisiana, during the period April-August 1995. The streams were sampled to assess the effects of different streamflow conditions on the concentrations of water-quality constituents. The streams included in the study were Tchefuncte River, Bogue Falaya, Abita River, Bayou Chinchouba, Bayou Castine, Cane Bayou, Bayou Lacombe, Bayou Liberty, Bayou Bonfouca, Bogue Chitto, and West Pearl River. Water-quality samples were collected under several hydrologic conditions. These conditions included a period of wet weather and sustained high river stages; a period of local storms several days apart and river stages typical of that situation; and a period of dry weather and low river stages. The concentrations of inorganic chemical constituents in water from the upstream sites generally were low. Concentrations from the downstream sites varied and were higher. Nutrient and fecal-coliform bacteria concentrations varied and indicated that degraded water-quality conditions that typically occur during storms persisted less than 1-3 days. In general, the larger the drainage basin, the longer it takes for the stream to recover. Fecal-coliform concen- trations reflected the effects of small, isolated storms in the area. Bayou Castine, sampled immediately after a storm, had a fecal-coliform concentration of 26,000 colonies per 100 milliliters. The stream was resampled 24 hours later, and the fecal-coliform concentration had decreased to 1,700 colonies per 100 milliliters. This is an indication of the rapid water-quality changes that typically occur in small streams.

Psychometric evaluation of commonly used game-specific skills tests in rugby: A systematic review

PubMed Central

Oorschot, Sander; Chiwaridzo, Matthew; CM Smits-Engelsman, Bouwien

2017-01-01

Objectives To (1) give an overview of commonly used game-specific skills tests in rugby and (2) evaluate available psychometric information of these tests. Methods The databases PubMed, MEDLINE CINAHL and Africa Wide information were systematically searched for articles published between January 1995 and March 2017. First, commonly used game-specific skills tests were identified. Second, the available psychometrics of these tests were evaluated and the methodological quality of the studies assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist. Studies included in the first step had to report detailed information on the construct and testing procedure of at least one game-specific skill, and studies included in the second step had additionally to report at least one psychometric property evaluating reliability, validity or responsiveness. Results 287 articles were identified in the first step, of which 30 articles met the inclusion criteria and 64 articles were identified in the second step of which 10 articles were included. Reactive agility, tackling and simulated rugby games were the most commonly used tests. All 10 studies reporting psychometrics reported reliability outcomes, revealing mainly strong evidence. However, all studies scored poor or fair on methodological quality. Four studies reported validity outcomes in which mainly moderate evidence was indicated, but all articles had fair methodological quality. Conclusion Game-specific skills tests indicated mainly high reliability and validity evidence, but the studies lacked methodological quality. Reactive agility seems to be a promising domain, but the specific tests need further development. Future high methodological quality studies are required in order to develop valid and reliable test batteries for rugby talent identification. Trial registration number PROSPERO CRD42015029747. PMID:29259812

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.

A church-based diet and physical activity intervention for rural, lower Mississippi Delta African American adults: Delta Body and Soul effectiveness study, 2010-2011.

PubMed

Tussing-Humphreys, Lisa; Thomson, Jessica L; Mayo, Tanyatta; Edmond, Emanuel

2013-06-06

Obesity, diabetes, and hypertension have reached epidemic levels in the largely rural Lower Mississippi Delta (LMD) region. We assessed the effectiveness of a 6-month, church-based diet and physical activity intervention, conducted during 2010 through 2011, for improving diet quality (measured by the Healthy Eating Index-2005) and increasing physical activity of African American adults in the LMD region. We used a quasi-experimental design in which 8 self-selected eligible churches were assigned to intervention or control. Assessments included dietary, physical activity, anthropometric, and clinical measures. Statistical tests for group comparisons included χ(2), Fisher's exact, and McNemar's tests for categorical variables, and mixed-model regression analysis for continuous variables and modeling intervention effects. Retention rates were 85% (176 of 208) for control and 84% (163 of 195) for intervention churches. Diet quality components, including total fruit, total vegetables, and total quality improved significantly in both control (mean [standard deviation], 0.3 [1.8], 0.2 [1.1], and 3.4 [9.6], respectively) and intervention (0.6 [1.7], 0.3 [1.2], and 3.2 [9.7], respectively) groups, while significant increases in aerobic (22%) and strength/flexibility (24%) physical activity indicators were apparent in the intervention group only. Regression analysis indicated that intervention participation level and vehicle ownership were significant positive predictors of change for several diet quality components. This church-based diet and physical activity intervention may be effective in improving diet quality and increasing physical activity of LMD African American adults. Components key to the success of such programs are participant engagement in educational sessions and vehicle access.

The measurement of quality of care in the Veterans Health Administration.

PubMed

Halpern, J

1996-03-01

The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the databases.

Urban and industrial land uses have a higher soil biological quality than expected from physicochemical quality.

PubMed

Joimel, Sophie; Schwartz, Christophe; Hedde, Mickaël; Kiyota, Sayuri; Krogh, Paul Henning; Nahmani, Johanne; Pérès, Guénola; Vergnes, Alan; Cortet, Jérôme

2017-04-15

Despite their importance both in soil functioning and as soil indicators, the response of microarthropods to various land uses is still unclear. The aim of this study is to assess the effect of land use on microarthropod diversity and determine whether a soil's biological quality follows the same physicochemical quality-based gradient from forest, agriculture-grassland, agriculture-arable land, vineyards, urban vegetable gardens to urban, industrial, traffic, mining and military areas. A database compiling the characteristics of 758 communities has been established. We calculated Collembola community indices including: species richness, Pielou's evenness index, collembolan life forms, the abundance of Collembola and of Acari, the Acari/Collembola abundance ratio, and the Collembolan ecomorphological index. Results show that agricultural land use was the most harmful for soil microarthropod biodiversity, whilst urban and industrial land uses give the same level of soil biological quality as forests do. Furthermore, differences between the proportions of Acari and ecomorphological groups were observed between land uses. This study, defining soil microarthropod diversity baselines for current land uses, should therefore help in managing and preserving soil microarthropod biodiversity, especially by supporting the preservation of soil quality. Copyright © 2017 Elsevier B.V. All rights reserved.

Definition, willingness-to-pay, and ranking of quality attributes of U.S. pork as defined by importers in Asia and Mexico.

PubMed

Murphy, R G L; Howard, S T; Woerner, D R; Pendell, D L; Dixon, C L; Desimone, T L; Green, M D; Igo, J L; Tatum, J D; Belk, K E

2015-01-01

A survey was conducted from November 2009 to April 2010 to determine how importers of pork define 7 predetermined quality categories (food safety, customer service, eating quality, product specification, packaging, visual characteristics, and production history) and to estimate willingness-to-pay (WTP) and establish best-worst (B/W) scaling (rank) for the 7 quality categories. Interviews were conducted in Hong Kong/China (n = 83), Japan (n = 48), Mexico (n = 70) and Russia (n = 54) with importers of U.S. pork or those who had purchased U.S. pork from distributors in the last 3 yr. Interviews used dynamic routing software and were structured such that economic factors for purchase were addressed first, allowing all responses to focus on quality. Questions about WTP and B/W were asked and then each respondent was asked to define what each quality category meant to them. Generalized linear mixed models were used to analyze frequency data. Over 70% of interviewees in Hong Kong/China, Japan, and Mexico responded that purchase price was influential in deciding whether or not to purchase imported pork. This number was lower in Russia, where respondents stated tariff rates were also important, indicating market access was a larger issue in Russia. Food safety was the most important quality category (price was not included as a part of quality) for imported pork followed by specifications. Respondents indicated some form of government inspection was how they defined food safety, whereas product size, weight, and subcutaneous fat were all included in the definition of specifications. Interviewees were more likely to pay premiums for customer service and less likely to pay premiums for packaging (P < 0.05). The premiums that were willing to be paid for guarantees of quality for imported pork variety meats were numerically lower than for whole muscle cuts or processed products. A guarantee associated with food safety of processed pork products was found to be the quality attribute for which importers would be willing to pay the highest premium. Production history was found to be the least important quality attribute for importers of all types of U.S. pork, except those in Japan. Exporters could increase profitability if a guarantee of customer service was made. Price, tariffs, and exchange rates are important to pork importers; these results indicated that if certain quality attributes could be guaranteed, exporters could increase profitability.

The public gets what the public wants: experiences of public reporting in long-term care in Europe.

PubMed

Rodrigues, Ricardo; Trigg, Lisa; Schmidt, Andrea E; Leichsenring, Kai

2014-05-01

Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. There was little evidence to show whether public reporting has a significant impact on driving users' choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2011-05-01

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

[Using routine data for quality of care assessments: a critical review, taking quality indicators for the "National Disease Management Guideline for Chronic Heart Failure" as an example].

PubMed

Laux, Gunter; Nothacker, Monika; Weinbrenner, Susanne; Störk, Stefan; Blozik, Eva; Peters-Klimm, Frank; Szecsenyi, Jürgen; Scherer, Martin

2011-01-01

In December 2009, the first version of the German Disease Management Guideline (DM-CPG) for chronic heart failure was completed, including a set of proposed quality indicators for heart failure. This article explores whether proposed indicators can be derived from data collected routinely in general practices. For this purpose, previous experiences and data from the research project CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) conducted under guidance of the Department of General Medicine and Health Services Research at the University of Heidelberg, Germany, were applied. The availability of numerators and denominators needed for calculating the four quality indicators for diagnosis and pharmacotherapy proposed in the DM-CPG was checked within so-called "routine data" from the existing dataset of the CONTENT project. Within the given context, routine data are defined as data that are periodically transmitted from health care providers to cost units within the health care system. A thorough assessment has revealed that within the given context only one indicator could be deduced from routine data collection. This was the indicator measuring the proportion of patients receiving beta receptor antagonists, compared to all patients with heart failure NYHA class II to IV. Indeed, this single indicator will only be computable if the NYHA grade of heart failure severity and the presence or absence of contraindications to beta receptor antagonist therapy are routinely collected and the data merged into a central database. Against the background of these results it is obvious that a fully developed, transsectoral concept for data collection and data transfer needs to be implemented.

Life after cervical cancer: quality of life among Chinese women.

PubMed

Zeng, Ying Chun; Li, Dingmei; Loke, Alice Yuen

2011-09-01

This study explored the meaning of "quality of life" among Chinese survivors of cervical cancer and the impact of cervical cancer survivorship on these women's quality of life. Written responses were used as the means of data collection. The qualitative data were analyzed by using a qualitative content analysis. The meaning of "quality of life", as perceived by 35 Chinese survivors of cervical cancer, included being free of disease, having a good standard of living, having a harmonious family atmosphere, and having a harmonious sex life. The impact of cervical cancer on the Chinese women's quality of life included physical and psychological sequelae, family distress, financial burden, and disruptions to their social functioning and sexual life. Nevertheless, there were positive gains that were reported by these survivors, including changes in their outlook on life, treasuring their life, and better family relationships. This study revealed that the Chinese survivors of cervical cancer identified their sexual life as one of the essential indicators of quality of life. It is necessary to raise nurses' awareness so that women's sexuality-related concerns are addressed. Health professionals also should provide relevant supportive care in order to address this target population's physical and psychosocial needs across the survivorship continuum. © 2011 Blackwell Publishing Asia Pty Ltd.

Monitoring and Assessment of Youshui River Water Quality in Youyang

NASA Astrophysics Data System (ADS)

Wang, Xue-qin; Wen, Juan; Chen, Ping-hua; Liu, Na-na

2018-02-01

By monitoring the water quality of Youshui River from January 2016 to December 2016, according to the indicator grading and the assessment standard of water quality, the formulas for 3 types water quality indexes are established. These 3 types water quality indexes, the single indicator index Ai, single moment index Ak and the comprehensive water quality index A, were used to quantitatively evaluate the quality of single indicator, the water quality and the change of water quality with time. The results show that, both total phosphorus and fecal coliform indicators exceeded the standard, while the other 16 indicators measured up to the standard. The water quality index of Youshui River is 0.93 and the grade of water quality comprehensive assessment is level 2, which indicated that the water quality of Youshui River is good, and there is room for further improvement. To this end, several protection measures for Youshui River environmental management and pollution treatment are proposed.

Clinical dysphagia risk predictors after prolonged orotracheal intubation

PubMed Central

de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; de Andrade, Claudia Regina Furquim

2014-01-01

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. PMID:24473554

Clinical dysphagia risk predictors after prolonged orotracheal intubation.

PubMed

Medeiros, Gisele Chagas de; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; Andrade, Claudia Regina Furquim de

2014-01-01

To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

Health assessment using aqua-quality indicators of alpine streams (Khunjerab National Park), Gilgit, Pakistan.

PubMed

Ali, Salar; Gao, Junfeng; Begum, Farida; Rasool, Atta; Ismail, Muhammad; Cai, Yongjiu; Ali, Shaukat; Ali, Shujaat

2017-02-01

This preliminary research was conducted to evaluate the alpine stream health by using water quality as an indicator in Khunjerab National park of the Karakoram ranges located in Pak-China boarder Pakistan having altitude of 3660 m. This study investigated the stream health in the context of the presence or absence of sensitive species, their diversity, and their taxa richness. The water and macroinvertebrate samples were collected from 17 different locations from upstream and downstream of the river by using random sampling method. Macroinvertebrate samples were obtained using kick net (500-μm mesh size) and hand-picking method (NYSDEC). A total of 710 counts including 41 families of macroinvertebrates were recorded comprising of 7 orders including: Ephemeroptera (46%) being the most dominant group, Plecoptera (33%), Trichoptera (5%), Chironomidae (Diptera) (14%), Heteroptera (1%), and Coleoptera (1%). Ephemeroptera, Trichoptera, and Plecoptera (EPT) were found in abundance at the main source, Qarchanai, Dhee, and Tourqeen Nullah, as compared to the other locations of the stream. The most dominant macroinvertebrate was Ephemeroptera whose relative abundance is Pi = 0.49 by using the Shannon index. However, different statistical tools, including principal component analysis (PCA), cluster analysis (CA), ANOVA, and linear regression model, show a strong correlation between water quality and macroinvertebrates. The overall results of the biological indicators showed better ecological health at downstream compared to upstream. This study will provide basic information and understanding about the macroinvertebrates for future researchers, and the data will be helpful for upcoming research programs on alpine streams for the discovery and occurrences of macroinvertebrates and associated fauna.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship Between Quality of Comorbid Condition Care and Costs for Cancer Survivors

PubMed Central

Snyder, Claire F.; Herbert, Robert J.; Blackford, Amanda L.; Neville, Bridget A.; Wolff, Antonio C.; Carducci, Michael A.; Earle, Craig C.

2016-01-01

Purpose: To estimate the association between cancer survivors’ comorbid condition care quality and costs; to determine whether the association differs between cancer survivors and other patients. Methods: Using the SEER–Medicare-linked database, we identified survivors of breast, prostate, and colorectal cancers who were diagnosed in 2004, enrolled in Medicare fee-for-service for at least 12 months before diagnosis, and survived ≥ 3 years. Quality of care was assessed using nine process indicators for chronic conditions, and a composite indicator representing seven avoidable outcomes. Total costs on the basis of Medicare amount paid were grouped as inpatient and outpatient. We examined the association between care quality and costs for cancer survivors, and compared this association among 2:1 frequency-matched noncancer controls, using comparisons of means and generalized linear regressions. Results: Our sample included 8,661 cancer survivors and 17,332 matched noncancer controls. Receipt of recommended care was associated with higher outpatient costs for eight indicators, and higher inpatient and total costs for five indicators. For three measures (visit every 6 months for patients with chronic obstructive pulmonary disease or diabetes, and glycosylated hemoglobin or fructosamine every 6 months for patients with diabetes), costs for cancer survivors who received recommended care increased less than for noncancer controls. The absence of avoidable events was associated with lower costs of each type. An annual eye examination for patients with diabetes was associated with lower inpatient costs. Conclusion: Higher-quality processes of care may not reduce short-term costs, but the prevention of avoidable outcomes reduces costs. The association between quality and cost was similar for cancer survivors and noncancer controls. PMID:27165487

Optimal design of monitoring networks for multiple groundwater quality parameters using a Kalman filter: application to the Irapuato-Valle aquifer.

PubMed

Júnez-Ferreira, H E; Herrera, G S; González-Hita, L; Cardona, A; Mora-Rodríguez, J

2016-01-01

A new method for the optimal design of groundwater quality monitoring networks is introduced in this paper. Various indicator parameters were considered simultaneously and tested for the Irapuato-Valle aquifer in Mexico. The steps followed in the design were (1) establishment of the monitoring network objectives, (2) definition of a groundwater quality conceptual model for the study area, (3) selection of the parameters to be sampled, and (4) selection of a monitoring network by choosing the well positions that minimize the estimate error variance of the selected indicator parameters. Equal weight for each parameter was given to most of the aquifer positions and a higher weight to priority zones. The objective for the monitoring network in the specific application was to obtain a general reconnaissance of the water quality, including water types, water origin, and first indications of contamination. Water quality indicator parameters were chosen in accordance with this objective, and for the selection of the optimal monitoring sites, it was sought to obtain a low-uncertainty estimate of these parameters for the entire aquifer and with more certainty in priority zones. The optimal monitoring network was selected using a combination of geostatistical methods, a Kalman filter and a heuristic optimization method. Results show that when monitoring the 69 locations with higher priority order (the optimal monitoring network), the joint average standard error in the study area for all the groundwater quality parameters was approximately 90 % of the obtained with the 140 available sampling locations (the set of pilot wells). This demonstrates that an optimal design can help to reduce monitoring costs, by avoiding redundancy in data acquisition.

Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review

PubMed Central

van Mourik, Maaike S M; van Duijn, Pleun Joppe; Moons, Karel G M; Bonten, Marc J M; Lee, Grace M

2015-01-01

Objective Measuring the incidence of healthcare-associated infections (HAI) is of increasing importance in current healthcare delivery systems. Administrative data algorithms, including (combinations of) diagnosis codes, are commonly used to determine the occurrence of HAI, either to support within-hospital surveillance programmes or as free-standing quality indicators. We conducted a systematic review evaluating the diagnostic accuracy of administrative data for the detection of HAI. Methods Systematic search of Medline, Embase, CINAHL and Cochrane for relevant studies (1995–2013). Methodological quality assessment was performed using QUADAS-2 criteria; diagnostic accuracy estimates were stratified by HAI type and key study characteristics. Results 57 studies were included, the majority aiming to detect surgical site or bloodstream infections. Study designs were very diverse regarding the specification of their administrative data algorithm (code selections, follow-up) and definitions of HAI presence. One-third of studies had important methodological limitations including differential or incomplete HAI ascertainment or lack of blinding of assessors. Observed sensitivity and positive predictive values of administrative data algorithms for HAI detection were very heterogeneous and generally modest at best, both for within-hospital algorithms and for formal quality indicators; accuracy was particularly poor for the identification of device-associated HAI such as central line associated bloodstream infections. The large heterogeneity in study designs across the included studies precluded formal calculation of summary diagnostic accuracy estimates in most instances. Conclusions Administrative data had limited and highly variable accuracy for the detection of HAI, and their judicious use for internal surveillance efforts and external quality assessment is recommended. If hospitals and policymakers choose to rely on administrative data for HAI surveillance, continued improvements to existing algorithms and their robust validation are imperative. PMID:26316651

Performance Measures in Neurosurgical Patient Care: Differing Applications of Patient Safety Indicators.

PubMed

Moghavem, Nuriel; McDonald, Kathryn; Ratliff, John K; Hernandez-Boussard, Tina

2016-04-01

Patient Safety Indicators (PSIs) are administratively coded identifiers of potentially preventable adverse events. These indicators are used for multiple purposes, including benchmarking and quality improvement efforts. Baseline PSI evaluation in high-risk surgeries is fundamental to both purposes. Determine PSI rates and their impact on other outcomes in patients undergoing cranial neurosurgery compared with other surgeries. The Agency for Healthcare Research and Quality (AHRQ) PSI software was used to flag adverse events and determine risk-adjusted rates (RAR). Regression models were built to assess the association between PSIs and important patient outcomes. We identified cranial neurosurgeries based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in California, Florida, New York, Arkansas, and Mississippi State Inpatient Databases, AHRQ, 2010-2011. PSI development, 30-day all-cause readmission, length of stay, hospital costs, and inpatient mortality. A total of 48,424 neurosurgical patients were identified. Procedure indication was strongly associated with PSI development. The neurosurgical population had significantly higher RAR of most PSIs evaluated compared with other surgical patients. Development of a PSI was strongly associated with increased length of stay and hospital cost and, in certain PSIs, increased inpatient mortality and 30-day readmission. In this population-based study, certain accountability measures proposed for use as value-based payment modifiers show higher RAR in neurosurgery patients compared with other surgical patients and were subsequently associated with poor outcomes. Our results indicate that for quality improvement efforts, the current AHRQ risk-adjustment models should be viewed in clinically meaningful stratified subgroups: for profiling and pay-for-performance applications, additional factors should be included in the risk-adjustment models. Further evaluation of PSIs in additional high-risk surgeries is needed to better inform the use of these metrics.

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 decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark is recommended.

Perspectives on the Use of Algae as Biological Indicators for Monitoring and Protecting Aquatic Environments, with Special Reference to Malaysian Freshwater Ecosystems

PubMed Central

Omar, Wan Maznah Wan

2010-01-01

Algal communities possess many attributes as biological indicators of spatial and temporal environmental changes. Algal parameters, especially the community structural and functional variables that have been used in biological monitoring programs, are highlighted in this document. Biological indicators like algae have only recently been included in water quality assessments in some areas of Malaysia. The use of algal parameters in identifying various types of water degradation is essential and complementary to other environmental indicators. PMID:24575199

Development and validation of the Chinese version of dry eye related quality of life scale.

PubMed

Zheng, Bang; Liu, Xiao-Jing; Sun, Yue-Qian Fiona; Su, Jia-Zeng; Zhao, Yang; Xie, Zheng; Yu, Guang-Yan

2017-07-17

To develop the Chinese version of quality of life scale for dry eye patients based on the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire and to assess the reliability and validity of the developed scale. The original IDEEL was adapted cross-culturally to Chinese language and further developed following standard procedures. A total of 100 Chinese patients diagnosed with dry eye syndrome were included to investigate the psychometric properties of the Chinese version of scale. Psychometric tests included internal consistency (Cronbach's ɑ coefficients), construct validity (exploratory factor analysis), and known-groups validity (the analysis of variance). The Chinese version of Dry Eye Related Quality of Life (CDERQOL) Scale contains 45 items classified into 5 domains. Good to excellent internal consistency reliability was demonstrated for all 5 domains (Cronbach's ɑ coefficients range from 0.716 to 0.913). Construct validity assessment indicated a consistent factorial structure of the CDERQOL scale with hypothesized construct, with the exception of "Dry Eye Symptom-Bother" domain. All domain scores were detected with significant difference across three severity groups of dry eye patients (P < 0.05) except for "Satisfaction with Treatment" domain, indicating good known-groups validity. The results indicated that the CDERQOL scale is a reliable and valid instrument for patients with dry eye syndrome among Chinese population, and could be used as a supplementary diagnostic and treatment-effectiveness measure.

Transport of Cryptosporidium, Giardia, Source-specific Indicator Organisms, and Standard Water Quality Constituents During Storm Events

NASA Astrophysics Data System (ADS)

Sturdevant-Rees, P. L.; Bourdeau, D.; Baker, R.; Long, S. C.; Barten, P. K.

2004-05-01

Microbial and water-quality measurements are collected during storm events under a variety of meteorological and land-use conditions in order to 1) identify risk of Cryptosporidium oocysts, Giardia cysts and other constituents, including microbial indicator organisms, entering surface waters from various land uses during periods of surface runoff; 2) optimize storm sampling procedures for these parameters; and 3) optimize strategies for accurate determination of constituent loads. The investigation is focused on four isolated land uses: forested with free ranging wildlife, beaver influenced forested with free ranging wildlife, residential/commercial, and dairy farm grazing/pastureland using an upstream and downstream sampling strategy. Traditional water-quality analyses include pH, temperature, turbidity, conductivity, total suspended solids, total phosphorus, total Kjeldahl-nitrogen, and ammonia nitrogen, Giardia cysts and Cryptosporidium oocysts. Total coliforms and fecal coliforms are measured as industry standard microbial analyses. Sorbitol-fermenting Bifidobacteria, Rhodococcus coprophilus, Clostridium perfringens spores, and Somatic and F-specific coliphages are measured at select sites as potential alternative source-specific indicator organisms. Upon completion of the project, the final database will consist of wet weather transport data for a set of parameters during twenty-four distinct storm-events in addition to monthly baseline data. A subset of the results to date will be presented, with focus placed on demonstrating the impact of beaver on constituent loadings over a variety of hydrologic and meteorological conditions.

Bacteria in beach sands: an emerging challenge in protecting coastal water quality and bather health

PubMed Central

Gast, Rebecca J.

2011-01-01

To protect bather health at recreational beaches, fecal indicator bacterial standards are used to monitor water quality, and waters exceeding the standards are subsequently closed to bathers. However beachgoers are also in contact with beach sands, the sanitary quality of which is not included within beach monitoring programs. In fact, sands and sediments provide habitat where fecal bacterial populations may persist, and in some cases grow, in the coastal zone. Specific pathogens are less well studied in beach sands and sediments, but there is a body of evidence that they too may persist in these environments. This paper reviews the current state of knowledge regarding the abundance and distribution of fecal indicator bacteria and pathogens in beach sands of diverse climatological regions, and at beaches subjected to varied levels of anthropogenic impact. In all regions fecal indicator bacteria are nearly ubiquitous in beach sands, and similar relationships emerge between fecal indicator abundance in dry sand, submerged sands, and water. Taken together, these studies contextualize a potential public health issue and identify research questions that must be addressed in order to support future policy decisions. PMID:21162561

Water quality of flow through cured-in-place pipe (CIPP).

DOT National Transportation Integrated Search

2017-02-01

Though this study did not include replication, the preponderance of the data from field and simulated-field experiments indicates that Curedin- : Place Pipe (CIPP), with some care in enforcing the Caltrans specification and delaying the reintroductio...

Measurement of gas and aerosol agricultural emissions

USDA-ARS?s Scientific Manuscript database

Studies of air quality indicate that agricultural emissions may impact particulate mass concentrations through both primary and secondary processes. Agriculture impacts can include primary dust emission, on-facility combustion from vehicles or seasonal field burning, and gaseous emissions from waste...

The association between role overload and women's mental health.

PubMed

Glynn, Keva; Maclean, Heather; Forte, Tonia; Cohen, Marsha

2009-02-01

To determine the importance of role overload (the extent to which a person feels overwhelmed by her total responsibilities) relative to other known social determinants of women's mental health. A Canadian national, random sample, cross-sectional telephone survey in 2003 assessed the association among role overload, types and quality of roles (parent, employee, spouse), sociodemographics, and mental health (using the SF-12) using linear regression. Analysis included 716 women aged 25-54 who indicated that their youngest child living in the household was aged < or =17 years. Perceptions of greater role overload were associated with poorer mental health (p < 0.0001). Women working <35 hours per week (p = 0.04) or 35-40 hours per week (p 5 0.002) reported better mental health than nonemployed women, as did women with the highest annual household income ($70,000+)(p = 0.001). Also associated with better mental health were higher marital status quality scores for both married and single women (p < 0.001), higher job quality scores among employed women (p = 0.02), greater homemaking quality scores among unemployed women (p = 0.03), and women reporting high parental quality (p = 0.04) Role overload showed a stronger relationship to mental health than other sociodemographic variables, including income. Our findings indicate the importance of measuring women's experience of their multiple roles rather than focusing on single roles. More research is warranted on the totality of women's experiences of their many social role obligations.

Effectiveness of Back Massage on Sleep Pattern among Patients with Congestive Cardiac Failure.

PubMed

Sable, Amol; Sivabalan, Thangaraj; Shetti, Akshaya Narayan

2017-01-01

Sleep plays an important role in congestive cardiac failure (CCF). Back massage reduces anxiety, discomfort, and physical suffering in CCF patients. Study objective is to assess sleep pattern in CCF patients before and after back massage. A quasi-experimental study was conducted in Pravara Rural hospital, Loni, India over 4 months in 2016. Thirty CCF patients were included in the study with purposive sampling. Nurse investigator performed 20-min back massage thrice daily, 5 min for each step from the day of admission till discharge. In back massage, effleurage, stroking, kneading, and assessment of effectiveness was recorded using the Pittsburg sleep quality index. Thirty CCF patients were included, out of which individuals aged >65, 56-65, and 35-45 years age group were 40%, 24%, and 13%, respectively. Twenty-four had left and 6 had right heart failure. Distribution of mean and standard deviation of pretest for sleep quality was 9.50 (3.14), indicating poor sleep quality. Posttest, the mean score was 4.47 (0.89), indicating good quality sleep. Eleven patients had >8 h of sleep, 15 patients had 6-8 h of sleep, whereas 4 patients had less than 6 h of sleep pretest. Posttest, 22 patients had >8 h and the remaining had 6-8 h of sleep. Back massage technique is safe and cost-effective in CCF patients, by which the quality and duration of sleep is improved. It can be a part of the standard treatment.

Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach

PubMed Central

Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

2014-01-01

We examine whether a hospital's quality is affected by the quality provided by other hospitals in the same market. We first sketch a theoretical model with regulated prices and derive conditions on demand and cost functions which determine whether a hospital will increase its quality if its rivals increase their quality. We then apply spatial econometric methods to a sample of English hospitals in 2009–10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates, and three patient reported indicators, to examine the relationship between the quality of hospitals. We find that a hospital's quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures. There are no statistically significant negative associations. In those cases where there is a significant positive association, an increase in rivals' quality by 10% increases a hospital's quality by 1.7% to 2.9%. The finding suggests that for some quality measures a policy which improves the quality in one hospital will have positive spillover effects on the quality in other hospitals. PMID:25843994

Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach.

PubMed

Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

2014-11-01

We examine whether a hospital's quality is affected by the quality provided by other hospitals in the same market. We first sketch a theoretical model with regulated prices and derive conditions on demand and cost functions which determine whether a hospital will increase its quality if its rivals increase their quality. We then apply spatial econometric methods to a sample of English hospitals in 2009-10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates, and three patient reported indicators, to examine the relationship between the quality of hospitals. We find that a hospital's quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures. There are no statistically significant negative associations. In those cases where there is a significant positive association, an increase in rivals' quality by 10% increases a hospital's quality by 1.7% to 2.9%. The finding suggests that for some quality measures a policy which improves the quality in one hospital will have positive spillover effects on the quality in other hospitals.

Orion Handling Qualities During ISS Proximity Operations and Docking

NASA Technical Reports Server (NTRS)

Stephens, John-Paul; Vos, Gordon A.; Bilimoria, Karl D.; Mueller, Eric R.; Brazzel, Jack; Spehar, Pete

2011-01-01

NASA's Orion spacecraft is designed to autonomously rendezvous and dock with many vehicles including the International Space Station. However, the crew is able to assume manual control of the vehicle s attitude and flight path. In these instances, Orion must meet handling qualities requirements established by NASA. Two handling qualities assessments were conducted at the Johnson Space Center to evaluate preliminary designs of the vehicle using a six degree of freedom, high-fidelity guidance, navigation, and control simulation. The first assessed Orion s handling qualities during the last 20 ft before docking, and included both steady and oscillatory motions of the docking target. The second focused on manual acquisition of the docking axis during the proximity operations phase and subsequent station-keeping. Cooper-Harper handling qualities ratings, workload ratings and comments were provided by 10 evaluation pilots for the docking study and 5 evaluation pilots for the proximity operations study. For the docking task, both cases received 90% Level 1 (satisfactory) handling qualities ratings, exceeding NASA s requirement. All ratings for the ProxOps task were Level 1. These evaluations indicate that Orion is on course to meet NASA's handling quality requirements for ProxOps and docking.

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

Conservation practice establishment in two northeast Iowa watersheds: Strategies, water quality implications, and lessons learned

USGS Publications Warehouse

Gassman, Philip W.; Tisl, J.A.; Palas, E.A.; Fields, C.L.; Isenhart, T.M.; Schilling, K.E.; Wolter, C.F.; Seigley, L.S.; Helmers, M.J.

2010-01-01

Coldwater trout streams are important natural resources in northeast Iowa. Extensive efforts have been made by state and federal agencies to protect and improve water quality in northeast Iowa streams that include Sny Magill Creek and Bloody Run Creek, which are located in Clayton County. A series of three water quality projects were implemented in Sny Magill Creek watershed during 1988 to 1999, which were supported by multiple agencies and focused on best management practice (BMP) adoption. Water quality monitoring was performed during 1992 to 2001 to assess the impact of these installed BMPs in the Sny Magill Creek watershed using a paired watershed approach, where the Bloody Run Creek watershed served as the control. Conservation practice adoption still occurred in the Bloody Run Creek watershed during the 10-year monitoring project and accelerated after the project ended, when a multiagency supported water quality project was implemented during 2002 to 2007. Statistical analysis of the paired watershed results using a pre/post model indicated that discharge increased 8% in Sny Magill Creek watershed relative to the Bloody Run Creek watershed, turbidity declined 41%, total suspended sediment declined 7%, and NOx-N (nitrate-nitrogen plus nitrite-nitrogen) increased 15%. Similar results were obtained with a gradual change statistical model.The weak sediment reductions and increased NOx-N levels were both unexpected and indicate that dynamics between adopted BMPs and stream systems need to be better understood. Fish surveys indicate that conditions for supporting trout fisheries have improved in both streams. Important lessons to be taken from the overall study include (1) committed project coordinators, agency collaborators, and landowners/producers are all needed for successful water quality projects; (2) smaller watershed areas should be used in paired studies; (3) reductions in stream discharge may be required in these systems in order for significant sediment load decreases to occur; (4) long-term monitoring on the order of decades can be required to detect meaningful changes in water quality in response to BMP implementation; and (5) all consequences of specific BMPs need to be considered when considering strategies for watershed protection.

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

Preanalytical errors in medical laboratories: a review of the available methodologies of data collection and analysis.

PubMed

West, Jamie; Atherton, Jennifer; Costelloe, Seán J; Pourmahram, Ghazaleh; Stretton, Adam; Cornes, Michael

2017-01-01

Preanalytical errors have previously been shown to contribute a significant proportion of errors in laboratory processes and contribute to a number of patient safety risks. Accreditation against ISO 15189:2012 requires that laboratory Quality Management Systems consider the impact of preanalytical processes in areas such as the identification and control of non-conformances, continual improvement, internal audit and quality indicators. Previous studies have shown that there is a wide variation in the definition, repertoire and collection methods for preanalytical quality indicators. The International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety has defined a number of quality indicators for the preanalytical stage, and the adoption of harmonized definitions will support interlaboratory comparisons and continual improvement. There are a variety of data collection methods, including audit, manual recording processes, incident reporting mechanisms and laboratory information systems. Quality management processes such as benchmarking, statistical process control, Pareto analysis and failure mode and effect analysis can be used to review data and should be incorporated into clinical governance mechanisms. In this paper, The Association for Clinical Biochemistry and Laboratory Medicine PreAnalytical Specialist Interest Group review the various data collection methods available. Our recommendation is the use of the laboratory information management systems as a recording mechanism for preanalytical errors as this provides the easiest and most standardized mechanism of data capture.

Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS).

PubMed

Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

2015-01-01

Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait.

Intimate Partner Victimization, Poor Relationship Quality, and Depressive Symptoms during Young Adulthood

PubMed Central

Longmore, Monica A.; Manning, Wendy D.; Giordano, Peggy C.; Copp, Jennifer E.

2014-01-01

Examining longitudinal data from the Toledo Adolescent Relationships Study (TARS) (n = 927), we assessed associations between physical victimization by an intimate partner, indicators of poor relationship quality, and depressive symptoms among young adult men and women in casually dating, exclusively dating, cohabiting, and marital relationships. In zero-order models, we found that physical victimization increased depressive symptoms. In multivariate models, victimization was a risk factor for depressive symptoms with the inclusion of prior depressive symptoms, family factors reflecting the intergenerational transmission of violence, sociodemographic background, and relationship characteristics including union status. Yet with the additional inclusion of indicators of poor relational quality, victimization was not a significant predictor of depressive symptoms. Arguing and poor communication influenced victimization and depressive symptoms. The associations between victimization and depressive symptoms did not differ by gender, nor were the effects of poor relationship quality on depressive symptoms conditional on gender. Thus, depressive symptoms are similarly responsive to intimate partner victimization, and for both women and men these associations were not significant with the inclusion of indicators of poor relationship quality. Findings underscored that victimization often occurs within relationship contexts characterized by a range of negative dynamics; thus multifaceted relationship-centered prevention and intervention efforts are likely to be more useful than those focusing only on negative messages about the use of aggression with an intimate partner. PMID:25131276

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.

Government, politics and health policy: A quantitative analysis of 30 European countries.

PubMed

Mackenbach, Johan P; McKee, Martin

2015-10-01

Public health policies are often dependent on political decision-making, but little is known of the impact of different forms of government on countries' health policies. In this exploratory study we studied the association between a wide range of process and outcome indicators of health policy and four groups of political factors (levels of democracy, e.g. voice and accountability; political representation, e.g. voter turnout; distribution of power, e.g. constraints on the executive; and quality of government, e.g. absence of corruption) in contemporary Europe. Data on 15 aspects of government and 18 indicators of health policy as well as on potential confounders were extracted from harmonized international data sources, covering 30 European countries and the years 1990-2010. In a first step, multivariate regression analysis was used to relate cumulative measures of government to indicators of health policy, and in a second step panel regression with country fixed effects was used to relate changes in selected measures of government to changes in indicators of health policy. In multivariate regression analyses, measures of quality of democracy and quality of government had many positive associations with process and outcome indicators of health policy, while measures of distribution of power and political representation had few and inconsistent associations. Associations for quality of democracy were robust against more extensive control for confounding variables, including tests in panel regressions with country fixed effects, but associations for quality of government were not. In this period in Europe, the predominant political influence on health policy has been the rise of levels of democracy in countries in the Central & Eastern part of the region. In contrast to other areas of public policy, health policy does not appear to be strongly influenced by institutional features of democracy determining the distribution of power, nor by aspects of political representation. The effect of quality of government on health policy warrants more study. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluating the quality of perinatal anxiety information available online.

PubMed

Kirby, Paige L; Reynolds, Kristin A; Walker, John R; Furer, Patricia; Pryor, Teaghan A M

2018-06-22

The Internet is an easily accessible source of information for women experiencing anxiety in pregnancy and/or postpartum to use when seeking health information. However, the Internet has several drawbacks, including inaccurate content that may be perceived as being accurate, non-biased, and evidence-based. Prior research indicates that anxiety and postpartum mental health websites have poor quality in terms of describing treatment options. There is a lack of research and knowledge in the area of perinatal anxiety, and an absence of research evaluating perinatal anxiety websites. The purpose of this study was to evaluate the quality of information regarding perinatal anxiety available on the Internet. Websites concerning perinatal anxiety were selected using the Google search engine. Each website was evaluated based on quality of health information, website usability, and readability. The 20 websites included in this study had low to moderate quality scores based on the DISCERN tool. There were no associations found between website order and website quality, or between website readability and website quality. Many websites had high PEMAT scores for the understandability section, which included content, style, and layout of information; however, most did not use visual aids to enhance comprehension. Most websites had low actionability scores, suggesting that information may not be useful in describing what actions may be taken to manage perinatal anxiety. This study highlights the need for high-quality websites concerning perinatal anxiety that are easy to navigate and provide the public with evidence-based information.

Social media as a sensor of air quality and public response in China.

PubMed

Wang, Shiliang; Paul, Michael J; Dredze, Mark

2015-03-26

Recent studies have demonstrated the utility of social media data sources for a wide range of public health goals, including disease surveillance, mental health trends, and health perceptions and sentiment. Most such research has focused on English-language social media for the task of disease surveillance. We investigated the value of Chinese social media for monitoring air quality trends and related public perceptions and response. The goal was to determine if this data is suitable for learning actionable information about pollution levels and public response. We mined a collection of 93 million messages from Sina Weibo, China's largest microblogging service. We experimented with different filters to identify messages relevant to air quality, based on keyword matching and topic modeling. We evaluated the reliability of the data filters by comparing message volume per city to air particle pollution rates obtained from the Chinese government for 74 cities. Additionally, we performed a qualitative study of the content of pollution-related messages by coding a sample of 170 messages for relevance to air quality, and whether the message included details such as a reactive behavior or a health concern. The volume of pollution-related messages is highly correlated with particle pollution levels, with Pearson correlation values up to .718 (n=74, P<.001). Our qualitative results found that 67.1% (114/170) of messages were relevant to air quality and of those, 78.9% (90/114) were a firsthand report. Of firsthand reports, 28% (32/90) indicated a reactive behavior and 19% (17/90) expressed a health concern. Additionally, 3 messages of 170 requested that action be taken to improve quality. We have found quantitatively that message volume in Sina Weibo is indicative of true particle pollution levels, and we have found qualitatively that messages contain rich details including perceptions, behaviors, and self-reported health effects. Social media data can augment existing air pollution surveillance data, especially perception and health-related data that traditionally requires expensive surveys or interviews.

Quest for quality care and patient safety: the case of Singapore

PubMed Central

Lim, M

2004-01-01



 Quality of care in Singapore has seen a paradigm shift from a traditional focus on structural approaches to a broader multidimensional concept which includes the monitoring of clinical indicators and medical errors. Strong political commitment and institutional capacities have been important factors for making the transition. What is still lacking, however, is a culture of rigorous programme evaluation, public involvement, and patient empowerment. Despite these imperfections, Singapore has made considerable strides and its experience may hold lessons for other small developing countries in the common quest for quality care and patient safety. PMID:14757804

The relations among child quality, family structure, and the value of the mother's time in Malaysia.

PubMed

Leppel, K

1982-10-01

A model of the determinants of child quality and of the value of a woman's time is developed and tested using data from the Malaysian Family Life Survey of 1976-1977. Child quality is measured by educational attainment; factors influencing the value of the mother's time include size and age composition of household, family income, education, and hours worked. The results indicate that size and age composition of household affect a woman's asking wage. However, more data are needed before the effects of family structure on schooling can be measured with confidence.

Perceived Residential Environment Quality Indicators and neighborhood attachment: A confirmation study on a Chinese sample in Chongqing.

PubMed

Mao, Yanhui; Fornara, Ferdinando; Manca, Sara; Bonnes, Mirilia; Bonaiuto, Marino

2015-09-01

This paper concerns people's assessment of their neighborhood of residence in a Chinese urban context. The aim of the study was to verify the factorial structure and the reliability of two instruments originally developed and validated in Italy (the full versions of the Perceived Residential Environment Quality Indicators [PREQIs] and of the Neighborhood Attachment Scale [NAS]) in a different cultural and linguistic context. The instruments consist of 11 scales measuring the PREQIs and one scale measuring neighborhood attachment (NA). The PREQIs scales include items covering four macroevaluative domains of residential environment quality: architectural and urban planning aspects (three scales: Architectural and Town-planning Space, Organization of Accessibility and Roads, Green Areas), sociorelational aspects (one scale: People and Social Relations), functional aspects (four scales: Welfare Services, Recreational Services, Commercial Services, and Transport Services), and contextual aspects (three scales: Pace of Life, Environmental Health, Upkeep and Care). The PREQIs and NAS were included in a self-report questionnaire, which had been translated and back-translated from English to Chinese, and was then administered to 340 residents in six districts (differing along various features) of a highly urbanized context in China, the city of Chongqing. Results confirmed the factorial structure of the scales and demonstrated good internal consistency of the indicators, thus reaffirming the results of previous studies carried out in Western urban contexts. The indicators tapping the neighborhood's contextual aspects (i.e., pace of life, environmental health, and upkeep) emerged as most correlated to NA. © 2015 The Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.

Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth.

PubMed

Chaput, Jean-Philippe; Gray, Casey E; Poitras, Veronica J; Carson, Valerie; Gruber, Reut; Olds, Timothy; Weiss, Shelly K; Connor Gorber, Sarah; Kho, Michelle E; Sampson, Margaret; Belanger, Kevin; Eryuzlu, Sheniz; Callender, Laura; Tremblay, Mark S

2016-06-01

The objective of this systematic review was to examine the relationships between objectively and subjectively measured sleep duration and various health indicators in children and youth aged 5-17 years. Online databases were searched in January 2015 with no date or study design limits. Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth aged 5-17 years), intervention/exposure/comparator (various sleep durations), and outcome (adiposity, emotional regulation, cognition/academic achievement, quality of life/well-being, harms/injuries, and cardiometabolic biomarkers) criteria. Because of high levels of heterogeneity across studies, narrative syntheses were employed. A total of 141 articles (110 unique samples), including 592 215 unique participants from 40 different countries, met inclusion criteria. Overall, longer sleep duration was associated with lower adiposity indicators, better emotional regulation, better academic achievement, and better quality of life/well-being. The evidence was mixed and/or limited for the association between sleep duration and cognition, harms/injuries, and cardiometabolic biomarkers. The quality of evidence ranged from very low to high across study designs and health indicators. In conclusion, we confirmed previous investigations showing that shorter sleep duration is associated with adverse physical and mental health outcomes. However, the available evidence relies heavily on cross-sectional studies using self-reported sleep. To better inform contemporary sleep recommendations, there is a need for sleep restriction/extension interventions that examine the changes in different outcome measures against various amounts of objectively measured sleep to have a better sense of dose-response relationships.

[HYGIENIC JUSTIFICATION OF OPTIMIZATION OF THE INTEGRATED ASSESSMENT OF DRINKING WATER ACCORDING TO THE WATER QUALITY INDEX].

PubMed

Krasovskiy, G N; Rakhmanin, Yu; Egorova, N

2015-01-01

The present study is devoted to theoretical questions of optimization of integrated assessment of the composition and properties of drinking water with the use of the Water Quality Index (WQI) and considering in it all 4 criteria for its hygienic quality-sanitary-toxicological, microbiological, radiation and organoleptic. There is presented a sequence of the analysis of benchmark data of the laboratory study of drinking water, including the selection of priority indices, their distribution into 4 groups according to hygienic criteria, calculations the ratios of real values (C) of indices to their hygiene MPC and the final calculation of the WQI. There is emphasized the importance of classes of hazard of substances, and the need for the special attention to the substances-carcinogens in the integrated assessment of water quality. To overcome the non-equivalence of contributions to the assessment of water quality factors, measured in different units, often disparated in their effect on human health, there are used the principles of combined action at levels below the MCL:C/MPC indices of performance of the unidirectional action are summed (e.g. carcinogenic substances), from indices of the independent action there are selected the most significant ones with the highest values of C/MPC, besides that there are also used counterbalancing factors K determined accordingly to Delphi method, with a maximum values of 5 for carcinogens and the minimum value of 1 for the substances affecting the organoleptic properties ofwater. There is presented the scheme of the final calculation of the value of WQI.

Evaluation of feedback interventions for improving the quality assurance of cancer screening in Japan: study design and report of the baseline survey.

PubMed

Machii, Ryoko; Saika, Kumiko; Higashi, Takahiro; Aoki, Ayako; Hamashima, Chisato; Saito, Hiroshi

2012-02-01

The importance of quality assurance in cancer screening has recently gained increasing attention in Japan. To evaluate and improve quality, checklists and process indicators have been developed. To explore effective methods of enhancing quality in cancer screening, we started a randomized control study of the methods of evaluation and feedback for cancer control from 2009 to 2014. We randomly assigned 1270 municipal governments, equivalent to 71% of all Japanese municipal governments that performed screening programs, into three groups. The high-intensity intervention groups (n = 425) were individually evaluated using both checklist performance and process indicator values, while the low-intensity intervention groups (n= 421) were individually evaluated on the basis of only checklist performance. The control group (n = 424) received only a basic report that included the national average of checklist performance scores. We repeated the survey for each municipality's quality assurance activity performance using checklists and process indicators. In this paper, we report our study design and the result of the baseline survey. The checklist adherence rates were especially low in the checklist elements related to invitation of individuals, detailed monitoring of process indicators such as cancer detection rates according to screening histories and appropriate selection of screening facilities. Screening rate and percentage of examinees who underwent detailed examination tended to be lower for large cities when compared with smaller cities for all cancer sites. The performance of the Japanese cancer screening program in 2009 was identified for the first time.

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 insight into the quality of pharmaceutical care in the Netherlands. The quality of pharmaceutical care improved over time. As of 2012 quality structures were present in at least 80 % of the community pharmacies. Variation in scores on care processes and outcomes between individual pharmacies and over time can initiate future research to better understand and facilitate quality improvement in community pharmacies.

LANDSAT-4 image data quality analysis

NASA Technical Reports Server (NTRS)

Anuta, P. E. (Principal Investigator)

1982-01-01

Work done on evaluating the geometric and radiometric quality of early LANDSAT-4 sensor data is described. Band to band and channel to channel registration evaluations were carried out using a line correlator. Visual blink comparisons were run on an image display to observe band to band registration over 512 x 512 pixel blocks. The results indicate a .5 pixel line misregistration between the 1.55 to 1.75, 2.08 to 2.35 micrometer bands and the first four bands. Also a four 30M line and column misregistration of the thermal IR band was observed. Radiometric evaluation included mean and variance analysis of individual detectors and principal components analysis. Results indicate that detector bias for all bands is very close or within tolerance. Bright spots were observed in the thermal IR band on an 18 line by 128 pixel grid. No explanation for this was pursued. The general overall quality of the TM was judged to be very high.

Study of ceramic products and processing techniques in space. [using computerized simulation

NASA Technical Reports Server (NTRS)

Markworth, A. J.; Oldfield, W.

1974-01-01

An analysis of the solidification kinetics of beta alumina in a zero-gravity environment was carried out, using computer-simulation techniques, in order to assess the feasibility of producing high-quality single crystals of this material in space. The two coupled transport processes included were movement of the solid-liquid interface and diffusion of sodium atoms in the melt. Results of the simulation indicate that appreciable crystal-growth rates can be attained in space. Considerations were also made of the advantages offered by high-quality single crystals of beta alumina for use as a solid electrolyte; these clearly indicate that space-grown materials are superior in many respects to analogous terrestrially-grown crystals. Likewise, economic considerations, based on the rapidly expanding technological applications for beta alumina and related fast ionic conductors, reveal that the many superior qualities of space-grown material justify the added expense and experimental detail associated with space processing.

Dietary and lifestyle quality indices with/without physical activity and markers of insulin resistance in European adolescents: the HELENA study.

PubMed

Jiménez-Pavón, David; Sesé, Maria A; Huybrechts, Inge; Cuenca-García, Magdalena; Palacios, Gonzalo; Ruiz, Jonatan R; Breidenassel, Christina; Leclercq, Catherine; Beghin, Laurent; Plada, Maria; Manios, Yannis; Androutsos, Odysseas; Dallongeville, Jean; Kafatos, Anthony; Widhalm, Kurt; Molnar, Dénes; Moreno, Luis A

2013-11-01

Emerging data indicate that higher levels of insulin resistance (IR) are common among children and adolescents and are related to cardiometabolic risk; therefore, IR requires consideration early in life. In addition, there is a lack of conclusive evidence regarding the role of dietary nutrients on IR. The Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) was conducted in European adolescents aged 12·5–17·5 years. A total of 637 participants with valid homeostasis model assessment (HOMA) index data and who completed at least a 2 d 24 h dietary recall were included in the study (60% of the total HELENA-CSS sample). There were two dietary indices calculated, with the only difference between them being the inclusion or not of physical activity (PA). Markers of IR such as HOMA and the quantitative insulin sensitivity check index (QUICKI) were calculated. Pubertal status, BMI and cardiorespiratory fitness (CRF) were measured as potential confounders. The dietary index including PA was inversely associated with HOMA and directly with the QUICKI in females, but not in males, after adjusting for pubertal status, centre, BMI and CRF. In conclusion, the present study indicates that considering PA as part of the dietary index is of relevance as the resulted index is inversely related to IR independently of potential confounders including CRF. Overall, these findings suggest that intervention studies aimed at preventing IR in young people should focus on increasing the quality of the diet and also on including an optimal PA level in healthy adolescents.

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.

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

PubMed

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

2017-12-13

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

A methodology model for quality management in a general hospital.

PubMed

Stern, Z; Naveh, E

1997-01-01

A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

The impact of care pathways for exacerbation of Chronic Obstructive Pulmonary Disease: rationale and design of a cluster randomized controlled trial

PubMed Central

2010-01-01

Background Hospital treatment of chronic obstructive pulmonary disease (COPD) frequently does not follow published evidences. This lack of adherence can contribute to the high morbidity, mortality and readmissions rates. The European Quality of Care Pathway (EQCP) study on acute exacerbations of COPD (NTC00962468) is undertaken to determine how care pathways (CP) as complex intervention for hospital treatment of COPD affects care variability, adherence to evidence based key interventions and clinical outcomes. Methods An international cluster Randomized Controlled Trial (cRCT) will be performed in Belgium, Italy, Ireland and Portugal. Based on the power analysis, a sample of 40 hospital teams and 398 patients will be included in the study. In the control arm of the study, usual care will be provided. The experimental teams will implement a CP as complex intervention which will include three active components: a formative evaluation of the quality and organization of care, a set of evidence based key interventions, and support on the development and implementation of the CP. The main outcome will be six-month readmission rate. As a secondary endpoint a set of clinical outcome and performance indicators (including care process evaluation and team functioning indicators) will be measured in both groups. Discussion The EQCP study is the first international cRCT on care pathways. The design of the EQCP project is both a research study and a quality improvement project and will include a realistic evaluation framework including process analysis to further understand why and when CP can really work. Trial Registration number NCT00962468 PMID:21092098

Management of the Hospital Environment

ERIC Educational Resources Information Center

Turner, Alvis G.

1976-01-01

Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

Water quality of flow through cured-in-place pipe (CIPP) : final report.

DOT National Transportation Integrated Search

2017-02-01

Though this study did not include replication, the preponderance of the data from field and simulated-field experiments indicates that Curedin-Place : Pipe (CIPP), with some care in enforcing the Caltrans specification and delaying the reintroduction...

Applicability of universal Bacteroidales genetic marker for microbial monitoring of drinking water sources in comparison to conventional indicators.

PubMed

Shahryari, A; Nikaeen, M; Khiadani Hajian, M; Nabavi, F; Hatamzadeh, M; Hassanzadeh, A

2014-11-01

Water quality monitoring is essential for the provision of safe drinking water. In this study, we compared a selection of fecal indicators with universal Bacteroidales genetic marker to identify fecal pollution of a variety of drinking water sources. A total of 60 samples were collected from water sources. The microbiological parameters included total coliforms, fecal coliforms, Escherichia coli and fecal streptococci as the fecal indicator bacteria (FIB), Clostridium perfringens and H2S bacteria as alternative indicators, universal Bacteroidales genetic marker as a promising alternative fecal indicator, and Salmonella spp., Shigella spp., and E. coli O157 as pathogenic bacteria. From 60 samples analyzed, Bacteroidales was the most frequently detected indicator followed by total coliforms. However, the Bacteroidales assay failed to detect the marker in nine samples positive for FIB and other alternative indicators. The results of our study showed that the absence of Bacteroidales is not necessarily an evidence of fecal and pathogenic bacteria absence and may be unable to ensure the safety of the water. Further research, however, is required for a better understanding of the use of a Bacteroidales genetic marker as an indicator in water quality monitoring programs.

Quality measurement in physician-staffed emergency medical services: a systematic literature review.

PubMed

Haugland, Helge; Uleberg, Oddvar; Klepstad, Pål; Krüger, Andreas; Rehn, Marius

2018-05-15

Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.

Strategies for soil quality assessment using VNIR gyperspectral spectroscopy in a western Kenya Chronosequence

USGS Publications Warehouse

Kinoshita, Rintaro; Moebius-Clune, Bianca N.; van Es, Harold M.; Hively, W. Dean; Bilgilis, A. Volkan

2012-01-01

Visible and near-infrared reflectance spectroscopy (VNIRS) is a rapid and nondestructive method that can predict multiple soil properties simultaneously, but its application in multidimensional soil quality (SQ) assessment in the tropics still needs to be further assessed. In this study, VNIRS (350–2500 nm) was employed to analyze 227 air-dried soil samples of Ultisols from a soil chronosequence in western Kenya and assess 16 SQ indicators. Partial least squares regression (PLSR) was validated using the full-site cross-validation method by grouping samples from each farm or forest site. Most suitable models successfully predicted SQ indicators (R2 ≥ 0.80; ratio of performance to deviation [RPD] ≥ 2.00) including soil organic matter (OMLOI), active C, Ca, cation exchange capacity (CEC), and clay. Moderately-well predicted indicators (0.50 ≤ R2 pwp), and field capacity (Θfc). Poorly predicted indicators (R2 < 0.50; RPD < 1.40) were EC, S, P, available water capacity (AWC), K, Zn, and penetration resistance. Combining VNIRS with selected field- and laboratory-measured SQ indicator values increased predictability. Furthermore, VNIRS showed moderate to substantial agreement in predicting interpretive SQ scores and a composite soil quality index (CSQI) especially when combined with directly measured SQ indicator values. In conclusion, VNIRS has good potential for low cost, rapid assessment of physical and biological SQ indicators but conventional soil chemical tests may need to be retained to provide comprehensive SQ assessments.

A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes.

PubMed

Driessen, Sara R C; Van Zwet, Erik W; Haazebroek, Pascal; Sandberg, Evelien M; Blikkendaal, Mathijs D; Twijnstra, Andries R H; Jansen, Frank Willem

2016-12-01

The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance. We report the development and test of a real-time, dynamic, quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality evaluation of yellow peach chips prepared by explosion puffing drying.

PubMed

Lyu, Jian; Zhou, Lin-Yan; Bi, Jin-Feng; Liu, Xuan; Wu, Xin-Ye

2015-12-01

Nineteen evaluation indicators in 15 yellow peach chips prepared by explosion puffing drying were analyzed, including color, rehydration ratio, texture, and so on. The analysis methods of principle component analysis (PCA), analytic hierarchy process (AHP), K-means cluster (KC) and Discriminate analysis (DA) were used to analyze the comprehensive quality of the yellow peach chips. The dispersed coefficient of variation of the 19 evaluation indicators varied from 3.58 to 852.89 %, suggesting significant differences among yellow peach cultivars. The characteristic evaluation indicators, namely, reducing sugar content, out-put ratio, water content, a value and L value were analyzed by PCA, and their weights 0.0429, 0.1140, 0.4816, 1.1807 and 0.1807 were obtained by AHP. The levels in 15 cultivars effectively were classified by discrimination functions which obtained by KC and DA. The results suggested that three levels of comprehensive quality for yellow peach chips were divided, and the highest synthesis scores was observed in "senggelin" (11.1037), while the lowest synthesis value was found in "goldbaby" (-3.7600).

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

Time series study of weather, water quality, and acute gastroenteritis at Water Safety Plan implementation sites in France and Spain

PubMed Central

Setty, Karen E.; Enault, Jerome; Loret, Jean-Francois; Serra, Claudia Puigdomenech; Martin-Alonso, Jordi; Bartram, Jamie

2018-01-01

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, can help drinking water suppliers to proactively identify potential risks and implement preventive barriers that improve safety. Few studies have investigated long-term impacts of WSPs, such as changes in drinking water quality or public health; however, some evidence from high-income countries associates WSP implementation with a reduction in diarrheal disease. To validate the previously observed linkages between WSPs and health outcomes, this time series study examined site-specific relationships between water-related exposures and acute gastroenteritis rates at three locations in France and Spain, including the role of WSP status. Relationships between control or exposure variables and health outcomes were tested using Poisson regression within generalized additive models. Controls included suspected temporal trends in disease reporting. Exposures included temperature, precipitation, raw water quality, and finished water quality (e.g., turbidity, free chlorine). In France, daily acute gastroenteritis cases were tracked using prescription reimbursements; Spanish data aggregated monthly acute gastroenteritis hospital visits. The models identified several significant relationships between indicators of exposure and acute gastroenteritis. Lag times of 6–9 days (including transit time) were most relevant for hydrological indicators (related to precipitation, runoff, and flow) at the two French sites, indicative of viral pathogens. Flush events (defined as surface runoff after a two-week antecedent dry period) linked to nonpoint source pollution were associated with a 10% increase in acute gastroenteritis rates at one location supplied by surface water. Acute gastroenteritis rates were positively associated with elevated turbidity average or maximum values in finished water at locations supplied by both surface and groundwater, by about 4% per 1-NTU increase in the two-week moving average of daily maxima or about 10% per 0.1 NTU increase in the prior month’s average value. In some cases, risk appeared to be mitigated by WSP-related treatment interventions. Our results suggest drinking water exposure is associated with some potentially preventable gastrointestinal illness risk in high-income regions. PMID:29678324

Quality of care in family planning services in Morocco.

PubMed

Brown, L; Tyane, M; Bertrand, J; Lauro, D; Abou-ouakil, M; deMaria, L

1995-01-01

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.

Systematic reviews addressing microsurgical head and neck reconstruction.

PubMed

Momeni, Arash; Jacobson, Joshua Y; Lee, Gordon K

2015-01-01

Systematic reviews frequently form the basis for clinical decision making and guideline development. Yet, the quality of systematic reviews has been variable, thus raising concerns about the validity of their conclusions. In the current study, a quality analysis of systematic reviews was performed, addressing microsurgical head and neck reconstruction. A PubMed search was performed to identify all systematic reviews published up to and including December 2012 in 12 surgical journals. Two authors independently reviewed the literature and extracted data from the included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR. The initial search retrieved 1020 articles. After screening titles and abstracts, 987 articles were excluded. Full-text review of the remaining 33 articles resulted in further exclusion of 18 articles, leaving 15 systematic reviews for final analysis. A marked increase in the number of published systematic reviews over time was noted (P = 0.07). The median AMSTAR score was 5, thus reflecting a "fair" quality. No evidence for improvement in methodological quality over time was noted. The trend to publish more systematic reviews in microsurgical head and neck reconstruction is encouraging. However, efforts are indicated to improve the methodological quality of systematic reviews. Familiarity with criteria of methodological quality is critical to ensure future improvements in the quality of systematic reviews conducted in microsurgery.

Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.

PubMed

Farida, Helmia; Rondags, Angelique; Gasem, M Hussein; Leong, Katharina; Adityana, A; van den Broek, Peterhans J; Keuter, Monique; Natsch, Stephanie

2015-04-01

To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia. Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting. Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting. © 2014 John Wiley & Sons Ltd.

Quality of care after acute coronary syndromes in a prospective cohort with reasons for non-prescription of recommended medications.

PubMed

Auer, Reto; Gencer, Baris; Räber, Lorenz; Klingenberg, Roland; Carballo, Sebastian; Carballo, David; Nanchen, David; Cornuz, Jacques; Vader, John-Paul; Vogt, Pierre; Jüni, Peter; Matter, Christian M; Windecker, Stephan; Lüscher, Thomas Felix; Mach, François; Rodondi, Nicolas

2014-01-01

Adherence to guidelines is associated with improved outcomes of patients with acute coronary syndrome (ACS). Clinical registries developed to assess quality of care at discharge often do not collect the reasons for non-prescription for proven efficacious preventive medication in Continental Europe. In a prospective cohort of patients hospitalized for an ACS, we aimed at measuring the rate of recommended treatment at discharge, using pre-specified quality indicators recommended in cardiologic guidelines and including systematic collection of reasons for non-prescription for preventive medications. In a prospective cohort with 1260 patients hospitalized for ACS, we measured the rate of recommended treatment at discharge in 4 academic centers in Switzerland. Performance measures for medication at discharge were pre-specified according to guidelines, systematically collected for all patients and included in a centralized database. Six hundred and eighty eight patients(54.6%) were discharged with a main diagnosis of STEMI, 491(39%) of NSTEMI and 81(6.4%) of unstable angina. Mean age was 64 years and 21.3% were women. 94.6% were prescribed angiotensin converting enzyme inhibitors/angiotensin II receptor blockers at discharge when only considering raw prescription rates, but increased to 99.5% when including reasons non-prescription. For statins, rates increased from 98% to 98.6% when including reasons for non-prescription and for beta-blockers, from 82% to 93%. For aspirin, rates further increased from 99.4% to 100% and from to 99.8% to 100% for P2Y12 inhibitors. We found a very high adherence to ACS guidelines for drug prescriptions at discharge when including reasons for non-prescription to drug therapy. For beta-blockers, prescription rates were suboptimal, even after taking into account reason for non-prescription. In an era of improving quality of care to achieve 100% prescription rates at discharge unless contra-indicated, pre-specification of reasons for non-prescription for cardiovascular preventive medication permits to identify remaining gaps in quality of care at discharge. ClinicalTrials.gov NCT01000701.

An anaesthesia information management system as a tool for a quality assurance program: 10years of experience.

PubMed

Motamed, Cyrus; Bourgain, Jean Louis

2016-06-01

Anaesthesia Information Management Systems (AIMS) generate large amounts of data, which might be useful for quality assurance programs. This study was designed to highlight the multiple contributions of our AIMS system in extracting quality indicators over a period of 10years. The study was conducted from 2002 to 2011. Two methods were used to extract anaesthesia indicators: the manual extraction of individual files for monitoring neuromuscular relaxation and structured query language (SQL) extraction for other indicators which were postoperative nausea and vomiting (PONV), pain, sedation scores, pain-related medications, scores and postoperative hypothermia. For each indicator, a program of information/meetings and adaptation/suggestions for operating room and PACU personnel was initiated to improve quality assurance, while data were extracted each year. The study included 77,573 patients. The mean overall completeness of data for the initial years ranged from 55 to 85% and was indicator-dependent, which then improved to 95% completeness for the last 5years. The incidence of neuromuscular monitoring was initially 67% and then increased to 95% (P<0.05). The rate of pharmacological reversal remained around 53% throughout the study. Regarding SQL data, an improvement of severe postoperative pain and PONV scores was observed throughout the study, while mild postoperative hypothermia remained a challenge, despite efforts for improvement. The AIMS system permitted the follow-up of certain indicators through manual sampling and many more via SQL extraction in a sustained and non-time-consuming way across years. However, it requires competent and especially dedicated resources to handle the database. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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.

A fuzzy-logic based decision-making approach for identification of groundwater quality based on groundwater quality indices.

PubMed

Vadiati, M; Asghari-Moghaddam, A; Nakhaei, M; Adamowski, J; Akbarzadeh, A H

2016-12-15

Due to inherent uncertainties in measurement and analysis, groundwater quality assessment is a difficult task. Artificial intelligence techniques, specifically fuzzy inference systems, have proven useful in evaluating groundwater quality in uncertain and complex hydrogeological systems. In the present study, a Mamdani fuzzy-logic-based decision-making approach was developed to assess groundwater quality based on relevant indices. In an effort to develop a set of new hybrid fuzzy indices for groundwater quality assessment, a Mamdani fuzzy inference model was developed with widely-accepted groundwater quality indices: the Groundwater Quality Index (GQI), the Water Quality Index (WQI), and the Ground Water Quality Index (GWQI). In an effort to present generalized hybrid fuzzy indices a significant effort was made to employ well-known groundwater quality index acceptability ranges as fuzzy model output ranges rather than employing expert knowledge in the fuzzification of output parameters. The proposed approach was evaluated for its ability to assess the drinking water quality of 49 samples collected seasonally from groundwater resources in Iran's Sarab Plain during 2013-2014. Input membership functions were defined as "desirable", "acceptable" and "unacceptable" based on expert knowledge and the standard and permissible limits prescribed by the World Health Organization. Output data were categorized into multiple categories based on the GQI (5 categories), WQI (5 categories), and GWQI (3 categories). Given the potential of fuzzy models to minimize uncertainties, hybrid fuzzy-based indices produce significantly more accurate assessments of groundwater quality than traditional indices. The developed models' accuracy was assessed and a comparison of the performance indices demonstrated the Fuzzy Groundwater Quality Index model to be more accurate than both the Fuzzy Water Quality Index and Fuzzy Ground Water Quality Index models. This suggests that the new hybrid fuzzy indices developed in this research are reliable and flexible when used in groundwater quality assessment for drinking purposes. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-12-01

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

Groundwater-quality data from the National Water-Quality Assessment Project, January through December 2014 and select quality-control data from May 2012 through December 2014

USGS Publications Warehouse

Arnold, Terri L.; Bexfield, Laura M.; Musgrove, MaryLynn; Lindsey, Bruce D.; Stackelberg, Paul E.; Barlow, Jeannie R.; Desimone, Leslie A.; Kulongoski, Justin T.; Kingsbury, James A.; Ayotte, Joseph D.; Fleming, Brandon J.; Belitz, Kenneth

2017-10-05

Groundwater-quality data were collected from 559 wells as part of the National Water-Quality Assessment Project of the U.S. Geological Survey National Water-Quality Program from January through December 2014. The data were collected from four types of well networks: principal aquifer study networks, which are used to assess the quality of groundwater used for public water supply; land-use study networks, which are used to assess land-use effects on shallow groundwater quality; major aquifer study networks, which are used to assess the quality of groundwater used for domestic supply; and enhanced trends networks, which are used to evaluate the time scales during which groundwater quality changes. Groundwater samples were analyzed for a large number of water-quality indicators and constituents, including major ions, nutrients, trace elements, volatile organic compounds, pesticides, radionuclides, and some constituents of special interest (arsenic speciation, chromium [VI] and perchlorate). These groundwater-quality data, along with data from quality-control samples, are tabulated in this report and in an associated data release.

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

USGS Publications Warehouse

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

2010-01-01

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

Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland.

PubMed

Fekete, Christine; Siegrist, Johannes; Reinhardt, Jan D; Brinkhof, Martin W G

2014-01-01

To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland. Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions. Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18-5.21), comorbidities (OR 2.88, 95% CI 1.83-4.53) and pain (OR 3.32, 95% CI 2.21-4.99), whereas mental health (OR 0.23, 95% CI 0.15-0.36), participation (OR 0.30, 95% CI 0.21-0.43) and quality of life (OR 0.22, 95% CI 0.15-0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00-1.07) and higher quality of life (OR 1.06, 95% CI 1.02-1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship. Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.

Impacts of nutrients and pesticides from small- and large-scale agriculture on the water quality of Lake Ziway, Ethiopia.

PubMed

Teklu, Berhan M; Hailu, Amare; Wiegant, Daniel A; Scholten, Bernice S; Van den Brink, Paul J

2018-05-01

The area around Lake Ziway in Ethiopia is going through a major agricultural transformation with both small-scale farmers and large horticultural companies using pesticides and fertilisers at an increased rate. To be able to understand how this influences the water quality of Lake Ziway, water quality data was gathered to study the dynamics of pesticide concentrations and physicochemical parameters for the years from 2009 to 2015. Results indicate that for some physicochemical parameters, including pH, potassium and iron, over 50 % of the values were above the maximum permissible limit of the Ethiopian standard for drinking water. The fungicide spiroxamine poses a high chronic risk when the water is used for drinking water, while the estimated intake of diazinon was approximately 50 % of the acceptable daily intake. Higher-tier risk assessment indicated that the fungicide spiroxamine poses a high acute risk to aquatic organisms, while possible acute risks were indicated for the insecticides deltamethrin and endosulfan. Longer-term monitoring needs to be established to show the water quality changes across time and space, and the current study can be used as a baseline measurement for further research in the area as well as an example for other surface water systems in Ethiopia and Africa.

Optimization of contrast-enhanced spectral mammography depending on clinical indication

PubMed Central

Dromain, Clarisse; Canale, Sandra; Saab-Puong, Sylvie; Carton, Ann-Katherine; Muller, Serge; Fallenberg, Eva Maria

2014-01-01

Abstract. The objective is to optimize low-energy (LE) and high-energy (HE) exposure parameters of contrast-enhanced spectral mammography (CESM) examinations in four different clinical applications for which different levels of average glandular dose (AGD) and ratios between LE and total doses are required. The optimization was performed on a Senographe DS with a SenoBright® upgrade. Simulations were performed to find the optima by maximizing the contrast-to-noise ratio (CNR) on the recombined CESM image using different targeted doses and LE image quality. The linearity between iodine concentration and CNR as well as the minimal detectable iodine concentration was assessed. The image quality of the LE image was assessed on the CDMAM contrast-detail phantom. Experiments confirmed the optima found on simulation. The CNR was higher for each clinical indication than for SenoBright®, including the screening indication for which the total AGD was 22% lower. Minimal iodine concentrations detectable in the case of a 3-mm-diameter round tumor were 12.5% lower than those obtained for the same dose in the clinical routine. LE image quality satisfied EUREF acceptable limits for threshold contrast. This newly optimized set of acquisition parameters allows increased contrast detectability compared to parameters currently used without a significant loss in LE image quality. PMID:26158058

Optimization of contrast-enhanced spectral mammography depending on clinical indication.

PubMed

Dromain, Clarisse; Canale, Sandra; Saab-Puong, Sylvie; Carton, Ann-Katherine; Muller, Serge; Fallenberg, Eva Maria

2014-10-01

The objective is to optimize low-energy (LE) and high-energy (HE) exposure parameters of contrast-enhanced spectral mammography (CESM) examinations in four different clinical applications for which different levels of average glandular dose (AGD) and ratios between LE and total doses are required. The optimization was performed on a Senographe DS with a SenoBright® upgrade. Simulations were performed to find the optima by maximizing the contrast-to-noise ratio (CNR) on the recombined CESM image using different targeted doses and LE image quality. The linearity between iodine concentration and CNR as well as the minimal detectable iodine concentration was assessed. The image quality of the LE image was assessed on the CDMAM contrast-detail phantom. Experiments confirmed the optima found on simulation. The CNR was higher for each clinical indication than for SenoBright®, including the screening indication for which the total AGD was 22% lower. Minimal iodine concentrations detectable in the case of a 3-mm-diameter round tumor were 12.5% lower than those obtained for the same dose in the clinical routine. LE image quality satisfied EUREF acceptable limits for threshold contrast. This newly optimized set of acquisition parameters allows increased contrast detectability compared to parameters currently used without a significant loss in LE image quality.

Meeting the ambition of measuring the quality of hospitals' stroke care using routinely collected administrative data: a feasibility study.

PubMed

Palmer, William L; Bottle, Alex; Davie, Charlie; Vincent, Charles A; Aylin, Paul

2013-09-01

To examine the potential for using routinely collected administrative data to compare the quality and safety of stroke care at a hospital level, including evaluating any bias due to variations in coding practice. A retrospective cohort study of English hospitals' performance against six process and outcome indicators covering the acute care pathway. We used logistic regression to adjust the outcome measures for case mix. Hospitals in England. Stroke patients (ICD-10 I60-I64) admitted to English National Health Service public acute hospitals between April 2009 and March 2010, accounting for 91 936 admissions. The quality and safety were measured using six indicators spanning the hospital care pathway, from timely access to brain scans to emergency readmissions following discharge after stroke. There were 182 occurrences of hospitals performing statistically differently from the national average at the 99.8% significance level across the six indicators. Differences in coding practice appeared to only partially explain the variation. Hospital administrative data provide a practical and achievable method for evaluating aspects of stroke care across the acute pathway. However, without improvements in coding and further validation, it is unclear whether the cause of the variation is the quality of care or the result of different local care pathways and data coding accuracy.

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.

Identifying the most significant indicators of the total road safety performance index.

PubMed

Tešić, Milan; Hermans, Elke; Lipovac, Krsto; Pešić, Dalibor

2018-04-01

The review of the national and international literature dealing with the assessment of the road safety level has shown great efforts of the authors who tried to define the methodology for calculating the composite road safety index on a territory (region, state, etc.). The procedure for obtaining a road safety composite index of an area has been largely harmonized. The question that has not been fully resolved yet concerns the selection of indicators. There is a wide range of road safety indicators used to show a road safety situation on a territory. Road safety performance index (RSPI) obtained on the basis of a larger number of safety performance indicators (SPIs) enable decision makers to more precisely define the earlier goal- oriented actions. However, recording a broader comprehensive set of SPIs helps identify the strengths and weaknesses of a country's road safety system. Providing high quality national and international databases that would include comparable SPIs seems to be difficult since a larger number of countries dispose of a small number of identical indicators available for use. Therefore, there is a need for calculating a road safety performance index with a limited number of indicators (RSPI ln n ) which will provide a comparison of a sufficient quality, of as many countries as possible. The application of the Data Envelopment Analysis (DEA) method and correlative analysis has helped to check if the RSPI ln n is likely to be of sufficient quality. A strong correlation between the RSPI ln n and the RSPI has been identified using the proposed methodology. Based on this, the most contributing indicators and methodologies for gradual monitoring of SPIs, have been defined for each country analyzed. The indicator monitoring phases in the analyzed countries have been defined in the following way: Phase 1- the indicators relating to alcohol, speed and protective systems; Phase 2- the indicators relating to roads and Phase 3- the indicators relating to trauma management. This will help achieve the standardization of indicators including data collection procedures and selection of the key list of indicators that need to be monitored. Based on the results, it has been concluded that the use of the most contributing indicators will make it possible to assess the level of road safety on a territory, with an acceptable quality score by focusing on the low-ranked countries. A smaller set of significant indicators defined in this manner can serve for a fast and simple understanding of a road safety situation and assessment of effects of measures undertaken. Also, this universal index approach is applicable in cases when a broader comprehensive set of indicators is analyzed, which provides a more accurate identification of weaker points and rank the countries in a more meaningful way. Copyright © 2018 Elsevier Ltd. All rights reserved.

The new health-care quality: value, outcomes, and continuous improvement.

PubMed

O'Connor, S J; Lanning, J A

1991-01-01

No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

Assessment of Water-Quality Monitoring and a Proposed Water-Quality Monitoring Network for the Mosquito Lagoon Basin, East-Central Florida

USGS Publications Warehouse

Kroening, Sharon E.

2008-01-01

Surface- and ground-water quality data from the Mosquito Lagoon Basin were compiled and analyzed to: (1) describe historical and current monitoring in the basin, (2) summarize surface- and ground-water quality conditions with an emphasis on identifying areas that require additional monitoring, and (3) develop a water-quality monitoring network to meet the goals of Canaveral National Seashore (a National Park) and to fill gaps in current monitoring. Water-quality data were compiled from the U.S. Environmental Protection Agency's STORET system, the U.S. Geological Survey's National Water Information System, or from the agency which collected the data. Most water-quality monitoring focused on assessing conditions in Mosquito Lagoon. Significant spatial and/or seasonal variations in water-quality constituents in the lagoon were quantified for pH values, fecal coliform bacteria counts, and concentrations of dissolved oxygen, total nitrogen, total phosphorus, chlorophyll-a, and total suspended solids. Trace element, pesticide, and ground-water-quality data were more limited. Organochlorine insecticides were the major class of pesticides analyzed. A surface- and ground-water-quality monitoring network was designed for the Mosquito Lagoon Basin which emphasizes: (1) analysis of compounds indicative of human activities, including pesticides and other trace organic compounds present in domestic and industrial waste; (2) greater data collection in the southern part of Mosquito Lagoon where spatial variations in water-quality constituents were quantified; and (3) additional ground-water-quality data collection in the surficial aquifer system and Upper Floridan aquifer. Surface-water-quality data collected as part of this network would include a fixed-station monitoring network of eight sites in the southern part of the basin, including a canal draining Oak Hill. Ground-water quality monitoring should be done routinely at about 20 wells in the surficial aquifer system and Upper Floridan aquifer, distributed between developed and undeveloped parts of the basin. Water samples collected should be analyzed for a wide range of constituents, including physical properties, nutrients, suspended sediment, and constituents associated with increased urban development such as pesticides, other trace organic compounds associated with domestic and industrial waste, and trace elements.