Quality in Web-Supported Learning.

ERIC Educational Resources Information Center

Fresen, Jill

2002-01-01

Discusses quality assurance for Web-based courses, based on experiences at the University of Pretoria. Topics include evaluation of courseware; the concept of quality, including quality control, quality assurance, and total quality management; implementing a quality management system; measurement techniques; and partnerships. (LRW)

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

PubMed

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

2017-01-01

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

Linking Quality and Spending to Measure Value for People with Serious Illness.

PubMed

Ryan, Andrew M; Rodgers, Phillip E

2018-03-01

Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.

Linking Quality and Spending to Measure Value for People with Serious Illness

PubMed Central

Rodgers, Phillip E.

2018-01-01

Abstract Background: Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. Objective: To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. Design: We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Results: Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending—or are likely to within the next few years—the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. Conclusions: We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs. PMID:29091529

Data envelopment analysis in service quality evaluation: an empirical study

NASA Astrophysics Data System (ADS)

Najafi, Seyedvahid; Saati, Saber; Tavana, Madjid

2015-09-01

Service quality is often conceptualized as the comparison between service expectations and the actual performance perceptions. It enhances customer satisfaction, decreases customer defection, and promotes customer loyalty. Substantial literature has examined the concept of service quality, its dimensions, and measurement methods. We introduce the perceived service quality index (PSQI) as a single measure for evaluating the multiple-item service quality construct based on the SERVQUAL model. A slack-based measure (SBM) of efficiency with constant inputs is used to calculate the PSQI. In addition, a non-linear programming model based on the SBM is proposed to delineate an improvement guideline and improve service quality. An empirical study is conducted to assess the applicability of the method proposed in this study. A large number of studies have used DEA as a benchmarking tool to measure service quality. These models do not propose a coherent performance evaluation construct and consequently fail to deliver improvement guidelines for improving service quality. The DEA models proposed in this study are designed to evaluate and improve service quality within a comprehensive framework and without any dependency on external data.

Quality Measures for the Care of Patients with Insomnia

PubMed Central

Edinger, Jack D.; Buysse, Daniel J.; Deriy, Ludmila; Germain, Anne; Lewin, Daniel S.; Ong, Jason C.; Morgenthaler, Timothy I.

2015-01-01

The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia. Citation: Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Quality measures for the care of patients with insomnia. J Clin Sleep Med 2015;11(3):311–334. PMID:25700881

Sleeping well, aging well: a descriptive and cross-sectional study of sleep in "successful agers" 75 and older.

PubMed

Driscoll, Henry C; Serody, Linda; Patrick, Susan; Maurer, Jennifer; Bensasi, Salem; Houck, Patricia R; Mazumdar, Sati; Nofzinger, Eric A; Bell, Bethany; Nebes, Robert D; Miller, Mark D; Reynolds, Charles F

2008-01-01

To examine diary-based, laboratory-based, and actigraphic measures of sleep in a group of healthy older women and men (> or =75 years of age) without sleep/wake complaints and to describe sleep characteristics which may be correlates of health-related quality of life in old age. Cross-sectional, descriptive study. University-based sleep and chronobiology program. None. Sixty-four older adults (30 women, 34 men; mean age 79). We used diary-, actigraphic-, and laboratory-based measures of sleep, health-related quality of life, mental health, social support, and coping strategies. We used two-group t-tests to compare baseline demographic and clinical measures between men and women, followed by ANOVA on selected EEG measures to examine first-night effects as evidence of physiological adaptability. Finally, we examined correlations between measure of sleep and health-related quality of life. We observed that healthy men and women aged 75 and older can experience satisfactory nocturnal sleep quality and daytime alertness, especially as reflected in self-report and diary-based measures. Polysomnography (psg) suggested the presence of a first-night effect, especially in men, consistent with continued normal adaptability in this cohort of healthy older adults. Continuity and depth of sleep in older women were superior to that of men. Diary-based measures of sleep quality (but not psg measures) correlated positively (small to moderate effect sizes) with physical and mental health-related quality of life. Sleep quality and daytime alertness in late life may be more important aspects of successful aging than previously appreciated. Good sleep may be a marker of good functioning across a variety of domains in old age. Our observations suggest the need to study interventions which protect sleep quality in older adults to determine if doing so fosters continued successful aging.

Empirical Assessment of the Impact of Low-Cost Generic Programs on Adherence-Based Quality Measures

PubMed Central

Pauly, Nathan J.; Talbert, Jeffery C.; Brown, Joshua D.

2017-01-01

In the United States, federally-funded health plans are mandated to measure the quality of care. Adherence-based medication quality metrics depend on completeness of administrative claims data for accurate measurement. Low-cost generic programs (LCGPs) cause medications fills to be missing from claims data as medications are not adjudicated through a patient’s insurance. This study sought to assess the magnitude of the impact of LCGPs on these quality measures. Data from the 2012–2013 Medical Expenditure Panel Survey (MEPS) were used. Medication fills for select medication classes were classified as LCGP fills and individuals were classified as never, sometimes, and always users of LCGPs. Individuals were classified based on insurance type (private, Medicare, Medicaid, dual-eligible). The proportion of days covered (PDC) was calculated for each medication class and the proportion of users with PDC ≥ 0.80 was reported as an observed metric for what would be calculated based on claims data and a true metric which included missing medication fills due to LCGPs. True measures of adherence were higher than the observed measures. The effect’s magnitude was highest for private insurance and for medication classes utilized more often through LCGPs. Thus, medication-based quality measures may be underestimated due to LCGPs. PMID:28970427

Design and Testing of an Air Force Services Mystery Shopping Program.

DTIC Science & Technology

1998-11-01

Base level Air Force Services’ lodging and foodservice activities use limited service quality measurement tools to determine customer perceptions of... service quality . These tools, specifically management observation and customer comment cards, do not provide a complete picture of service quality . Other... service quality measurement methods such as mystery shopping are rarely used. Bases do not consider using mystery shopping programs because of the

Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society.

PubMed

Rudmik, Luke; Mattos, Jose; Schneider, John; Manes, Peter R; Stokken, Janalee K; Lee, Jivianne; Higgins, Thomas S; Schlosser, Rodney J; Reh, Douglas D; Setzen, Michael; Soler, Zachary M

2017-09-01

Measuring quality outcomes is an important prerequisite to improve quality of care. Rhinosinusitis represents a high value target to improve quality of care because it has a high prevalence of disease, large economic burden, and large practice variation. In this study we review the current state of quality measurement for management of both acute (ARS) and chronic rhinosinusitis (CRS). The major national quality metric repositories and clearinghouses were queried. Additional searches included the American Academy of Otolaryngology-Head and Neck Surgery database, PubMed, and Google to attempt to capture any additional quality metrics. Seven quality metrics for ARS and 4 quality metrics for CRS were identified. ARS metrics focused on appropriateness of diagnosis (n = 1), antibiotic prescribing (n = 4), and radiologic imaging (n = 2). CRS quality metrics focused on appropriateness of diagnosis (n = 1), radiologic imaging (n = 1), and measurement of patient quality of life (n = 2). The Physician Quality Reporting System (PQRS) currently tracks 3 ARS quality metrics and 1 CRS quality metric. There are no outcome-based rhinosinusitis quality metrics and no metrics that assess domains of safety, patient-centeredness, and timeliness of care. The current status of quality measurement for rhinosinusitis has focused primarily on the quality domain of efficiency and process measures for ARS. More work is needed to develop, validate, and track outcome-based quality metrics along with CRS-specific metrics. Although there has been excellent work done to improve quality measurement for rhinosinusitis, there remain major gaps and challenges that need to be considered during the development of future metrics. © 2017 ARS-AAOA, LLC.

Measuring Customer Satisfaction and Quality of Service in Special Libraries.

ERIC Educational Resources Information Center

White, Marilyn Domas; Abels, Eileen G.; Nitecki, Danuta

This project tested the appropriateness of SERVQUAL (i.e., an instrument widely used in the service industry for assessing service quality based on repeated service encounters rather than a particular service encounter) to measure service quality in special libraries and developed a modified version for special libraries. SERVQUAL is based on an…

Can high quality overcome consumer resistance to restricted provider access? Evidence from a health plan choice experiment.

PubMed

Harris, Katherine M

2002-06-01

To investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. A survey administered to respondents between the ages of 25 and 64 in the West Los Angeles area with private health insurance. An experimental approach is used to measure the effect of variation in provider network features and information about the quality of network physicians on hypothetical plan choices. Conditional logit models are used to analyze the experimental choice data. Next, choice model parameter estimates are used to simulate the impact of changes in plan features on the market shares of competing health plans and to calculate the quality level required to make consumers indifferent to changes in provider access. The presence of quality information reduced the importance of provider network features in plan choices as hypothesized. However, there were not statistically meaningful differences by type of quality measure (i.e., consumer assessed versus expert assessed). The results imply that large quality differences are required to make consumers indifferent to changes in provider access. The impact of quality on plan choices depended more on the particular measure and less on the type of measure. Quality ratings based on the proportion of survey respondents "extremely satisfied with results of care" had the greatest impact on plan choice while the proportion of network doctors "affiliated with university medical centers" had the least. Other consumer and expert assessed measures had more comparable effects. Overall the results provide empirical evidence that consumers are willing to trade high quality for restrictions on provider access. This willingness to trade implies that relatively small plans that place restrictions on provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, the results of this study suggest that in many cases, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable. The results provide empirical support for the current focus of decision support efforts on consumer assessed quality measures. At the same time, however, the results suggest that consumers would also value quality measures based on expert assessments. This finding is relevant given the lack of comparative quality information based on expert judgment and research suggesting that consumers have apprehensions about their ability to meaningfully interpret performance-based quality measures.

Integrating automated support for a software management cycle into the TAME system

NASA Technical Reports Server (NTRS)

Sunazuka, Toshihiko; Basili, Victor R.

1989-01-01

Software managers are interested in the quantitative management of software quality, cost and progress. An integrated software management methodology, which can be applied throughout the software life cycle for any number purposes, is required. The TAME (Tailoring A Measurement Environment) methodology is based on the improvement paradigm and the goal/question/metric (GQM) paradigm. This methodology helps generate a software engineering process and measurement environment based on the project characteristics. The SQMAR (software quality measurement and assurance technology) is a software quality metric system and methodology applied to the development processes. It is based on the feed forward control principle. Quality target setting is carried out before the plan-do-check-action activities are performed. These methodologies are integrated to realize goal oriented measurement, process control and visual management. A metric setting procedure based on the GQM paradigm, a management system called the software management cycle (SMC), and its application to a case study based on NASA/SEL data are discussed. The expected effects of SMC are quality improvement, managerial cost reduction, accumulation and reuse of experience, and a highly visual management reporting system.

A proteomics performance standard to support measurement quality in proteomics.

PubMed

Beasley-Green, Ashley; Bunk, David; Rudnick, Paul; Kilpatrick, Lisa; Phinney, Karen

2012-04-01

The emergence of MS-based proteomic platforms as a prominent technology utilized in biochemical and biomedical research has increased the need for high-quality MS measurements. To address this need, National Institute of Standards and Technology (NIST) reference material (RM) 8323 yeast protein extract is introduced as a proteomics quality control material for benchmarking the preanalytical and analytical performance of proteomics-based experimental workflows. RM 8323 yeast protein extract is based upon the well-characterized eukaryote Saccharomyces cerevisiae and can be utilized in the design and optimization of proteomics-based methodologies from sample preparation to data analysis. To demonstrate its utility as a proteomics quality control material, we coupled LC-MS/MS measurements of RM 8323 with the NIST MS Quality Control (MSQC) performance metrics to quantitatively assess the LC-MS/MS instrumentation parameters that influence measurement accuracy, repeatability, and reproducibility. Due to the complexity of the yeast proteome, we also demonstrate how NIST RM 8323, along with the NIST MSQC performance metrics, can be used in the evaluation and optimization of proteomics-based sample preparation methods. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Value-based medicine: evidence-based medicine and beyond.

PubMed

Brown, Gary C; Brown, Melissa M; Sharma, Sanjay

2003-09-01

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

Composite measures of watershed health from a water quality perspective.

PubMed

Mallya, Ganeshchandra; Hantush, Mohamed; Govindaraju, Rao S

2018-05-15

Water quality data at gaging stations are typically compared with established federal, state, or local water quality standards to determine if violations (concentrations of specific constituents falling outside acceptable limits) have occurred. Based on the frequency and severity of water quality violations, risk metrics such as reliability, resilience, and vulnerability (R-R-V) are computed for assessing water quality-based watershed health. In this study, a modified methodology for computing R-R-V measures is presented, and a new composite watershed health index is proposed. Risk-based assessments for different water quality parameters are carried out using identified national sampling stations within the Upper Mississippi River Basin, the Maumee River Basin, and the Ohio River Basin. The distributional properties of risk measures with respect to water quality parameters are reported. Scaling behaviors of risk measures using stream order, specifically for the watershed health (WH) index, suggest that WH values increased with stream order for suspended sediment concentration, nitrogen, and orthophosphate in the Upper Mississippi River Basin. Spatial distribution of risk measures enable identification of locations exhibiting poor watershed health with respect to the chosen numerical standard, and the role of land use characteristics within the watershed. Copyright © 2018 Elsevier Ltd. All rights reserved.

The quality of instruments to assess the process of shared decision making: A systematic review.

PubMed

Gärtner, Fania R; Bomhof-Roordink, Hanna; Smith, Ian P; Scholl, Isabelle; Stiggelbout, Anne M; Pieterse, Arwen H

2018-01-01

To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.

Assessing the Quality of Problems in Problem-Based Learning

ERIC Educational Resources Information Center

Sockalingam, Nachamma; Rotgans, Jerome; Schmidt, Henk

2012-01-01

This study evaluated the construct validity and reliability of a newly devised 32-item problem quality rating scale intended to measure the quality of problems in problem-based learning. The rating scale measured the following five characteristics of problems: the extent to which the problem (1) leads to learning objectives, (2) is familiar, (3)…

Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

PubMed

McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

2013-01-01

In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

Quality evaluation on an e-learning system in continuing professional education of nurses.

PubMed

Lin, I-Chun; Chien, Yu-Mei; Chang, I-Chiu

2006-01-01

Maintaining high quality in Web-based learning is a powerful means of increasing the overall efficiency and effectiveness of distance learning. Many studies have evaluated Web-based learning but seldom evaluate from the information systems (IS) perspective. This study applied the famous IS Success model in measuring the quality of a Web-based learning system using a Web-based questionnaire for data collection. One hundred and fifty four nurses participated in the survey. Based on confirmatory factor analysis, the variables of the research model fit for measuring the quality of a Web-based learning system. As Web-based education continues to grow worldwide, the results of this study may assist the system adopter (hospital executives), the learner (nurses), and the system designers in making reasonable and informed judgments with regard to the quality of Web-based learning system in continuing professional education.

Challenges and Opportunities in Using Patient-Reported Outcomes in Quality Measurement in Rheumatology

PubMed Central

Wahl, Elizabeth; Yazdany, Jinoos

2016-01-01

Summary Use of Patient-reported outcome measures (PROs) in rheumatology research is widespread, but use of PRO data to evaluate the quality of rheumatologic care delivered is less well established. This article reviews the use of PROs in assessing healthcare quality, and highlights challenges and opportunities specific to their use in rheumatology quality measurement. We first explore other countries’ experiences collecting and evaluating national PRO data to assess quality of care. We describe the current use of PROs as quality measures in rheumatology, and frame an agenda for future work supporting development of meaningful quality measures based on PROs. PMID:27133495

Individualization and quality improvement: two new scales to complement measurement of program fidelity.

PubMed

Bond, Gary R; Drake, Robert E; Rapp, Charles A; McHugo, Gregory J; Xie, Haiyi

2009-09-01

Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.

Towards the XML schema measurement based on mapping between XML and OO domain

NASA Astrophysics Data System (ADS)

Rakić, Gordana; Budimac, Zoran; Heričko, Marjan; Pušnik, Maja

2017-07-01

Measuring quality of IT solutions is a priority in software engineering. Although numerous metrics for measuring object-oriented code already exist, measuring quality of UML models or XML Schemas is still developing. One of the research questions in the overall research leaded by ideas described in this paper is whether we can apply already defined object-oriented design metrics on XML schemas based on predefined mappings. In this paper, basic ideas for mentioned mapping are presented. This mapping is prerequisite for setting the future approach to XML schema quality measuring with object-oriented metrics.

SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

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

Olch, A

2015-06-15

Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Elevenmore » neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has provded a license for the software described.« less

Toward the Development of Integrative Risk-Adjusted Measures of Quality Using Large Clinical Data Bases: The Case of Anesthesia Services.

ERIC Educational Resources Information Center

Fleming, Steven T.

1992-01-01

The concept of risk-adjusted measures of quality is discussed, and a methodology is proposed for risk-adjusting and integrating multiple adverse outcomes of anesthesia services into measures for quality assurance and quality improvement programs. Although designed for a new anesthesiology database, the methods should apply to other health…

Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from a Health Plan Choice Experiment

PubMed Central

Harris, Katherine M

2002-01-01

Objective To investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. Data Sources and Setting A survey administered to respondents between the ages of 25 and 64 in the West Los Angeles area with private health insurance. Study Design An experimental approach is used to measure the effect of variation in provider network features and information about the quality of network physicians on hypothetical plan choices. Conditional logit models are used to analyze the experimental choice data. Next, choice model parameter estimates are used to simulate the impact of changes in plan features on the market shares of competing health plans and to calculate the quality level required to make consumers indifferent to changes in provider access. Principal Findings The presence of quality information reduced the importance of provider network features in plan choices as hypothesized. However, there were not statistically meaningful differences by type of quality measure (i.e., consumer assessed versus expert assessed). The results imply that large quality differences are required to make consumers indifferent to changes in provider access. The impact of quality on plan choices depended more on the particular measure and less on the type of measure. Quality ratings based on the proportion of survey respondents “extremely satisfied with results of care” had the greatest impact on plan choice while the proportion of network doctors “affiliated with university medical centers” had the least. Other consumer and expert assessed measures had more comparable effects. Conclusions Overall the results provide empirical evidence that consumers are willing to trade high quality for restrictions on provider access. This willingness to trade implies that relatively small plans that place restrictions on provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, the results of this study suggest that in many cases, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable. The results provide empirical support for the current focus of decision support efforts on consumer assessed quality measures. At the same time, however, the results suggest that consumers would also value quality measures based on expert assessments. This finding is relevant given the lack of comparative quality information based on expert judgment and research suggesting that consumers have apprehensions about their ability to meaningfully interpret performance-based quality measures. PMID:12132595

Optical classification for quality and defect analysis of train brakes

NASA Astrophysics Data System (ADS)

Glock, Stefan; Hausmann, Stefan; Gerke, Sebastian; Warok, Alexander; Spiess, Peter; Witte, Stefan; Lohweg, Volker

2009-06-01

In this paper we present an optical measurement system approach for quality analysis of brakes which are used in high-speed trains. The brakes consist of the so called brake discs and pads. In a deceleration process the discs will be heated up to 500°C. The quality measure is based on the fact that the heated brake discs should not generate hot spots inside the brake material. Instead, the brake disc should be heated homogeneously by the deceleration. Therefore, it makes sense to analyze the number of hot spots and their relative gradients to create a quality measure for train brakes. In this contribution we present a new approach for a quality measurement system which is based on an image analysis and classification of infra-red based heat images. Brake images which are represented in pseudo-color are first transformed in a linear grayscale space by a hue-saturation-intensity (HSI) space. This transform is necessary for the following gradient analysis which is based on gray scale gradient filters. Furthermore, different features based on Haralick's measures are generated from the gray scale and gradient images. A following Fuzzy-Pattern-Classifier is used for the classification of good and bad brakes. It has to be pointed out that the classifier returns a score value for each brake which is between 0 and 100% good quality. This fact guarantees that not only good and bad bakes can be distinguished, but also their quality can be labeled. The results show that all critical thermal patterns of train brakes can be sensed and verified.

Video quality assesment using M-SVD

NASA Astrophysics Data System (ADS)

Tao, Peining; Eskicioglu, Ahmet M.

2007-01-01

Objective video quality measurement is a challenging problem in a variety of video processing application ranging from lossy compression to printing. An ideal video quality measure should be able to mimic the human observer. We present a new video quality measure, M-SVD, to evaluate distorted video sequences based on singular value decomposition. A computationally efficient approach is developed for full-reference (FR) video quality assessment. This measure is tested on the Video Quality Experts Group (VQEG) phase I FR-TV test data set. Our experiments show the graphical measure displays the amount of distortion as well as the distribution of error in all frames of the video sequence while the numerical measure has a good correlation with perceived video quality outperforms PSNR and other objective measures by a clear margin.

Impact of the present-on-admission indicator on hospital quality measurement: experience with the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators.

PubMed

Glance, Laurent G; Osler, Turner M; Mukamel, Dana B; Dick, Andrew W

2008-02-01

The Agency for Healthcare Research and Quality (AHRQ) has constructed Inpatient Quality Indicator (IQI) mortality measures to measure hospital quality using routinely available administrative data. With the exception of California, New York State, and Wisconsin, administrative data do not include a present-on-admission (POA) indicator to distinguish between preexisting conditions and complications. The extent to which the lack of a POA indicator biases quality assessment based on the AHRQ mortality measures is unknown. To examine the impact of the POA indicator on hospital quality assessment based on the AHRQ mortality measures using enhanced administrative data from California, which includes a POA indicator. Retrospective cohort study based on 2.07 million inpatient admissions between 1998 and 2000 in the California State Inpatient Database. The AHRQ IQI software was used to calculate risk-adjusted mortality rates using either (1) routine administrative data that included all the International Classification of Diseases (ICD)-9-CM codes or (2) enhanced administrative data that included only the ICD-9-CM codes representing preexisting conditions. The inclusion of the POA indicator frequently results in changes in the quality ranking of hospitals classified as high-quality or low-quality using routine administrative data. Twenty-seven percent (stroke) to 94% (coronary artery bypass graft) of hospitals classified as high-quality using routine administrative data were reclassified as intermediate- or low-quality hospitals using the enhanced administrative data. Twenty-five percent (congestive heart failure) to 76% (percutaneous coronary intervention) of hospitals classified as low-quality hospitals using enhanced administrative data were misclassified as intermediate-quality hospitals using routine administrative data. Despite the fact that the AHRQ IQIs were primarily intended to serve as a screening tool, they are being increasingly used to publicly report hospital quality. Our findings emphasize the need to improve the "quality" of administrative data by including a POA indicator if these data are to serve as the information infrastructure for quality reporting.

The Attributive Theory of Quality: A Model for Quality Measurement in Higher Education.

ERIC Educational Resources Information Center

Afshar, Arash

A theoretical basis for defining and measuring the quality of institutions of higher education, namely for accreditation purposes, is developed. The theory, the Attributive Theory of Quality, is illustrated using a calculation model that is based on general systems theory. The theory postulates that quality only exists in relation to the…

ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures.

PubMed

Bonow, Robert O; Douglas, Pamela S; Buxton, Alfred E; Cohen, David J; Curtis, Jeptha P; Delong, Elizabeth; Drozda, Joseph P; Ferguson, T Bruce; Heidenreich, Paul A; Hendel, Robert C; Masoudi, Frederick A; Peterson, Eric D; Taylor, Allen J

2011-09-27

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.

Guiding Principles and Checklist for Population-Based Quality Metrics

PubMed Central

Brunelli, Steven M.; Maddux, Franklin W.; Parker, Thomas F.; Johnson, Douglas; Nissenson, Allen R.; Collins, Allan; Lacson, Eduardo

2014-01-01

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. PMID:24558050

Observed characteristics of dust storm events over the western United States using meteorological, satellite, and air quality measurements

NASA Astrophysics Data System (ADS)

Lei, H.; Wang, J. X. L.

2014-08-01

To improve dust storm identification over the western United States, historical dust events measured by air quality and satellite observations are analyzed based on their characteristics in data sets of regular meteorology, satellite-based aerosol optical depth (AOD), and air quality measurements. Based on the prevailing weather conditions associated with dust emission, dust storm events are classified into the following four typical types: (1) The key feature of cold front-induced dust storms is their rapid process with strong dust emissions. (2) Events caused by meso- to small-scale weather systems have the highest levels of emissions. (3) Dust storms caused by tropical disturbances show a stronger air concentration of dust and last longer than those in (1) and (2). (4) Dust storms triggered by cyclogenesis last the longest. In this paper, sample events of each type are selected and examined to explore characteristics observed from in situ and remote-sensing measurements. These characteristics include the lasting period, surface wind speeds, areas affected, average loading on ground-based optical and/or air quality measurements, peak loading on ground-based optical and/or air quality measurements, and loading on satellite-based aerosol optical depth. Based on these analyses, we compare the characteristics of the same dust events captured in different data sets in order to define the dust identification criteria. The analyses show that the variability in mass concentrations captured by in situ measurements is consistent with the variability in AOD from stationary and satellite observations. Our analyses also find that different data sets are capable of identifying certain common characteristics, while each data set also provides specific information about a dust storm event. For example, the meteorological data are good at identifying the lasting period and area impacted by a dust event; the ground-based air quality and optical measurements can capture the peak strength well; aerosol optical depth (AOD) from satellite data sets allows us to better identify dust-storm-affected areas and the spatial extent of dust. The current study also indicates that the combination of in situ and satellite observations is a better method to fill gaps in dust storm recordings.

Quality Measures for Dialysis: Time for a Balanced Scorecard

PubMed Central

2016-01-01

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. PMID:26316622

The quality of instruments to assess the process of shared decision making: A systematic review

PubMed Central

Bomhof-Roordink, Hanna; Smith, Ian P.; Scholl, Isabelle; Stiggelbout, Anne M.; Pieterse, Arwen H.

2018-01-01

Objective To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. Methods In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. Results We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. Conclusions Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument’s content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations. PMID:29447193

QRS detection based ECG quality assessment.

PubMed

Hayn, Dieter; Jammerbund, Bernhard; Schreier, Günter

2012-09-01

Although immediate feedback concerning ECG signal quality during recording is useful, up to now not much literature describing quality measures is available. We have implemented and evaluated four ECG quality measures. Empty lead criterion (A), spike detection criterion (B) and lead crossing point criterion (C) were calculated from basic signal properties. Measure D quantified the robustness of QRS detection when applied to the signal. An advanced Matlab-based algorithm combining all four measures and a simplified algorithm for Android platforms, excluding measure D, were developed. Both algorithms were evaluated by taking part in the Computing in Cardiology Challenge 2011. Each measure's accuracy and computing time was evaluated separately. During the challenge, the advanced algorithm correctly classified 93.3% of the ECGs in the training-set and 91.6 % in the test-set. Scores for the simplified algorithm were 0.834 in event 2 and 0.873 in event 3. Computing time for measure D was almost five times higher than for other measures. Required accuracy levels depend on the application and are related to computing time. While our simplified algorithm may be accurate for real-time feedback during ECG self-recordings, QRS detection based measures can further increase the performance if sufficient computing power is available.

Measuring and improving the quality of mental health care: a global perspective

PubMed Central

Kilbourne, Amy M.; Beck, Kathryn; Spaeth‐Rublee, Brigitta; Ramanuj, Parashar; O'Brien, Robert W.; Tomoyasu, Naomi; Pincus, Harold Alan

2018-01-01

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology‐based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient‐centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement‐based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems. PMID:29352529

More quality measures versus measuring what matters: a call for balance and parsimony

PubMed Central

Nelson, Eugene C; Pryor, David B; James, Brent; Swensen, Stephen J; Kaplan, Gary S; Weissberg, Jed I; Bisognano, Maureen; Yates, Gary R; Hunt, Gordon C

2012-01-01

External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs. PMID:22893696

More quality measures versus measuring what matters: a call for balance and parsimony.

PubMed

Meyer, Gregg S; Nelson, Eugene C; Pryor, David B; James, Brent; Swensen, Stephen J; Kaplan, Gary S; Weissberg, Jed I; Bisognano, Maureen; Yates, Gary R; Hunt, Gordon C

2012-11-01

External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.

A Delphi Study to Examine the Quality Measurement Standards by Online Instructors Using the Quality Matters™ Rubric as a Basis for Creating Instructional Materials

ERIC Educational Resources Information Center

Robinson, Daniel J.

2017-01-01

Quality measurement tools such as the Rubric for Online Instruction (ROI) and Quality Matters (QM) have developed guidelines by providing research based educational criteria for planning, creating, and implementing quality online education courses. This dissertation reviews QM program standards and identifies the primary characteristics of…

Development and Validation of a Consumer Quality Assessment Instrument for Dentistry.

ERIC Educational Resources Information Center

Johnson, Jeffrey D.; And Others

1990-01-01

This paper reviews the literature on consumer involvement in dental quality assessment, argues for inclusion of this information in quality assessment measures, outlines a conceptual model for measuring dental consumer quality assessment, and presents data relating to the development and validation of an instrument based on the conceptual model.…

QUALITY ASSURANCE HANDBOOK FOR AIR POLLUTION MEASUREMENT SYSTEMS: VOLUME IV - METEOROLOGICAL MEASUREMENTS (REVISED - AUGUST 1994)

EPA Science Inventory

Procedures on installing, acceptance testing, operating, maintaining and quality assuring three types of ground-based, upper air meteorological measurement systems are described. he limitations and uncertainties in precision and accuracy measurements associated with these systems...

A robot control formalism based on an information quality concept

NASA Technical Reports Server (NTRS)

Ekman, A.; Torne, A.; Stromberg, D.

1994-01-01

A relevance measure based on Jaynes maximum entropy principle is introduced. Information quality is the conjunction of accuracy and relevance. The formalism based on information quality is developed for one-agent applications. The robot requires a well defined working environment where properties of each object must be accurately specified.

The quality dilemma.

PubMed

Lucassen, Peter

2007-06-01

In the language and logic of the free market, providers of health care will have to demonstrate the quality of their work. However, in this setting quality is only interpreted in quantitative ways and consequently does not necessarily do justice to good physicians. Moreover, both outcome measures and process measures have serious drawbacks. An emphasis on outcome measures will disadvantage physicians working in deprived areas and doctors managing more complicated cases. Although process measures give the most direct information on the physician's performance, their evidence base is not always as straightforward as commonly supposed. Finally, measurement of quality indicators is complicated and time consuming. Physicians should be aware of the drawbacks of quality measurement and of the poor effects of quality improvement strategies on patient outcomes.

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.

Using Rasch Measurement to Validate an Instrument for Measuring the Quality of Classroom Teaching in Secondary Chemistry Lessons

ERIC Educational Resources Information Center

He, Peng; Liu, Xiufeng; Zheng, Changlong; Jia, Mengying

2016-01-01

This study intends to develop a standardized instrument for measuring classroom teaching and learning in secondary chemistry lessons. Based on previous studies and interviews with expert teachers, the progression of five quality levels was constructed hypothetically to represent the quality of chemistry lessons in Chinese secondary schools. The…

A systematic review of instruments for measuring outcomes in economic evaluation within aged care.

PubMed

Bulamu, Norma B; Kaambwa, Billingsley; Ratcliffe, Julie

2015-11-09

This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector. Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000. The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care. In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.

[Comparative quality measurements part 3: funnel plots].

PubMed

Kottner, Jan; Lahmann, Nils

2014-02-01

Comparative quality measurements between organisations or institutions are common. Quality measures need to be standardised and risk adjusted. Random error must also be taken adequately into account. Rankings without consideration of the precision lead to flawed interpretations and enhances "gaming". Application of confidence intervals is one possibility to take chance variation into account. Funnel plots are modified control charts based on Statistical Process Control (SPC) theory. The quality measures are plotted against their sample size. Warning and control limits that are 2 or 3 standard deviations from the center line are added. With increasing group size the precision increases and so the control limits are forming a funnel. Data points within the control limits are considered to show common cause variation; data points outside special cause variation without the focus of spurious rankings. Funnel plots offer data based information about how to evaluate institutional performance within quality management contexts.

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.

ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures.

PubMed

Bonow, Robert O; Douglas, Pamela S; Buxton, Alfred E; Cohen, David J; Curtis, Jeptha P; Delong, Elizabeth; Drozda, Joseph P; Ferguson, T Bruce; Heidenreich, Paul A; Hendel, Robert C; Masoudi, Frederick A; Peterson, Eric D; Taylor, Allen J

2011-09-27

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value. Copyright © 2011 American College of Cardiology Foundation and the American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.

An evidence-based framework to measure quality of allied health care.

PubMed

Grimmer, Karen; Lizarondo, Lucylynn; Kumar, Saravana; Bell, Erica; Buist, Michael; Weinstein, Philip

2014-02-26

There is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services. A realist synthesis framework describing what AH does, how it does it, and what is achieved, was developed. This was populated by the findings of a systematic review of literature published since 1980 reporting concepts of quality relevant to AH. Articles were included on quality measurement concepts, theories, debates, and/or hypothetical frameworks. Of 139 included articles, 21 reported on descriptions of quality potentially relevant to AH. From these, 24 measures of quality were identified, with 15 potentially relating to what AH does, 17 to how AH delivers care, 8 relating to short term functional outcomes, and 9 relating to longer term functional and health system outcomes. A novel evidence-based quality framework was proposed to address the complexity of AH therapies. This should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.

Initial investigation of dietitian perception of plant-based protein quality.

PubMed

Hughes, Glenna J; Kress, Kathleen S; Armbrecht, Eric S; Mukherjea, Ratna; Mattfeldt-Beman, Mildred

2014-07-01

Interest in plant-based diets is increasing, evidenced by scientific and regulatory recommendations, including Dietary Guidelines for Americans. Dietitians provide guidance in dietary protein selection but little is known about how familiar dietitians are with the quality of plant versus animal proteins or methods for measuring protein quality. Likewise, there is a need to explore their beliefs related to dietary recommendations. The aim of this study was to assess dietitians' perceptions of plant-based protein quality and to determine if these are affected by demographic factors such as age and dietary practice group (DPG) membership. This was a cross-sectional design using an online survey. The survey was sent to all members of the Missouri Dietetic Association. All completed surveys (136) were analyzed. The main outcome measures were responses to belief and knowledge questions about the protein quality of plant-based diets, along with demographic information including age and DPG membership. Descriptive statistics and frequencies were determined, and chi-square analysis was used to determine the associations between belief and knowledge responses and demographic characteristics. Responses to belief statements suggested a high level of support for plant-based diets. No associations were found between any of the belief questions and demographic factors. A majority of respondents were not familiar with protein quality determination methods that are currently recognized by global regulatory and advisory agencies. Potential barriers identified in shifting to a more plant-based diet were lack of interest and perceived difficulty. Knowledge among dietitians of plant-based protein quality in general, and methods of protein quality measurement more specifically, needs to be addressed to enhance their knowledge base for making dietary protein recommendations. Two potential avenues for training are university curricula and continuing education opportunities provided to practitioners who provide dietary advice.

Information quality measurement of medical encoding support based on usability.

PubMed

Puentes, John; Montagner, Julien; Lecornu, Laurent; Cauvin, Jean-Michel

2013-12-01

Medical encoding support systems for diagnoses and medical procedures are an emerging technology that begins to play a key role in billing, reimbursement, and health policies decisions. A significant problem to exploit these systems is how to measure the appropriateness of any automatically generated list of codes, in terms of fitness for use, i.e. their quality. Until now, only information retrieval performance measurements have been applied to estimate the accuracy of codes lists as quality indicator. Such measurements do not give the value of codes lists for practical medical encoding, and cannot be used to globally compare the quality of multiple codes lists. This paper defines and validates a new encoding information quality measure that addresses the problem of measuring medical codes lists quality. It is based on a usability study of how expert coders and physicians apply computer-assisted medical encoding. The proposed measure, named ADN, evaluates codes Accuracy, Dispersion and Noise, and is adapted to the variable length and content of generated codes lists, coping with limitations of previous measures. According to the ADN measure, the information quality of a codes list is fully represented by a single point, within a suitably constrained feature space. Using one scheme, our approach is reliable to measure and compare the information quality of hundreds of codes lists, showing their practical value for medical encoding. Its pertinence is demonstrated by simulation and application to real data corresponding to 502 inpatient stays in four clinic departments. Results are compared to the consensus of three expert coders who also coded this anonymized database of discharge summaries, and to five information retrieval measures. Information quality assessment applying the ADN measure showed the degree of encoding-support system variability from one clinic department to another, providing a global evaluation of quality measurement trends. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Measuring patient-perceived hospital service quality: a conceptual framework.

PubMed

Pai, Yogesh P; Chary, Satyanarayana T

2016-04-18

Purpose - Although measuring healthcare service quality is not a new phenomenon, the instruments used to measure are timeworn. With the shift in focus to patient centric processes in hospitals and recognizing healthcare to be different compared to other services, service quality measurement needs to be tuned specifically to healthcare. The purpose of this paper is to design a conceptual framework for measuring patient perceived hospital service quality (HSQ), based on existing service quality literature. Design/methodology/approach - Using HSQ theories, expanding existing healthcare service models and literature, a conceptual framework is proposed to measure HSQ. The paper outlines patient perceived service quality dimensions. Findings - An instrument for measuring HSQ dimensions is developed and compared with other service quality measuring instruments. The latest dimensions are in line with previous studies, but a relationship dimension is added. Practical implications - The framework empowers managers to assess healthcare quality in corporate, public and teaching hospitals. Originality/value - The paper helps academics and practitioners to assess HSQ from a patient perspective.

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

PubMed

Ali, Syed Mustafa; Anjum, Naveed; Kamel Boulos, Maged N; Ishaq, Muhammad; Aamir, Javariya; Haider, Ghulam Rasool

2018-01-16

Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.

Task-based measures of image quality and their relation to radiation dose and patient risk

PubMed Central

Barrett, Harrison H.; Myers, Kyle J.; Hoeschen, Christoph; Kupinski, Matthew A.; Little, Mark P.

2015-01-01

The theory of task-based assessment of image quality is reviewed in the context of imaging with ionizing radiation, and objective figures of merit (FOMs) for image quality are summarized. The variation of the FOMs with the task, the observer and especially with the mean number of photons recorded in the image is discussed. Then various standard methods for specifying radiation dose are reviewed and related to the mean number of photons in the image and hence to image quality. Current knowledge of the relation between local radiation dose and the risk of various adverse effects is summarized, and some graphical depictions of the tradeoffs between image quality and risk are introduced. Then various dose-reduction strategies are discussed in terms of their effect on task-based measures of image quality. PMID:25564960

Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist.

PubMed

Terwee, Caroline B; Mokkink, Lidwine B; Knol, Dirk L; Ostelo, Raymond W J G; Bouter, Lex M; de Vet, Henrica C W

2012-05-01

The COSMIN checklist is a standardized tool for assessing the methodological quality of studies on measurement properties. It contains 9 boxes, each dealing with one measurement property, with 5-18 items per box about design aspects and statistical methods. Our aim was to develop a scoring system for the COSMIN checklist to calculate quality scores per measurement property when using the checklist in systematic reviews of measurement properties. The scoring system was developed based on discussions among experts and testing of the scoring system on 46 articles from a systematic review. Four response options were defined for each COSMIN item (excellent, good, fair, and poor). A quality score per measurement property is obtained by taking the lowest rating of any item in a box ("worst score counts"). Specific criteria for excellent, good, fair, and poor quality for each COSMIN item are described. In defining the criteria, the "worst score counts" algorithm was taken into consideration. This means that only fatal flaws were defined as poor quality. The scores of the 46 articles show how the scoring system can be used to provide an overview of the methodological quality of studies included in a systematic review of measurement properties. Based on experience in testing this scoring system on 46 articles, the COSMIN checklist with the proposed scoring system seems to be a useful tool for assessing the methodological quality of studies included in systematic reviews of measurement properties.

Performance-Based Service Quality Model: An Empirical Study on Japanese Universities

ERIC Educational Resources Information Center

Sultan, Parves; Wong, Ho

2010-01-01

Purpose: This paper aims to develop and empirically test the performance-based higher education service quality model. Design/methodology/approach: The study develops 67-item instrument for measuring performance-based service quality with a particular focus on the higher education sector. Scale reliability is confirmed using the Cronbach's alpha.…

Y1Ba2Cu3O(7-delta) thin film dc SQUIDs (superconducting quantum interference device)

NASA Astrophysics Data System (ADS)

Racah, Daniel

1991-03-01

Direct current superconducting quantum interferometers (SQUIDs) based on HTSC thin films have been measured and characterized. The thin films used were of different quality: (1) Granular films on Sapphire substrates, prepared either by e-gun evaporation, by laser ablation or by MOCVD (metal oxide chemical vapor deposition), (2) Epitaxial films on MgO substrates. Modulations of the voltage on the SQUIDs as a function of the applied flux have been observed in a wide range of temperatures. The nature of the modulation was found to be strongly dependent on the morphology of the film and on its critical current. The SQUIDs based on granular films were relatively noisy, hysteretic and with a complicated V-phi shape. Those devices based on low quality (lowIc) granular films could be measured only at low temperatures (much lower than 77 K). While those of higher quality (granular films with high Ic) could be measured near to the superconductive transition. The SQUID based on high quality epitaxial film was measured near Tc and showed an anomalous, time dependent behavior.

Health Care Quality: Measuring Obesity in Performance Frameworks.

PubMed

Zvenyach, Tracy; Pickering, Matthew K

2017-08-01

Obesity affects over one-third of Americans and leads to several chronic and costly comorbid conditions. The national movement toward value-based care calls for a refocusing of efforts to address the US obesity epidemic. To help set the stage, the current landscape of obesity-specific quality measures was evaluated. Seven quality measure databases and nine professional societies were searched. Inclusion and exclusion criteria were applied. Measures were then classified by domain and by implementation in national public programs. Eleven obesity-specific quality measures in adults were identified (nine process and two outcome). Three measures received National Quality Forum (NQF) endorsement. Two measures were actively used within Centers for Medicare and Medicaid Services (CMS) programs. Only one measure was both NQF-endorsed and used by CMS. Limitations exist with respect to obesity-specific quality metrics. Such gaps provide opportunities for obesity care specialists to engage and offer valuable insights and pragmatic approaches toward quality measurement. © 2017 The Obesity Society.

Implications of weight-based stigma and self-bias on quality of life among individuals with Schizophrenia

PubMed Central

Barber, Jessica; Palmese, Laura; Reutenauer, Erin L.; Grilo, Carlos; Tek, Cenk

2011-01-01

Obesity has been associated with significant stigma and weight-related self-bias in community and clinical studies, but these issues have not been studied among individuals with schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization, self-directed weight-bias, negative affect, medication compliance, and quality of life. Levels of weight-based stigmatization and self-bias were compared to levels reported for non-psychiatric overweight/obese samples. Weight measures were unrelated to stigma, self-bias, affect, and quality of life. Weight-based stigmatization was lower than published levels for non-psychiatric samples, whereas levels of weight-based self-bias did not differ. After controlling for negative affect, weight-based self-bias predicted an additional 11% of the variance in the quality of life measure. Individuals with schizophrenia and schizoaffective disorder reported weight-based self-bias to the same extent as non-psychiatric samples despite reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life after controlling for negative affect. PMID:21716053

Development of indoor environmental index: Air quality index and thermal comfort index

NASA Astrophysics Data System (ADS)

Saad, S. M.; Shakaff, A. Y. M.; Saad, A. R. M.; Yusof, A. M.; Andrew, A. M.; Zakaria, A.; Adom, A. H.

2017-03-01

In this paper, index for indoor air quality (also known as IAQI) and thermal comfort index (TCI) have been developed. The IAQI was actually modified from previous outdoor air quality index (AQI) designed by the United States Environmental Protection Agency (US EPA). In order to measure the index, a real-time monitoring system to monitor indoor air quality level was developed. The proposed system consists of three parts: sensor module cloud, base station and service-oriented client. The sensor module cloud (SMC) contains collections of sensor modules that measures the air quality data and transmit the captured data to base station through wireless. Each sensor modules includes an integrated sensor array that can measure indoor air parameters like Carbon Dioxide, Carbon Monoxide, Ozone, Nitrogen Dioxide, Oxygen, Volatile Organic Compound and Particulate Matter. Temperature and humidity were also being measured in order to determine comfort condition in indoor environment. The result from several experiments show that the system is able to measure the air quality presented in IAQI and TCI in many indoor environment settings like air-conditioner, chemical present and cigarette smoke that may impact the air quality. It also shows that the air quality are changing dramatically, thus real-time monitoring system is essential.

Image Quality Assessment Using the Joint Spatial/Spatial-Frequency Representation

NASA Astrophysics Data System (ADS)

Beghdadi, Azeddine; Iordache, Răzvan

2006-12-01

This paper demonstrates the usefulness of spatial/spatial-frequency representations in image quality assessment by introducing a new image dissimilarity measure based on 2D Wigner-Ville distribution (WVD). The properties of 2D WVD are shortly reviewed, and the important issue of choosing the analytic image is emphasized. The WVD-based measure is shown to be correlated with subjective human evaluation, which is the premise towards an image quality assessor developed on this principle.

Commentary: A call to leadership: the role of the academic medical center in driving sustainable health system improvement through performance measurement.

PubMed

Nedza, Susan M

2009-12-01

As the government attempts to address the high cost of health care in the United States, the issues being confronted include variations in the quality of care administered and the inconsistent application of scientifically proven treatments. To improve quality, methods of measurement and reporting with rewards or, eventually, penalties based on performance, must be developed. To date, well-intentioned national policy initiatives, such as value-based purchasing, have focused primarily on the measurement of discrete events and on attempts to construct incentives. While important, the current approach alone cannot improve quality, ensure equitability, decrease variability, and optimize value. Additional thought-leadership is required, both theoretical and applied. Academic medical centers' (AMCs') scholarly and practical participation is needed. Although quality cannot be sustainably improved without measurement, the existing measures alone do not ensure quality. There is not enough evidence to support strong measure development and, further, not enough insight regarding whether the existing measures have their intended effect of enhancing health care delivery that results in quality outcomes for patients. Perhaps the only way that the United States health care system will achieve a standard of quality care is through the strong embrace, effective engagement, intellectual insights, educational contributions, and practical applications in AMCs. Quality will never be achieved through public policies or national initiatives alone but instead through the commitment of the academic community to forward the science of performance measurement and to ensure that measurement leads to better health outcomes for our nation.

How Can We Best Assess the Quality of Life of People with Dementia? The Bath Assessment of Subjective Quality of Life in Dementia (BASQID)

ERIC Educational Resources Information Center

Trigg, Richard; Skevington, Suzanne M.; Jones, Roy W.

2007-01-01

Purpose: The study aim was to develop a measure of self-reported quality of life (QoL) for people with mild to moderate dementia based on their views--the Bath Assessment of Subjective Quality of Life in Dementia (BASQID). Design and Methods: We developed the measure through multiple stages. Two field tests of the measure (ns = 60 and 150)…

Quality Measures for Dialysis: Time for a Balanced Scorecard.

PubMed

Kliger, Alan S

2016-02-05

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. Copyright © 2016 by the American Society of Nephrology.

Small and big quality in health care.

PubMed

Lillrank, Paul Martin

2015-01-01

The purpose of this paper is to clarify healthcare quality's ontological and epistemological foundations; and examine how these lead to different measurements and technologies. Conceptual analysis. Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies. The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare. This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts.

Guiding principles and checklist for population-based quality metrics.

PubMed

Krishnan, Mahesh; Brunelli, Steven M; Maddux, Franklin W; Parker, Thomas F; Johnson, Douglas; Nissenson, Allen R; Collins, Allan; Lacson, Eduardo

2014-06-06

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. Copyright © 2014 by the American Society of Nephrology.

40 CFR 50.3 - Reference conditions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.3 Reference conditions. All measurements of air quality that... reported based on actual ambient air volume measured at the actual ambient temperature and pressure at the...

Relationships between Population Density and the Perceived Quality of Neighbourhood

ERIC Educational Resources Information Center

Walton, D.; Murray, S. J.; Thomas, J. A.

2008-01-01

Two overseas survey-based scales measuring perceived quality of neighbourhood were adapted and replicated in a New Zealand context. An Italian study (Bonaiuto, Fornara, and Bonnes. (2003). "Landscape and Urban Planning," 65, 41-52) measuring Perceived Residential Environmental Quality (PREQ) and an American study (Carp and Carp. (1982).…

A Linear Algebra Measure of Cluster Quality.

ERIC Educational Resources Information Center

Mather, Laura A.

2000-01-01

Discussion of models for information retrieval focuses on an application of linear algebra to text clustering, namely, a metric for measuring cluster quality based on the theory that cluster quality is proportional to the number of terms that are disjoint across the clusters. Explains term-document matrices and clustering algorithms. (Author/LRW)

Visualizing Topic Flow in Students' Essays

ERIC Educational Resources Information Center

O'Rourke, Stephen T.; Calvo, Rafael A.; McNamara, Danielle S.

2011-01-01

Visualizing how the parts of a document relate to each other and producing automatically generated quality measures that people can understand are means that writers can use to improve the quality of their compositions. This paper presents a novel document visualization technique and a measure of quality based on the average semantic distance…

Developing Information Services and Tools to Access and Evaluate Data Quality in Global Satellite-based Precipitation Products

NASA Astrophysics Data System (ADS)

Liu, Z.; Shie, C. L.; Meyer, D. J.

2017-12-01

Global satellite-based precipitation products have been widely used in research and applications around the world. Compared to ground-based observations, satellite-based measurements provide precipitation data on a global scale, especially in remote continents and over oceans. Over the years, satellite-based precipitation products have evolved from single sensor and single algorithm to multi-sensors and multi-algorithms. As a result, many satellite-based precipitation products have been enhanced such as spatial and temporal coverages. With inclusion of ground-based measurements, biases of satellite-based precipitation products have been significantly reduced. However, data quality issues still exist and can be caused by many factors such as observations, satellite platform anomaly, algorithms, production, calibration, validation, data services, etc. The NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC) is home to NASA global precipitation product archives including the Tropical Rainfall Measuring Mission (TRMM), the Global Precipitation Measurement (GPM), as well as other global and regional precipitation products. Precipitation is one of the top downloaded and accessed parameters in the GES DISC data archive. Meanwhile, users want to easily locate and obtain data quality information at regional and global scales to better understand how precipitation products perform and how reliable they are. As data service providers, it is necessary to provide an easy access to data quality information, however, such information normally is not available, and when it is available, it is not in one place and difficult to locate. In this presentation, we will present challenges and activities at the GES DISC to address precipitation data quality issues.

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Performance measurement: integrating quality management and activity-based cost management.

PubMed

McKeon, T

1996-04-01

The development of an activity-based management system provides a framework for developing performance measures integral to quality and cost management. Performance measures that cross operational boundaries and embrace core processes provide a mechanism to evaluate operational results related to strategic intention and internal and external customers. The author discusses this measurement process that allows managers to evaluate where they are and where they want to be, and to set a course of action that closes the gap between the two.

Serengeti real estate: density vs. fitness-based indicators of lion habitat quality.

PubMed

Mosser, Anna; Fryxell, John M; Eberly, Lynn; Packer, Craig

2009-10-01

Habitat quality is typically inferred by assuming a direct relationship between consumer density and resource abundance, although it has been suggested that consumer fitness may be a more accurate measure of habitat quality. We examined density vs. fitness-based measures of habitat quality for lions in the Serengeti National Park, Tanzania. A 40-year average of female reproductive success (yearling cubs per female) was best explained by proximity to river confluences, whereas patterns of productivity (yearling cubs per km(2)) and adult female density (individuals per km(2)) were associated with more general measures of habitat quality and areas of shelter in poor habitat. This suggests that density may not accurately distinguish between high-quality 'source' areas and low-quality sites that merely provide refuges for effectively non-reproductive individuals. Our results indicate that density may be a misleading indicator of real estate value, particularly for populations that do not conform to an ideal free distribution.

Thin-slice vision: inference of confidence measure from perceptual video quality

NASA Astrophysics Data System (ADS)

Hameed, Abdul; Balas, Benjamin; Dai, Rui

2016-11-01

There has been considerable research on thin-slice judgments, but no study has demonstrated the predictive validity of confidence measures when assessors watch videos acquired from communication systems, in which the perceptual quality of videos could be degraded by limited bandwidth and unreliable network conditions. This paper studies the relationship between high-level thin-slice judgments of human behavior and factors that contribute to perceptual video quality. Based on a large number of subjective test results, it has been found that the confidence of a single individual present in all the videos, called speaker's confidence (SC), could be predicted by a list of features that contribute to perceptual video quality. Two prediction models, one based on artificial neural network and the other based on a decision tree, were built to predict SC. Experimental results have shown that both prediction models can result in high correlation measures.

How Do Students Measure Service Quality in e-Learning? A Case Study regarding an Internet-Based University

ERIC Educational Resources Information Center

Martinez-Arguelles, Maria; Castan, Jose; Juan, Angel

2010-01-01

This article discusses the importance of measuring how students perceive quality of service in online higher education. The article also reviews the existing literature on measuring users' perceptions about quality in e-services. Even when there are a lot of articles on this matter, none of them focuses on e-learning services, so this paper tries…

WSN based indoor air quality monitoring in classrooms

NASA Astrophysics Data System (ADS)

Wang, S. K.; Chew, S. P.; Jusoh, M. T.; Khairunissa, A.; Leong, K. Y.; Azid, A. A.

2017-03-01

Indoor air quality monitoring is essential as the human health is directly affected by indoor air quality. This paper presents the investigations of the impact of undergraduate students' concentration during lecture due to the indoor air quality in classroom. Three environmental parameters such as temperature, relative humidity and concentration of carbon dioxide are measured using wireless sensor network based air quality monitoring system. This simple yet reliable system is incorporated with DHT-11 and MG-811 sensors. Two classrooms were selected to install the monitoring system. The level of indoor air quality were measured and students' concentration was assessed using intelligent test during normal lecturing section. The test showed significant correlation between the collected environmental parameters and the students' level of performances in their study.

Developing a Health-Related Quality-of-Life Measure for People with Intellectual Disability

ERIC Educational Resources Information Center

Clark, Lauren; Pett, Marjorie A.; Cardell, Elizabeth M.; Guo, Jia-Wen; Johnson, Erin

2017-01-01

Using principles of community-based participatory research we developed a new theory-based measure of health-related quality of life (HRQOL) for individuals with intellectual disability (ID). We recruited adults with ID (n = 129) to take part in interviews and review successive versions of HRQOL items. Critical input about content and…

Curriculum-Based Measurement of Oral Reading: Quality of Progress Monitoring Outcomes

ERIC Educational Resources Information Center

Christ, Theodore J.; Zopluoglu, Cengiz; Long, Jeffery D.; Monaghen, Barbara D.

2012-01-01

Curriculum-based measurement of oral reading (CBM-R) is frequently used to set student goals and monitor student progress. This study examined the quality of growth estimates derived from CBM-R progress monitoring data. The authors used a linear mixed effects regression (LMER) model to simulate progress monitoring data for multiple levels of…

Instrumentation for air quality measurements.

NASA Technical Reports Server (NTRS)

Loewenstein, M.

1973-01-01

Comparison of the new generation of air quality monitoring instruments with some more traditional methods. The first generation of air quality measurement instruments, based on the use of oxidant coulometric cells, nitrogen oxide colorimetry, carbon monoxide infrared analyzers, and other types of detectors, is compared with new techniques now coming into wide use in the air monitoring field and involving the use of chemiluminescent reactions, optical absorption detectors, a refinement of the carbon monoxide infrared analyzer, electrochemical cells based on solid electrolytes, and laser detectors.

Large radius of curvature measurement based on the evaluation of interferogram-quality metric in non-null interferometry

NASA Astrophysics Data System (ADS)

Yang, Zhongming; Dou, Jiantai; Du, Jinyu; Gao, Zhishan

2018-03-01

Non-null interferometry could use to measure the radius of curvature (ROC), we have presented a virtual quadratic Newton rings phase-shifting moiré-fringes measurement method for large ROC measurement (Yang et al., 2016). In this paper, we propose a large ROC measurement method based on the evaluation of the interferogram-quality metric by the non-null interferometer. With the multi-configuration model of the non-null interferometric system in ZEMAX, the retrace errors and the phase introduced by the test surface are reconstructed. The interferogram-quality metric is obtained by the normalized phase-shifted testing Newton rings with the spherical surface model in the non-null interferometric system. The radius curvature of the test spherical surface can be obtained until the minimum of the interferogram-quality metric is found. Simulations and experimental results are verified the feasibility of our proposed method. For a spherical mirror with a ROC of 41,400 mm, the measurement accuracy is better than 0.13%.

AQA-PM: Extension of the Air-Quality model for Austria with satellite based Particulate Matter estimates

NASA Astrophysics Data System (ADS)

Hirtl, M.; Mantovani, S.; Krüger, B. C.; Triebnig, G.

2012-04-01

Air quality is a key element for the well-being and quality of life of European citizens. Air pollution measurements and modeling tools are essential for assessment of air quality according to EU legislation. The responsibilities of ZAMG as the national weather service of Austria include the support of the federal states and the public in questions connected to the protection of the environment in the frame of advisory and counseling services as well as expert opinions. The Air Quality model for Austria (AQA) is operated at ZAMG in cooperation with the University of Natural Resources and Applied Life Sciences in Vienna (BOKU) by order of the regional governments since 2005. AQA conducts daily forecasts of gaseous and particulate (PM10) air pollutants over Austria. In the frame of the project AQA-PM (funded by FFG), satellite measurements of the Aerosol Optical Thickness (AOT) and ground-based PM10-measurements are combined to highly-resolved initial fields using assimilation techniques. It is expected that the assimilation of satellite measurements will significantly improve the quality of AQA. Currently no observations are considered in the modeling system. At the current stage of the project, different datasets have been collected (ground measurements, satellite measurements, fine resolved regional emission inventories) and are analyzed and prepared for further processing. This contribution gives an overview of the project working plan and the upcoming developments. The goal of this project is to improve the PM10-forecasts for Austria with the integration of satellite based measurements and to provide a comprehensive product-platform.

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

PubMed Central

2010-01-01

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

Development of a questionnaire to measure the key attributes of the community palliative care specialist nurse role.

PubMed

Cameron, Dee; Johnston, Bridget

2015-02-01

Recent worldwide economic events have forced an examination of the nurse's contribution to high-quality, effective, person-centred care. Since the role of specialist nurses is considered one of the least understood or valued developments in nursing, specialist nurses must demonstrate their contribution to quality, person-centred health care. To develop a questionnaire which aims to measure the quality of care provided by palliative care specialist nurses from the patients' perspective and to undertake initial validation. The process of questionnaire development involved six phases including systematic literature reviews, patient advisory groups and expert panel reviews, each of which contributed to the questionnaire face and content validity. Johnston's Expert Palliative Care Nurse Model (2002; 2005) provided an evidence-based framework for the development of the questionnaire, and enabled the identification of the key attributes of the palliative care specialist nurse role, thereby providing the themes on which to base the questionnaire. The Quality Measure for Palliative Nursing, a questionnaire, was developed. The themes identified in the questionnaire--personal characteristics, communication skills, knowledge, relationship with patient and providing comfort--aim to facilitate measurement of the quality of care provided by palliative care specialist nurses. Designed for use by palliative patients the Quality Measure for Palliative Nursing is a one-page questionnaire comprising of 15 questions. The Quality Measure for Palliative Nursing is unique since it aims to measure the quality of care provided by community palliative care specialist nurses, and could also be used to measure patient satisfaction with the quality of care provided. Further testing is recommended to ensure that this questionnaire can provide reliable and valid results.

Making Meaningful Measurement in Survey Research: The Use of Person and Item Maps

ERIC Educational Resources Information Center

Royal, Kenneth D.

2009-01-01

Quality measurement is essential in every form of research, including institutional research and assessment. Unfortunately, most survey research today (both published and unpublished) is lacking with regards to quality measurement. Reporting means and standard deviations based on ordinal measures is an inappropriate, yet widespread practice in the…

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

PubMed

Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

2018-04-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

PubMed Central

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer D.; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred Y.; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

2018-01-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures. PMID:29608365

The effects of hospital competition on inpatient quality of care.

PubMed

Mutter, Ryan L; Wong, Herbert S; Goldfarb, Marsha G

2008-01-01

Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However, the effect is not unidirectional: some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain.

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

NASA Astrophysics Data System (ADS)

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

2015-12-01

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

Evaluating Performance Measurement Systems in Nonprofit Agencies: The Program Accountability Quality Scale (PAQS).

ERIC Educational Resources Information Center

Poole, Dennis L.; Nelson, Joan; Carnahan, Sharon; Chepenik, Nancy G.; Tubiak, Christine

2000-01-01

Developed and field tested the Performance Accountability Quality Scale (PAQS) on 191 program performance measurement systems developed by nonprofit agencies in central Florida. Preliminary findings indicate that the PAQS provides a structure for obtaining expert opinions based on a theory-driven model about the quality of proposed measurement…

Developing a Scale for Quality of Using Learning Strategies

ERIC Educational Resources Information Center

Tasci, Guntay; Yurdugul, Halil

2016-01-01

This study aims to develop a measurement tool to measure the quality of using learning strategies. First, the quality of using learning strategies was described based on the literature. The 32 items in the 5-point Likert scale were then administered to 320 prospective teachers, and they were analysed with exploratory factor analysis using…

Quality of life in dementia: a systematically conducted narrative review of dementia-specific measurement scales.

PubMed

Bowling, Ann; Rowe, Gene; Adams, Sue; Sands, Paula; Samsi, Kritika; Crane, Maureen; Joly, Louise; Manthorpe, Jill

2015-01-01

Ascertaining the quality of life (QoL) in people with dementia is important for evaluating service outcomes and cost-effectiveness. This paper identifies QoL measures for people with dementia and assesses their properties. A systematic narrative review identified articles using dementia QoL measures. Electronic databases searched were AMED, CINAHL, EMBASE, Index to Theses, IBSS, MEDLINE, PsycINFO, Sociological Abstracts, and Web of Science. All available years and languages (if with an English language abstract) were included. Searches yielded 6806 citations; 3043 were multiple duplicates (759 being true duplicates). Abstracts were read; 182 full papers were selected/obtained, of which 126 were included as relevant. Few measures were based on rigorous conceptual frameworks. Some referenced Lawton's model (Dementia Quality of Life [DQOL] and Quality of Life in Alzheimer's Disease [QOL-AD]), though these tapped part of this only; others claimed relationship to a health-related QoL concept (e.g. DEMQOL), though had less social relevance; others were based on limited domains (e.g. activity, affect) or clinical opinions (Quality of Life in Late-Stage Dementia [QUALID]). Many measures were based on proxy assessments or observations of people with dementia's QoL, rather than their own ratings. The Bath Assessment of Subjective Quality of Life in Dementia (BASQID) was developed involving people with dementia and caregivers, but excluded some of their main themes. All measures were tested on selective samples only (ranging from community to hospital clinics, or subsamples/waves of existing population surveys), in a few sites. Their general applicability remains unknown, and predictive validity remains largely untested. The lack of consensus on measuring QoL in dementia suggests a need for a broader, more rigorously tested QoL measure.

Measuring Website Quality: Asymmetric Effect of User Satisfaction

ERIC Educational Resources Information Center

Kincl, Tomas; Strach, Pavel

2012-01-01

Website quality measurement tools have been largely static and have struggled to determine relevant attributes of user satisfaction. This study compares and contrasts attributes of user satisfaction based on usability guidelines seeking to identify practical easy-to-administer measurement tools. The website users assessed business school homepages…

Systematic review of measurement properties of self-reported instruments for evaluating self-care in adults.

PubMed

Matarese, Maria; Lommi, Marzia; De Marinis, Maria Grazia

2017-06-01

The aims of this study were as follows: to identify instruments developed to assess self-care in healthy adults; to determine the theory on which they were based; their validity and reliability properties and to synthesize the evidence on their measurement properties. Many instruments have been developed to assess self-care in many different populations and conditions. Clinicians and researchers should select the most appropriate self-care instrument based on the knowledge of their measurement properties. Systematic review of measurement instruments according to the protocol recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel. PubMed, Embase, PsycINFO, Scopus and CINAHL databases were searched from inception to December 2015. Studies testing measurement properties of self-report instruments assessing self-care in healthy adults, published in the English language and in peer review journals were selected. Two reviewers independently appraised the methodological quality of the studies with the COSMIN checklist and the quality of results using specific quality criteria. Twenty-six articles were included in the review testing the measurement properties of nine instruments. Seven instruments were based on Orem's Self-care theory. Not all the measurement properties were evaluated for the identified instruments. No self-care instrument showed strong evidence supporting the evaluated measurement properties. Despite the development of several instruments to assess self-care in the adult population, no instrument can be fully recommended to clinical nurses and researchers. Further studies of high methodological quality are needed to confirm the measurement properties of these instruments. © 2016 John Wiley & Sons Ltd.

Associations between nutritional quality of meals and snacks assessed by the Food Standards Agency nutrient profiling system and overall diet quality and adiposity measures in British children and adolescents.

PubMed

Murakami, Kentaro

2018-05-01

This cross-sectional study examined how the nutritional quality of meals and snacks was associated with overall diet quality and adiposity measures. Based on 7-d weighed dietary record data, all eating occasions were divided into meals or snacks based on time (meals: 06:00-09:00 h, 12:00-14:00 h, and 17:00-20:00 h; snacks: others) or contribution to energy intake (meals: ≥15%; snacks: <15%) in British children aged 4-10 (n = 808) and adolescents aged 11-18 (n = 809). The nutritional quality of meals and snacks was assessed as the arithmetical energy intake-weighted means of the Food Standards Agency (FSA) nutrient profiling system score of each food and beverage consumed, based on the contents of energy, saturated fatty acid, total sugar, sodium, fruits/vegetables/nuts, dietary fiber, and protein. Regardless of the definition of meals and snacks, higher FSA score (lower nutritional quality) of meals was inversely associated with overall diet quality assessed by the Mediterranean diet score in both children and adolescents (P <0.0001), whereas the inverse associations for the FSA score of snacks did not reach statistical significance. The FSA score of meals based on time was inversely associated with body mass index z-score only in children, whereas that of snacks based on time showed a positive association. Lower nutritional quality of meals, but not snacks, assessed by the FSA score was associated with lower overall diet quality, whereas no consistent associations were observed with regard to adiposity measures. Copyright © 2017 Elsevier Inc. All rights reserved.

Kramers-Kronig based quality factor for shear wave propagation in soft tissue

PubMed Central

Urban, M W; Greenleaf, J F

2009-01-01

Shear wave propagation techniques have been introduced for measuring the viscoelastic material properties of tissue, but assessing the accuracy of these measurements is difficult for in vivo measurements in tissue. We propose using the Kramers-Kronig relationships to assess the consistency and quality of the measurements of shear wave attenuation and phase velocity. In ex vivo skeletal muscle we measured the wave attenuation at different frequencies, and then applied finite bandwidth Kramers-Kronig equations to predict the phase velocities. We compared these predictions with the measured phase velocities and assessed the mean square error (MSE) as a quality factor. An algorithm was derived for computing a quality factor using the Kramers-Kronig relationships. PMID:19759409

Design and Testing of a Tool for Evaluating the Quality of Diabetes Consumer-Information Web Sites

PubMed Central

Steinwachs, Donald; Rubin, Haya R

2003-01-01

Background Most existing tools for measuring the quality of Internet health information focus almost exclusively on structural criteria or other proxies for quality information rather than evaluating actual accuracy and comprehensiveness. Objective This research sought to develop a new performance-measurement tool for evaluating the quality of Internet health information, test the validity and reliability of the tool, and assess the variability in diabetes Web site quality. Methods An objective, systematic tool was developed to evaluate Internet diabetes information based on a quality-of-care measurement framework. The principal investigator developed an abstraction tool and trained an external reviewer on its use. The tool included 7 structural measures and 34 performance measures created by using evidence-based practice guidelines and experts' judgments of accuracy and comprehensiveness. Results Substantial variation existed in all categories, with overall scores following a normal distribution and ranging from 15% to 95% (mean was 50% and median was 51%). Lin's concordance correlation coefficient to assess agreement between raters produced a rho of 0.761 (Pearson's r of 0.769), suggesting moderate to high agreement. The average agreement between raters for the performance measures was 0.80. Conclusions Diabetes Web site quality varies widely. Alpha testing of this new tool suggests that it could become a reliable and valid method for evaluating the quality of Internet health sites. Such an instrument could help lay people distinguish between beneficial and misleading information. PMID:14713658

Quality improvement in neurology: AAN Parkinson disease quality measures

PubMed Central

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

2010-01-01

Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this. Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs. Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors. Results: Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes. Conclusion: The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures. GLOSSARY AAN = American Academy of Neurology; ABPN = American Board of Psychiatry and Neurology; AMA = American Medical Association; CPT II = Current Procedural Terminology; PCPI = Physician Consortium for Performance Improvement; PD = Parkinson disease; PMAG = Performance Measurement Advisory Group; PQRI = Physician Quality Reporting Initiative; QMR = Quality Measurement and Reporting Subcommittee. PMID:21115958

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Where should Momma go? Current nursing home performance measurement strategies and a less ambitious approach.

PubMed

Phillips, Charles D; Hawes, Catherine; Lieberman, Trudy; Koren, Mary Jane

2007-06-25

Nursing home performance measurement systems are practically ubiquitous. The vast majority of these systems aspire to rank order all nursing homes based on quantitative measures of quality. However, the ability of such systems to identify homes differing in quality is hampered by the multidimensional nature of nursing homes and their residents. As a result, the authors doubt the ability of many nursing home performance systems to truly help consumers differentiate among homes providing different levels of quality. We also argue that, for consumers, performance measurement models are better at identifying problem facilities than potentially good homes. In response to these concerns we present a proposal for a less ambitious approach to nursing home performance measurement than previously used. We believe consumers can make better informed choice using a simpler system designed to pinpoint poor-quality nursing homes, rather than one designed to rank hundreds of facilities based on differences in quality-of-care indicators that are of questionable importance. The suggested performance model is based on five principles used in the development of the Consumers Union 2006 Nursing Home Quality Monitor. We can best serve policy-makers and consumers by eschewing nursing home reporting systems that present information about all the facilities in a city, a state, or the nation on a website or in a report. We argue for greater modesty in our efforts and a focus on identifying only the potentially poorest or best homes. In the end, however, it is important to remember that information from any performance measurement website or report is no substitute for multiple visits to a home at different times of the day to personally assess quality.

Determining hospital performance based on rank ordering: is it appropriate?

PubMed

Anderson, Judy; Hackman, Mark; Burnich, Jeff; Gurgiolo, Thomas R

2007-01-01

An increasing number of "pay for performance" initiatives for hospitals and physicians ascribe performance by ranking hospitals or physicians on quality of care measures. Payment is subsequently based on where a hospital or physician ranks among peers. This study examines the variability of ranking hospitals on quality of care measures and its impact on comparing hospital performance. Variability in the ranks of 3 quality of care measures was examined: discharge instruction for congestive heart failure, use of beta-blockers at discharge for heart attack, and timing of initial antibiotic therapy within 4 hours of admission to the hospital for pneumonia. The data are available on the Centers for Medicare and Medicaid Services Web site as part of the Hospital Quality Alliance project. We found that considerable uncertainty exists in ranking of hospitals on these measures, which calls into question the use of rank ordering as a determinant of performance.

A Regression-Based Family of Measures for Full-Reference Image Quality Assessment

NASA Astrophysics Data System (ADS)

Oszust, Mariusz

2016-12-01

The advances in the development of imaging devices resulted in the need of an automatic quality evaluation of displayed visual content in a way that is consistent with human visual perception. In this paper, an approach to full-reference image quality assessment (IQA) is proposed, in which several IQA measures, representing different approaches to modelling human visual perception, are efficiently combined in order to produce objective quality evaluation of examined images, which is highly correlated with evaluation provided by human subjects. In the paper, an optimisation problem of selection of several IQA measures for creating a regression-based IQA hybrid measure, or a multimeasure, is defined and solved using a genetic algorithm. Experimental evaluation on four largest IQA benchmarks reveals that the multimeasures obtained using the proposed approach outperform state-of-the-art full-reference IQA techniques, including other recently developed fusion approaches.

Benchmarking: A Process for Improvement.

ERIC Educational Resources Information Center

Peischl, Thomas M.

One problem with the outcome-based measures used in higher education is that they measure quantity but not quality. Benchmarking, or the use of some external standard of quality to measure tasks, processes, and outputs, is partially solving that difficulty. Benchmarking allows for the establishment of a systematic process to indicate if outputs…

Gloss uniformity measurement update for ISO/IEC 19751

NASA Astrophysics Data System (ADS)

Ng, Yee S.; Cui, Chengwu; Kuo, Chunghui; Maggard, Eric; Mashtare, Dale; Morris, Peter

2005-01-01

To address the standardization issues of perceptually based image quality for printing systems, ISO/IEC JTC1/SC28, the standardization committee for office equipment chartered the W1.1 project with the responsibility of drafting a proposal for an international standard for the evaluation of printed image quality1. An ISO draft Standard2, ISO/WD 19751-1, Office Equipment - Appearance-based image quality standards for printers - Part 1: Overview, Procedure and Common Methods, 2004 describes the overview of this multi-part appearance-based image quality standard. One of the ISO 19751 multi-part Standard"s tasks is to address the appearance-based gloss and gloss uniformity issues (in ISO 19751-2). This paper summarizes the current status and technical progress since the last two updates3, 4. In particular, we will be discussion our attempt to include 75 degree gloss (G75) objective measurement5 in differential gloss and within-page gloss uniformity. The result for a round-robin experiment involving objective measurement of differential gloss using G60 and G75 gloss measurement geometry is described. The results for two perceptual-based round-robin experiments relating to haze effect on the perception of gloss, and gloss artifacts (gloss streaks/bands, gloss graininess/mottle) are discussed.

Gloss uniformity measurement update for ISO/IEC 19751

NASA Astrophysics Data System (ADS)

Ng, Yee S.; Cui, Chengwu; Kuo, Chunghui; Maggard, Eric; Mashtare, Dale; Morris, Peter

2004-10-01

To address the standardization issues of perceptually based image quality for printing systems, ISO/IEC JTC1/SC28, the standardization committee for office equipment chartered the W1.1 project with the responsibility of drafting a proposal for an international standard for the evaluation of printed image quality1. An ISO draft Standard2, ISO/WD 19751-1, Office Equipment - Appearance-based image quality standards for printers - Part 1: Overview, Procedure and Common Methods, 2004 describes the overview of this multi-part appearance-based image quality standard. One of the ISO 19751 multi-part Standard"s tasks is to address the appearance-based gloss and gloss uniformity issues (in ISO 19751-2). This paper summarizes the current status and technical progress since the last two updates3, 4. In particular, we will be discussion our attempt to include 75 degree gloss (G75) objective measurement5 in differential gloss and within-page gloss uniformity. The result for a round-robin experiment involving objective measurement of differential gloss using G60 and G75 gloss measurement geometry is described. The results for two perceptual-based round-robin experiments relating to haze effect on the perception of gloss, and gloss artifacts (gloss streaks/bands, gloss graininess/mottle) are discussed.

A Unified Approach for Reporting ARM Measurement Uncertainties Technical Report

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

Campos, E; Sisterson, DL

The Atmospheric Radiation Measurement (ARM) Climate Research Facility is observationally based, and quantifying the uncertainty of its measurements is critically important. With over 300 widely differing instruments providing over 2,500 datastreams, concise expression of measurement uncertainty is quite challenging. The ARM Facility currently provides data and supporting metadata (information about the data or data quality) to its users through a number of sources. Because the continued success of the ARM Facility depends on the known quality of its measurements, the Facility relies on instrument mentors and the ARM Data Quality Office (DQO) to ensure, assess, and report measurement quality. Therefore,more » an easily-accessible, well-articulated estimate of ARM measurement uncertainty is needed.« less

An approach to bioassessment of water quality using diversity measures based on species accumulative curves.

PubMed

Xu, Guangjian; Zhang, Wei; Xu, Henglong

2015-02-15

Traditional community-based bioassessment is time-consuming because they rely on full species-abundance data of a community. To improve bioassessment efficiency, the feasibility of the diversity measures based on species accumulative curves for bioassessment of water quality status was studied based on a dataset of microperiphyton fauna. The results showed that: (1) the species accumulative curves well fitted the Michaelis-Menten equation; (2) the β- and γ-diversity, as well as the number of samples to 50% of the maximum species number (Michaelis-Menten constant K), can be statistically estimated based on the formulation; (3) the rarefied α-diversity represented a significant negative correlation with the changes in the nutrient NH4-N; and (4) the estimated β-diversity and the K constant were significantly positively related to the concentration of NH4-N. The results suggest that the diversity measures based on species accumulative curves might be used as a potential bioindicator of water quality in marine ecosystems. Copyright © 2014 Elsevier Ltd. All rights reserved.

Design and Measurement of a Digital Phase Locked BWO for Accurately Extracting the Quality Factors in a Biconcave Resonator System

NASA Astrophysics Data System (ADS)

Gao, Yuanci; Charles, Jones R.; Yu, Guofen; Jyotsna, Dutta M.

2012-03-01

A long loop phase locked backward-wave oscillator (BWO) for a high quality factor resonator system operating at D-band frequencies (130-170GHz) was described, the phase noise of the phased locked BWO was analyzed and measured at typical frequencies. When it used with a high quality factor open resonator for measuring the quality factor of simple harmonic resonators based on the magnitude transfer characteristic, this system has proven to be capable of accurate measuring the quality factor as high as 0.8 million with an uncertainty of less than 1.3% (Lorentzian fitting) at typical frequencies in the range of 130GHz-170GHz.

Measuring melasma patients' quality of life using willingness to pay and time trade-off methods in thai population

PubMed Central

2011-01-01

Background Melasma is a common hyperpigmentation disorder that has a significant effect on an individual's quality of life. However, there is no preference-based measurement that reflects quality of life in patients with melasma. The objective of this study was to assess the impact of melasma on quality of life by using a health status measurement - the Dermatology Life Quality Index (DLQI) - and a preference-based measurement - Willingness to Pay (WTP) and Time Trade-Off (TTO). Methods A cross-sectional descriptive study was conducted. Seventy-eight patients with melasma who attended the melasma clinic at Siriraj Hospital from February to March 2009 were recruited in this study. The Thai version of the DLQI, questionnaires about WTP, standard TTO, and daily TTO were used to assess patients' quality of life. Results Seventy-seven (98.7%) patients were female with a mean age of 47.8 ± 7.9 years. The mean health utility based on standard TTO was 0.96. The utility obtained by the daily TTO method was 0.92 and was significantly correlated with an economically inactive occupation (p < 0.05). The mean monthly WTP for the most effective treatment was 1,157 baht (7.2% of monthly income), ranging from 100 to 5,000 baht (1 USD ~ 35.1 baht). The WTP was significantly correlated with monthly personal income and the total DLQI score. Conclusion The WTP method could be a useful tool with which to measure the quality of life of patients with melasma. PMID:22182399

Sustainability of quality improvement following removal of pay-for-performance incentives.

PubMed

Benzer, Justin K; Young, Gary J; Burgess, James F; Baker, Errol; Mohr, David C; Charns, Martin P; Kaboli, Peter J

2014-01-01

Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. To investigate sustainability of performance levels following removal of performance-based incentives. Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. This is a quasi-experimental study without a comparison group; causal conclusions are limited. The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.

Quality based approach for adaptive face recognition

NASA Astrophysics Data System (ADS)

Abboud, Ali J.; Sellahewa, Harin; Jassim, Sabah A.

2009-05-01

Recent advances in biometric technology have pushed towards more robust and reliable systems. We aim to build systems that have low recognition errors and are less affected by variation in recording conditions. Recognition errors are often attributed to the usage of low quality biometric samples. Hence, there is a need to develop new intelligent techniques and strategies to automatically measure/quantify the quality of biometric image samples and if necessary restore image quality according to the need of the intended application. In this paper, we present no-reference image quality measures in the spatial domain that have impact on face recognition. The first is called symmetrical adaptive local quality index (SALQI) and the second is called middle halve (MH). Also, an adaptive strategy has been developed to select the best way to restore the image quality, called symmetrical adaptive histogram equalization (SAHE). The main benefits of using quality measures for adaptive strategy are: (1) avoidance of excessive unnecessary enhancement procedures that may cause undesired artifacts, and (2) reduced computational complexity which is essential for real time applications. We test the success of the proposed measures and adaptive approach for a wavelet-based face recognition system that uses the nearest neighborhood classifier. We shall demonstrate noticeable improvements in the performance of adaptive face recognition system over the corresponding non-adaptive scheme.

No-reference video quality measurement: added value of machine learning

NASA Astrophysics Data System (ADS)

Mocanu, Decebal Constantin; Pokhrel, Jeevan; Garella, Juan Pablo; Seppänen, Janne; Liotou, Eirini; Narwaria, Manish

2015-11-01

Video quality measurement is an important component in the end-to-end video delivery chain. Video quality is, however, subjective, and thus, there will always be interobserver differences in the subjective opinion about the visual quality of the same video. Despite this, most existing works on objective quality measurement typically focus only on predicting a single score and evaluate their prediction accuracies based on how close it is to the mean opinion scores (or similar average based ratings). Clearly, such an approach ignores the underlying diversities in the subjective scoring process and, as a result, does not allow further analysis on how reliable the objective prediction is in terms of subjective variability. Consequently, the aim of this paper is to analyze this issue and present a machine-learning based solution to address it. We demonstrate the utility of our ideas by considering the practical scenario of video broadcast transmissions with focus on digital terrestrial television (DTT) and proposing a no-reference objective video quality estimator for such application. We conducted meaningful verification studies on different video content (including video clips recorded from real DTT broadcast transmissions) in order to verify the performance of the proposed solution.

Clustering of reads with alignment-free measures and quality values.

PubMed

Comin, Matteo; Leoni, Andrea; Schimd, Michele

2015-01-01

The data volume generated by Next-Generation Sequencing (NGS) technologies is growing at a pace that is now challenging the storage and data processing capacities of modern computer systems. In this context an important aspect is the reduction of data complexity by collapsing redundant reads in a single cluster to improve the run time, memory requirements, and quality of post-processing steps like assembly and error correction. Several alignment-free measures, based on k-mers counts, have been used to cluster reads. Quality scores produced by NGS platforms are fundamental for various analysis of NGS data like reads mapping and error detection. Moreover future-generation sequencing platforms will produce long reads but with a large number of erroneous bases (up to 15 %). In this scenario it will be fundamental to exploit quality value information within the alignment-free framework. To the best of our knowledge this is the first study that incorporates quality value information and k-mers counts, in the context of alignment-free measures, for the comparison of reads data. Based on this principles, in this paper we present a family of alignment-free measures called D (q) -type. A set of experiments on simulated and real reads data confirms that the new measures are superior to other classical alignment-free statistics, especially when erroneous reads are considered. Also results on de novo assembly and metagenomic reads classification show that the introduction of quality values improves over standard alignment-free measures. These statistics are implemented in a software called QCluster (http://www.dei.unipd.it/~ciompin/main/qcluster.html).

Scalable and High-Throughput Execution of Clinical Quality Measures from Electronic Health Records using MapReduce and the JBoss® Drools Engine

PubMed Central

Peterson, Kevin J.; Pathak, Jyotishman

2014-01-01

Automated execution of electronic Clinical Quality Measures (eCQMs) from electronic health records (EHRs) on large patient populations remains a significant challenge, and the testability, interoperability, and scalability of measure execution are critical. The High Throughput Phenotyping (HTP; http://phenotypeportal.org) project aligns with these goals by using the standards-based HL7 Health Quality Measures Format (HQMF) and Quality Data Model (QDM) for measure specification, as well as Common Terminology Services 2 (CTS2) for semantic interpretation. The HQMF/QDM representation is automatically transformed into a JBoss® Drools workflow, enabling horizontal scalability via clustering and MapReduce algorithms. Using Project Cypress, automated verification metrics can then be produced. Our results show linear scalability for nine executed 2014 Center for Medicare and Medicaid Services (CMS) eCQMs for eligible professionals and hospitals for >1,000,000 patients, and verified execution correctness of 96.4% based on Project Cypress test data of 58 eCQMs. PMID:25954459

QoS measurement of workflow-based web service compositions using Colored Petri net.

PubMed

Nematzadeh, Hossein; Motameni, Homayun; Mohamad, Radziah; Nematzadeh, Zahra

2014-01-01

Workflow-based web service compositions (WB-WSCs) is one of the main composition categories in service oriented architecture (SOA). Eflow, polymorphic process model (PPM), and business process execution language (BPEL) are the main techniques of the category of WB-WSCs. Due to maturity of web services, measuring the quality of composite web services being developed by different techniques becomes one of the most important challenges in today's web environments. Business should try to provide good quality regarding the customers' requirements to a composed web service. Thus, quality of service (QoS) which refers to nonfunctional parameters is important to be measured since the quality degree of a certain web service composition could be achieved. This paper tried to find a deterministic analytical method for dependability and performance measurement using Colored Petri net (CPN) with explicit routing constructs and application of theory of probability. A computer tool called WSET was also developed for modeling and supporting QoS measurement through simulation.

Use of a Pediatric Cardiovascular Nursing Consortium for Development and Evaluation of Quality Measures: The C4-MNP Experience.

PubMed

Connor, Jean A; Larson, Carol; Baird, Jennifer; Hickey, Patricia A

2016-01-01

The evidence linking nursing care and patient outcomes has been globally demonstrated. Thus, it is time for translation and application of this evidence to robust measurement that uniquely demonstrates the value of nursing care and the characteristics of the nursing workforce that contribute to optimal patient outcomes. The aim of this study was to identify and develop standardized measures representative of pediatric nursing care of the cardiovascular patient for benchmarking within freestanding children's hospitals. Using a consensus-based approach, the Consortium of Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) members developed quality measures within working groups and then individually critiqued all drafted measures. Final draft measures were then independently reviewed and critiqued by an external nursing quality measurement committee. The final quality measures were also made available to a national parent support group for feedback. The development process used by C4-MNP resulted in 10 measures eligible for testing across freestanding children's hospitals. Employing a collaborative consensus-based method plus implementing the criteria of the National Quality Forum and external vetting period provided a strong framework for the development and evaluation of standardized measures. The Consortium will continue with implementation and testing of each measure in 9 of our 28 collaborating centers. This activity will support initial development of benchmarks and evaluation of the association of the measures with patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

First clinicial results on the feasibility, quality and reproducibility of aberrometry-based intraoperative refraction during cataract surgery.

PubMed

Huelle, Jan O; Katz, Toam; Druchkiv, Vasyl; Pahlitzsch, Milena; Steinberg, Johannes; Richard, Gisbert; Linke, Stephan J

2014-11-01

To provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract. IWA refraction was recorded at 7 defined measurement points during standardised cataract surgery in 74 eyes of 74 consecutive patients (mean age 69±11.3 years). Precision and measurement quality was evaluated by the 'limits of agreement' approach, regression analysis, correlation analysis, Analysis of variance (ANOVA) and ORs for predicting measurement failure. Wavefront map (WFM) quality was objectivised and compared with the Pentacam Nuclear Staging analysis. Out of 814 IWA measurement attempts, 462 WFMs could be obtained. The most successful readings (n=63) were achieved in aphakia with viscoelastic. The highest (50.63%, SD 20.23) and lowest (29.19%, SD 13.94) quality of WFMs across all measurement points were found after clear corneal incision and in pseudophakia with viscoelastic, respectively. High consistency across repeated measures were found for mean spherical equivalent (SE) differences in aphakia with -0.01D and pseudophakia with -0.01D, but ranges were high (limits of agreement +0.69 D and -0.72 D; +1.53 D and -1.54 D, respectively). With increasing WFM quality, higher precision in measurements was observed. This is the first report addressing quality and reproducibility of WA in a large sample. IWA refraction in aphakia, for instance, appears to be reliable once stable and pressurised anterior chamber conditions are achieved. More efforts are required to improve the precision and quality of measurements before IWA can be used to guide the surgical refractive plan in cataract surgery. 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.

British Thoracic Society quality standards for home oxygen use in adults

PubMed Central

Suntharalingam, Jay; Wilkinson, Tom; Annandale, Joseph; Davey, Claire; Fielding, Rhea; Freeman, Daryl; Gibbons, Michael; Hardinge, Maxine; Hippolyte, Sabrine; Knowles, Vikki; Lee, Cassandra; MacNee, William; Pollington, Jacqueline; Vora, Vandana; Watts, Trefor; Wijesinghe, Meme

2017-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Methods Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations. PMID:29018527

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

Effect of pooled comparative information on judgments of quality

PubMed Central

Baumgart, Leigh A.; Bass, Ellen J.; Voss, John D.; Lyman, Jason A.

2015-01-01

Quality assessment is the focus of many health care initiatives. Yet it is not well understood how the type of information used in decision support tools to enable judgments of quality based on data impacts the accuracy, consistency and reliability of judgments made by physicians. Comparative pooled information could allow physicians to judge the quality of their practice by making comparisons to other practices or other specific populations of patients. In this study, resident physicians were provided with varying types of information derived from pooled patient data sets: quality component measures at the individual and group level, a qualitative interpretation of the quality measures using percentile rank, and an aggregate composite quality score. 32 participants viewed thirty quality profiles consisting of information applicable to the practice of thirty de-identified resident physicians. Those provided with quality component measures and a qualitative interpretation of the quality measures (rankings) judged quality of care more similarly to experts and were more internally consistent compared to participants who were provided with quality component measures alone. Reliability between participants was significantly less for those who were provided with a composite quality score compared to those who were not. PMID:26949581

Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.

PubMed

Anderson, Andrew C; O'Rourke, Erin; Chin, Marshall H; Ponce, Ninez A; Bernheim, Susannah M; Burstin, Helen

2018-03-01

Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

A novel client service quality measuring model and an eHealthcare mitigating approach.

PubMed

Cheng, L M; Choi, Wai Ping Choi; Wong, Anita Yiu Ming

2016-07-01

Facing population ageing in Hong Kong, the demand of long-term elderly health care services is increasing. The challenge is to support a good quality service under the constraints faced by recent shortage of nursing and care services professionals without redesigning the work flow operated in the existing elderly health care industries. the existing elderly health care industries. The Total QoS measure based on Finite Capacity Queuing Model is a reliable method and an effective measurement for Quality of services. The value is good for measuring the staffing level and offers a measurement for efficiency enhancement when incorporate new technologies like ICT. The implemented system has improved the Quality of Service by more than 14% and the extra released manpower resource will allow clinical care provider to offer further value added services without actually increasing head count. We have developed a novel Quality of Service measurement for Clinical Care services based on multi-queue using finite capacity queue model M/M/c/K/n and the measurement is useful for estimating the shortage of staff resource in a caring institution. It is essential for future integration with the existing widely used assessment model to develop reliable measuring limits which allow an effective measurement of public fund used in health care industries. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Impact of image quality on OCT angiography based quantitative measurements.

PubMed

Al-Sheikh, Mayss; Ghasemi Falavarjani, Khalil; Akil, Handan; Sadda, SriniVas R

2017-01-01

To study the impact of image quality on quantitative measurements and the frequency of segmentation error with optical coherence tomography angiography (OCTA). Seventeen eyes of 10 healthy individuals were included in this study. OCTA was performed using a swept-source device (Triton, Topcon). Each subject underwent three scanning sessions 1-2 min apart; the first two scans were obtained under standard conditions and for the third session, the image quality index was reduced using application of a topical ointment. En face OCTA images of the retinal vasculature were generated using the default segmentation for the superficial and deep retinal layer (SRL, DRL). Intraclass correlation coefficient (ICC) was used as a measure for repeatability. The frequency of segmentation error, motion artifact, banding artifact and projection artifact was also compared among the three sessions. The frequency of segmentation error, and motion artifact was statistically similar between high and low image quality sessions (P = 0.707, and P = 1 respectively). However, the frequency of projection and banding artifact was higher with a lower image quality. The vessel density in the SRL was highly repeatable in the high image quality sessions (ICC = 0.8), however, the repeatability was low, comparing the high and low image quality measurements (ICC = 0.3). In the DRL, the repeatability of the vessel density measurements was fair in the high quality sessions (ICC = 0.6 and ICC = 0.5, with and without automatic artifact removal, respectively) and poor comparing high and low image quality sessions (ICC = 0.3 and ICC = 0.06, with and without automatic artifact removal, respectively). The frequency of artifacts is higher and the repeatability of the measurements is lower with lower image quality. The impact of image quality index should be always considered in OCTA based quantitative measurements.

Safety considerations in providing allergen immunotherapy in the office.

PubMed

Mattos, Jose L; Lee, Stella

2016-06-01

This review highlights the risks of allergy immunotherapy, methods to improve the quality and safety of allergy treatment, the current status of allergy quality metrics, and the future of quality measurement. In the current healthcare environment, the emphasis on outcomes measurement is increasing, and providers must be better equipped in the development, measurement, and reporting of safety and quality measures. Immunotherapy offers the only potential cure for allergic disease and asthma. Although well tolerated and effective, immunotherapy can be associated with serious consequence, including anaphylaxis and death. Many predisposing factors and errors that lead to serious systemic reactions are preventable, and the evaluation and implementation of quality measures are crucial to developing a safe immunotherapy practice. Although quality metrics for immunotherapy are in their infancy, they will become increasingly sophisticated, and providers will face increased pressure to deliver safe, high-quality, patient-centered, evidence-based, and efficient allergy care. The establishment of safety in the allergy office involves recognition of potential risk factors for anaphylaxis, the development and measurement of quality metrics, and changing systems-wide practices if needed. Quality improvement is a continuous process, and although national allergy-specific quality metrics do not yet exist, they are in development.

Toward an applied technology for quality measurement in health care.

PubMed

Berwick, D M

1988-01-01

Cost containment, financial incentives to conserve resources, the growth of for-profit hospitals, an aggressive malpractice environment, and demands from purchasers are among the forces today increasing the need for improved methods that measure quality in health care. At the same time, increasingly sophisticated databases and the existence of managed care systems yield new opportunities to observe and correct quality problems. Research on targets of measurement (structure, process, and outcome) and methods of measurement (implicit, explicit, and sentinel methods) has not yet produced managerially useful applied technology for quality measurement in real-world settings. Such an applied technology would have to be cheaper, faster, more flexible, better reported, and more multidimensional than the majority of current research on quality assurance. In developing a new applied technology for the measurement of health care quality, quantitative disciplines have much to offer, such as decision support systems, criteria based on rigorous decision analyses, utility theory, tools for functional status measurement, and advances in operations research.

Measurement properties of rheumatoid arthritis-specific quality-of-life questionnaires: systematic review of the literature.

PubMed

Lee, Jiyeon; Kim, Soo Hyun; Moon, Seung Hei; Lee, Eun-Hyun

2014-12-01

This study conducted a systematic review of the methodological quality of the psychometric evaluation process and the quality of measurement properties of rheumatoid arthritis (RA)-specific health-related quality-of-life (HRQOL) questionnaires with the purpose of obtaining the best evidence to help in the selection of the most appropriate instrument for measuring HRQOL in RA patients. A systematic literature search was performed to identify RA-specific HRQOL questionnaires in databases. The methodological quality of the studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The quality of the measurement properties was assessed using quality criteria. The evidence regarding the measurement properties was pooled using best-evidence synthesis, with considerations of the number and methodological quality of the studies, and the consistency of their findings in terms of the quality of the measurement properties. The search identified 37 studies describing 9 instruments. Best-evidence synthesis suggested that the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire had the strongest positive evidence, especially with respect to reliability, measurement error, and content validity, and moderate positive evidence with respect to hypothesis testing and responsiveness. The current evidence suggests that the best-validated instrument among the RA-specific HRQOL measures is the RAQoL questionnaire in terms of both methodological quality in the process of psychometric evaluation and the quality of the measurement properties. However, there is limited evidence regarding internal consistency and structural validity of the RAQoL. Further efforts are warranted to establish the psychometric quality of this questionnaire.

Quality of Mental Health Care for Nursing Home Residents: A Literature Review

PubMed Central

Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.

2010-01-01

Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

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.

Development and implementation of an automated quantitative film digitizer quality control program

NASA Astrophysics Data System (ADS)

Fetterly, Kenneth A.; Avula, Ramesh T. V.; Hangiandreou, Nicholas J.

1999-05-01

A semi-automated, quantitative film digitizer quality control program that is based on the computer analysis of the image data from a single digitized test film was developed. This program includes measurements of the geometric accuracy, optical density performance, signal to noise ratio, and presampled modulation transfer function. The variability of the measurements was less than plus or minus 5%. Measurements were made on a group of two clinical and two laboratory laser film digitizers during a trial period of approximately four months. Quality control limits were established based on clinical necessity, vendor specifications and digitizer performance. During the trial period, one of the digitizers failed the performance requirements and was corrected by calibration.

Real-time video quality monitoring

NASA Astrophysics Data System (ADS)

Liu, Tao; Narvekar, Niranjan; Wang, Beibei; Ding, Ran; Zou, Dekun; Cash, Glenn; Bhagavathy, Sitaram; Bloom, Jeffrey

2011-12-01

The ITU-T Recommendation G.1070 is a standardized opinion model for video telephony applications that uses video bitrate, frame rate, and packet-loss rate to measure the video quality. However, this model was original designed as an offline quality planning tool. It cannot be directly used for quality monitoring since the above three input parameters are not readily available within a network or at the decoder. And there is a great room for the performance improvement of this quality metric. In this article, we present a real-time video quality monitoring solution based on this Recommendation. We first propose a scheme to efficiently estimate the three parameters from video bitstreams, so that it can be used as a real-time video quality monitoring tool. Furthermore, an enhanced algorithm based on the G.1070 model that provides more accurate quality prediction is proposed. Finally, to use this metric in real-world applications, we present an example emerging application of real-time quality measurement to the management of transmitted videos, especially those delivered to mobile devices.

What Adherence Measures Should Be Used in Trials of Home-Based Rehabilitation Interventions? A Systematic Review of the Validity, Reliability, and Acceptability of Measures.

PubMed

Frost, Rachael; Levati, Sara; McClurg, Doreen; Brady, Marian; Williams, Brian

2017-06-01

To systematically review methods for measuring adherence used in home-based rehabilitation trials and to evaluate their validity, reliability, and acceptability. In phase 1 we searched the CENTRAL database, NHS Economic Evaluation Database, and Health Technology Assessment Database (January 2000 to April 2013) to identify adherence measures used in randomized controlled trials of allied health professional home-based rehabilitation interventions. In phase 2 we searched the databases of MEDLINE, Embase, CINAHL, Allied and Complementary Medicine Database, PsycINFO, CENTRAL, ProQuest Nursing and Allied Health, and Web of Science (inception to April 2015) for measurement property assessments for each measure. Studies assessing the validity, reliability, or acceptability of adherence measures. Two reviewers independently extracted data on participant and measure characteristics, measurement properties evaluated, evaluation methods, and outcome statistics and assessed study quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. In phase 1 we included 8 adherence measures (56 trials). In phase 2, from the 222 measurement property assessments identified in 109 studies, 22 high-quality measurement property assessments were narratively synthesized. Low-quality studies were used as supporting data. StepWatch Activity Monitor validly and acceptably measured short-term step count adherence. The Problematic Experiences of Therapy Scale validly and reliably assessed adherence to vestibular rehabilitation exercises. Adherence diaries had moderately high validity and acceptability across limited populations. The Borg 6 to 20 scale, Bassett and Prapavessis scale, and Yamax CW series had insufficient validity. Low-quality evidence supported use of the Joint Protection Behaviour Assessment. Polar A1 series heart monitors were considered acceptable by 1 study. Current rehabilitation adherence measures are limited. Some possess promising validity and acceptability for certain parameters of adherence, situations, and populations and should be used in these situations. Rigorous evaluation of adherence measures in a broader range of populations is needed. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Enhanced data validation strategy of air quality monitoring network.

PubMed

Harkat, Mohamed-Faouzi; Mansouri, Majdi; Nounou, Mohamed; Nounou, Hazem

2018-01-01

Quick validation and detection of faults in measured air quality data is a crucial step towards achieving the objectives of air quality networks. Therefore, the objectives of this paper are threefold: (i) to develop a modeling technique that can be used to predict the normal behavior of air quality variables and help provide accurate reference for monitoring purposes; (ii) to develop fault detection method that can effectively and quickly detect any anomalies in measured air quality data. For this purpose, a new fault detection method that is based on the combination of generalized likelihood ratio test (GLRT) and exponentially weighted moving average (EWMA) will be developed. GLRT is a well-known statistical fault detection method that relies on maximizing the detection probability for a given false alarm rate. In this paper, we propose to develop GLRT-based EWMA fault detection method that will be able to detect the changes in the values of certain air quality variables; (iii) to develop fault isolation and identification method that allows defining the fault source(s) in order to properly apply appropriate corrective actions. In this paper, reconstruction approach that is based on Midpoint-Radii Principal Component Analysis (MRPCA) model will be developed to handle the types of data and models associated with air quality monitoring networks. All air quality modeling, fault detection, fault isolation and reconstruction methods developed in this paper will be validated using real air quality data (such as particulate matter, ozone, nitrogen and carbon oxides measurement). Copyright © 2017 Elsevier Inc. All rights reserved.

Researches of fruit quality prediction model based on near infrared spectrum

NASA Astrophysics Data System (ADS)

Shen, Yulin; Li, Lian

2018-04-01

With the improvement in standards for food quality and safety, people pay more attention to the internal quality of fruits, therefore the measurement of fruit internal quality is increasingly imperative. In general, nondestructive soluble solid content (SSC) and total acid content (TAC) analysis of fruits is vital and effective for quality measurement in global fresh produce markets, so in this paper, we aim at establishing a novel fruit internal quality prediction model based on SSC and TAC for Near Infrared Spectrum. Firstly, the model of fruit quality prediction based on PCA + BP neural network, PCA + GRNN network, PCA + BP adaboost strong classifier, PCA + ELM and PCA + LS_SVM classifier are designed and implemented respectively; then, in the NSCT domain, the median filter and the SavitzkyGolay filter are used to preprocess the spectral signal, Kennard-Stone algorithm is used to automatically select the training samples and test samples; thirdly, we achieve the optimal models by comparing 15 kinds of prediction model based on the theory of multi-classifier competition mechanism, specifically, the non-parametric estimation is introduced to measure the effectiveness of proposed model, the reliability and variance of nonparametric estimation evaluation of each prediction model to evaluate the prediction result, while the estimated value and confidence interval regard as a reference, the experimental results demonstrate that this model can better achieve the optimal evaluation of the internal quality of fruit; finally, we employ cat swarm optimization to optimize two optimal models above obtained from nonparametric estimation, empirical testing indicates that the proposed method can provide more accurate and effective results than other forecasting methods.

Adaptive EAGLE dynamic solution adaptation and grid quality enhancement

NASA Technical Reports Server (NTRS)

Luong, Phu Vinh; Thompson, J. F.; Gatlin, B.; Mastin, C. W.; Kim, H. J.

1992-01-01

In the effort described here, the elliptic grid generation procedure in the EAGLE grid code was separated from the main code into a subroutine, and a new subroutine which evaluates several grid quality measures at each grid point was added. The elliptic grid routine can now be called, either by a computational fluid dynamics (CFD) code to generate a new adaptive grid based on flow variables and quality measures through multiple adaptation, or by the EAGLE main code to generate a grid based on quality measure variables through static adaptation. Arrays of flow variables can be read into the EAGLE grid code for use in static adaptation as well. These major changes in the EAGLE adaptive grid system make it easier to convert any CFD code that operates on a block-structured grid (or single-block grid) into a multiple adaptive code.

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Objective Speech Quality Assessment Based on Payload Discrimination of Lost Packets for Cellular Phones in NGN Environment

NASA Astrophysics Data System (ADS)

Uemura, Satoshi; Fukumoto, Norihiro; Yamada, Hideaki; Nakamura, Hajime

A feature of services provided in a Next Generation Network (NGN) is that the end-to-end quality is guaranteed. This is quite a challenging issue, given the considerable fluctuation in network conditions within a Fixed Mobile Convergence (FMC) network. Therefore, a novel approach, whereby a network node and a mobile terminal such as a cellular phone cooperate with each other to control service quality is essential. In order to achieve such cooperation, the mobile terminal needs to become more intelligent so it can estimate the service quality, including the user's perceptual quality, and notify the measurement result to the network node. Subsequently, the network node implements some kind of service control function, such as a resource and admission control function, based on the notification from the mobile terminal. In this paper, the role of the mobile terminal in such collaborative system is focused on. As a part of a QoS/QoE measurement system, we describe an objective speech quality assessment with payload discrimination of lost packets to measure the user's perceptual quality of VoIP. The proposed assessment is so simple that it can be implemented on a cellular phone. We therefore did this as part of the QoS/QoE measurement system. By using the implemented system, we can measure the user's perceptual quality of VoIP as well as the network QoS metrics, in terms of criteria such as packet loss rate, jitter and burstiness in real time.

Doctors or technicians: assessing quality of medical education

PubMed Central

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products. PMID:23745059

Doctors or technicians: assessing quality of medical education.

PubMed

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products.

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

EPA Science Inventory

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

Quality measures and pediatric radiology: suggestions for the transition to value-based payment.

PubMed

Heller, Richard E; Coley, Brian D; Simoneaux, Stephen F; Podberesky, Daniel J; Hernanz-Schulman, Marta; Robertson, Richard L; Donnelly, Lane F

2017-06-01

Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.

An effectiveness analysis of healthcare systems using a systems theoretic approach.

PubMed

Chuang, Sheuwen; Inder, Kerry

2009-10-24

The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provides a systematic search for improving the impact of accreditation on quality of care and hence on the accreditation/performance correlation. There is clear value in developing a theoretical systems approach to achieving quality in health care. The introduction of the systematic surveyor-based search for improvements creates an adaptive-control system to optimize health care quality. It is hoped that these outcomes will stimulate further research in the development of strategic planning using systems theoretic approach for the improvement of quality in health care.

Which Questionnaire Should Be Used to Measure Quality-of-Life Utilities in Patients with Acute Leukemia? An Evaluation of the Validity and Interpretability of the EQ-5D-5L and Preference-Based Questionnaires Derived from the EORTC QLQ-C30.

PubMed

van Dongen-Leunis, Annemieke; Redekop, W Ken; Uyl-de Groot, Carin A

The aim of this study was to assess the validity and interpretability of different preference-based questionnaires (generic 5-level EuroQol five-dimensional questionnaire [EQ-5D-5L], cancer-specific Quality of Life Questionnaire Preference-Based Measure, and European Organization of Randomized Controlled Trials 8 Dimension [EORTC-8D]) in patients with acute leukemia. Patients who participated in Hemato-Oncologie voor Volwassenen Nederland (HOVON - the Haemato Oncology Foundation for Adults in the Netherlands) clinical trials between 1999 and 2011 at a single hospital were invited to complete the questionnaires. Interpretability was evaluated by the frequency of incomplete data and highest and lowest possible scores. Content validity was evaluated by exploring the health-related quality-of-life domains included in the questionnaires. Construct validity was assessed using correlations with other quality-of-life scales (EQ-visual analogue scale score and global quality-of-life scale of the EORTC Quality of Life Questionnaire) and ability to distinguish between patients with different health statuses. Questionnaires were returned by 89% (111 of 125) of the patients. Six to seven respondents did not return full questionnaires. Perfect health on the EQ-5D-5L was reported by 32 respondents and many of them (N = 17) did report health problems on other questionnaires. All questionnaires were strongly correlated (range 0.61-0.78) with other quality-of-life scales and yielded substantially different utility values for patients with different health statuses. Nevertheless, the disease-specific preference-based questionnaires showed greater discriminatory power. Although the Quality of Life Questionnaire Preference-Based Measure and the EORTC-8D appear to have better validity, this study does not provide any strong evidence against the use of the EQ-5D-5L for measuring quality-of-life utilities in acute leukemia. However, our findings need to be confirmed in larger longitudinal studies. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The association of Nursing Home Compare quality measures with market competition and occupancy rates.

PubMed

Castle, Nicholas G; Liu, Darren; Engberg, John

2008-01-01

Since 2002, the Centers for Medicare and Medicaid Services have reported quality measures on the Nursing Home Compare Web site. It has been assumed that nursing homes are able to make improvements on these measures. In this study researchers examined nursing homes to see whether they have improved their quality scores, after accounting for regression to the mean. Researchers also examined whether gains varied according to market competition or market occupancy rates. They identified some regression to the mean for the quality measure scores over time; nevertheless, they also determined that some nursing homes had indeed made small improvements in their quality measure scores. As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, the greatest improvements occurred in the most competitive markets and in those with the Lowest average occupancy rates. As policies to promote more competition in Long-term care proceed, further reducing occupancy rates, further, albeit small, quality gains will likely be made in the future.

European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare.

PubMed

Gaebel, W; Großimlinghaus, I; Heun, R; Janssen, B; Johnson, B; Kurimay, T; Montellano, P; Muijen, M; Munk-Jorgensen, P; Rössler, W; Ruggeri, M; Thornicroft, G; Zielasek, J

2015-03-01

To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance. We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding). Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level). There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels. Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument.

PubMed

Mokkink, Lidwine B; Prinsen, Cecilia A C; Bouter, Lex M; Vet, Henrica C W de; Terwee, Caroline B

2016-01-19

COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) is an initiative of an international multidisciplinary team of researchers who aim to improve the selection of outcome measurement instruments both in research and in clinical practice by developing tools for selecting the most appropriate available instrument. In this paper these tools are described, i.e. the COSMIN taxonomy and definition of measurement properties; the COSMIN checklist to evaluate the methodological quality of studies on measurement properties; a search filter for finding studies on measurement properties; a protocol for systematic reviews of outcome measurement instruments; a database of systematic reviews of outcome measurement instruments; and a guideline for selecting outcome measurement instruments for Core Outcome Sets in clinical trials. Currently, we are updating the COSMIN checklist, particularly the standards for content validity studies. Also new standards for studies using Item Response Theory methods will be developed. Additionally, in the future we want to develop standards for studies on the quality of non-patient reported outcome measures, such as clinician-reported outcomes and performance-based outcomes. In summary, we plea for more standardization in the use of outcome measurement instruments, for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended, and for stopping the use of poor outcome measurement instruments.

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument

PubMed Central

Mokkink, Lidwine B.; Prinsen, Cecilia A. C.; Bouter, Lex M.; de Vet, Henrica C. W.; Terwee, Caroline B.

2016-01-01

Background: COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) is an initiative of an international multidisciplinary team of researchers who aim to improve the selection of outcome measurement instruments both in research and in clinical practice by developing tools for selecting the most appropriate available instrument. Method: In this paper these tools are described, i.e. the COSMIN taxonomy and definition of measurement properties; the COSMIN checklist to evaluate the methodological quality of studies on measurement properties; a search filter for finding studies on measurement properties; a protocol for systematic reviews of outcome measurement instruments; a database of systematic reviews of outcome measurement instruments; and a guideline for selecting outcome measurement instruments for Core Outcome Sets in clinical trials. Currently, we are updating the COSMIN checklist, particularly the standards for content validity studies. Also new standards for studies using Item Response Theory methods will be developed. Additionally, in the future we want to develop standards for studies on the quality of non-patient reported outcome measures, such as clinician-reported outcomes and performance-based outcomes. Conclusions: In summary, we plea for more standardization in the use of outcome measurement instruments, for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended, and for stopping the use of poor outcome measurement instruments. PMID:26786084

The Child Care Ecology Inventory: A Domain-Specific Measure of Home-Based Child Care Quality to Promote Social Competence for School Readiness

ERIC Educational Resources Information Center

Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

2013-01-01

This study investigates the reliability and validity of the Child Care Ecology Inventory (CCEI), a measure of the quality of family child care in the social domain. The CCEI focuses on research-based environmental features and caregiving practices for promoting positive social development in preschool-age children. A total of 198 family child care…

Measuring surgical performance: A risky game?

PubMed

Kiernan, F; Rahman, F

2015-08-01

Interest in performance measurement has been driven by increased demand for better indicators of hospital quality of care. This is due in part to policy makers wishing to benchmark standards of care and implement quality improvements, and also by an increased demand for transparency and accountability. We describe the role of performance measurement, which is not only about quality improvement, but also serves as a guide in allocating resources within health systems, and between health, education, and social welfare systems. As hospital based healthcare is responsible for the most cost within the healthcare system, and treats the most severely ill of patients, it is no surprise that performance measurement has focused attention on hospital based care, and in particular on surgery, as an important means of improving quality and accountability. We are particularly concerned about the choice of mortality as an outcome measure in surgery, as this choice assumes that all mortality in surgery is preventable. In reality, as a low quality indicator of care it risks both gaming, and cream-skimming, unless accurate risk adjustment exists. Further concerns relate to the public reporting of this outcome measure. As mortality rates are an imperfect measure of quality, the reputation of individual surgeons will be threatened by the public release of this data. Significant effort should be made to communicate the results to the public in an appropriate manner. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

A Proposed Roadmap for Inpatient Neurology Quality Indicators

PubMed Central

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

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

Combining Quality and Curriculum-Based Measurement: A Suggested Assessment Protocol in Writing

ERIC Educational Resources Information Center

Ganzeveld, Paula

2015-01-01

Curriculum-Based Measures in writing (CBM-W) assesses a variety of fluency-based components of writing. While support exists for the use of CBM measures in the area of writing, there is a need to conduct further validation studies to investigate the utility of these measures within elementary and secondary classrooms. Since only countable indices…

Service Quality in Postgraduate Education

ERIC Educational Resources Information Center

Angell, Robert J.; Heffernan, Troy W.; Megicks, Phil

2008-01-01

Purpose: Measuring service quality in higher education is increasingly important for attracting and retaining tuition-based revenues. Nonetheless, whilst undergraduates have received substantial academic exposure, postgraduate-based research has been scant. Consequently, the objectives of this paper are threefold: first, to identify the service…

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

NASA Astrophysics Data System (ADS)

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

2017-03-01

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

Defining and evaluating quality for ambulatory care educational programs.

PubMed

Bowen, J L; Stearns, J A; Dohner, C; Blackman, J; Simpson, D

1997-06-01

As the training of medical students and residents increasingly moves to ambulatory care settings, clerkship and program directors must find a way to use their limited resources to guide the development and evaluation of the quality of these ambulatory-based learning experiences. To evaluate quality, directors must first define, in operational and measurable terms, what is meant by the term "quality" as it is applied to ambulatory-based education. Using educational theories and the definition of quality used by health care systems, the authors propose an operational definition of quality for guiding the planning, implementation, and evaluation of ambulatory care educational programs. They assert that quality is achieved through the interaction of an optimal learning environment, defined educational goals and positive outcomes, participant satisfaction, and cost-effectiveness. By describing the components of quality along with examples of measurable indicators, the authors provide a foundation for the evaluation and improvement of instructional innovations in ambulatory care education for the benefit of teachers, learners, and patients.

Clinical Decision Support-based Quality Measurement (CDS-QM) Framework: Prototype Implementation, Evaluation, and Future Directions

PubMed Central

Kukhareva, Polina V; Kawamoto, Kensaku; Shields, David E; Barfuss, Darryl T; Halley, Anne M; Tippetts, Tyler J; Warner, Phillip B; Bray, Bruce E; Staes, Catherine J

2014-01-01

Electronic quality measurement (QM) and clinical decision support (CDS) are closely related but are typically implemented independently, resulting in significant duplication of effort. While it seems intuitive that technical approaches could be re-used across these two related use cases, such reuse is seldom reported in the literature, especially for standards-based approaches. Therefore, we evaluated the feasibility of using a standards-based CDS framework aligned with anticipated EHR certification criteria to implement electronic QM. The CDS-QM framework was used to automate a complex national quality measure (SCIP-VTE-2) at an academic healthcare system which had previously relied on time-consuming manual chart abstractions. Compared with 305 manually-reviewed reference cases, the recall of automated measurement was 100%. The precision was 96.3% (CI:92.6%-98.5%) for ascertaining the denominator and 96.2% (CI:92.3%-98.4%) for the numerator. We therefore validated that a standards-based CDS-QM framework can successfully enable automated QM, and we identified benefits and challenges with this approach. PMID:25954389

Space Shuttle flying qualities criteria assessment. Phase 5: Data acquistion and analysis

NASA Technical Reports Server (NTRS)

Myers, T. T.; Johnston, D. E.; Mcruer, D. T.

1986-01-01

The development of flying qualities experiments (OFQ) as a part of the Orbiter Experiments Program (OEX) was continued. The data base was extended to use the ground based cinetheodolite measurements of orbiter approach and landing. Onboard the cinetheodolite data were analyzed from flights STS 2 through 7 to identify the effective augmented vehicle dynamics, the control strategy employed by the pilot during preflare, shallow glide, and final flare segments of the landing, and the key approach and touchdown performance measures. A plan for an OFQ flying qualities data archive and processing is presented.

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

Delivery system integration and health care spending and quality for Medicare beneficiaries.

PubMed

McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Hamed, Pasha; Landon, Bruce E

2013-08-12

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care. To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers. Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.

Quality, management, and the interplay of self-assessment, process assessments, and performance-based observations

NASA Astrophysics Data System (ADS)

Willett, D. J.

1993-04-01

In this document, the author presents his observations on the topic of quality assurance (QA). Traditionally the focus of quality management has been on QA organizations, manuals, procedures, audits, and assessments; quality was measured by the degree of conformance to specifications or standards. Today quality is defined as satisfying user needs and is measured by user satisfaction. The author proposes that quality is the responsibility of line organizations and staff and not the responsibility of the QA group. This work outlines an effective Conduct of Operations program. The author concludes his observations with a discussion of how quality is analogous to leadership.

Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

PubMed

Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

2016-07-01

Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

Stress and health behaviors as potential mediators of the relationship between neighborhood quality and allostatic load.

PubMed

Buschmann, Robert N; Prochaska, John D; Cutchin, Malcolm P; Peek, M Kristen

2018-03-29

Neighborhood quality is associated with health. Increasingly, researchers are focusing on the mechanisms underlying that association, including the role of stress, risky health behaviors, and subclinical measures such as allostatic load (AL). This study uses mixed-effects regression modeling to examine the association between two objective measures and one subjective measure of neighborhood quality and AL in an ethnically diverse population-based sample (N = 2706) from a medium-sized Texas city. We also examine whether several measures of psychological stress and health behaviors mediate any relationship between neighborhood quality and AL. In this sample, all three separate measures of neighborhood quality were associated with individual AL (P < .01). However, only the subjective measure, perceived neighborhood quality, was associated with AL after adjusting for covariates. In mixed-effects multiple regression models there was no evidence of mediation by either stress or health behaviors. In this study, only one measure of neighborhood quality was related to a measure of health, which contrasts with considerable previous research in this area. In this sample, neighborhood quality may affect AL through other mechanisms, or there may be other health-affecting factors is this area that share that overshadow local neighborhood variation. Copyright © 2018 Elsevier Inc. All rights reserved.

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment.

PubMed

Engel, Lisa; Chui, Adora; Beaton, Dorcas E; Green, Robin E; Dawson, Deirdre R

2018-03-07

To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. Seven databases were searched in May 2015. Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A framework for automatic information quality ranking of diabetes websites.

PubMed

Belen Sağlam, Rahime; Taskaya Temizel, Tugba

2015-01-01

Objective: When searching for particular medical information on the internet the challenge lies in distinguishing the websites that are relevant to the topic, and contain accurate information. In this article, we propose a framework that automatically identifies and ranks diabetes websites according to their relevance and information quality based on the website content. Design: The proposed framework ranks diabetes websites according to their content quality, relevance and evidence based medicine. The framework combines information retrieval techniques with a lexical resource based on Sentiwordnet making it possible to work with biased and untrusted websites while, at the same time, ensuring the content relevance. Measurement: The evaluation measurements used were Pearson-correlation, true positives, false positives and accuracy. We tested the framework with a benchmark data set consisting of 55 websites with varying degrees of information quality problems. Results: The proposed framework gives good results that are comparable with the non-automated information quality measuring approaches in the literature. The correlation between the results of the proposed automated framework and ground-truth is 0.68 on an average with p < 0.001 which is greater than the other proposed automated methods in the literature (r score in average is 0.33).

Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages

NASA Astrophysics Data System (ADS)

Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

2017-04-01

Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages.

PubMed

Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

2017-04-01

Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

Analysis of Open Education Service Quality with the Descriptive-Quantitative Approach

ERIC Educational Resources Information Center

Priyogi, Bilih; Santoso, Harry B.; Berliyanto; Hasibuan, Zainal A.

2017-01-01

The concept of Open Education (OE) is based on the philosophy of e-Learning which aims to provide learning environment anywhere, anytime, and for anyone. One of the main issue in the development of OE services is the availability of the quality assurance mechanism. This study proposes a metric for measuring the quality of OE service. Based on…

Building a bridge for integrating Chinese medicine into conventional healthcare: observations drawn from the development of the Chinese quality of life instrument.

PubMed

Zhao, Li; Chan, Kelvin

2005-01-01

This paper describes the methods and theories of patient-reported outcomes, in particular to the health-related quality of life recently applied in Chinese medicine research. It begins with an investigation of the reasons for a patient-reported outcomes measure for Chinese medicine and the development of a new health-related quality of life instrument based on Chinese culture and Chinese medicine. Discussions on the importance and application of patient-reported outcomes as well as the relationship between quality of life and Chinese medicine are at the focus of this paper. Through a description of the Chinese Quality of Life Instrument and its development, the present work demonstrates an evidence-based approach using patient-reported outcomes or health-related quality of life measures to evaluate treatment efficacy of Chinese medicine, and thereby build a bridge for the integration of Chinese medicine into mainstream health care.

[Valuation of health-related quality of life and utilities in health economics].

PubMed

Greiner, Wolfgang; Klose, Kristina

2014-01-01

Measuring health-related quality of life is an important aspect in economic evaluation of health programmes. The development of utility-based (preference-based) measures is advanced by the discipline of health economics. Different preference measures are applied for valuing health states to produce a weighted health state index. Those preference weights should be derived from a general population sample in case of resource allocation on a collective level (as in current valuation studies of the EuroQol group). Copyright © 2014. Published by Elsevier GmbH.

Pay for performance in thoracic surgery.

PubMed

Varela, Gonzalo

2007-08-01

In the context of improving the quality of the medical practice, PFP programs have been developed to reward best medical practice. Early studies showed little gain in quality after implementing PFP family practice programs and some unintended consequences, like excluding high-risk patients from medical services when good outcomes were linked to payment. To date, no PFP programs have been implemented in surgical practice, but it is expected that value-based purchasing philosophy will be extended to surgical specialties in the near future. Quality initiatives in surgery can be based on outcome or process measures. Outcomes-focused quality approaches rely on accurate information obtained from multiinstitutional clinical databases for calculation of risk-adjusted models. Primary outcomes such surgical mortality are uncommon in modern thoracic surgery and outcome measures should rely on more prevalent intermediate outcomes such as specific postoperative morbidities or emergency readmission. Process-based quality approaches need to be based on scientific evidence linking process to outcomes. It is our responsibility to develop practice guidelines or international practice consensus to facilitate the parameters to be evaluated in the near future.

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

EPA Science Inventory

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

Nutrient Credit Trading--a Market-based Approach for Improving Water Quality

USDA-ARS?s Scientific Manuscript database

Farmers are getting financial rewards for implementing conservation measures on their farms. Industrial wastewater treatment plants are buying credits generated from these measures to meet their NPDES permit regulatory requirements. This is referred to as “water quality trading.” The treatment p...

Quality control and gap-filling of PM10 daily mean concentrations with the best linear unbiased estimator.

PubMed

Sozzi, R; Bolignano, A; Ceradini, S; Morelli, M; Petenko, I; Argentini, S

2017-10-15

According to the European Directive 2008/50/CE, the air quality assessment consists in the measurement of the concentration fields, and the evaluation of the mean, number of exceedances, etc. of some chemical species dangerous to human health. The measurements provided by an air quality ground-based monitoring network are the main information source but the availability of these data is often limited by several technical and operational problems. In this paper, the best linear unbiased estimator (BLUE) is proposed to validate the pollutant concentration values and to fill the gaps in the measurement of time series collected by a monitoring network. The BLUE algorithm is tested using the daily mean concentrations of particulate matter having aerodynamic diameter less than 10 μ (PM 10 concentrations) measured by the air quality monitoring sensors operating in the Lazio Region in Italy. The comparison between the estimated and measured data evidences an error comparable with the measurement uncertainty. Due to its simplicity and reliability, the BLUE will be used in the routine quality test procedures of the Lazio air quality monitoring network measurements.

Governing Healthcare through Performance Measurement in Massachusetts and the Netherlands

PubMed Central

Van der Wees, Philip J.; der Sanden, Maria W.G. Nijhuis-van; van Ginneken, Ewout; Ayanian, John Z.; Schneider, Eric C.; Westert, Gert P.

2016-01-01

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of institutes to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives. PMID:24138729

Comparative evaluation of two asthma care quality measures among Medicaid beneficiaries.

PubMed

Samnaliev, Mihail; Baxter, Jeffrey D; Clark, Robin E

2009-05-01

The relative performance of asthma care quality measures has not been evaluated in Medicaid populations. Using complete claims and pharmaceutical data for 19,076 patients with persistent asthma (based on Health Effectiveness and Data Information Set criteria) in five Medicaid populations, we compared the following two measures of asthma care quality: filling prescriptions for controller asthma medications within 1 year and the ratio of controller medication to the total number of asthma medication prescriptions filled within 1 year. We calculated whether meeting each quality measure was associated with decreased odds of emergency department (ED) treatment episodes. We then compared the odds ratios, receiver operating characteristic (ROC) curves, and deviances between models, using each measure to predict ED utilization in Medicaid populations. Although meeting each measure was associated with lower odds of ED utilization, this decrease was larger if the controller asthma medication measure was met rather than the ratio measure. Additionally, models using the controller medication measure had greater areas under the ROC curve and smaller deviances than models using the ratio measure. Both administrative measures of asthma care quality were associated with lower odds of ED utilization. The controller medication measure of asthma care quality may be better than the ratio measure in relation to emergency asthma care utilization by Medicaid beneficiaries.

Evaluation of the measurement properties of self-reported health-related work-functioning instruments among workers with common mental disorders.

PubMed

Abma, Femke I; van der Klink, Jac J L; Terwee, Caroline B; Amick, Benjamin C; Bültmann, Ute

2012-01-01

During the past decade, common mental disorders (CMD) have emerged as a major public and occupational health problem in many countries. Several instruments have been developed to measure the influence of health on functioning at work. To select appropriate instruments for use in occupational health practice and research, the measurement properties (eg, reliability, validity, responsiveness) must be evaluated. The objective of this study is to appraise critically and compare the measurement properties of self-reported health-related work-functioning instruments among workers with CMD. A systematic review was performed searching three electronic databases. Papers were included that: (i) mainly focused on the development and/or evaluation of the measurement properties of a self-reported health-related work-functioning instrument; (ii) were conducted in a CMD population; and (iii) were fulltext original papers. Quality appraisal was performed using the consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist. Five papers evaluating measurement properties of five self-reported health-related work-functioning instruments in CMD populations were included. There is little evidence available for the measurement properties of the identified instruments in this population, mainly due to low methodological quality of the included studies. The available evidence on measurement properties is based on studies of poor-to-fair methodological quality. Information on a number of measurement properties, such as measurement error, content validity, and cross-cultural validity is still lacking. Therefore, no evidence-based decisions and recommendations can be made for the use of health-related work functioning instruments. Studies of high methodological quality are needed to properly assess the existing instruments' measurement properties.

Development of the Quality of Australian Nursing Documentation in Aged Care (QANDAC) instrument to assess paper-based and electronic resident records.

PubMed

Wang, Ning; Björvell, Catrin; Hailey, David; Yu, Ping

2014-12-01

To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. The QANDAC instrument may be a useful audit tool for quality improvement and research in aged care documentation. © 2013 ACOTA.

Quality of life in acne vulgaris: Relationship to clinical severity and demographic data.

PubMed

Gupta, Aayush; Sharma, Yugal Kishor; Dash, Kedar Nath; Chaudhari, Nitin Dinkar; Jethani, Sumit

2016-01-01

Acne vulgaris is known to impair many aspects of quality of life. However, the correlation of this impairment with clinical severity remains equivocal despite various school, community and hospital-based studies. A hospital-based study was undertaken to measure the impairment of quality of life of patients of acne vulgaris and correlate it with the severity of lesions. This was a cross-sectional, questionnaire-based study in a cohort of 100 patients of acne vulgaris attending the outpatient department of our referral hospital. A physician measured the severity of lesions using the global acne grading system, and patients assessed quality of life by completing a questionnaire (Cardiff acne disability index). A correlation of these two was done; some additional correlations were brought out through demographic data collected from the patients. There was no correlation between the severity of acne vulgaris and an impaired quality of life. Patients who consumed alcohol and/or smoked cigarettes were found to have an impaired quality of life. While the severity of acne progressively lessened in older patients, the impact on quality of life increased. The sample size was small and there was a lack of guaranteed reliability on the self-reported quality of life. The severity of acne vulgaris does not correlate with impairment in quality of life.

Questionnaires for Measuring Refractive Surgery Outcomes.

PubMed

Kandel, Himal; Khadka, Jyoti; Lundström, Mats; Goggin, Michael; Pesudovs, Konrad

2017-06-01

To identify the questionnaires used to assess refractive surgery outcomes, assess the available questionnaires in regard to their psychometric properties, validity, and reliability, and evaluate the performance of the available questionnaires in measuring refractive surgery outcomes. An extensive literature search was done on PubMed, MEDLINE, Scopus, CINAHL, Cochrane, and Web of Science databases to identify articles that described or used at least one questionnaire to assess refractive surgery outcomes. The information on content quality, validity, reliability, responsiveness, and psychometric properties was extracted and analyzed based on an extensive set of quality criteria. Eighty-one articles describing 27 questionnaires (12 refractive error-specific, including 4 refractive surgery-specific, 7 vision-but-non-refractive, and 8 generic) were included in the review. Most articles (56, 69.1%) described refractive error-specific questionnaires. The Quality of Life Impact of Refractive Correction (QIRC), the Quality of Vision (QoV), and the Near Activity Visual Questionnaire (NAVQ) were originally constructed using Rasch analysis; others were developed using the Classical Test Theory. The National Eye Institute Refractive Quality of Life questionnaire was the most frequently used questionnaire, but it does not provide a valid measurement. The QoV, QIRC, and NAVQ are the three best existing questionnaires to assess visual symptoms, quality of life, and activity limitations, respectively. This review identified three superior quality questionnaires for measuring different aspects of quality of life in refractive surgery. Clinicians and researchers should choose a questionnaire based on the concept being measured with superior psychometric properties. [J Refract Surg. 2017;33(6):416-424.]. Copyright 2017, SLACK Incorporated.

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

PubMed

Greene, Laurence; Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Patel, Barry; Higgins, Peter D R

2015-09-01

In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD. Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200). Trained abstractors reviewed randomly selected charts of adults with moderate or severe Crohn's disease. The charts were retrospectively abstracted for physicians' documented performance of the 2013 Physician Quality Reporting System IBD quality measures. We compared the physicians' baseline and posteducation rates of documented adherence with 10 of these measures. In a secondary analysis, we compared preeducation with posteducation difference scores of low-performing physicians, those whose baseline documentation rates were in the lowest quartile, and the rest of the cohort. At baseline, documentation of mean provider-level adherence to the 10 quality measures ranged from 3% to 98% (grand mean = 35.8%). In the overall analysis, baseline and posteducation rates of documented adherence did not differ significantly for any of the measures. However, for 4 measures, preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles. The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists.

AQA-PM: Extension of the Air-Quality Model For Austria with Satellite based Particulate Matter Estimates

NASA Astrophysics Data System (ADS)

Hirtl, Marcus; Mantovani, Simone; Krüger, Bernd C.; Triebnig, Gerhard; Flandorfer, Claudia

2013-04-01

Air quality is a key element for the well-being and quality of life of European citizens. Air pollution measurements and modeling tools are essential for assessment of air quality according to EU legislation. The responsibilities of ZAMG as the national weather service of Austria include the support of the federal states and the public in questions connected to the protection of the environment in the frame of advisory and counseling services as well as expert opinions. The Air Quality model for Austria (AQA) is operated at ZAMG in cooperation with the University of Natural Resources and Life Sciences in Vienna (BOKU) by order of the regional governments since 2005. AQA conducts daily forecasts of gaseous and particulate (PM10) air pollutants over Austria. In the frame of the project AQA-PM (funded by FFG), satellite measurements of the Aerosol Optical Thickness (AOT) and ground-based PM10-measurements are combined to highly-resolved initial fields using regression- and assimilation techniques. For the model simulations WRF/Chem is used with a resolution of 3 km over the alpine region. Interfaces have been developed to account for the different measurements as input data. The available local emission inventories provided by the different Austrian regional governments were harmonized and used for the model simulations. An episode in February 2010 is chosen for the model evaluation. During that month exceedances of PM10-thresholds occurred at many measurement stations of the Austrian network. Different model runs (only model/only ground stations assimilated/satellite and ground stations assimilated) are compared to the respective measurements. The goal of this project is to improve the PM10-forecasts for Austria with the integration of satellite based measurements and to provide a comprehensive product-platform.

Application of an IRT Polytomous Model for Measuring Health Related Quality of Life

ERIC Educational Resources Information Center

Tejada, Antonio J. Rojas; Rojas, Oscar M. Lozano

2005-01-01

Background: The Item Response Theory (IRT) has advantages for measuring Health Related Quality of Life (HRQOL) as opposed to the Classical Tests Theory (CTT). Objectives: To present the results of the application of a polytomous model based on IRT, specifically, the Rating Scale Model (RSM), to measure HRQOL with the EORTC QLQ-C30. Methods: 103…

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

PubMed Central

Lamb, Geoffrey C.; Smith, Maureen; Weeks, William B.; Queram, Christopher

2014-01-01

Public reporting of performance on quality measures is increasingly common but little is known about the impact, especially among physician groups. The Wisconsin Collaborative for Healthcare Quality (Collaborative) is a voluntary consortium of physician groups which has publicly reported quality measures since 2004, providing an opportunity to study the effect of this effort on participating groups. Analyses included member performance on 14 ambulatory measures from 2004–2009, a survey regarding reporting and its relationship to improvement efforts, and use of Medicare billing data to independently compare Collaborative members to the rest of Wisconsin, neighboring states and the rest of the United States. Faced with limited resources, groups prioritized their efforts based on the nature of the measure and their performance compared to others. The outcomes demonstrated that public reporting was associated with improvement in health quality and that large physician group practices will engage in improvement efforts in response. PMID:23459733

Economic method for helical gear flank surface characterisation

NASA Astrophysics Data System (ADS)

Koulin, G.; Reavie, T.; Frazer, R. C.; Shaw, B. A.

2018-03-01

Typically the quality of a gear pair is assessed based on simplified geometric tolerances which do not always correlate with functional performance. In order to identify and quantify functional performance based parameters, further development of the gear measurement approach is required. Methodology for interpolation of the full active helical gear flank surface, from sparse line measurements, is presented. The method seeks to identify the minimum number of line measurements required to sufficiently characterise an active gear flank. In the form ground gear example presented, a single helix and three profile line measurements was considered to be acceptable. The resulting surfaces can be used to simulate the meshing engagement of a gear pair and therefore provide insight into functional performance based parameters. Therefore the assessment of the quality can be based on the predicted performance in the context of an application.

Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

PubMed Central

Aurora, R. Nisha; Collop, Nancy A.; Jacobowitz, Ofer; Thomas, Sherene M.; Quan, Stuart F.; Aronsky, Amy J.

2015-01-01

Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA. Citation: Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med 2015;11(3):357–383. PMID:25700878

Students Matter: Quality Measurements in Online Courses

ERIC Educational Resources Information Center

Unal, Zafer; Unal, Aslihan

2016-01-01

Quality Matters (QM) is a peer review process designed to certify the quality of online courses and online components. It has generated widespread interest and received national recognition for its peer-based approach to quality assurance and continuous improvement in online education. While the entire QM online course design process is…

Ranking Quality in Higher Education: Guiding or Misleading?

ERIC Educational Resources Information Center

Bergseth, Brita; Petocz, Peter; Abrandt Dahlgren, Madeleine

2014-01-01

The study examines two different models of measuring, assessing and ranking quality in higher education. Do different systems of quality assessment lead to equivalent conclusions about the quality of education? This comparative study is based on the rankings of 24 Swedish higher education institutions. Two ranking actors have independently…

A Review and Analysis of Remote Sensing Capability for Air Quality Measurements as a Potential Decision Support Tool Conducted by the NASA DEVELOP Program

NASA Technical Reports Server (NTRS)

Ross, A.; Richards, A.; Keith, K.; Frew, C.; Boseck, J.; Sutton, S.; Watts, C.; Rickman, D.

2007-01-01

This project focused on a comprehensive utilization of air quality model products as decision support tools (DST) needed for public health applications. A review of past and future air quality measurement methods and their uncertainty, along with the relationship of air quality to national and global public health, is vital. This project described current and future NASA satellite remote sensing and ground sensing capabilities and the potential for using these sensors to enhance the prediction, prevention, and control of public health effects that result from poor air quality. The qualitative uncertainty of current satellite remotely sensed air quality, the ground-based remotely sensed air quality, the air quality/public health model, and the decision making process is evaluated in this study. Current peer-reviewed literature suggests that remotely sensed air quality parameters correlate well with ground-based sensor data. A satellite remote-sensed and ground-sensed data complement is needed to enhance the models/tools used by policy makers for the protection of national and global public health communities

Classification accuracy of claims-based methods for identifying providers failing to meet performance targets.

PubMed

Hubbard, Rebecca A; Benjamin-Johnson, Rhondee; Onega, Tracy; Smith-Bindman, Rebecca; Zhu, Weiwei; Fenton, Joshua J

2015-01-15

Quality assessment is critical for healthcare reform, but data sources are lacking for measurement of many important healthcare outcomes. With over 49 million people covered by Medicare as of 2010, Medicare claims data offer a potentially valuable source that could be used in targeted health care quality improvement efforts. However, little is known about the operating characteristics of provider profiling methods using claims-based outcome measures that may estimate provider performance with error. Motivated by the example of screening mammography performance, we compared approaches to identifying providers failing to meet guideline targets using Medicare claims data. We used data from the Breast Cancer Surveillance Consortium and linked Medicare claims to compare claims-based and clinical estimates of cancer detection rate. We then demonstrated the performance of claim-based estimates across a broad range of operating characteristics using simulation studies. We found that identification of poor performing providers was extremely sensitive to algorithm specificity, with no approach identifying more than 65% of poor performing providers when claims-based measures had specificity of 0.995 or less. We conclude that claims have the potential to contribute important information on healthcare outcomes to quality improvement efforts. However, to achieve this potential, development of highly accurate claims-based outcome measures should remain a priority. Copyright © 2014 John Wiley & Sons, Ltd.

Measuring Student Course Evaluations: The Use of a Loglinear Model

ERIC Educational Resources Information Center

Ting, Ding Hooi; Abella, Mireya Sosa

2007-01-01

In this paper, the researchers attempt to incorporate the marketing theory (specifically the service quality model) into the education system. The service quality measurements have been employed to investigate its applicability in the education environment. Most of previous studies employ the regression-based analysis to test the effectiveness of…

The Quality of Home Environment in Brazil: An Ecological Model

ERIC Educational Resources Information Center

de Oliveira, Ebenezer A.; Barros, Fernando C.; Anselmi, Luciana D. da Silva; Piccinini, Cesar A.

2006-01-01

Based on Bronfenbrenner's (1999) ecological perspective, a longitudinal, prospective model of individual differences in the quality of home environment (Home Observation for Measurement of the Environment--HOME) was tested in a sample of 179 Brazilian children and their families. Perinatal measures of family socioeconomic status (SES) and child…

76 FR 31339 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... extension of the currently approved tool for the collection of ambulatory care clinical performance measure...: Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (``PAT''); Use: This... based system. This system will also provide a platform for developing tools to collect clinical quality...

RAPID, PCR-BASED METHODS FOR MEASURING THE QUALITY OF BATHING BEACH WATERS

EPA Science Inventory

The current methods for measuring the quality of recreational waters were developed in the 1970's and were recommended to the States by EPA in 1986. These methods detect and quantify Escherichia coli and enterococci, two bacteria that are consistently associated with fecal wast...

New paradigms for measuring clinical performance using electronic health records.

PubMed

Weiner, Jonathan P; Fowles, Jinnet B; Chan, Kitty S

2012-06-01

Measures of provider success are the centerpiece of quality improvement and pay-for-performance programs around the globe. In most nations, these measures are derived from administrative records, paper charts and consumer surveys; increasingly, electronic patient record systems are also being used. We use the term 'e-QMs' to describe quality measures that are based on data found within electronic health records and other related health information technology (HIT). We offer a framework or typology for e-QMs and describe opportunities and impediments associated with the transition from old to new If public and private systems of care are to effectively use HIT to support and evaluate health-care system quality and safety, the quality measurement field must embrace new paradigms and strategically address a series of technical, conceptual and practical challenges.

Objective quality assessment for multiexposure multifocus image fusion.

PubMed

Hassen, Rania; Wang, Zhou; Salama, Magdy M A

2015-09-01

There has been a growing interest in image fusion technologies, but how to objectively evaluate the quality of fused images has not been fully understood. Here, we propose a method for objective quality assessment of multiexposure multifocus image fusion based on the evaluation of three key factors of fused image quality: 1) contrast preservation; 2) sharpness; and 3) structure preservation. Subjective experiments are conducted to create an image fusion database, based on which, performance evaluation shows that the proposed fusion quality index correlates well with subjective scores, and gives a significant improvement over the existing fusion quality measures.

Quality appraisal of generic self-reported instruments measuring health-related productivity changes: a systematic review

PubMed Central

2014-01-01

Background Health impairments can result in disability and changed work productivity imposing considerable costs for the employee, employer and society as a whole. A large number of instruments exist to measure health-related productivity changes; however their methodological quality remains unclear. This systematic review critically appraised the measurement properties in generic self-reported instruments that measure health-related productivity changes to recommend appropriate instruments for use in occupational and economic health practice. Methods PubMed, PsycINFO, Econlit and Embase were systematically searched for studies whereof: (i) instruments measured health-related productivity changes; (ii) the aim was to evaluate instrument measurement properties; (iii) instruments were generic; (iv) ratings were self-reported; (v) full-texts were available. Next, methodological quality appraisal was based on COSMIN elements: (i) internal consistency; (ii) reliability; (iii) measurement error; (iv) content validity; (v) structural validity; (vi) hypotheses testing; (vii) cross-cultural validity; (viii) criterion validity; and (ix) responsiveness. Recommendations are based on evidence syntheses. Results This review included 25 articles assessing the reliability, validity and responsiveness of 15 different generic self-reported instruments measuring health-related productivity changes. Most studies evaluated criterion validity, none evaluated cross-cultural validity and information on measurement error is lacking. The Work Limitation Questionnaire (WLQ) was most frequently evaluated with moderate respectively strong positive evidence for content and structural validity and negative evidence for reliability, hypothesis testing and responsiveness. Less frequently evaluated, the Stanford Presenteeism Scale (SPS) showed strong positive evidence for internal consistency and structural validity, and moderate positive evidence for hypotheses testing and criterion validity. The Productivity and Disease Questionnaire (PRODISQ) yielded strong positive evidence for content validity, evidence for other properties is lacking. The other instruments resulted in mostly fair-to-poor quality ratings with limited evidence. Conclusions Decisions based on the content of the instrument, usage purpose, target country and population, and available evidence are recommended. Until high-quality studies are in place to accurately assess the measurement properties of the currently available instruments, the WLQ and, in a Dutch context, the PRODISQ are cautiously preferred based on its strong positive evidence for content validity. Based on its strong positive evidence for internal consistency and structural validity, the SPS is cautiously recommended. PMID:24495301

Service Quality in Higher Education--A Case Study of Universiti Brunei Darussalam

ERIC Educational Resources Information Center

Alani, Farooq; Yaqoub, Yasir; Hamdan, Mahani

2015-01-01

No one doubts the value and importance of quality education, and quality assurance is one major driving force to achieve this. Measuring the performance of service quality of education services of Universiti Brunei Darussalam (UBD), as part of the quality assessment, was assessed based on Parasuraman's five Servqual dimensions. The assessment was…

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.

Composite Quality Measures for Common Inpatient Medical Conditions

PubMed Central

Chen, Lena M.; Staiger, Douglas O.; Birkmeyer, John D.; Ryan, Andrew M.; Zhang, Wenying; Dimick, Justin B.

2014-01-01

Background Public reporting on quality aims to help patients select better hospitals. However, individual quality measures are sub-optimal in identifying superior and inferior hospitals based on outcome performance. Objective To combine structure, process, and outcome measures into an empirically-derived composite quality measure for heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PNA). To assess how well the composite measure predicts future high and low performers, and explains variance in future hospital mortality. Research Design Using national Medicare data, we created a cohort of older patients treated at an acute care hospital for HF (n=1,203,595), AMI (n=625,595), or PNA (n=1,234,299). We ranked hospitals based on their July 2005 to June 2008 performance on the composite. We then estimated the odds of future (July to December 2009) 30-day, risk-adjusted mortality at the worst vs. best quintile of hospitals. We repeated this analysis using 2005-2008 performance on existing quality indicators, including mortality. Results The composite (vs. Hospital Compare) explained 68% (vs. 39%) of variation in future AMI mortality rates. In 2009, if an AMI patient had chosen a hospital in the worst vs. best quintile of performance using 2005-2008 composite (vs. Hospital Compare) rankings, he or she would have had 1.61 (vs. 1.39) times the odds of dying in 30 days (p-value for difference < 0.001). Results were similar for HF and PNA. Conclusions Composite measures of quality for HF, AMI, and PNA performed better than existing measures at explaining variation in future mortality and predicting future high and low performers. PMID:23942222

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.

Microsiemens or Milligrams: Measures of Ionic Mixtures ...

EPA Pesticide Factsheets

In December of 2016, EPA released the Draft Field-Based Methods for Developing Aquatic Life Criteria for Specific Conductivity for public comment. Once final, states and authorized tribes may use these methods to derive field-based ecoregional ambient Aquatic Life Ambient Water Quality Criteria (AWQC) for specific conductivity (SC) in flowing waters. The methods provide flexible approaches for developing science-based SC criteria that reflect ecoregional or state specific factors. The concentration of a dissolved salt mixture can be measured in a number of ways including measurement of total dissolved solids, freezing point depression, refractive index, density, or the sum of the concentrations of individually measured ions. For the draft method, SC was selected as the measure because SC is a measure of all ions in the mixture; the measurement technology is fast, inexpensive, and accurate, and it measures only dissolved ions. When developing water quality criteria for major ions, some stakeholders may prefer to identify the ionic constituents as a measure of exposure instead of SC. A field-based method was used to derive example chronic and acute water quality criteria for SC and two anions a common mixture of ions (bicarbonate plus sulfate, [HCO3−] + [SO42−] in mg/L) that represent common mixtures in streams. These two anions are sufficient to model the ion mixture and SC (R2 = 0.94). Using [HCO3−] + [SO42−] does not imply that these two anions are the

Evidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction.

PubMed

Manahan, Michele A; Wooden, William A; Becker, Stephen M; Cacioppo, Jason R; Edge, Stephen B; Grandinetti, Amanda C; Gray, Diedra D; Holley, Susan O; Karp, Nolan S; Kocak, Ergun; Rao, Roshni; Rosson, Gedge D; Schwartz, Jaime S; Sitzman, Thomas J; Soltanian, Hooman T; TerKonda, Sarvam P; Wallace, Anne M

2017-12-01

The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure. The second desired outcome was to reduce flap loss within 30 days of the initial reconstructive procedure. All measures in this report were approved by the American Society of Plastic Surgeons Breast Reconstruction Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality reporting programs.

The choices, choosing model of quality of life: description and rationale.

PubMed

Gurland, Barry J; Gurland, Roni V

2009-01-01

This introductory paper offers a critical review of current models and measures of quality of life, and describes a choices and choosing (c-c) process as a new model of quality of life. Criteria are proposed for judging the relative merits of models of quality of life with preference being given to explicit mechanisms, linkages to a science base, a means of identifying deficits amenable to rational restorative interventions, and with embedded values of the whole person. A conjectured model, based on the processes of gaining access to choices and choosing among them, matches the proposed criteria. The c-c process is an evolved adaptive mechanism dedicated to the pursuit of quality of life, driven by specific biological and psychological systems, and influenced by social and environmental forces. This model strengthens the science base for the field of quality of life, unifies approaches to concept and measurement, and guides the evaluation of impairments of quality of life. Corresponding interventions can be aimed at relieving restrictions or distortions of the c-c process; thus helping people to preserve and improve their quality of life. RELATED WORK: Companion papers detail relevant aspects of the science base, present methods of identifying deficits and distortions of the c-c model so as to open opportunities for rational restorative interventions, and explore empirical analyses of the relationship between health imposed restrictions of c-c and conventional indicators of diminished quality of life. [corrected] (c) 2008 John Wiley & Sons, Ltd.

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

Composite measures of watershed health from a water quality perspective

EPA Science Inventory

Water quality data at gaging stations are typically compared with established federal, state, or local water quality standards to determine if violations (concentrations of specific constituents falling outside acceptable limits) have occurred. Based on the frequency and severity...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

Place-Based Social Network Quality and Correlates of Substance Use among Urban Adolescents

ERIC Educational Resources Information Center

Mason, Michael J.; Valente, Thomas W.; Coatsworth, J. Douglas; Mennis, Jeremy; Lawrence, Frank; Zelenak, Patricia

2010-01-01

A sample of 301 Philadelphia adolescents were assessed for substance use and place-based social network quality, a weighted variable based upon risky and protective behaviors of alters. The network measure was anchored in routine locations identified as safe, risky, important, or favorite. Results show young females' (13-16) substance use was…

Evaluating Response Cards as Evidence Based

ERIC Educational Resources Information Center

Owiny, Ruby L.; Spriggs, Amy D.; Sartini, Emily C.; Mills, Jeremy R.

2018-01-01

Increased accountability for quality instruction leading to higher achievement for all students has made it essential for identification and implementation of evidence-based practices. The Council for Exceptional Children's development of quality indicators (QI) has provided measures for researchers to apply to a body of literature to determine if…

Physician Quality Reporting System (PQRS) for Interventional Pain Management Practices: Challenges and Opportunities.

PubMed

Manchikanti, Laxmaiah; Hammer, Marvel; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many existing policies regarding PQRS from 2015 to 2016. In addition, 2016 will be the year that is utilized to determine the 2018 PQRS payment adjustment. However, after 2018 the PQRS payment adjustment will be transitioned to the Merit-Based Incentive Payment System (MIPS), as required by MACRA. Overall, there will be over 280 measures in the 2016 PQRS.Readers might be surprised to find out that despite the cost intensity including time requirements personnel, the negative payment adjustments, are only the tip of the iceberg of cost. Indeed, all of the above may only be one-third or one-fourth of the cost to completely implement the PQRS system. Thus far, data across all specialties shows participation to be around 50%. In addition, penalties for lack of reporting of PQRS measures stands to be controversial to the Supreme Court ruling that unfunded mandates must not be permitted and also lack of significant relationships with improvement in quality in the overall analysis in multiple publications.

Analysis of Indoor Environment in Classroom Based on Hygienic Requirements

NASA Astrophysics Data System (ADS)

Javorček, Miroslav; Sternová, Zuzana

2016-06-01

The article contains the analysis of experimental ventilation measurement in selected classrooms of the Elementary School Štrba. Mathematical model of selected classroom was prepared according to in-situ measurements and air exchange was calculated. Interior air temperature and quality influences the students ´ comfort. Evaluated data were compared to requirements of standard (STN EN 15251,2008) applicable to classroom indoor environment during lectures, highlighting the difference between required ambiance quality and actually measured values. CO2 concentration refers to one of the parameters indicating indoor environment quality.

Using Computer-Extracted Data from Electronic Health Records to Measure the Quality of Adolescent Well-Care

PubMed Central

Gardner, William; Morton, Suzanne; Byron, Sepheen C; Tinoco, Aldo; Canan, Benjamin D; Leonhart, Karen; Kong, Vivian; Scholle, Sarah Hudson

2014-01-01

Objective To determine whether quality measures based on computer-extracted EHR data can reproduce findings based on data manually extracted by reviewers. Data Sources We studied 12 measures of care indicated for adolescent well-care visits for 597 patients in three pediatric health systems. Study Design Observational study. Data Collection/Extraction Methods Manual reviewers collected quality data from the EHR. Site personnel programmed their EHR systems to extract the same data from structured fields in the EHR according to national health IT standards. Principal Findings Overall performance measured via computer-extracted data was 21.9 percent, compared with 53.2 percent for manual data. Agreement measures were high for immunizations. Otherwise, agreement between computer extraction and manual review was modest (Kappa = 0.36) because computer-extracted data frequently missed care events (sensitivity = 39.5 percent). Measure validity varied by health care domain and setting. A limitation of our findings is that we studied only three domains and three sites. Conclusions The accuracy of computer-extracted EHR quality reporting depends on the use of structured data fields, with the highest agreement found for measures and in the setting that had the greatest concentration of structured fields. We need to improve documentation of care, data extraction, and adaptation of EHR systems to practice workflow. PMID:24471935

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.

Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

PubMed

DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

2013-01-01

The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. © 2013 National Association for Healthcare Quality.

A research agenda to advance quality measurement and improvement.

PubMed

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

2003-01-01

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

Systematic uncertainties in RF-based measurement of superconducting cavity quality factors

DOE PAGES

Holzbauer, J. P.; Pischalnikov, Yu.; Sergatskov, D. A.; ...

2016-05-10

Q 0 determinations based on RF power measurements are subject to at least three potentially large systematic effects that have not been previously appreciated. Here, instrumental factors that can systematically bias RF based measurements of Q 0 are quantified and steps that can be taken to improve the determination of Q 0 are discussed.

Development and validation of a new Prescription Quality Index

PubMed Central

Hassan, Norul Badriah; Ismail, Hasanah Che; Naing, Lin; Conroy, Ronán M; Abdul Rahman, Abdul Rashid

2010-01-01

AIMS The aims were to develop and validate a new Prescription Quality Index (PQI) for the measurement of prescription quality in chronic diseases. METHODS The PQI were developed and validated based on three separate surveys and one pilot study. Criteria were developed based on literature search, discussions and brainstorming sessions. Validity of the criteria was examined using modified Delphi method. Pre-testing was performed on 30 patients suffering from chronic diseases. The modified version was then subjected to reviews by pharmacists and clinicians in two separate surveys. The rater-based PQI with 22 criteria was then piloted in 120 patients with chronic illnesses. Results were analysed using SPSS version 12.0.1 RESULTS Exploratory principal components analysis revealed multiple factors contributing to prescription quality. Cronbach's α for the entire 22 criteria was 0.60. The average intra-rater and inter-rater reliability showed good to moderate stability (intraclass correlation coefficient 0.76 and 0.52, respectively). The PQI was significantly and negatively correlated with age (correlation coefficient −0.34, P < 0.001), number of drugs in prescriptions (correlation coefficient −0.51, P < 0.001) and number of chronic diseases/conditions (correlation coefficient −0.35, P < 0.001). CONCLUSIONS The PQI is a promising new instrument for measuring prescription quality. It has been shown that the PQI is a valid, reliable and responsive tool to measure quality of prescription in chronic diseases. PMID:20840442

Knowledge of quality performance measures associated with endoscopy among gastroenterology trainees and the impact of a web-based intervention

PubMed Central

Thompson, Jennifer S.; Lebwohl, Benjamin; Syngal, Sapna; Kastrinos, Fay

2013-01-01

Background Knowledge of quality measures in endoscopy among trainees is unknown. Objective To assess knowledge of endoscopy-related quality indicators among U.S. trainees and determine whether it improves with a Web-based intervention. Design Randomized, controlled study. Setting Multicenter. Participants This study involved trainees identified from the American Society for Gastrointestinal Endoscopy membership database. Intervention Participants were invited to complete an 18-question online test. Respondents were randomized to receive a Web-based tutorial (intervention) or not. The test was readministered 6 weeks after randomization to determine the intervention’s impact. Main Outcome Measurements Baseline knowledge of endoscopy-related quality indicators and impact of the tutorial. Results A total of 347 of 1220 trainees (28%) completed the test; the mean percentage of correct responses was 55%. For screening colonoscopy, 44% knew the adenoma detection rate benchmark, 42% identified the cecal intubation rate goal, and 74% knew the recommended minimum withdrawal time. A total of 208 of 347 trainees (59%) completed the second test; baseline scores were similar for the tutorial (n = 106) and no tutorial (n = 102) groups (56.4% vs 56.9%, respectively). Scores improved after intervention for the tutorial group (65%, P = .003) but remained unchanged in the no tutorial group. On multivariate analysis, each additional year in training (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.5–3.4), training at an academic institution (OR 2.6; 95% CI, 1.1–6.3), and receiving the tutorial (OR 3.2; 95% CI, 1.7–5.9) were associated with scores in the upper tertile. Limitations Low response rate. Conclusion Knowledge of endoscopy-related quality performance measures is low among trainees but can improve with a Web-based tutorial. Gastroenterology training programs may need to incorporate a formal didactic curriculum to supplement practice-based learning of quality standards in endoscopy. (Gastrointest Endosc 2012;76:100–6.) PMID:22421498

Local environmental quality positively predicts breastfeeding in the UK’s Millennium Cohort Study

PubMed Central

Sear, Rebecca

2017-01-01

ABSTRACT Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis—one ‘objective’ (based on an independent assessor’s neighbourhood scores) and one ‘subjective’ (based on respondent’s scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women’s decision making contexts when considering behaviours relevant to public health. PMID:29354262

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study.

PubMed

Brown, Laura J; Sear, Rebecca

2017-01-01

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

The Other Side of Accountability: Measuring Students' Use of Facilities and Opportunities. AIR Forum 1979 Paper.

ERIC Educational Resources Information Center

Pace, C. Robert

A set of measures was developed to assess the quality of student effort in the utilization of the facilities and opportunities available in the college setting. The measures are based on the assumption that students are accountable for the amount, scope, and quality of effort they invest in using the available resources for their learning and…

An evaluative review of questionnaires recommended for the assessment of quality of life and symptom severity in women with urinary incontinence.

PubMed

Hewison, Ann; McCaughan, Dorothy; Watt, Ian

2014-11-01

To provide an up-to-date assessment of the quality of commonly recommended questionnaires for measuring symptom severity and quality of life in women with urinary incontinence and also to consider their application to practice. Urinary incontinence is a common problem for women. In addition to various physical symptoms, there is a known effect on quality of life. Psychometrically robust questionnaires are reported to be the best way to measure an individual's perceptions of symptom severity and quality of life, and a number of different ones are recommended for use in international and national guidance, which can be confusing for clinicians. Moreover, there are concerns over the applicability of some of these instruments in clinical practice. An evaluative review was carried out examining selected questionnaires measuring symptom severity and/or quality of life. Selection of questionnaires for inclusion in the review was based on the recommendations of evidence-based guidance, followed by systematic scrutiny of the characteristics of the individual recommended questionnaires. Thirteen questionnaires were included in the review, of which three appeared to 'outperform' the remainder in terms of their psychometric properties and other characteristics. This review provides the most up-to-date and comprehensive analysis of the quality and applicability of the included questionnaires and offers the practitioner advice on which to select for use in practice. This review aims to help the practitioner choose a questionnaire based on a sound evaluation of the quality of the questionnaire and its applicability to the clinical setting. © 2013 John Wiley & Sons Ltd.

Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PubMed

Klein, Jonathan D; Handwerker, Lisa; Sesselberg, Tracy S; Sutter, Erika; Flanagan, Erinn; Gawronski, Beth

2007-08-01

To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review.

PubMed

de Vries, C E E; Kalff, M C; Prinsen, C A C; Coulman, K D; den Haan, C; Welbourn, R; Blazeby, J M; Morton, J M; van Wagensveld, B A

2018-06-08

The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS). We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D). Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D). The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials. © 2018 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Understanding Consumer Perceptions and Awareness of Hospital-Based Maternity Care Quality Measures.

PubMed

Maurer, Maureen; Firminger, Kirsten; Dardess, Pam; Ikeler, Kourtney; Sofaer, Shoshanna; Carman, Kristin L

2016-06-01

To explore factors that may influence use of comparative public reports for hospital maternity care. Four focus groups conducted in 2013 with 41 women and preintervention survey data collected in 2014 to 2015 from 245 pregnant women in North Carolina. As part of a larger randomized controlled trial, we conducted qualitative formative research to develop an intervention that will be evaluated through pre- and postintervention surveys. Analysis of focus group transcripts examined participants' perceptions of high-quality maternity care and the importance of different quality measures. Quantitative analysis included descriptive results of the preintervention survey and subgroup analyses to examine the impact of race, education, and being a first-time mom on outcomes. When describing high-quality maternity care, participants focused on interactions with providers, including respect for preferences and communication. The importance of quality measures was influenced by the extent to which they focused on babies' health, were perceived as the hospital's responsibility, and were perceived as representing "standard care." At baseline, 28 percent of survey respondents had used quality information to choose a hospital. Survey respondents were more aware of some quality measures (e.g., breastfeeding support) than others (e.g., episiotomy rates). Public reporting efforts could help increase relevance of maternity care quality measures by creating measures that reflect women's concerns, clearly explaining the hospital's role in supporting quality care, and showing how available quality measures can inform decisions about childbirth. © Health Research and Educational Trust.

National Assessment of Quality Programs in Emergency Medical Services.

PubMed

Redlener, Michael; Olivieri, Patrick; Loo, George T; Munjal, Kevin; Hilton, Michael T; Potkin, Katya Trudeau; Levy, Michael; Rabrich, Jeffrey; Gunderson, Michael R; Braithwaite, Sabina A

2018-01-01

This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©. A convenience sample of respondents was enrolled between August and November, 2015. Univariate, bivariate and multiple logistic regression analyses were conducted to describe demographics and relationships between outcomes of interest and their covariates using SAS 9.3©. A total of 1,733 surveys were initiated and 1,060 surveys had complete or near-complete responses. This includes agencies from 45 states representing over 6.23 million 9-1-1 responses annually. Totals of 70.5% (747) agencies reported dedicated QI personnel, 62.5% (663) follow clinical metrics and 33.3% (353) participate in outside quality or research program. Medical director hours varied, notably, 61.5% (649) of EMS agencies had <5 hours of medical director time per month. Presence of medical director time was correlated with tracking of QI measures. Air medical [OR 9.64 (1.13, 82.16)] and hospital-based EMS agencies [OR 2.49 (1.36, 4.59)] were more likely to track quality measures compared to fire-based agencies. Agencies in rural only environments were less likely to follow clinical quality metrics. (OR 0.47 CI 0.31 -0.72 p < 0.0004). For those that track QI measures, the most common are; Response Time (Emergency) (68.3%), On-Scene Time (66.4%), prehospital stroke screen (64.6%), aspirin administration (64.5%), and 12 lead ECG in chest pain patients (63.0%). EMS agencies in the United States have significant practice variability with regard to quality improvement resources, medical direction and specific clinical quality measures. More research is needed to understand the impact of this variation on patient care outcomes.

Application of online measures to monitor and evaluate multiplatform fusion performance

NASA Astrophysics Data System (ADS)

Stubberud, Stephen C.; Kowalski, Charlene; Klamer, Dale M.

1999-07-01

A primary concern of multiplatform data fusion is assessing the quality and utility of data shared among platforms. Constraints such as platform and sensor capability and task load necessitate development of an on-line system that computes a metric to determine which other platform can provide the best data for processing. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. Entropy measures quality of processed information such as localization, classification, and ambiguity in measurement-to-track association. Lower entropy scores imply less uncertainty about a particular target. When new information is provided, we compuete the level of improvement a particular track obtains from one measurement to another. The measure permits us to evaluate the utility of the new information. We couple entropy with intelligent agents that provide two main data gathering functions: estimation of another platform's performance and evaluation of the new measurement data's quality. Both functions result from the entropy metric. The intelligent agent on a platform makes an estimate of another platform's measurement and provides it to its own fusion system, which can then incorporate it, for a particular target. A resulting entropy measure is then calculated and returned to its own agent. From this metric, the agent determines a perceived value of the offboard platform's measurement. If the value is satisfactory, the agent requests the measurement from the other platform, usually by interacting with the other platform's agent. Once the actual measurement is received, again entropy is computed and the agent assesses its estimation process and refines it accordingly.

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PubMed

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-12-01

To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

PubMed Central

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-01-01

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. PMID:23066956

Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing

PubMed Central

Pogach, Melanie S.; Punjabi, Naresh M.; Thomas, Neil; Thomas, Robert J.

2012-01-01

Study Objectives: Sleep disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. Experimental sleep fragmentation has been shown to impair insulin sensitivity. Conventional electroencephalogram (EEG)-based sleep-quality measures have been inconsistently associated with indices of glucose metabolism. This analysis explored associations between glucose metabolism and an EEG-independent measure of sleep quality, the sleep spectrogram, which maps coupled oscillations of heart-rate variability and electrocardiogram (ECG)-derived respiration. The method allows improved characterization of the quality of stage 2 non-rapid eye movement (NREM) sleep. Design: Cross-sectional study. Setting: N/A. Participants: Nondiabetic subjects with and without SDB (n = 118) underwent the frequently sampled intravenous glucose tolerance test (FSIVGTT) and a full-montage polysomnogram. The sleep spectrogram was generated from ECG collected during polysomnography. Interventions: N/A. Measurements and Results: Standard polysomnographic stages (stages 1, 2, 3+4, and rapid eye movement [REM]) were not associated with the disposition index (DI) derived from the FSIVGTT. In contrast, spectrographic high-frequency coupling (a marker of stable or “effective” sleep) duration was associated with increased, and very-low-frequency coupling (a marker of wake/REM/transitions) associated with reduced DI. This relationship was noted after adjusting for age, sex, body mass index, slow wave sleep, total sleep time, stage 1, the arousal index, and the apnea-hypopnea index. Conclusions: ECG-derived sleep-spectrogram measures of sleep quality are associated with alterations in glucose-insulin homeostasis. This alternate mode of estimating sleep quality could improve our understanding of sleep and sleep-breathing effects on glucose metabolism. Citation: Pogach MS; Punjabi NM; Thomas N; Thomas RJ. Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing. SLEEP 2012;35(1):139-148. PMID:22215928

Performance-based quality assurance/quality control (QA/QC) acceptance procedures for in-place soil testing phase 3.

DOT National Transportation Integrated Search

2015-01-01

One of the objectives of this study was to evaluate soil testing equipment based on its capability of measuring in-place stiffness or modulus values. : As design criteria transition from empirical to mechanistic-empirical, soil test methods and equip...

Standardizing lightweight deflectometer modulus measurements for compaction quality assurance : research summary.

DOT National Transportation Integrated Search

2017-09-01

The mechanistic-empirical pavement design method requires the elastic resilient modulus as the key input for characterization of geomaterials. Current density-based QA procedures do not measure resilient modulus. Additionally, the density-based metho...

Value Based Care and Patient-Centered Care: Divergent or Complementary?

PubMed

Tseng, Eric K; Hicks, Lisa K

2016-08-01

Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

Automatic assessment of voice quality according to the GRBAS scale.

PubMed

Sáenz-Lechón, Nicolás; Godino-Llorente, Juan I; Osma-Ruiz, Víctor; Blanco-Velasco, Manuel; Cruz-Roldán, Fernando

2006-01-01

Nowadays, the most extended techniques to measure the voice quality are based on perceptual evaluation by well trained professionals. The GRBAS scale is a widely used method for perceptual evaluation of voice quality. The GRBAS scale is widely used in Japan and there is increasing interest in both Europe and the United States. However, this technique needs well-trained experts, and is based on the evaluator's expertise, depending a lot on his own psycho-physical state. Furthermore, a great variability in the assessments performed from one evaluator to another is observed. Therefore, an objective method to provide such measurement of voice quality would be very valuable. In this paper, the automatic assessment of voice quality is addressed by means of short-term Mel cepstral parameters (MFCC), and learning vector quantization (LVQ) in a pattern recognition stage. Results show that this approach provides acceptable results for this purpose, with accuracy around 65% at the best.

Visualization of Discontinuous Galerkin Based High-Order Methods

DTIC Science & Technology

2015-08-19

function and the reference- to physical- space mapping functions. This formulation can be used to measure the quality of a high-order element and also for...to physical- space mapping functions. This formulation can be used to measure the quality of a high-order element and also for AMR. We find that the

Effect-size measures as descriptors of assay quality in high-content screening: A brief review of some available methodologies

USDA-ARS?s Scientific Manuscript database

The field of high-content screening (HCS) typically uses measures of screen quality conceived for fairly straightforward high-throughput screening (HTS) scenarios. However, in contrast to HTS, image-based HCS systems rely on multidimensional readouts reporting biological responses associated with co...

Improvement of a Harvester Based, Multispectral, Seed Cotton Fiber Quality Sensor

USDA-ARS?s Scientific Manuscript database

A multispectral sensor for in-situ seed cotton fiber quality measurement was developed and tested at Texas A&M University. Results of initial testing of the sensor using machine harvested seed cotton have shown promise. Improvements have been made to the system and the measurement method to meet t...

Measurement properties of asthma-specific quality-of-life measures: protocol for a systematic review.

PubMed

Apfelbacher, Christian; Paudyal, Priya; Bülbül, Alpaslan; Smith, Helen

2014-07-24

Asthma is a frequent chronic inflammatory disease of the airways, and the assessment of health-related quality of life (HrQoL) is important in both research and routine care. Various asthma-specific measures of HrQoL exist but there is uncertainty which measures are best suited for use in research and routine care. Therefore, the aim of the proposed research is a comprehensive systematic assessment of the measurement properties of the existing measures that were developed to measure asthma-specific quality of life. This study is a systematic review of the measurement properties of asthma-specific measures of health-related quality of life. PubMed and Embase will be searched using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing or comparing measurement properties of asthma-specific HRQL tools. Eligibility assessment and data abstraction will be performed independently by two reviewers. Evidence tables will be generated for study characteristics, instrument characteristics, measurement properties and interpretability. The quality of the measurement properties will be assessed using predefined criteria. Methodological quality of studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis will be undertaken if more than one study have investigated a particular measurement property. The proposed systematic review will produce a comprehensive assessment of measurement properties of existing measures of asthma-specific health-related quality of life. We also aim to derive recommendations in order to help researchers and practitioners alike in the choice of instrument. PROSPERO registration number: CRD42014010491.

[In-house team seminars: working together as a team--from data and statistics to quality development].

PubMed

Berlage, Silvia; Wenzlaff, Paul; Damm, Gabriele; Sens, Brigitte

2010-01-01

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Sleep Quality Estimation based on Chaos Analysis for Heart Rate Variability

NASA Astrophysics Data System (ADS)

Fukuda, Toshio; Wakuda, Yuki; Hasegawa, Yasuhisa; Arai, Fumihito; Kawaguchi, Mitsuo; Noda, Akiko

In this paper, we propose an algorithm to estimate sleep quality based on a heart rate variability using chaos analysis. Polysomnography(PSG) is a conventional and reliable system to diagnose sleep disorder and to evaluate its severity and therapeatic effect, by estimating sleep quality based on multiple channels. However, a recording process requires a lot of time and a controlled environment for measurement and then an analyzing process of PSG data is hard work because the huge sensed data should be manually evaluated. On the other hand, it is focused that some people make a mistake or cause an accident due to lost of regular sleep and of homeostasis these days. Therefore a simple home system for checking own sleep is required and then the estimation algorithm for the system should be developed. Therefore we propose an algorithm to estimate sleep quality based only on a heart rate variability which can be measured by a simple sensor such as a pressure sensor and an infrared sensor in an uncontrolled environment, by experimentally finding the relationship between chaos indices and sleep quality. The system including the estimation algorithm can inform patterns and quality of own daily sleep to a user, and then the user can previously arranges his life schedule, pays more attention based on sleep results and consult with a doctor.

Assessing Care of Vulnerable Elders – Alzheimer's Disease: A Pilot Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care

PubMed Central

Reuben, David B.; Roth, Carol P.; Frank, Janet C.; Hirsch, Susan H.; Katz, Diane; McCreath, Heather; Younger, Jon; Murawski, Marta; Edgerly, Elizabeth; Maher, Joanne; Maslow, Katie; Wenger, Neil S.

2013-01-01

Objectives To determine whether a practice redesign intervention coupled with referral to local Alzheimer's Association chapters can improve the quality of dementia care. Design Pre-post intervention Setting Two community-based physician practices Participants Five physicians in each practice and their patients age 75 and older with dementia Intervention Adaptation of the Assessing Care of Vulnerable Elders (ACOVE)-2 intervention (screening, efficient collection of clinical data, medical record prompts, patient education/empowerment materials, and physician decision support/education). In addition, physicians faxed referral forms to local Alzheimer's Association chapters who assessed patients, provided counseling and education, and faxed information back to the physicians. Measurements Audits of pre- (5 per physician) and post- (10 per physician) intervention medical records using ACOVE-3 quality indicators for dementia to measure the quality of care provided. Results Based on 47 pre- and 90 post-intervention audits, the percentage of quality indicators satisfied rose from 38% to 46% with significant differences on quality indicators measuring the assessment of functional status (20% versus 51%), discussion of risk/benefits of antipsychotics (32% versus 100%), and counseling caregivers (2% versus 30%). Referral of patients to Alzheimer's Association chapters increased from 0 to 17%. Referred patients had higher quality scores (65% versus 41%) and better counseling about driving (50% versus 14%), caregiver counseling (100% versus 15%) and surrogate decision-maker specification (75% versus 44%). However, some quality indicators related to cognitive assessment and examination did not improve. Conclusions This pilot study suggests that a practice-based intervention can increase referral to AA chapters and improve quality of dementia care. PMID:20374405

Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study

PubMed Central

2017-01-01

Background Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. Objective The aim of this study was to develop and prioritize measures of digital patient engagement based on patients’ use of the US Department of Veterans Affairs (VA)’s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. Methods We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. Results All 12 experts completed the study’s three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian’s three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). Conclusions This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients’ use of VA’s My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. PMID:28550008

Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study.

PubMed

Garvin, Lynn A; Simon, Steven R

2017-05-26

Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. The aim of this study was to develop and prioritize measures of digital patient engagement based on patients' use of the US Department of Veterans Affairs (VA)'s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. All 12 experts completed the study's three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian's three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients' use of VA's My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. ©Lynn A Garvin, Steven R Simon. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2017.

EFFECT OF QUALITY CHRONIC DISEASE MANAGEMENT FOR ALCOHOL AND DRUG DEPENDENCE ON ADDICTION OUTCOMES

PubMed Central

Kim, Theresa W.; Saitz, Richard; Cheng, Debbie M.; Winter, Michael R; Witas, Julie; Samet, Jeffrey H.

2012-01-01

We examinedthe effect ofthe quality of primary care-basedchronic disease management (CDM)for alcohol and/or other drug (AOD) dependenceonaddiction outcomes.We assessed qualityusing 1)avisit frequencybased measure and 2) a self-reported assessment measuring alignment with the chronic care model. The visit frequency based measure had no significant association with addiction outcomes. Theself-reported measure of care - when care was at a CDM clinic - was associated with lower drug addiction severity.The self-reported assessment of care from any healthcare source (CDM clinic or elsewhere)was associated with lower alcoholaddiction severity and abstinence.These findings suggest that high quality CDM for AOD dependence may improve addiction outcomes.Quality measuresbased upon alignment with the chronic care model may better capture features of effective CDM care than a visitfrequency measure. PMID:22840687

DUQuE quality management measures: associations between quality management at hospital and pathway levels.

PubMed

Wagner, Cordula; Groene, Oliver; Thompson, Caroline A; Dersarkissian, Maral; Klazinga, Niek S; Arah, Onyebuchi A; Suñol, Rosa

2014-04-01

The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. It is a multi-level, cross-sectional, mixed-method study. As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.

Do prominent quality measurement surveys capture the concerns of persons with disability?

PubMed

Iezzoni, Lisa I; Marsella, Sarah A; Lopinsky, Tiffany; Heaphy, Dennis; Warsett, Kimberley S

2017-04-01

Demonstration programs nationwide aim to control costs and improve care for people dually-eligible for Medicare and Medicaid, including many persons with disability. Ensuring these initiatives maintain or improve care quality requires comprehensive evaluation of quality of care. To examine whether the common quality measures being used to evaluate the Massachusetts One Care duals demonstration program comprehensively address the concerns of persons with disability. Drawing upon existing conceptual frameworks, we developed a model of interrelationships of personal, health care, and environmental factors for achieving wellness for persons with disability. Based on this model, we specified a scheme to code individual quality measurement items and coded the items contained in 12 measures being used to assess Massachusetts One Care, which exclusively enrolls non-elderly adults with disability. Across these 12 measures, we assigned 376 codes to 302 items; some items received two codes. Taken together, the 12 measures contain items addressing most factors in our conceptual model that affect health care quality for persons with disability, including long-term services and supports. Some important gaps exist. No items examine sexual or reproductive health care, peer support, housing security, disability stigmatization, and specific services obtained outside the home like adult day care. Certain key concepts are covered only by a single or several of the 12 quality measures. Common quality metrics cover most - although not all-health care quality concerns of persons with disability. However, multiple different quality measures are required for this comprehensive coverage, raising questions about respondent burden. Copyright © 2017 Elsevier Inc. All rights reserved.

The use of vision-based image quality metrics to predict low-light performance of camera phones

NASA Astrophysics Data System (ADS)

Hultgren, B.; Hertel, D.

2010-01-01

Small digital camera modules such as those in mobile phones have become ubiquitous. Their low-light performance is of utmost importance since a high percentage of images are made under low lighting conditions where image quality failure may occur due to blur, noise, and/or underexposure. These modes of image degradation are not mutually exclusive: they share common roots in the physics of the imager, the constraints of image processing, and the general trade-off situations in camera design. A comprehensive analysis of failure modes is needed in order to understand how their interactions affect overall image quality. Low-light performance is reported for DSLR, point-and-shoot, and mobile phone cameras. The measurements target blur, noise, and exposure error. Image sharpness is evaluated from three different physical measurements: static spatial frequency response, handheld motion blur, and statistical information loss due to image processing. Visual metrics for sharpness, graininess, and brightness are calculated from the physical measurements, and displayed as orthogonal image quality metrics to illustrate the relative magnitude of image quality degradation as a function of subject illumination. The impact of each of the three sharpness measurements on overall sharpness quality is displayed for different light levels. The power spectrum of the statistical information target is a good representation of natural scenes, thus providing a defined input signal for the measurement of power-spectrum based signal-to-noise ratio to characterize overall imaging performance.

Impact of sampling techniques on measured stormwater quality data for small streams

USDA-ARS?s Scientific Manuscript database

Science-based sampling methodologies are needed to enhance water quality characterization for developing Total Maximum Daily Loads (TMDLs), setting appropriate water quality standards, and managing nonpoint source pollution. Storm event sampling, which is vital for adequate assessment of water qual...

Home Health Aides' Perceptions of Quality Care: Goals, Challenges, and Implications for a Rapidly Changing Industry.

PubMed

Franzosa, Emily; Tsui, Emma K; Baron, Sherry

2018-02-01

Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide-client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker-client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.

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.

Candidate Quality Measures for Hand Surgery.

PubMed

2017-11-01

Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts. A consortium of 9 academic upper limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, scientific acceptability, usability, and feasibility of 44 candidate quality measures. These addressed hand problems the panelists felt were most appropriate for quality measure development. Panelists rated the measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 as equivocal or uncertain, and 7 to 9 as valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), the panelists were considered to be in agreement. If 3 or more of the panelists' ratings of a measure were within the 1 to 3 range and 3 or more ratings were in the 7 to 9 range, the panelists were considered to be in disagreement. There was agreement on 43% (19) of the measures as important, 27% (12) as scientifically sound, 48% (21) as usable, and 59% (26) as feasible to complete. Ten measures met all 4 of these criteria and were, therefore, considered valid measurements of quality. Quality measures that were developed address outcomes (patient-reported outcomes for assessment and improvement of function) and processes of care (utilization rates of imaging, antibiotics, occupational therapy, ultrasound, and operative treatment). The consortium developed 10 measures of hand surgery quality using a validated methodology. These measures merit further development. Quality measures can be used to evaluate the quality of care provided by physicians and health systems and can inform quality and value-based reimbursement models. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Measurement properties of adult quality-of-life measurement instruments for eczema: protocol for a systematic review.

PubMed

Apfelbacher, Christian J; Heinl, Daniel; Prinsen, Cecilia A C; Deckert, Stefanie; Chalmers, Joanne; Ofenloch, Robert; Humphreys, Rosemary; Sach, Tracey; Chamlin, Sarah; Schmitt, Jochen

2015-04-16

Eczema is a common chronic or chronically relapsing skin disease that has a substantial impact on quality of life (QoL). By means of a consensus-based process, the Harmonising Outcome Measures in Eczema (HOME) initiative has identified QoL as one of the four core outcome domains to be assessed in all eczema trials (Allergy 67(9):1111-7, 2012). Various measurement instruments exist to measure QoL in adults with eczema, but there is a great variability in both content and quality (for example, reliability and validity) of the instruments used, and it is not always clear if the best instrument is being used. Therefore, the aim of the proposed research is a comprehensive systematic assessment of the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in adults with eczema. This study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for adults with eczema. Medline via PubMed and EMBASE will be searched using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for adult patients with eczema. Eligibility assessment and data abstraction will be performed independently by two reviewers. Evidence tables will be generated for study characteristics, instrument characteristics, measurement properties, and interpretability. The quality of the measurement properties will be assessed using predefined criteria. Methodological quality of studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis will be undertaken if more than one study has investigated a particular measurement property. The proposed systematic review will produce a comprehensive assessment of measurement properties of existing QoL instruments in adult patients with eczema. We aim to identify one best currently available instrument to measure QoL in eczema patients. PROSPERO CRD42015017138.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery.

PubMed

Moonesinghe, S Ramani; Grocott, Michael P W; Bennett-Guerrero, Elliott; Bergamaschi, Roberto; Gottumukkala, Vijaya; Hopkins, Thomas J; McCluskey, Stuart; Gan, Tong J; Mythen, Michael Monty G; Shaw, Andrew D; Miller, Timothy E

2017-01-01

This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection. Core, Quality Improvement, and Best Practice datasets are proposed. The suggested datasets incorporate patient data to describe case-mix, process measures to describe delivery of enhanced recovery and clinical outcomes. The fundamental importance of routine collection of data for the initiation, maintenance, and enhancement of enhanced recovery pathways is emphasized.

The development of NEdSERV: quantitative instrumentation to measure service quality in nurse education.

PubMed

Roberts, P

1999-07-01

The political climate of health care provision and education for health care in the latter years of the 20th century is evolving from the uncertainty of newly created markets to a more clearly focused culture of collaboration, dissemination of good practice, with an increased emphasis on quality provision and its measurement. The need for provider units to prove and improve efficiency and effectiveness through evidence-based quality strategies in order to stay firmly in the market place has never been more necessary. The measurement of customer expectations and perceptions of delivered service quality is widely utilized as a basis for customer retention and business growth in both commercial and non-profit organizations. This paper describes the methodological development of NEdSERV--quantitative instrumentation designed to measure and respond to ongoing stakeholder expectations and perceptions of delivered service quality within nurse education.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries

PubMed Central

Sun, Zeye

2017-01-01

Background It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)—the structural inputs to care—predicts the clinical quality of care provided to patients. Methods and findings Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers’ adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from −0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Conclusion Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care. PMID:29232377

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

PubMed

Leslie, Hannah H; Sun, Zeye; Kruk, Margaret E

2017-12-01

It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

PubMed

Render, Marta L; Freyberg, Ron W; Hasselbeck, Rachael; Hofer, Timothy P; Sales, Anne E; Deddens, James; Levesque, Odette; Almenoff, Peter L

2011-06-01

BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU. RESULTS The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106-299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews. CONCLUSION Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard.

Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol

PubMed Central

Vitoratou, Silia; Sevdalis, Nick; Hull, Louise

2017-01-01

Introduction Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures. Methods and analysis The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored. Ethics and dissemination Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for reviewers of papers and grants to determine the psychometric quality of the measures used in implementation research. Trial registration number International Prospective Register of Systematic Reviews (PROSPERO): CRD42017065348. PMID:28993392

Components and Quality Measures of DIME (Devitalized Tissue, Infection/Inflammation, Moisture Balance, and Edge Preparation) in Wound Care

PubMed Central

Snyder, Robert J.; Fife, Caroline; Moore, Zena

2016-01-01

ABSTRACT OBJECTIVES: To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles. DISCUSSION: The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions. As complex care is required for chronic wounds, treatment guidelines such as DIME have evolved to include consideration of patient-centered concerns and etiology, as well as features of wound bed preparation. The US healthcare system is in the midst of transitioning to a quality-based system. However, as wound care is not yet a recognized specialty, it is poorly represented in the current approved quality-based measures. CONCLUSION: This article helps to identify the practice guidelines that are not currently represented by quality metrics. PMID:27089149

Quality assessment of patients’ self-monitoring of blood glucose in community pharmacies

PubMed Central

Kjome, Reidun L. S.; Granas, Anne G.; Nerhus, Kari; Sandberg, Sverre

2009-01-01

Objective To evaluate diabetes patients’ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion A community pharmacy-based quality assessment procedure of patients’ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients’ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy. PMID:25152795

A Socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective

PubMed Central

2013-01-01

Background With the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS. Methods An updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling. Results Socio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed. Conclusions Managers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future. PMID:24053458

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

PubMed

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

2009-10-01

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

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

Measuring housing quality in the absence of a monetized real estate market.

PubMed

Rindfuss, Ronald R; Piotrowski, Martin; Thongthai, Varachai; Prasartkul, Pramote

2007-03-01

Measuring housing quality or value or both has been a weak component of demographic and development research in less developed countries that lack an active real estate (housing) market. We describe a new method based on a standardized subjective rating process. It is designed to be used in settings that do not have an active, monetized housing market. The method is applied in an ongoing longitudinal study in north-east Thailand and could be straightforwardly used in many other settings. We develop a conceptual model of the process whereby households come to reside in high-quality or low-quality housing units. We use this theoretical model in conjunction with longitudinal data to show that the new method of measuring housing quality behaves as theoretically expected, thus providing evidence of face validity.

Feasibility model study for Blumbangreksa product model based on lean startup method

NASA Astrophysics Data System (ADS)

Pakpahan, A. K.; Dewobroto, W. S.; Pratama, R. Y.

2017-12-01

Based on the data from Ministry of Maritime Affairs and Fisheries in 2015, the productivity of shrimp farmers in Indonesia is still below China, India and Thailand, because of the low survival rate of shrimp seeds were planted in Indonesia. Water quality factors become a significant factor that increasesthe survival rate of shrimp seeds plantation, therefore team of PT. Atnic EkoteknoWicaksana create a tool called Blumbangreksa that able to monitor water quality of shrimp farms, measure temperature, salinity, pH, DO (dissolved oxygen), TDS (total dissolve solid) in water and moist air over the surface of the water and GSM -based and Internet of things. Based on the research results, unique value proposition of Blumbangreksa products is the measurement result of water quality are accurate, real-time measurements, based on Internet of things and have the ability measurements at once. Based on the feasibility study using the opportunity assessment of Marty Cagan, it can be seen that the product has fulfilled ten elements of assessment opportunity, so Blumbangreksa products are considered feasible. Initial investment fund of Blumbangreksa products is Rp 1,369,856,574, with profitability index of 1:51 and average breakeven products each year as many as 18 products are sold, and the payback period for 4 years and 2 months, therefore the business of Blumbangreksa product is feasible.

Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment

PubMed Central

Van Such, Monica B.; Nesse, Robert E.; Dilling, James A.; Swensen, Stephen J.; Thompson, Kristine M.; Orlowski, Janis M.; Santrach, Paula J.

2017-01-01

The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices. In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias. With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions. PMID:28353502

Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment.

PubMed

Naessens, James M; Van Such, Monica B; Nesse, Robert E; Dilling, James A; Swensen, Stephen J; Thompson, Kristine M; Orlowski, Janis M; Santrach, Paula J

2017-07-01

The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.

The Mental Health Recovery Measure Can Be Used to Assess Aspects of Both Customer-Based and Service-Based Recovery in the Context of Severe Mental Illness.

PubMed

Oliveira-Maia, Albino J; Mendonça, Carina; Pessoa, Maria J; Camacho, Marta; Gago, Joaquim

2016-01-01

Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective well-being in patients suffering from SMI.

The Mental Health Recovery Measure Can Be Used to Assess Aspects of Both Customer-Based and Service-Based Recovery in the Context of Severe Mental Illness

PubMed Central

Oliveira-Maia, Albino J.; Mendonça, Carina; Pessoa, Maria J.; Camacho, Marta; Gago, Joaquim

2016-01-01

Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective well-being in patients suffering from SMI. PMID:27857698

Are validated outcome measures used in distal radial fractures truly valid?

PubMed Central

Nienhuis, R. W.; Bhandari, M.; Goslings, J. C.; Poolman, R. W.; Scholtes, V. A. B.

2016-01-01

Objectives Patient-reported outcome measures (PROMs) are often used to evaluate the outcome of treatment in patients with distal radial fractures. Which PROM to select is often based on assessment of measurement properties, such as validity and reliability. Measurement properties are assessed in clinimetric studies, and results are often reviewed without considering the methodological quality of these studies. Our aim was to systematically review the methodological quality of clinimetric studies that evaluated measurement properties of PROMs used in patients with distal radial fractures, and to make recommendations for the selection of PROMs based on the level of evidence of each individual measurement property. Methods A systematic literature search was performed in PubMed, EMbase, CINAHL and PsycINFO databases to identify relevant clinimetric studies. Two reviewers independently assessed the methodological quality of the studies on measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Level of evidence (strong / moderate / limited / lacking) for each measurement property per PROM was determined by combining the methodological quality and the results of the different clinimetric studies. Results In all, 19 out of 1508 identified unique studies were included, in which 12 PROMs were rated. The Patient-rated wrist evaluation (PRWE) and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH) were evaluated on most measurement properties. The evidence for the PRWE is moderate that its reliability, validity (content and hypothesis testing), and responsiveness are good. The evidence is limited that its internal consistency and cross-cultural validity are good, and its measurement error is acceptable. There is no evidence for its structural and criterion validity. The evidence for the DASH is moderate that its responsiveness is good. The evidence is limited that its reliability and the validity on hypothesis testing are good. There is no evidence for the other measurement properties. Conclusion According to this systematic review, there is, at best, moderate evidence that the responsiveness of the PRWE and DASH are good, as are the reliability and validity of the PRWE. We recommend these PROMs in clinical studies in patients with distal radial fractures; however, more clinimetric studies of higher methodological quality are needed to adequately determine the other measurement properties. Cite this article: Dr Y. V. Kleinlugtenbelt. Are validated outcome measures used in distal radial fractures truly valid?: A critical assessment using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Bone Joint Res 2016;5:153–161. DOI: 10.1302/2046-3758.54.2000462. PMID:27132246

Measuring Teachers and Learners' Perceptions of the Quality of Their Online Learning Experience

ERIC Educational Resources Information Center

Gómez-Rey, Pilar; Barbera, Elena; Fernández-Navarro, Francisco

2016-01-01

This article explores the quality of the online learning experience based on the Sloan-C framework and the Online Learning Consortium's (OLC) quality scorecard. The OLC index has been implemented to evaluate quality in online programs from different perspectives. Despite this, the opinions of learners are ignored, and it is built using feedback…

Carnegie Knowledge Network Concluding Recommendations. What We Know Series

ERIC Educational Resources Information Center

Goldhaber, Dan; Harris Douglas N.; Loeb, Susanna; McCaffrey, Daniel F.; Raudenbush, Stephen W.

2015-01-01

It is common knowledge that teacher quality is a key in-school factor affecting student achievement. While the quality of teaching clearly matters for how much students learn, this quality is challenging to measure. Evaluating teacher quality based on the level of their students' end-of-year test scores has been one method of assessing…

The effects of kinesiotape on athletic-based performance outcomes in healthy, active individuals: a literature synthesis

PubMed Central

Drouin, Jillian L.; McAlpine, Caitlin T.; Primak, Kari A.; Kissel, Jaclyn

2013-01-01

Context: The effect of the application of kinesiotape to skin overlying musculature on measurable athletic-based performance outcomes in healthy individuals has not been well established. Objective: To systematically search and assess the quality of the literature on the effect of kinesiotape on athletic-based performance outcomes in healthy, active individuals. Methods: An electronic search strategy was conducted in MANTIS, Cochrane Library and EBSCO databases. Retrieved articles that met the eligibility criteria were rated for methodological quality by using an adaption of the critical appraisal criteria in Clinical Epidemiology by Sackett et al. Results: Ten articles met the inclusion criteria. Seven articles had positive results in at least one athletic-based performance measure compared to controls. Conclusion: Evidence is lacking to support the use of kinesiotape as a successful measure for improving athletic-based performance outcomes in healthy individuals. However, there is no evidence to show that kinesiotape has a negative effect on any of the performace measures. PMID:24302784

Human voice quality measurement in noisy environments.

PubMed

Ueng, Shyh-Kuang; Luo, Cheng-Ming; Tsai, Tsung-Yu; Yeh, Hsuan-Chen

2015-01-01

Computerized acoustic voice measurement is essential for the diagnosis of vocal pathologies. Previous studies showed that ambient noises have significant influences on the accuracy of voice quality assessment. This paper presents a voice quality assessment system that can accurately measure qualities of voice signals, even though the input voice data are contaminated by low-frequency noises. The ambient noises in our living rooms and laboratories are collected and the frequencies of these noises are analyzed. Based on the analysis, a filter is designed to reduce noise level of the input voice signal. Then, improved numerical algorithms are employed to extract voice parameters from the voice signal to reveal the health of the voice signal. Compared with MDVP and Praat, the proposed method outperforms these two widely used programs in measuring fundamental frequency and harmonic-to-noise ratio, and its performance is comparable to these two famous programs in computing jitter and shimmer. The proposed voice quality assessment method is resistant to low-frequency noises and it can measure human voice quality in environments filled with noises from air-conditioners, ceiling fans and cooling fans of computers.

The Grassmannian Atlas: A General Framework for Exploring Linear Projections of High-Dimensional Data

DOE PAGES

Liu, S.; Bremer, P. -T; Jayaraman, J. J.; ...

2016-06-04

Linear projections are one of the most common approaches to visualize high-dimensional data. Since the space of possible projections is large, existing systems usually select a small set of interesting projections by ranking a large set of candidate projections based on a chosen quality measure. However, while highly ranked projections can be informative, some lower ranked ones could offer important complementary information. Therefore, selection based on ranking may miss projections that are important to provide a global picture of the data. Here, the proposed work fills this gap by presenting the Grassmannian Atlas, a framework that captures the global structuresmore » of quality measures in the space of all projections, which enables a systematic exploration of many complementary projections and provides new insights into the properties of existing quality measures.« less

A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development.

PubMed

Goujon, Nicolas; Devine, Alexandra; Baker, Sally M; Sprunt, Beth; Edmonds, Tanya J; Booth, Jennifer K; Keeffe, Jill E

2014-01-01

A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries. From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO's International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains. Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication. The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs. Implications for Rehabilitation Surveys and tools are needed to plan disability inclusive development. Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed. No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities. A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.

External Quality Control for Dried Blood Spot Based C-reactive Protein Assay: Experience from the Indonesia Family Life Survey and the Longitudinal Aging Study in India

PubMed Central

Hu, Peifeng; Herningtyas, Elizabeth H.; Kale, Varsha; Crimmins, Eileen M.; Risbud, Arun R.; McCreath, Heather; Lee, Jinkook; Strauss, John; O’Brien, Jennifer C.; Bloom, David E.; Seeman, Teresa E.

2015-01-01

Measurement of C-reactive protein, a marker of inflammation, in dried blood spots has been increasingly incorporated in community-based social surveys internationally. Although the dried blood spot based CRP assay protocol has been validated in the United States, it remains unclear whether laboratories in other less developed countries can generate C-reactive protein results of similar quality. We therefore conducted external quality monitoring for dried blood spot based C-reactive protein measurement for the Indonesia Family Life Survey and the Longitudinal Aging Study in India. Our results show that dried blood spot based C-reactive protein results in these two countries have excellent and consistent correlations with serum-based values and dried blood spot based results from the reference laboratory in the United States. Even though the results from duplicate samples may have fluctuations in absolute values over time, the relative order of C-reactive protein levels remains similar and the estimates are reasonably precise for population-based studies that investigate the association between socioeconomic factors and health. PMID:25879265

Improving care transitions through meaningful use stage 2: continuity of care document.

PubMed

Murphy, Lyn Stankiewicz; Wilson, Marisa L; Newhouse, Robin P

2013-02-01

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

Measuring the Quality of Professional Development Training

ERIC Educational Resources Information Center

Gaumer Erickson, Amy S.; Noonan, Patricia M.; Brussow, Jennifer; Supon Carter, Kayla

2017-01-01

High-quality, evidence-based professional development is essential to ensure that teachers obtain the knowledge, strategies and skills necessary to positively impact student learning. While the primary form of professional development, training has rarely been evaluated for quality beyond the satisfaction of those being trained. The Observation…

An Investigation of the Overlap Between the ICECAP-A and Five Preference-Based Health-Related Quality of Life Instruments.

PubMed

Engel, Lidia; Mortimer, Duncan; Bryan, Stirling; Lear, Scott A; Whitehurst, David G T

2017-07-01

The ICEpop CAPability measure for Adults (ICECAP-A) is a measure of capability wellbeing developed for use in economic evaluations. It was designed to overcome perceived limitations associated with existing preference-based instruments, where the explicit focus on health-related aspects of quality of life may result in the failure to capture fully the broader benefits of interventions and treatments that go beyond health. The aim of this study was to investigate the extent to which preference-based health-related quality of life (HRQoL) instruments are able to capture aspects of capability wellbeing, as measured by the ICECAP-A. Using data from the Multi Instrument Comparison project, pairwise exploratory factor analyses were conducted to compare the ICECAP-A with five preference-based HRQoL instruments [15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index Mark 3 (HUI-3), and SF-6D]. Data from 6756 individuals were used in the analyses. The ICECAP-A provides information above that garnered from most commonly used preference-based HRQoL instruments. The exception was the AQoL-8D; more common factors were identified between the ICECAP-A and AQoL-8D compared with the other pairwise analyses. Further investigations are needed to explore the extent and potential implications of 'double counting' when applying the ICECAP-A alongside health-related preference-based instruments.

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.

Use of NEXRAD radar-based observations for quality control of in-situ rain gauge measurements

NASA Astrophysics Data System (ADS)

Nelson, B. R.; Prat, O.; Leeper, R.

2017-12-01

Rain gauge quality control is an often over looked important step in the archive of historical precipitation estimates. We investigate the possibilities that exist for using ground based radar networks for quality control of rain gauge measurements. This process includes the point to pixel comparisons of the rain gauge measurements with NEXRAD observations. There are two NEXRAD based data sets used for reference; the NCEP stage IV and the NWS MRMS gridded data sets. The NCEP stage IV data set is available at 4km hourly for the period 2002-present and includes the radar-gauge bias adjusted precipitation estimate. The NWS MRMS data set includes several different variables such as reflectivity, radar-only estimates, precipitation flag, and radar-gauge bias adjusted precipitation estimates. The latter product provides for much more information to apply quality control such as identification of precipitation type, identification of storm type and Z-R relation. In addition, some of the variables are available at 5-minute scale. The rain gauge networks that are investigated are the Climate Reference Network (CRN), the Fischer-Porter Hourly Precipitation Database (HPD), and the Hydrometeorological Automated Data System (HADS). The CRN network is available at the 5-minute scale, the HPD network is available at the 15-minute and hourly scale, and HADS is available at the hourly scale. The varying scales present challenges for comparisons. However given the higher resolution radar-based products we identify an optimal combination of rain gauge observations that can be compared to the radar-based information. The quality control process focuses on identifying faulty gauges in direct comparison while a deeper investigation focuses on event-based differences from light rain to extreme storms.

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.

How Do We Value Postoperative Recovery?: A Systematic Review of the Measurement Properties of Patient-reported Outcomes After Abdominal Surgery.

PubMed

Fiore, Julio F; Figueiredo, Sabrina; Balvardi, Saba; Lee, Lawrence; Nauche, Bénédicte; Landry, Tara; Mayo, Nancy E; Feldman, Liane S

2018-04-01

To appraise the level of evidence supporting the measurement properties of patient-reported outcome measures (PROMs) in the context of postoperative recovery after abdominal surgery. There is growing interest in using PROMs to support value-based care in abdominal surgery; however, to draw valid conclusions regarding patient-reported outcomes data, PROMs with robust measurement properties are required. Eight databases (MEDLINE, EMBASE, Biosis, PsycINFO, The Cochrane Library, CINAHL, Scopus, Web of Science) were searched for studies focused on the measurement properties of PROMs in the context of recovery after abdominal surgery. The methodological quality of individual studies was evaluated using the consensus-based COSMIN checklist. Evidence supporting the measurement properties of each PROM was synthetized according to standardized criteria and compared against the International Society of Quality of Life Research minimum standards for the selection of PROMs for outcomes research. We identified 35 studies evaluating 22 PROMs [12 focused on nonspecific surgical populations (55%), 4 focused on abdominal surgery (18%), and 6 generic PROMs (27%)]. The great majority of the studies (74%) received only poor or fair quality ratings. Measurement properties of PROMs were predominantly supported by limited or unknown evidence. None of the PROMs fulfilled International Society of Quality of Life Research's minimum standards, hindering specific recommendations. There is very limited evidence supporting the measurement properties of existing PROMs used in the context of recovery after abdominal surgery. This precludes the use of these PROMs to support value-based surgical care. Further research is required to bridge this major knowledge gap. International Prospective Register of Systematic Reviews (PROSPERO): CRD42014014349.

Patient-reported outcome instruments that evaluate adherence behaviours in adults with asthma: A systematic review of measurement properties.

PubMed

Gagné, Myriam; Boulet, Louis-Philippe; Pérez, Norma; Moisan, Jocelyne

2018-04-30

To systematically identify the measurement properties of patient-reported outcome instruments (PROs) that evaluate adherence to inhaled maintenance medication in adults with asthma. We conducted a systematic review of six databases. Two reviewers independently included studies on the measurement properties of PROs that evaluated adherence in asthmatic participants aged ≥18 years. Based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), the reviewers (1) extracted data on internal consistency, reliability, measurement error, content validity, structural validity, hypotheses testing, cross-cultural validity, criterion validity, and responsiveness; (2) assessed the methodological quality of the included studies; (3) assessed the quality of the measurement properties (positive or negative); and (4) summarised the level of evidence (limited, moderate, or strong). We screened 6,068 records and included 15 studies (14 PROs). No studies evaluated measurement error or responsiveness. Based on methodological and measurement property quality assessments, we found limited positive evidence of: (a) internal consistency of the Adherence Questionnaire, Refined Medication Adherence Reason Scale (MAR-Scale), Medication Adherence Report Scale for Asthma (MARS-A), and Test of the Adherence to Inhalers (TAI); (b) reliability of the TAI; and (c) structural validity of the Adherence Questionnaire, MAR-Scale, MARS-A, and TAI. We also found limited negative evidence of: (d) hypotheses testing of Adherence Questionnaire; (e) reliability of the MARS-A; and (f) criterion validity of the MARS-A and TAI. Our results highlighted the need to conduct further high-quality studies that will positively evaluate the reliability, validity, and responsiveness of the available PROs. This article is protected by copyright. All rights reserved.

Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework.

PubMed

McLean, G; Sutton, M; Guthrie, B

2006-11-01

To examine whether the quality of primary care measured by the 2004 contract varies with socioeconomic deprivation. Retrospective analysis of publicly available data, comparing quality indicators used for payment that allow exclusion of patients (payment quality) and indicators based on the care delivered to all patients (delivered quality). 1024 general practices in Scotland. Regression coefficients summarising the relationships between deprivation and payment and delivered quality. Little systematic association is found between payment quality and deprivation but, for 17 of the 33 indicators examined, delivered quality falls with increasing deprivation. Absolute differences in delivered quality are small for most simpler process measures, such as recording of smoking status or blood pressure. Greater inequalities are seen for more complex process measures such as diagnostic procedures, some intermediate outcome measures such as glycaemic control in diabetes and measures of treatment such as influenza immunisation. The exclusions system succeeds in not penalising practices financially for the characteristics of the population they serve, but does not reward the additional work required in deprived areas and contributes to a continuation of the inverse care law. The contract data collected prevent examination of most complex process or treatment measures and this analysis is likely to underestimate the extent of continuing inequalities in care. Broader lessons cannot be drawn on the effect on inequalities of this new set of incentives until changes are made to the way contract data are collected and analysed.

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

Measuring wood quality in standing trees--a review

Treesearch

Mark Rudnicki; Xiping Wang; Robert J. Ross; R. Bruce Allison; Kevin Perzynski

2017-01-01

This report summarizes a state-of-the-art review conducted on the topic of field measurement of the quality of wood in trees. The foundation science of micro-resistance drilling and acoustic-based techniques for use with woody materials is presented, and use of these techniques for the detection of biodeterioration in wood is discussed. Quantification of the physical...

Improving coarse woody debris measurements: a taper-based technique

Treesearch

Christopher W. Woodall; James A. Westfall

2007-01-01

Coarse woody debris (CWD) are dead and down trees of a certain minimum size that are an important forest ecosystem component (e.g., wildlife habitat, carbon stocks, and fuels). Accurately measuring the dimensions of CWD is important for ensuring the quality of CWD estimates and hence for accurately assessing forest ecosystem attributes. To improve the quality of CWD...

Quantifying a Relationship between Place-Based Learning and Environmental Quality

ERIC Educational Resources Information Center

Johnson, Brian; Duffin, Michael; Murphy, Michael

2012-01-01

The goal of this study was to investigate the degree to which school-based and nonformal education programs that focus on air quality (AQ) achieved measurable AQ improvements, and whether specific instructional methods were associated with those improvements. We completed a standardized telephone interview with representatives of 54 AQ education…

Agent-based station for on-line diagnostics by self-adaptive laser Doppler vibrometry

NASA Astrophysics Data System (ADS)

Serafini, S.; Paone, N.; Castellini, P.

2013-12-01

A self-adaptive diagnostic system based on laser vibrometry is proposed for quality control of mechanical defects by vibration testing; it is developed for appliances at the end of an assembly line, but its characteristics are generally suited for testing most types of electromechanical products. It consists of a laser Doppler vibrometer, equipped with scanning mirrors and a camera, which implements self-adaptive bahaviour for optimizing the measurement. The system is conceived as a Quality Control Agent (QCA) and it is part of a Multi Agent System that supervises all the production line. The QCA behaviour is defined so to minimize measurement uncertainty during the on-line tests and to compensate target mis-positioning under guidance of a vision system. Best measurement conditions are reached by maximizing the amplitude of the optical Doppler beat signal (signal quality) and consequently minimize uncertainty. In this paper, the optimization strategy for measurement enhancement achieved by the down-hill algorithm (Nelder-Mead algorithm) and its effect on signal quality improvement is discussed. Tests on a washing machine in controlled operating conditions allow to evaluate the efficacy of the method; significant reduction of noise on vibration velocity spectra is observed. Results from on-line tests are presented, which demonstrate the potential of the system for industrial quality control.

Validity test and its consistency in the construction of patient loyalty model

NASA Astrophysics Data System (ADS)

Yanuar, Ferra

2016-04-01

The main objective of this present study is to demonstrate the estimation of validity values and its consistency based on structural equation model. The method of estimation was then implemented to an empirical data in case of the construction the patient loyalty model. In the hypothesis model, service quality, patient satisfaction and patient loyalty were determined simultaneously, each factor were measured by any indicator variables. The respondents involved in this study were the patients who ever got healthcare at Puskesmas in Padang, West Sumatera. All 394 respondents who had complete information were included in the analysis. This study found that each construct; service quality, patient satisfaction and patient loyalty were valid. It means that all hypothesized indicator variables were significant to measure their corresponding latent variable. Service quality is the most measured by tangible, patient satisfaction is the most mesured by satisfied on service and patient loyalty is the most measured by good service quality. Meanwhile in structural equation, this study found that patient loyalty was affected by patient satisfaction positively and directly. Service quality affected patient loyalty indirectly with patient satisfaction as mediator variable between both latent variables. Both structural equations were also valid. This study also proved that validity values which obtained here were also consistence based on simulation study using bootstrap approach.

The Use of Multidimensional Image-Based Analysis to Accurately Monitor Cell Growth in 3D Bioreactor Culture

PubMed Central

Baradez, Marc-Olivier; Marshall, Damian

2011-01-01

The transition from traditional culture methods towards bioreactor based bioprocessing to produce cells in commercially viable quantities for cell therapy applications requires the development of robust methods to ensure the quality of the cells produced. Standard methods for measuring cell quality parameters such as viability provide only limited information making process monitoring and optimisation difficult. Here we describe a 3D image-based approach to develop cell distribution maps which can be used to simultaneously measure the number, confluency and morphology of cells attached to microcarriers in a stirred tank bioreactor. The accuracy of the cell distribution measurements is validated using in silico modelling of synthetic image datasets and is shown to have an accuracy >90%. Using the cell distribution mapping process and principal component analysis we show how cell growth can be quantitatively monitored over a 13 day bioreactor culture period and how changes to manufacture processes such as initial cell seeding density can significantly influence cell morphology and the rate at which cells are produced. Taken together, these results demonstrate how image-based analysis can be incorporated in cell quality control processes facilitating the transition towards bioreactor based manufacture for clinical grade cells. PMID:22028809

The use of multidimensional image-based analysis to accurately monitor cell growth in 3D bioreactor culture.

PubMed

Baradez, Marc-Olivier; Marshall, Damian

2011-01-01

The transition from traditional culture methods towards bioreactor based bioprocessing to produce cells in commercially viable quantities for cell therapy applications requires the development of robust methods to ensure the quality of the cells produced. Standard methods for measuring cell quality parameters such as viability provide only limited information making process monitoring and optimisation difficult. Here we describe a 3D image-based approach to develop cell distribution maps which can be used to simultaneously measure the number, confluency and morphology of cells attached to microcarriers in a stirred tank bioreactor. The accuracy of the cell distribution measurements is validated using in silico modelling of synthetic image datasets and is shown to have an accuracy >90%. Using the cell distribution mapping process and principal component analysis we show how cell growth can be quantitatively monitored over a 13 day bioreactor culture period and how changes to manufacture processes such as initial cell seeding density can significantly influence cell morphology and the rate at which cells are produced. Taken together, these results demonstrate how image-based analysis can be incorporated in cell quality control processes facilitating the transition towards bioreactor based manufacture for clinical grade cells.

A systematic review finds limited data on measurement properties of instruments measuring outcomes in adult intensive care unit survivors.

PubMed

Robinson, Karen A; Davis, Wesley E; Dinglas, Victor D; Mendez-Tellez, Pedro A; Rabiee, Anahita; Sukrithan, Vineeth; Yalamanchilli, Ramakrishna; Turnbull, Alison E; Needham, Dale M

2017-02-01

There is a growing number of studies evaluating the physical, cognitive, mental health, and health-related quality of life (HRQOL) outcomes of adults surviving critical illness. However, there is little consensus on the most appropriate instruments to measure these outcomes. To inform the development of such consensus, we conducted a systematic review of the performance characteristics of instruments measuring physical, cognitive, mental health, and HRQOL outcomes in adult intensive care unit (ICU) survivors. We searched PubMed, Embase, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and The Cochrane Library in March 2015. We also conducted manual searches of reference lists of eligible studies and relevant review articles. Two people independently selected studies, completed data abstraction, and assessed the quality of eligible studies using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist. We identified 20 studies which explicitly evaluated measurement properties for 21 different instruments assessing outcomes in ICU survivors. Eleven of the instruments assessed quality of life, with few instruments assessing other domains. Of the nine measurement properties evaluated on the COSMIN checklist, six were assessed in <10% of the evaluations. Overall quality of eligible studies was generally poor to fair based on the COSMIN checklist. Although an increasing number of studies measure physical, cognitive, mental health, and HRQOL outcomes in adult ICU survivors, data on the measurement properties of such instruments are sparse and generally of poor to fair quality. Empirical analyses evaluating the performance of instruments in adult ICU survivors are needed to advance research in this field. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents

PubMed Central

Hoare, Erin; Fuller-Tyszkiewicz, Matthew; Skouteris, Helen; Millar, Lynne; Nichols, Melanie; Allender, Steven

2015-01-01

Objectives This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. Setting Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. Participants Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10–19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Primary and secondary outcome measures Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. Results Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. Conclusions Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health. PMID:25564145

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

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

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

Defining health-related quality of life for young wheelchair users: A qualitative health economics study

PubMed Central

2017-01-01

Background Wheelchairs for children with impaired mobility provide health, developmental and psychosocial benefits, however there is limited understanding of how mobility aids affect the health-related quality of life of children with impaired mobility. Preference-based health-related quality of life outcome measures are used to calculate quality-adjusted life years; an important concept in health economics. The aim of this research was to understand how young wheelchair users and their parents define health-related quality of life in relation to mobility impairment and wheelchair use. Methods The sampling frame was children with impaired mobility (≤18 years) who use a wheelchair and their parents. Data were collected through semi-structured face-to-face interviews conducted in participants’ homes. Qualitative framework analysis was used to analyse the interview transcripts. An a priori thematic coding framework was developed. Emerging codes were grouped into categories, and refined into analytical themes. The data were used to build an understanding of how children with impaired mobility define health-related quality of life in relation to mobility impairment, and to assess the applicability of two standard measures of health-related quality of life. Results Eleven children with impaired mobility and 24 parents were interviewed across 27 interviews. Participants defined mobility-related quality of life through three distinct but interrelated concepts: 1) participation and positive experiences; 2) self-worth and feeling fulfilled; 3) health and functioning. A good degree of consensus was found between child and parent responses, although there was some evidence to suggest a shift in perception of mobility-related quality of life with child age. Conclusions Young wheelchair users define health-related quality of life in a distinct way as a result of their mobility impairment and adaptation use. Generic, preference-based measures of health-related quality of life lack sensitivity in this population. Development of a mobility-related quality of life outcome measure for children is recommended. PMID:28617820

Network modeling of PM10 concentration in Malaysia

NASA Astrophysics Data System (ADS)

Supian, Muhammad Nazirul Aiman Abu; Bakar, Sakhinah Abu; Razak, Fatimah Abdul

2017-08-01

Air pollution is not a new phenomenon in Malaysia. The Department of Environment (DOE) monitors the country's ambient air quality through a network of 51 stations. The air quality is measured using the Air Pollution Index (API) which is mainly recorded based on the concentration of particulate matter, PM10 readings. The Continuous Air Quality Monitoring (CAQM) stations are located in various places across the country. In this study, a network model of air quality based on PM10 concen tration for selected CAQM stations in Malaysia has been developed. The model is built using a graph formulation, G = (V, E) where vertex, V is a set of CAQM stations and edges, E is a set of correlation values for each pair of vertices. The network measurements such as degree distributions, closeness centrality, and betweenness centrality are computed to analyse the behaviour of the network. As a result, a rank of CAQM stations has been produced based on their centrality characteristics.

Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions.

PubMed

Bowen, Michael E; Bhat, Deepa; Fish, Jason; Moran, Brett; Howell-Stampley, Temple; Kirk, Lynne; Persell, Stephen D; Halm, Ethan A

Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.

Dimensions of service quality in healthcare: a systematic review of literature.

PubMed

Fatima, Iram; Humayun, Ayesha; Iqbal, Usman; Shafiq, Muhammad

2018-06-13

Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality. Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index. In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016. Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis. Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality. There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.

Using collective expert judgements to evaluate quality measures of mass spectrometry images.

PubMed

Palmer, Andrew; Ovchinnikova, Ekaterina; Thuné, Mikael; Lavigne, Régis; Guével, Blandine; Dyatlov, Andrey; Vitek, Olga; Pineau, Charles; Borén, Mats; Alexandrov, Theodore

2015-06-15

Imaging mass spectrometry (IMS) is a maturating technique of molecular imaging. Confidence in the reproducible quality of IMS data is essential for its integration into routine use. However, the predominant method for assessing quality is visual examination, a time consuming, unstandardized and non-scalable approach. So far, the problem of assessing the quality has only been marginally addressed and existing measures do not account for the spatial information of IMS data. Importantly, no approach exists for unbiased evaluation of potential quality measures. We propose a novel approach for evaluating potential measures by creating a gold-standard set using collective expert judgements upon which we evaluated image-based measures. To produce a gold standard, we engaged 80 IMS experts, each to rate the relative quality between 52 pairs of ion images from MALDI-TOF IMS datasets of rat brain coronal sections. Experts' optional feedback on their expertise, the task and the survey showed that (i) they had diverse backgrounds and sufficient expertise, (ii) the task was properly understood, and (iii) the survey was comprehensible. A moderate inter-rater agreement was achieved with Krippendorff's alpha of 0.5. A gold-standard set of 634 pairs of images with accompanying ratings was constructed and showed a high agreement of 0.85. Eight families of potential measures with a range of parameters and statistical descriptors, giving 143 in total, were evaluated. Both signal-to-noise and spatial chaos-based measures performed highly with a correlation of 0.7 to 0.9 with the gold standard ratings. Moreover, we showed that a composite measure with the linear coefficients (trained on the gold standard with regularized least squares optimization and lasso) showed a strong linear correlation of 0.94 and an accuracy of 0.98 in predicting which image in a pair was of higher quality. The anonymized data collected from the survey and the Matlab source code for data processing can be found at: https://github.com/alexandrovteam/IMS_quality. © The Author 2015. Published by Oxford University Press.

Using collective expert judgements to evaluate quality measures of mass spectrometry images

PubMed Central

Palmer, Andrew; Ovchinnikova, Ekaterina; Thuné, Mikael; Lavigne, Régis; Guével, Blandine; Dyatlov, Andrey; Vitek, Olga; Pineau, Charles; Borén, Mats; Alexandrov, Theodore

2015-01-01

Motivation: Imaging mass spectrometry (IMS) is a maturating technique of molecular imaging. Confidence in the reproducible quality of IMS data is essential for its integration into routine use. However, the predominant method for assessing quality is visual examination, a time consuming, unstandardized and non-scalable approach. So far, the problem of assessing the quality has only been marginally addressed and existing measures do not account for the spatial information of IMS data. Importantly, no approach exists for unbiased evaluation of potential quality measures. Results: We propose a novel approach for evaluating potential measures by creating a gold-standard set using collective expert judgements upon which we evaluated image-based measures. To produce a gold standard, we engaged 80 IMS experts, each to rate the relative quality between 52 pairs of ion images from MALDI-TOF IMS datasets of rat brain coronal sections. Experts’ optional feedback on their expertise, the task and the survey showed that (i) they had diverse backgrounds and sufficient expertise, (ii) the task was properly understood, and (iii) the survey was comprehensible. A moderate inter-rater agreement was achieved with Krippendorff’s alpha of 0.5. A gold-standard set of 634 pairs of images with accompanying ratings was constructed and showed a high agreement of 0.85. Eight families of potential measures with a range of parameters and statistical descriptors, giving 143 in total, were evaluated. Both signal-to-noise and spatial chaos-based measures performed highly with a correlation of 0.7 to 0.9 with the gold standard ratings. Moreover, we showed that a composite measure with the linear coefficients (trained on the gold standard with regularized least squares optimization and lasso) showed a strong linear correlation of 0.94 and an accuracy of 0.98 in predicting which image in a pair was of higher quality. Availability and implementation: The anonymized data collected from the survey and the Matlab source code for data processing can be found at: https://github.com/alexandrovteam/IMS_quality. Contact: theodore.alexandrov@embl.de PMID:26072506

The development of effects-based air quality management regimes

NASA Astrophysics Data System (ADS)

Longhurst, J. W. S.; Irwin, J. G.; Chatterton, T. J.; Hayes, E. T.; Leksmono, N. S.; Symons, J. K.

This paper considers the evolution of attempts to control and manage air pollution, principally but not exclusively focussing upon the challenge of managing air pollution in urban environments. The development and implementation of a range of air pollution control measures are considered. Initially the measures implemented primarily addressed point sources, a small number of fuel types and a limited number of pollutants. The adequacy of such a source-control approach is assessed within the context of a changing and challenging air pollution climate. An assessment of air quality management in the United Kingdom over a 50-year timeframe exemplifies the range of issues and challenges in contemporary air quality management. The need for new approaches is explored and the development and implementation of an effects-based, risk management system for air quality regulation is evaluated.

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

PubMed

Robst, John; Rost, Kathryn; Marshall, Donna

2013-11-01

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

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.

Multisensor satellite data for water quality analysis and water pollution risk assessment: decision making under deep uncertainty with fuzzy algorithm in framework of multimodel approach

NASA Astrophysics Data System (ADS)

Kostyuchenko, Yuriy V.; Sztoyka, Yulia; Kopachevsky, Ivan; Artemenko, Igor; Yuschenko, Maxim

2017-10-01

Multi-model approach for remote sensing data processing and interpretation is described. The problem of satellite data utilization in multi-modeling approach for socio-ecological risks assessment is formally defined. Observation, measurement and modeling data utilization method in the framework of multi-model approach is described. Methodology and models of risk assessment in framework of decision support approach are defined and described. Method of water quality assessment using satellite observation data is described. Method is based on analysis of spectral reflectance of aquifers. Spectral signatures of freshwater bodies and offshores are analyzed. Correlations between spectral reflectance, pollutions and selected water quality parameters are analyzed and quantified. Data of MODIS, MISR, AIRS and Landsat sensors received in 2002-2014 have been utilized verified by in-field spectrometry and lab measurements. Fuzzy logic based approach for decision support in field of water quality degradation risk is discussed. Decision on water quality category is making based on fuzzy algorithm using limited set of uncertain parameters. Data from satellite observations, field measurements and modeling is utilizing in the framework of the approach proposed. It is shown that this algorithm allows estimate water quality degradation rate and pollution risks. Problems of construction of spatial and temporal distribution of calculated parameters, as well as a problem of data regularization are discussed. Using proposed approach, maps of surface water pollution risk from point and diffuse sources are calculated and discussed.

Improving patient safety through quality assurance.

PubMed

Raab, Stephen S

2006-05-01

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

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

Conformance Testing: Measurement Decision Rules

NASA Technical Reports Server (NTRS)

Mimbs, Scott M.

2010-01-01

The goal of a Quality Management System (QMS) as specified in ISO 9001 and AS9100 is to provide assurance to the customer that end products meet specifications. Measuring devices, often called measuring and test equipment (MTE), are used to provide the evidence of product conformity to specified requirements. Unfortunately, processes that employ MTE can become a weak link to the overall QMS if proper attention is not given to the measurement process design, capability, and implementation. Documented "decision rules" establish the requirements to ensure measurement processes provide the measurement data that supports the needs of the QMS. Measurement data are used to make the decisions that impact all areas of technology. Whether measurements support research, design, production, or maintenance, ensuring the data supports the decision is crucial. Measurement data quality can be critical to the resulting consequences of measurement-based decisions. Historically, most industries required simplistic, one-size-fits-all decision rules for measurements. One-size-fits-all rules in some cases are not rigorous enough to provide adequate measurement results, while in other cases are overly conservative and too costly to implement. Ideally, decision rules should be rigorous enough to match the criticality of the parameter being measured, while being flexible enough to be cost effective. The goal of a decision rule is to ensure that measurement processes provide data with a sufficient level of quality to support the decisions being made - no more, no less. This paper discusses the basic concepts of providing measurement-based evidence that end products meet specifications. Although relevant to all measurement-based conformance tests, the target audience is the MTE end-user, which is anyone using MTE other than calibration service providers. Topics include measurement fundamentals, the associated decision risks, verifying conformance to specifications, and basic measurement decisions rules.

Reduced dose CT with model-based iterative reconstruction compared to standard dose CT of the chest, abdomen, and pelvis in oncology patients: intra-individual comparison study on image quality and lesion conspicuity.

PubMed

Morimoto, Linda Nayeli; Kamaya, Aya; Boulay-Coletta, Isabelle; Fleischmann, Dominik; Molvin, Lior; Tian, Lu; Fisher, George; Wang, Jia; Willmann, Jürgen K

2017-09-01

To compare image quality and lesion conspicuity of reduced dose (RD) CT with model-based iterative reconstruction (MBIR) compared to standard dose (SD) CT in patients undergoing oncological follow-up imaging. Forty-four cancer patients who had a staging SD CT within 12 months were prospectively included to undergo a weight-based RD CT with MBIR. Radiation dose was recorded and tissue attenuation and image noise of four tissue types were measured. Reproducibility of target lesion size measurements of up to 5 target lesions per patient were analyzed. Subjective image quality was evaluated for three readers independently utilizing 4- or 5-point Likert scales. Median radiation dose reduction was 46% using RD CT (P < 0.01). Median image noise across all measured tissue types was lower (P < 0.01) in RD CT. Subjective image quality for RD CT was higher (P < 0.01) in regard to image noise and overall image quality; however, there was no statistically significant difference regarding image sharpness (P = 0.59). There were subjectively more artifacts on RD CT (P < 0.01). Lesion conspicuity was subjectively better in RD CT (P < 0.01). Repeated target lesion size measurements were highly reproducible both on SD CT (ICC = 0.987) and RD CT (ICC = 0.97). RD CT imaging with MBIR provides diagnostic imaging quality and comparable lesion conspicuity on follow-up exams while allowing dose reduction by a median of 46% compared to SD CT imaging.

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

PubMed

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

2016-02-01

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

Organisational Learning for School Quality and Health

ERIC Educational Resources Information Center

Lagrosen, Yvonne; Lagrosen, Stefan

2012-01-01

Purpose: The purpose of this paper is to shed light upon the connections between quality management, employee health and organisational learning in a school setting. Design/methodology/approach: The study is based on a quantitative survey. Items measuring health status and values of quality management were included in a questionnaire addressed to…

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

Forest Service Log Grades for Southern Pine

Treesearch

Robert A. Campbell

1964-01-01

Wood users have long recognized and evaluated differences in timber quality of southern pine. However, the many concepts of quality were based largely on individual experience. This varied concept of timber quality and the absence of a general system or systems for measuring it existed until the 1930's.

GENERAL GUIDELINES FOR USING THE SEDIMENT QUALITY TRIAD

EPA Science Inventory

The Sediment Quality Triad(Fig. 1),developed in the mid-1980s (Long and Chapman, 1985), is now widely used for conducting integrated assessments of sediment quality based on measures of chemistry,toxicity and benthos(e.g.,Canfield et al., 1994,1996,submitted; Carr et al., 1996;Ch...

Publication Ratings versus Peer Ratings of Universities

ERIC Educational Resources Information Center

Anderson, Richard C.; And Others

1978-01-01

A quantitative comparison of peer versus bibliometric procedures for rating the quality of U.S. universities is presented. The quality of graduate faculty is measured by the Roose-Andersen peer rating, while bibliometric ratings are based on the number, average "quality," and total influence of university papers in each field.…

[Value-based medicine for glaucoma].

PubMed

Hirneiss, C; Kampik, A; Neubauer, A S

2010-03-01

The application of value-based medicine (VBM) tenets in the area of glaucoma research requires valid and reliable data concerning the quality of life with glaucoma. A multitude of instruments for measuring quality of life of patients with glaucoma have been employed in the past. Any instrument used would need to capture peripheral vision loss and its influence on patient-reported quality of life as this is one of the hallmarks of this disease. Cost-utility analyses can then be based on the reported quality of life and the cost of glaucoma therapy. Several cost-utility analyses have been applied in the field of glaucoma screening as well as treating ocular hypertension and based on this a recommendation regarding population subgroups which can be treated cost efficiently can be made.

Development and testing of emergency department patient transfer communication measures.

PubMed

Klingner, Jill; Moscovice, Ira

2012-01-01

Communication problems are a major contributing factor to adverse events in hospitals.(1) The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013. © 2011 National Rural Health Association.

An Entropy-Based Measure for Assessing Fuzziness in Logistic Regression

PubMed Central

Weiss, Brandi A.; Dardick, William

2015-01-01

This article introduces an entropy-based measure of data–model fit that can be used to assess the quality of logistic regression models. Entropy has previously been used in mixture-modeling to quantify how well individuals are classified into latent classes. The current study proposes the use of entropy for logistic regression models to quantify the quality of classification and separation of group membership. Entropy complements preexisting measures of data–model fit and provides unique information not contained in other measures. Hypothetical data scenarios, an applied example, and Monte Carlo simulation results are used to demonstrate the application of entropy in logistic regression. Entropy should be used in conjunction with other measures of data–model fit to assess how well logistic regression models classify cases into observed categories. PMID:29795897

An Entropy-Based Measure for Assessing Fuzziness in Logistic Regression.

PubMed

Weiss, Brandi A; Dardick, William

2016-12-01

This article introduces an entropy-based measure of data-model fit that can be used to assess the quality of logistic regression models. Entropy has previously been used in mixture-modeling to quantify how well individuals are classified into latent classes. The current study proposes the use of entropy for logistic regression models to quantify the quality of classification and separation of group membership. Entropy complements preexisting measures of data-model fit and provides unique information not contained in other measures. Hypothetical data scenarios, an applied example, and Monte Carlo simulation results are used to demonstrate the application of entropy in logistic regression. Entropy should be used in conjunction with other measures of data-model fit to assess how well logistic regression models classify cases into observed categories.

Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

PubMed

Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L; Ruderman, Eric M; Carter, Jeffrey D; Patel, Barry; Moreo, Kathleen

2015-12-01

In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve performance on national quality measures for RA.

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.

Postacute rehabilitation quality of care: toward a shared conceptual framework.

PubMed

Jesus, Tiago Silva; Hoenig, Helen

2015-05-01

There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Installation Restoration Program. Phase II, Stage 1. Problem Confirmation Study, Luke Air Force Base, Glendale, Arizona.

DTIC Science & Technology

1984-11-01

CONTENTS Section Title Page 4.3 Water Chemistry Conditions 4-10 4.3.1 Groundwater Quality Results 4-10 0 4.4 Water Quality - General 4-11 4.4.1 Water...Quality - General 4-11 4.4.2 Water Quality at LAFB 4-11 4.4.3 Soil Quality - General 4-15 0 4.4.4 Soil Quality at LAFB 4-15 4.4.5 Conclusions 4-16 5...ALTERNATIVE MEASURES 5-1 5.1 General 5-1 0 5.1.1 Base Production Wells 5-2 5.1.2 Current and North Fire Depart- 5-2 ment Training Areas 5.2 Summary 5

Quality of asthma care under different primary care models in Canada: a population-based study.

PubMed

To, Teresa; Guan, Jun; Zhu, Jingqin; Lougheed, M Diane; Kaplan, Alan; Tamari, Itamar; Stanbrook, Matthew B; Simatovic, Jacqueline; Feldman, Laura; Gershon, Andrea S

2015-02-14

Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.

The choices, choosing model of quality of life: linkages to a science base.

PubMed

Gurland, Barry J; Gurland, Roni V

2009-01-01

A previous paper began with a critical review of current models and measures of quality of life and then proposed criteria for judging the relative merits of alternative models: preference was given to finding a model with explicit mechanisms, linkages to a science base, a means of identifying deficits amenable to rational restorative interventions, and with embedded values of the whole person. A conjectured model, based on the processes of accessing choices and choosing among them, matched the proposed criteria. The choices and choosing (c-c) process is an evolved adaptive mechanism dedicated to the pursuit of quality of life, driven by specific biological and psychological systems, and influenced also by social and environmental forces. In this paper the c-c model is examined for its potential to strengthen the science base for the field of quality of life and thus to unify many approaches to concept and measurement. A third paper in this set will lay out a guide to applying the c-c model in evaluating impairments of quality of life and will tie this evaluation to corresponding interventions aimed at relieving restrictions or distortions of the c-c process; thus helping people to preserve and improve their quality of life. The fourth paper will demonstrate empirical analyses of the relationship between health imposed restrictions of options for living and conventional indicators of diminished quality of life. (c) 2008 John Wiley & Sons, Ltd.

Air quality and ventilation fan control based on aerosol measurement in the bi-directional undersea Bømlafjord tunnel.

PubMed

Indrehus, Oddny; Aralt, Tor Tybring

2005-04-01

Aerosol, NO and CO concentration, temperature, air humidity, air flow and number of running ventilation fans were measured by continuous analysers every minute for a whole week for six different one-week periods spread over ten months in 2001 and 2002 at measuring stations in the 7860 m long tunnel. The ventilation control system was mainly based on aerosol measurements taken by optical scatter sensors. The ventilation turned out to be satisfactory according to Norwegian air quality standards for road tunnels; however, there was some uncertainty concerning the NO2 levels. The air humidity and temperature inside the tunnel were highly influenced by the outside metrological conditions. Statistical models for NO concentration were developed and tested; correlations between predicted and measured NO were 0.81 for a partial least squares regression (PLS1) model based on CO and aerosol, and 0.77 for a linear regression model based only on aerosol. Hence, the ventilation control system should not solely be based on aerosol measurements. Since NO2 is the hazardous polluter, modelling NO2 concentration rather than NO should be preferred in any further optimising of the ventilation control.

Prediction of HDR quality by combining perceptually transformed display measurements with machine learning

NASA Astrophysics Data System (ADS)

Choudhury, Anustup; Farrell, Suzanne; Atkins, Robin; Daly, Scott

2017-09-01

We present an approach to predict overall HDR display quality as a function of key HDR display parameters. We first performed subjective experiments on a high quality HDR display that explored five key HDR display parameters: maximum luminance, minimum luminance, color gamut, bit-depth and local contrast. Subjects rated overall quality for different combinations of these display parameters. We explored two models | a physical model solely based on physically measured display characteristics and a perceptual model that transforms physical parameters using human vision system models. For the perceptual model, we use a family of metrics based on a recently published color volume model (ICT-CP), which consists of the PQ luminance non-linearity (ST2084) and LMS-based opponent color, as well as an estimate of the display point spread function. To predict overall visual quality, we apply linear regression and machine learning techniques such as Multilayer Perceptron, RBF and SVM networks. We use RMSE and Pearson/Spearman correlation coefficients to quantify performance. We found that the perceptual model is better at predicting subjective quality than the physical model and that SVM is better at prediction than linear regression. The significance and contribution of each display parameter was investigated. In addition, we found that combined parameters such as contrast do not improve prediction. Traditional perceptual models were also evaluated and we found that models based on the PQ non-linearity performed better.

Quality Assessment in Oncology

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

Albert, Jeffrey M.; Das, Prajnan, E-mail: prajdas@mdanderson.org

2012-07-01

The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involvesmore » many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.« less

The advanced qualtiy control techniques planned for the Internation Soil Moisture Network

NASA Astrophysics Data System (ADS)

Xaver, A.; Gruber, A.; Hegiova, A.; Sanchis-Dufau, A. D.; Dorigo, W. A.

2012-04-01

In situ soil moisture observations are essential to evaluate and calibrate modeled and remotely sensed soil moisture products. Although a number of meteorological networks and field campaigns measuring soil moisture exist on a global and long-term scale, their observations are not easily accessible and lack standardization of both technique and protocol. Thus, handling and especially comparing these datasets with satellite products or land surface models is a demanding issue. To overcome these limitations the International Soil Moisture Network (ISMN; http://www.ipf.tuwien.ac.at/insitu/) has been initiated to act as a centralized data hosting facility. One advantage of the ISMN is that users are able to access the harmonized datasets easily through a web portal. Another advantage is the fully automated processing chain including the data harmonization in terms of units and sampling interval, but even more important is the advanced quality control system each measurement has to run through. The quality of in situ soil moisture measurements is crucial for the validation of satellite- and model-based soil moisture retrievals; therefore a sophisticated quality control system was developed. After a check for plausibility and geophysical limits a quality flag is added to each measurement. An enhanced flagging mechanism was recently defined using a spectrum based approach to detect spurious spikes, jumps and plateaus. The International Soil Moisture Network has already evolved to one of the most important distribution platforms for in situ soil moisture observations and is still growing. Currently, data from 27 networks in total covering more than 800 stations in Europe, North America, Australia, Asia and Africa is hosted by the ISMN. Available datasets also include historical datasets as well as near real-time measurements. The improved quality control system will provide important information for satellite-based as well as land surface model-based validation studies.

Impact of voice- and knowledge-enabled clinical reporting--US example.

PubMed

Bushko, Renata G; Havlicek, Penny L; Deppert, Edward; Epner, Stephen

2002-01-01

This study shows qualitative and quantitative estimates of the national and the clinic level impact of utilizing voice and knowledge enabled clinical reporting systems. Using common sense estimation methodology, we show that the delivery of health care can experience a dramatic improvement in four areas as a result of the broad use of voice and knowledge enabled clinical reporting: (1) Process Quality as measured by cost savings, (2) Organizational Quality as measured by compliance, (3) Clinical Quality as measured by clinical outcomes and (4) Service Quality as measured by patient satisfaction. If only 15 percent of US physicians replaced transcription with modem clinical reporting voice-based methodology, about one half billion dollars could be saved. $6.7 Billion could be saved annually if all medical reporting currently transcribed was handled with voice-and knowledge-enabled dictation and reporting systems.

Reinforcement as a means for quality improvement in management of coronary syndromes: adherence to evidence-based medicine.

PubMed

Khan, Ijaz A; Mehta, Nirav J; Gowda, Ramesh M; Sacchi, Terrence J; Vasavada, Balendu C

2004-06-01

To study the effect of reinforcement as a quality improvement intervention in the evidence-based management of the coronary syndromes. In the pre-intervention phase, the charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed for measurement of total cholesterol on admission and fasting low density lipoprotein (LDL) cholesterol, implementation of aspirin therapy on admission, beta-blockers' use during hospitalization, and treatment with angiotensin converting enzyme (ACE) inhibitors in patients with left ventricular systolic dysfunction. Reinforcement was used as an intervention for quality improvement. All personnel of Division of Cardiology including nursing staff, medical residents, cardiology fellows, and attending physicians were reinforced to adhere to the evidence-based management. In the post-intervention phase, charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed to assess the improvement in the same quality of care parameters. By reinforcement, a significant improvement was noted in all quality of care parameters studied. Proportion of patients who had total cholesterol measured on admission increased from 78% to 92% (P<0.005), and those who had fasting LDL cholesterol measured increased from 22% to 70% (P<0.0001). Use of aspirin at admission (in 74% of patients pre- vs. 80% of patients post-intervention, P<0.05), beta-blockers during hospitalization (in 62% of patients pre- vs. 78% of patients post-intervention, P<0.001), and ACE inhibitors in patients with left ventricular systolic dysfunction (in 58% of patients pre- vs. 89% of patients post-intervention, P<0.001) improved significantly after reinforcement to the medical personal. Reinforcement to adhere to the evidence-based management results in a significant improvement in the quality of care provided to the patients with coronary syndromes.

Health Service Quality Scale: Brazilian Portuguese translation, reliability and validity.

PubMed

Rocha, Luiz Roberto Martins; Veiga, Daniela Francescato; e Oliveira, Paulo Rocha; Song, Elaine Horibe; Ferreira, Lydia Masako

2013-01-17

The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson's correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach's alpha coefficient; the intraclass (ICC) and Pearson's correlation coefficients were used for test-retest reliability. One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson's correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson's correlation coefficient was 0.89 and ICC was 0.90. The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.

A Tale of Two Cities - HSI-DOAS Measurements of Air Quality

NASA Astrophysics Data System (ADS)

Graves, Rosemarie; Leigh, Roland; Anand, Jasdeep; McNally, Michael; Lawrence, James; Monks, Paul

2013-04-01

Differential Optical Absorption Spectroscopy is now commonly used as an air quality measuring system; primarily through the measurements of nitrogen dioxide (NO2) both as a ground-based and satellite technique. CityScan is a Hemispherical Scanning Imaging Differential Optical Absorption Spectrometer (HSI-DOAS) which has been optimised to measure concentrations of nitrogen dioxide. CityScan has a 95˚ field of view (FOV) between the zenith and 5˚ below the horizon. Across this FOV there are 128 resolved elements which are measured concurrently, the spectrometer is rotated azimuthally 1˚ per second providing full hemispherical coverage every 6 minutes. CityScan measures concentrations of nitrogen dioxide over specific lines of sight and due to the extensive field of view of the instrument this produces measurements which are representative over city-wide scales. Nitrogen dioxide is an important air pollutant which is produced in all combustion processes and can reduce lung function; especially in sensitised individuals. These instruments aim to bridge the gap in spatial scales between point source measurements of air quality and satellite measurements of air quality offering additional information on emissions, transport and the chemistry of nitrogen dioxide. More information regarding the CityScan technique can be found at http://www.leos.le.ac.uk/aq/index.html. CityScan has been deployed in both London and Bologna, Italy during 2012. The London deployment took place as part of the large NERC funded ClearfLo project in January and July/August. CityScan was deployed in Bologna in June as part of the large EU project PEGASOS. Analysis of both of these campaigns of data will be used to give unprecedented levels of spatial information to air quality measurements whilst also showing the difference in air quality between a relatively isolated mega city and a smaller city situated in a very polluted region; in this case the Po Valley. Results from multiple CityScan instruments will be used in conjunction with data from ground based in-situ monitor networks to evaluate the ability of in-situ monitors to effectively assess the air quality in an urban environment. Trend analysis will also be shown to demonstrate any changes in the air quality in London during the time of the Olympic Games in comparison with a normal summer.

Image quality assessment for CT used on small animals

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

Cisneros, Isabela Paredes, E-mail: iparedesc@unal.edu.co; Agulles-Pedrós, Luis, E-mail: lagullesp@unal.edu.co

Image acquisition on a CT scanner is nowadays necessary in almost any kind of medical study. Its purpose, to produce anatomical images with the best achievable quality, implies the highest diagnostic radiation exposure to patients. Image quality can be measured quantitatively based on parameters such as noise, uniformity and resolution. This measure allows the determination of optimal parameters of operation for the scanner in order to get the best diagnostic image. A human Phillips CT scanner is the first one minded for veterinary-use exclusively in Colombia. The aim of this study was to measure the CT image quality parameters usingmore » an acrylic phantom and then, using the computational tool MATLAB, determine these parameters as a function of current value and window of visualization, in order to reduce dose delivery by keeping the appropriate image quality.« less

Image quality assessment for CT used on small animals

NASA Astrophysics Data System (ADS)

Cisneros, Isabela Paredes; Agulles-Pedrós, Luis

2016-07-01

Image acquisition on a CT scanner is nowadays necessary in almost any kind of medical study. Its purpose, to produce anatomical images with the best achievable quality, implies the highest diagnostic radiation exposure to patients. Image quality can be measured quantitatively based on parameters such as noise, uniformity and resolution. This measure allows the determination of optimal parameters of operation for the scanner in order to get the best diagnostic image. A human Phillips CT scanner is the first one minded for veterinary-use exclusively in Colombia. The aim of this study was to measure the CT image quality parameters using an acrylic phantom and then, using the computational tool MatLab, determine these parameters as a function of current value and window of visualization, in order to reduce dose delivery by keeping the appropriate image quality.

A Laser-Based Measuring System for Online Quality Control of Car Engine Block.

PubMed

Li, Xing-Qiang; Wang, Zhong; Fu, Lu-Hua

2016-11-08

For online quality control of car engine production, pneumatic measurement instrument plays an unshakeable role in measuring diameters inside engine block because of its portability and high-accuracy. To the limitation of its measuring principle, however, the working space between the pneumatic device and measured surface is too small to require manual operation. This lowers the measuring efficiency and becomes an obstacle to perform automatic measurement. In this article, a high-speed, automatic measuring system is proposed to take the place of pneumatic devices by using a laser-based measuring unit. The measuring unit is considered as a set of several measuring modules, where each of them acts like a single bore gauge and is made of four laser triangulation sensors (LTSs), which are installed on different positions and in opposite directions. The spatial relationship among these LTSs was calibrated before measurements. Sampling points from measured shaft holes can be collected by the measuring unit. A unified mathematical model was established for both calibration and measurement. Based on the established model, the relative pose between the measuring unit and measured workpiece does not impact the measuring accuracy. This frees the measuring unit from accurate positioning or adjustment, and makes it possible to realize fast and automatic measurement. The proposed system and method were finally validated by experiments.

Instruments to assess patients with rotator cuff pathology: a systematic review of measurement properties.

PubMed

Longo, Umile Giuseppe; Saris, Daniël; Poolman, Rudolf W; Berton, Alessandra; Denaro, Vincenzo

2012-10-01

The aims of this study were to obtain an overview of the methodological quality of studies on the measurement properties of rotator cuff questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed. A systematic review of published studies on the measurement properties of rotator cuff questionnaires was performed. Two investigators independently rated the quality of the studies using the Consensus-based Standards for the selection of health Measurement Instruments checklist. This checklist was developed in an international Delphi consensus study. Sixteen studies were included, in which two measurement instruments were evaluated, namely the Western Ontario Rotator Cuff Index and the Rotator Cuff Quality-of-Life Measure. The methodological quality of the included studies was adequate on some properties (construct validity, reliability, responsiveness, internal consistency, and translation) but need to be improved on other aspects. The most important methodological aspects that need to be developed are as follows: measurement error, content validity, structural validity, cross-cultural validity, criterion validity, and interpretability. Considering the importance of adequate measurement properties, it is concluded that, in the field of rotator cuff pathology, there is room for improvement in the methodological quality of studies measurement properties. II.

Data-quality measures for stakeholder-implemented watershed-monitoring programs

USGS Publications Warehouse

Greve, Adrienne I.

2002-01-01

Community-based watershed groups, many of which collect environmental data, have steadily increased in number over the last decade. The data generated by these programs are often underutilized due to uncertainty in the quality of data produced. The incorporation of data-quality measures into stakeholder monitoring programs lends statistical validity to data. Data-quality measures are divided into three steps: quality assurance, quality control, and quality assessment. The quality-assurance step attempts to control sources of error that cannot be directly quantified. This step is part of the design phase of a monitoring program and includes clearly defined, quantifiable objectives, sampling sites that meet the objectives, standardized protocols for sample collection, and standardized laboratory methods. Quality control (QC) is the collection of samples to assess the magnitude of error in a data set due to sampling, processing, transport, and analysis. In order to design a QC sampling program, a series of issues needs to be considered: (1) potential sources of error, (2) the type of QC samples, (3) inference space, (4) the number of QC samples, and (5) the distribution of the QC samples. Quality assessment is the process of evaluating quality-assurance measures and analyzing the QC data in order to interpret the environmental data. Quality assessment has two parts: one that is conducted on an ongoing basis as the monitoring program is running, and one that is conducted during the analysis of environmental data. The discussion of the data-quality measures is followed by an example of their application to a monitoring program in the Big Thompson River watershed of northern Colorado.

Shifting the focus to practice quality improvement in radiation oncology.

PubMed

Crozier, Cheryl; Erickson-Wittmann, Beth; Movsas, Benjamin; Owen, Jean; Khalid, Najma; Wilson, J Frank

2011-09-01

To demonstrate how the American College of Radiology, Quality Research in Radiation Oncology (QRRO) process survey database can serve as an evidence base for assessing quality of care in radiation oncology. QRRO has drawn a stratified random sample of radiation oncology facilities in the USA and invited those facilities to participate in a Process Survey. Information from a prior QRRO Facilities Survey has been used along with data collected under the current National Process Survey to calculate national averages and make statistically valid inferences for national process measures for selected cancers in which radiation therapy plays a major role. These measures affect outcomes important to patients and providers and measure quality of care. QRRO's survey data provides national benchmark data for numerous quality indicators. The Process Survey is "fully qualified" as a Practice Quality Improvement project by the American Board of Radiology under its Maintenance of Certification requirements for radiation oncology and radiation physics. © 2011 National Association for Healthcare Quality.

Beam Characterization at the Neutron Radiography Facility

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

Sarah Morgan; Jeffrey King

The quality of a neutron imaging beam directly impacts the quality of radiographic images produced using that beam. Fully characterizing a neutron beam, including determination of the beam’s effective length-to-diameter ratio, neutron flux profile, energy spectrum, image quality, and beam divergence, is vital for producing quality radiographic images. This project characterized the east neutron imaging beamline at the Idaho National Laboratory Neutron Radiography Reactor (NRAD). The experiments which measured the beam’s effective length-to-diameter ratio and image quality are based on American Society for Testing and Materials (ASTM) standards. An analysis of the image produced by a calibrated phantom measured themore » beam divergence. The energy spectrum measurements consist of a series of foil irradiations using a selection of activation foils, compared to the results produced by a Monte Carlo n-Particle (MCNP) model of the beamline. Improvement of the existing NRAD MCNP beamline model includes validation of the model’s energy spectrum and the development of enhanced image simulation methods. The image simulation methods predict the radiographic image of an object based on the foil reaction rate data obtained by placing a model of the object in front of the image plane in an MCNP beamline model.« less

Dual redundant arm system operational quality measures and their applications - Dynamic measures

NASA Technical Reports Server (NTRS)

Lee, Sukhan; Kim, Sungbok

1990-01-01

Dual-arm dynamic operation quality measures are presented which quantify the efficiency and capability of generating Cartesian accelerations by two cooperative arms based on the analysis of dual-arm dynamic interactions. Dual-arm dynamic manipulability is defined as the efficiency of generating Cartesian accelerations under the dynamic and kinematic interactions between individual arms and an object under manipulation. The analysis of dual-arm dynamic interactions is based on the so-called Cartesian space agent model of an arm, which represents an individual arm as a force source acting upon a point mass with the effective Cartesian space arm dynamics and an environment or an object under manipulation. The Cartesian space agent model of an arm makes it possible to derive the dynamic and kinematic constraints involved in the transport, assembly and grasping modes of dual-arm cooperation. A task-oriented operational quality measure, (TOQd) is defined by evaluating dual-arm dynamic manipulability in terms of given task requirements. TOQd is used in dual-arm joint configuration optimization. Simulation results are shown. A complete set of forward dynamic equations for a dual-arm system is derived, and dual-arm dynamic operational quality measures for various modes of dual-arm cooperation allowing sliding contacts are established.

Understory vegetation data quality assessment for the Interior West Forest and Inventory Analysis program

Treesearch

Paul L. Patterson; Renee A. O' Brien

2011-01-01

The Interior West Forest Inventory and Analysis (IW-FIA) program of the USDA Forest Service collects field data on understory vegetation structure that have broad applications. In IW-FIA one aspect of quality assurance is assessed based on the repeatability of field measurements. The understory vegetation protocol consists of two suites of measurements; (1) the...

Factor selection for service quality evaluation: a hospital case study.

PubMed

Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

2017-02-13

Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

Transfer of knowledge from sound quality measurement to noise impact evaluation

NASA Astrophysics Data System (ADS)

Genuit, Klaus

2004-05-01

It is well known that the measurement and analysis of sound quality requires a complex procedure with consideration of the physical, psychoacoustical and psychological aspects of sound. Sound quality cannot be described only by a simple value based on A-weighted sound pressure level measurements. The A-weighted sound pressure level is sufficient to predict the probabilty that the human ear could be damaged by sound but the A-weighted level is not the correct descriptor for the annoyance of a complex sound situation given by several different sound events at different and especially moving positions (soundscape). On the one side, the consideration of the spectral distribution and the temporal pattern (psychoacoustics) is requested and, on the other side, the subjective attitude with respect to the sound situation, the expectation and experience of the people (psychology) have to be included in context with the complete noise impact evaluation. This paper describes applications of the newest methods of sound quality measurements-as it is well introduced at the car manufacturers-based on artifical head recordings and signal processing comparable to the human hearing used in noisy environments like community/traffic noise.

Communication and quality of life outcomes from an interprofessional intensive, comprehensive, aphasia program (ICAP).

PubMed

Hoover, Elizabeth L; Caplan, David N; Waters, Gloria S; Carney, Anne

2017-03-01

Intensive Comprehensive Aphasia Programs (ICAPs) have developed in response to a growing need for treatments which produce changes in language function in people with aphasia, especially in the chronic phase of recovery. ICAPs are growing in number and several papers have presented preliminary results of their use, but little data exist about their efficacy or effectiveness. This paper explores the communication effects of an ICAP program that incorporated evidenced-based individual and group treatment in an interprofessional program. Twenty-seven individuals with chronic aphasia were provided with 30 h of interprofessional treatment a week for a four-week period in both individual and group formats. A delayed treatment, within-participant research protocol was used. Language measures were taken at two intervals pre- and two intervals post treatment. Functional, narrative, and quality of life measures were taken once pre and once post treatment. Significant change was observed on targeted language functions post treatment. Significant treatment effects were also observed on functional and quality of life measures as well as on all impairment-based language measures for the group. The results provide evidence of linguistic and quality of life change in individuals with chronic aphasia who were treated in an interprofessional ICAP.

Preventing Heel Pressure Ulcers: Sustained Quality Improvement Initiative in a Canadian Acute Care Facility.

PubMed

Hanna-Bull, Debbie

2016-01-01

The setting for this quality improvement initiative designed to reduce the prevalence of facility-acquired heel pressure ulcers was a regional, acute-care, 490-bed facility in Ontario, Canada, responsible for dialysis, vascular, and orthopedic surgery. An interdisciplinary skin and wound care team designed an evidence-based quality improvement initiative based on a systematic literature review and standardization of heel offloading methods. The prevalence of heel pressure ulcers was measured at baseline (immediately prior to implementation of initiative) and at 1 and 4 years following implementation. The prevalence of facility-acquired heel pressure ulcers was 5.8% when measured before project implementation. It was 4.2% at 1 year following implementation and 1.6% when measured at the end of the 4-year initiative. Outcomes demonstrate that the initiative resulted in a continuous and sustained reduction in facility-acquired heel pressure ulcer incidence over a 4-year period.

Identifying and Investigating the "Best" Schools: A Network-Based Analysis

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2018-01-01

This paper aims to provide a fresh perspective on the predominantly negative discourse on schooling quality in low-income countries by focusing on the research questions: "How can one identify great schools and what makes them special?" Using a network-based perspective, I measure peer evaluations of quality in two districts in Nepal.…

Hardwood log grading and lumber value

Treesearch

Allen W. Bratton

1948-01-01

For practically every commodity - beef, wool, grains, hides, lard, milk, eggs, etc. - there are standard grades based on quality. A price based on these standards is a fairly accurate measure of value. A person who deals with one of these commodities can use such price quotations in his business operations; in fact, he must. These quality specifications are essential...

Quality of Web-based information on cocaine addiction.

PubMed

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

2008-08-01

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

What Is Nursing Home Quality and How Is It Measured?

PubMed Central

Castle, Nicholas G.; Ferguson, Jamie C.

2010-01-01

Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. PMID:20631035

Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions

PubMed Central

DuGoff, Eva H.; Dy, Sydney; Giovannetti, Erin R.; Leff, Bruce; Boyd, Cynthia M.

2015-01-01

The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for health care providers and policymakers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. PMID:24004040

Demonstration of cathode emittance dominated high bunch charge beams in a DC gun-based photoinjector

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

Gulliford, Colwyn, E-mail: cg248@cornell.edu; Bartnik, Adam, E-mail: acb20@cornell.edu; Bazarov, Ivan

We present the results of transverse emittance and longitudinal current profile measurements of high bunch charge (≥100 pC) beams produced in the DC gun-based Cornell energy recovery linac photoinjector. In particular, we show that the cathode thermal and core beam emittances dominate the final 95% and core emittances measured at 9–9.5 MeV. Additionally, we demonstrate excellent agreement between optimized 3D space charge simulations and measurement, and show that the quality of the transverse laser distribution limits the optimal simulated and measured emittances. These results, previously thought achievable only with RF guns, demonstrate that DC gun based photoinjectors are capable of deliveringmore » beams with sufficient single bunch charge and beam quality suitable for many current and next generation accelerator projects such as Energy Recovery Linacs and Free Electron Lasers.« less

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

Identifying positive deviants in healthcare quality and safety: a mixed methods study.

PubMed

O'Hara, Jane K; Grasic, Katja; Gutacker, Nils; Street, Andrew; Foy, Robbie; Thompson, Carl; Wright, John; Lawton, Rebecca

2018-01-01

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.

No-reference multiscale blur detection tool for content based image retrieval

NASA Astrophysics Data System (ADS)

Ezekiel, Soundararajan; Stocker, Russell; Harrity, Kyle; Alford, Mark; Ferris, David; Blasch, Erik; Gorniak, Mark

2014-06-01

In recent years, digital cameras have been widely used for image capturing. These devices are equipped in cell phones, laptops, tablets, webcams, etc. Image quality is an important component of digital image analysis. To assess image quality for these mobile products, a standard image is required as a reference image. In this case, Root Mean Square Error and Peak Signal to Noise Ratio can be used to measure the quality of the images. However, these methods are not possible if there is no reference image. In our approach, a discrete-wavelet transformation is applied to the blurred image, which decomposes into the approximate image and three detail sub-images, namely horizontal, vertical, and diagonal images. We then focus on noise-measuring the detail images and blur-measuring the approximate image to assess the image quality. We then compute noise mean and noise ratio from the detail images, and blur mean and blur ratio from the approximate image. The Multi-scale Blur Detection (MBD) metric provides both an assessment of the noise and blur content. These values are weighted based on a linear regression against full-reference y values. From these statistics, we can compare to normal useful image statistics for image quality without needing a reference image. We then test the validity of our obtained weights by R2 analysis as well as using them to estimate image quality of an image with a known quality measure. The result shows that our method provides acceptable results for images containing low to mid noise levels and blur content.

Content dependent selection of image enhancement parameters for mobile displays

NASA Astrophysics Data System (ADS)

Lee, Yoon-Gyoo; Kang, Yoo-Jin; Kim, Han-Eol; Kim, Ka-Hee; Kim, Choon-Woo

2011-01-01

Mobile devices such as cellular phones and portable multimedia player with capability of playing terrestrial digital multimedia broadcasting (T-DMB) contents have been introduced into consumer market. In this paper, content dependent image quality enhancement method for sharpness and colorfulness and noise reduction is presented to improve perceived image quality on mobile displays. Human visual experiments are performed to analyze viewers' preference. Relationship between the objective measures and the optimal values of image control parameters are modeled by simple lookup tables based on the results of human visual experiments. Content dependent values of image control parameters are determined based on the calculated measures and predetermined lookup tables. Experimental results indicate that dynamic selection of image control parameters yields better image quality.

Cluster-Randomized Trial of Personalized Site Performance Feedback in Get With The Guidelines-Heart Failure.

PubMed

DeVore, Adam D; Cox, Margueritte; Heidenreich, Paul A; Fonarow, Gregg C; Yancy, Clyde W; Eapen, Zubin J; Peterson, Eric D; Hernandez, Adrian F

2015-07-01

There is significant variation in the delivery of evidence-based care for patients with heart failure (HF), but there is limited evidence defining the best methods to improve the quality of care. We performed a cluster-randomized trial of personalized site performance feedback at 147 hospitals participating in the Get With The Guidelines-Heart Failure quality improvement program from October 2009 to March 2011. The intervention provided sites with specific data on their heart failure achievement and quality measures in addition to the usual Get With The Guidelines-Heart Failure tools. The primary outcome for our trial was improvement in site composite quality of care score. Overall, 73 hospitals (n=33 886 patients) received the intervention, whereas 74 hospitals (n=37 943 patients) did not. One year after the intervention, both the intervention and control arms had a similar mean change in percentage points in their composite quality score (absolute change, +0.31 [SE, 1.51] versus +3.18 [SE, 1.68] in control; P=0.21). Similarly, none of the individual achievement measures or quality measures improved more at intervention versus control hospitals. Our site-based intervention, which included personalized site feedback on adherence to quality metrics, was not able to elicit more quality improvement beyond that already associated with participation in the Get With The Guidelines-Heart Failure program. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979264. © 2015 American Heart Association, Inc.

How product trial changes quality perception of four new processed beef products.

PubMed

Saeed, Faiza; Grunert, Klaus G; Therkildsen, Margrethe

2013-01-01

The purpose of this paper is the quantitative analysis of the change in quality perception of four new processed beef products from pre to post trial phases. Based on the Total Food Quality Model, differences in pre and post-trial phases were measured using repeated measures technique for cue evaluation, quality evaluation and purchase motive fulfillment. For two of the tested products, trial resulted in a decline of the evaluation of cues, quality and purchase motive fulfillment compared to pre-trial expectations. For these products, positive expectations were created by giving information about ingredients and ways of processing, which were not confirmed during trial. For the other two products, evaluations on key sensory dimensions based on trial exceeded expectations, whereas the other evaluations remained unchanged. Several demographic factors influenced the pattern of results, notably age and gender, which may be due to underlying differences in previous experience. The study gives useful insights for testing of new processed meat products before market introduction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Toward coordinated space-based air quality, carbon cycle, and ecosystem measurements to quantify air quality-ecosystem interactions

NASA Astrophysics Data System (ADS)

Neu, J. L.; Schimel, D.; Lerdau, M.; Drewry, D.; Fu, D.; Payne, V.; Bowman, K. W.; Worden, J. R.

2016-12-01

Tropospheric ozone concentrations are increasing in many regions of the world, and this ozone can severely damage vegetation. Ozone enters plants through their stomata and oxidizes tissues, inhibiting physiology and decreasing ecosystem productivity. Ozone has been experimentally shown to reduce crop production, with important implications for global food security as concentrations rise. Ozone damage to forests also alters productivity and carbon storage and may drive changes in species distributions and biodiversity. Process-based quantitative estimates of these ozone impacts on terrestrial ecosystems at continental to global scales as well as of feedbacks to air quality via production of volatile organic compounds (VOCs) are thus crucial to sustainable development planning. We demonstrate that leveraging planned and proposed missions to measure ozone, formaldehyde, and isoprene along with solar-induced fluorescence (SiF), evapotranspiration, and plant nitrogen content can meet the requirements of an integrated observing system for air quality-ecosystem interactions while also meeting the needs of the individual Air Quality, Carbon Cycle, and Ecosystems communities.

Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"?

PubMed

Harris, Alex H S; Chen, Cheng; Rubinsky, Anna D; Hoggatt, Katherine J; Neuman, Matthew; Vanneman, Megan E

2016-04-01

Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-of-care quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. Measured performance improved over time (P < 0.001). Notably, the proportion of patients with SUD program contact who qualified for the denominator decreased more rapidly after the measure was implemented (p = 0.02). Facilities with higher pre-implementation denominator prevalence had steeper declines in denominator prevalence after implementation (p < 0.001). These results should motivate the development of measures that are less vulnerable to denominator management, and also the exploration of "shadow measures" to monitor and reduce undesirable denominator management.

NEMA image quality phantom measurements and attenuation correction in integrated PET/MR hybrid imaging.

PubMed

Ziegler, Susanne; Jakoby, Bjoern W; Braun, Harald; Paulus, Daniel H; Quick, Harald H

2015-12-01

In integrated PET/MR hybrid imaging the evaluation of PET performance characteristics according to the NEMA standard NU 2-2007 is challenging because of incomplete MR-based attenuation correction (AC) for phantom imaging. In this study, a strategy for CT-based AC of the NEMA image quality (IQ) phantom is assessed. The method is systematically evaluated in NEMA IQ phantom measurements on an integrated PET/MR system. NEMA IQ measurements were performed on the integrated 3.0 Tesla PET/MR hybrid system (Biograph mMR, Siemens Healthcare). AC of the NEMA IQ phantom was realized by an MR-based and by a CT-based method. The suggested CT-based AC uses a template μ-map of the NEMA IQ phantom and a phantom holder for exact repositioning of the phantom on the systems patient table. The PET image quality parameters contrast recovery, background variability, and signal-to-noise ratio (SNR) were determined and compared for both phantom AC methods. Reconstruction parameters of an iterative 3D OP-OSEM reconstruction were optimized for highest lesion SNR in NEMA IQ phantom imaging. Using a CT-based NEMA IQ phantom μ-map on the PET/MR system is straightforward and allowed performing accurate NEMA IQ measurements on the hybrid system. MR-based AC was determined to be insufficient for PET quantification in the tested NEMA IQ phantom because only photon attenuation caused by the MR-visible phantom filling but not the phantom housing is considered. Using the suggested CT-based AC, the highest SNR in this phantom experiment for small lesions (<= 13 mm) was obtained with 3 iterations, 21 subsets and 4 mm Gaussian filtering. This study suggests CT-based AC for the NEMA IQ phantom when performing PET NEMA IQ measurements on an integrated PET/MR hybrid system. The superiority of CT-based AC for this phantom is demonstrated by comparison to measurements using MR-based AC. Furthermore, optimized PET image reconstruction parameters are provided for the highest lesion SNR in NEMA IQ phantom measurements.

Physical Activity Interventions in Faith-Based Organizations: A Systematic Review.

PubMed

Tristão Parra, Maíra; Porfírio, Gustavo J M; Arredondo, Elva M; Atallah, Álvaro N

2018-03-01

To review and assess the effectiveness of physical activity interventions delivered in faith-based organizations. We searched the Cochrane Library, DoPHER, EMBASE, LILACS, MEDLINE, PsycINFO, WHO ICTRP, and Clinicaltrials.gov databases until January 2016, without restriction of language or publication date. Randomized and nonrandomized controlled trials investigating physical activity interventions for adults delivered in faith-based organizations. Two independent reviewers extracted data and assessed study methodological quality. We used relative risk and mean difference with 95% confidence interval to estimate the effect of the interventions on measures of physical activity, physical fitness, and health. The review included 18 studies. Study participants were predominantly female, and the majority of trials were conducted in the United States. Study heterogeneity did not allow us to conduct meta-analyses. Although interventions delivered in faith-based organizations increased physical activity and positively influenced measures of health and fitness in participants, the quality of the evidence was very low. Faith-based organizations are promising settings to promote physical activity, consequently addressing health disparities. However, high-quality randomized clinical trials are needed to adequately assess the effectiveness of interventions delivered in faith-based organizations.

[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.

Use of tolerance values to diagnose water-quality stressors to aquatic biota in New England streams

USGS Publications Warehouse

Meador, M.R.; Carlisle, D.M.; Coles, J.F.

2008-01-01

Identification of stressors related to biological impairment is critical to biological assessments. We applied nationally derived tolerance indicator values for four water-quality variables to fish and benthic macroinvertebrate assemblages at 29 sites along an urban gradient in New England. Tolerance indicator values (TIVs), as biologically based predictors of water-quality variables, were determined for dissolved oxygen, nitrite plus nitrate (nitrate), total phosphorus, and water temperature for each site based on observed biological assemblages (TIVO), and for expected assemblages (TIVE). The quotient method, based on a ratio of the TIVs for observed and expected assemblages (tolerance units), was used to diagnose potential water-quality stressors. In addition, the ratio of measured water-quality values to water-quality criteria (water-quality units) was calculated for each water-quality variable to assess measured water-quality stressors. Results from a RIVPACS predictive model for benthic macroinvertebrates and Bray-Curtis dissimilarity for fish were used to classify sites into categories of good or impaired ecological condition. Significant differences were detected between good and impaired sites for all biological tolerance units (fish and benthic macroinvertebrate assemblages averaged) except for nitrate (P = 0.480), and for all water-quality units except for nitrate (P = 0.183). Diagnosis of water-quality stressors at selected sites was, in general, consistent with State-reported causes of impairment. Tolerance units for benthic macroinvertebrate and fish assemblages were significantly correlated for water temperature (P = 0.001, r = 0.63), dissolved oxygen (P = 0.001, r = 0.61), and total phosphorus (P = 0.001, r = 0.61), but not for nitrate (P = 0.059, r = -0.35). Differences between the two assemblages in site-specific diagnosis of water-quality stressors may be the result of differences in nitrate tolerance.

An evaluation of the relative quality of dike pools for benthic macroinvertebrates in the Lower Missouri River, USA

USGS Publications Warehouse

Poulton, B.C.; Allert, A.L.

2012-01-01

A habitat-based aquatic macroinvertebrate study was initiated in the Lower Missouri River to evaluate relative quality and biological condition of dike pool habitats. Water-quality and sediment-quality parameters and macroinvertebrate assemblage structure were measured from depositional substrates at 18 sites. Sediment porewater was analysed for ammonia, sulphide, pH and oxidation-reduction potential. Whole sediments were analysed for particle-size distribution, organic carbon and contaminants. Field water-quality parameters were measured at subsurface and at the sediment-water interface. Pool area adjacent and downstream from each dike was estimated from aerial photography. Macroinvertebrate biotic condition scores were determined by integrating the following indicator response metrics: % of Ephemeroptera (mayflies), % of Oligochaeta worms, Shannon Diversity Index and total taxa richness. Regression models were developed for predicting macroinvertebrate scores based on individual water-quality and sediment-quality variables and a water/sediment-quality score that integrated all variables. Macroinvertebrate scores generated significant determination coefficients with dike pool area (R2=0.56), oxidation–reduction potential (R2=0.81) and water/sediment-quality score (R2=0.71). Dissolved oxygen saturation, oxidation-reduction potential and total ammonia in sediment porewater were most important in explaining variation in macroinvertebrate scores. The best two-variable regression models included dike pool size + the water/sediment-quality score (R2=0.84) and dike pool size + oxidation-reduction potential (R2=0.93). Results indicate that dike pool size and chemistry of sediments and overlying water can be used to evaluate dike pool quality and identify environmental conditions necessary for optimizing diversity and productivity of important aquatic macroinvertebrates. A combination of these variables could be utilized for measuring the success of habitat enhancement activities currently being implemented in this system.

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

PubMed Central

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

1995-01-01

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard. PMID:7782222

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

PubMed

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

1995-06-01

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

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

PubMed

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

2017-07-11

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

Self Report Co-Morbidity and Health Related Quality of Life -- A Comparison with Record Based Co-Morbidity Measures

ERIC Educational Resources Information Center

Voaklander, Donald C.; Kelly, Karen D.; Jones, C. Allyson; Suarez-Almazor, Maria E.

2004-01-01

The purpose of this project was to compare three hospital-based measures of co-morbidity to patient self-report co-morbidity and to determine the relative proportion of outcome predicted by each of the co-morbidity measures in a population of individuals receiving major joint arthroplasty. Baseline measures using the SF-36 general health…

Implementing and using quality measures for children's health care: perspectives on the state of the practice.

PubMed

Shaller, Dale

2004-01-01

The objective of this study was to identify issues, obstacles, and priorities related to implementing and using child health care quality measures from the perspectives of 4 groups: 1) funders of quality-measurement development and implementation; 2) developers of quality measures; 3) users of quality measures (including Medicaid and the State Children's Health Insurance Program, employer coalitions, and consumer groups); and 4) health plans and providers (in their role as both subjects and users of quality measures). A series of semistructured interviews was conducted with approximately 40 opinion leaders drawn from these 4 groups. The interviews were conducted by telephone between September and December of 2001. Major topic areas covered in the interviews were similar across the groups. Topic areas included 1) strategic vision and/or objectives for funding, developing, or using quality measures for children's health care; 2) a brief summary of the specific quality measures funded, developed, or used; 3) issues and challenges facing funders and developers of measures; 4) major successes achieved; 5) obstacles to implementation and use of measures; and 6) priority needs for future funding. Leaders from all 4 groups acknowledge the importance of developing a robust set of quality measures that can serve multiple objectives and multiple audiences. Standardization of measures is viewed as a critical feature related to all objectives. An assessment of specific quality measures funded, developed, or used by strategic objective shows a high correlation between the uses intended by funders and developers and the actual applications of the various users. The most commonly cited measures across all groups are the Consumer Assessment of Health Plans Survey and Health Plan Employer Data and Information Set, followed by the Child and Adolescent Health Measurement Initiative and special topic studies to support quality-improvement applications (eg, asthma, diabetes, etc). The major issues and challenges cited in common among funders and developers are 1) the lack of trained capacity in the field to conduct needed research and development, and 2) the difficulty in generating sustained interest and support among funders because of the complexity of quality-measurement issues, competing funding priorities in the face of limited funds available to allocate, and the lack of clear and compelling evidence that quality measurement and improvement actually result in better outcomes for children. The 3 most common successes cited across all 4 groups are 1) the growing consensus and collaboration among diverse stakeholder groups involved in measurement development and implementation; 2) the increasing collection and use of specific measures; and 3) early documentation of tangible results in terms of improved quality of care. Specific measurement tools cited as successes by funders and developers include the Medicaid Health Plan Employer Data and Information Set, Consumer Assessment of Health Plans Survey, the Child and Adolescent Health Measurement Initiative, and Rand QA Tools. The most important obstacle reported across all groups is the lack of a strong and compelling "business case" that clearly demonstrates the benefits of quality measurement relative to the costs of implementation. Strongly related to this barrier is the cost of implementing and using measures without a sustainable source of financing as well as the absence of strong public awareness and political support for children's health care quality measurement. Another major barrier cited is the lack of coordination among funders, which prevents the field from developing a unified approach to addressing the numerous technical, political, and administrative issues also cited at length by the leaders interviewed. The 5 top needs for future funding identified across all 4 groups follow directly from the major obstacles that they reported: 1) develop the business case for children's health care quality measurement and improvement based on rigorous cost-bigorous cost-benefit analysis and documentation of quantifiable successes; 2) develop new measures to fill the gaps in critical areas (including adolescent health care, behavioral health, and chronic conditions) that can be applied at the hospital and ambulatory care provider levels; 3) invest in building needed research capacity, a trained pool of users of quality measures, and the capacity among providers to understand and use quality-improvement methods and tools; 4) invest in developing an information infrastructure that will support the efficient collection and use of measures for multiple purposes, including clinical practice, quality measurement, and quality improvement; and 5) develop increased public awareness and support for quality measurement based on improved strategies for communicating with consumers, purchasers, providers, and policy makers. Several implications are suggested by these perspectives for the future direction of quality measurement in children's health care. First, to meet the funding needs identified, many funders must improve coordination to reduce the noise and fragmentation generated by numerous competing or redundant activities. Improved coordination among funders will help assure maximum impact and the efficient use of scarce resources. Second, the importance attached to standardization of measures by both users and developers may conflict at times with the need for innovation and flexibility. Child health quality leaders will need to manage this tension between standardization and innovation to maintain an appropriate balance between the benefits of both. Finally, many of the obstacles identified are not unique to children's health care. Child health quality leaders will need to determine to what extent their efforts to overcome these obstacles can be successfully undertaken independently as opposed to in concert with groups concerned about other populations and sectors in the health care system.

Selective corneal optical aberration (SCOA) for customized ablation

NASA Astrophysics Data System (ADS)

Jean, Benedikt J.; Bende, Thomas

2001-06-01

Wavefront analysis still have some technical problems which may be solved within the next years. There are some limitations to use wavefront as a diagnostic tool for customized ablation alone. An ideal combination would be wavefront and topography. Meanwhile Selective Corneal Aberration is a method to visualize the optical quality of a measured corneal surface. It is based on a true measured 3D elevation information of a video topometer. Thus values can be interpreted either using Zernike polynomials or visualized as a so called color coded surface quality map. This map gives a quality factor (corneal aberration) for each measured point of the cornea.

Site quality relationships for shortleaf pine

Treesearch

David L. Graney

1986-01-01

Existing information about site quality relationships for shortleaf pine (Pinus echinata Mill.) in the southeastern United States is reviewed in this paper. Estimates of site quality, whether from direct tree measurements or indirect estimates based on soil and site features, are only local observations for many points on the landscape. To be of value to the land...

Patterns of Classroom Quality in Head Start and Center-Based Early Childhood Education Programs. REL 2017-199

ERIC Educational Resources Information Center

Irwin, Clare W.; Madura, John P.; Bamat, David; McDermott, Paul A.

2016-01-01

Measuring classroom quality and ensuring high-quality learning experiences for young children are interests of the Early Childhood Education Research Alliance, a research alliance of Regional Educational Laboratory Northeast & Islands. This study, conducted in collaboration with the alliance, addresses these interests by examining multiple…

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

ERIC Educational Resources Information Center

Twachtman-Cullen, Diane; Twachtman-Reilly, Jennifer

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

Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

PubMed

Woo, Russell K; Skarsgard, Erik D

2015-06-01

Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Lorenz curve of a light beam: evaluating beam quality from a majorization perspective.

PubMed

Porras, Miguel A; Gonzalo, Isabel; Ahmir Malik, M

2017-08-01

We introduce a novel approach for the characterization of the quality of a laser beam that is not based on particular criteria for beam width definition. The Lorenz curve of a light beam is a sophisticated version of the so-called power-in-the-bucket curve, formed by the partial sums of discretized joint intensity distribution in the near and far fields, sorted in decreasing order. According to majorization theory, a higher Lorenz curve implies that all measures of spreading in phase space, and, in particular, all Rényi (and Shannon) entropy-based measures of the beam width products in near and far fields, are unanimously smaller, providing a strong assessment of a better beam quality. Two beams whose Lorenz curves intersect can be considered of relatively better or lower quality only according to specific criteria, which can be inferred from the plot of the respective Lorenz curves.

How to Select a Questionnaire with a Good Methodological Quality?

PubMed

Paiva, Saul Martins; Perazzo, Matheus de França; Ortiz, Fernanda Ruffo; Pordeus, Isabela Almeida; Martins-Júnior, Paulo Antônio

2018-01-01

In the last decades, several instruments have been used to evaluate the impact of oral health problems on the oral health-related quality of life (OHRQoL) of individuals. However, some instruments lack thorough methodological validation or present conceptual differences that hinder comparisons with instruments. Thus, it can be difficult to clinicians and researchers to select a questionnaire that accurately reflect what are really meaningful to individuals. This short communication aimed to discuss the importance of use an appropriate checklist to select an instrument with a good methodological quality. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was developed to provide tools for evidence-based instrument selection. The COSMIN checklist comprises ten boxes that evaluate whether a study meets the standard for good methodological quality and two additional boxes to meet studies that use the Item Response Theory method and general requirements for results generalization, resulting in four steps to be followed. In this way, it is required at least some expertise in psychometrics or clinimetrics to a wide-ranging use of this checklist. The COSMIN applications include its use to ensure the standardization of cross-cultural adaptations and safer comparisons between measurement studies and evaluation of methodological quality of systematic reviews of measurement properties. Also, it can be used by students when training about measurement properties and by editors and reviewers when revising manuscripts on this topic. The popularization of COSMIN checklist is therefore necessary to improve the selection and evaluation of health measurement instruments.

A review of preference-based measures for the assessment of quality of life in children and adolescents with cerebral palsy.

PubMed

Mpundu-Kaambwa, Christine; Chen, Gang; Huynh, Elisabeth; Russo, Remo; Ratcliffe, Julie

2018-07-01

To examine the psychometric properties and suitability for use within the context of cerebral palsy research in children and adolescents of generic preference-based outcome measures (PROMs). Nine electronic databases were searched in this systematic review. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist were used to measure the psychometric properties of the PROMs. A meta-analysis was used to pool correlation coefficients for convergent validity using the Schmidt-Hunter method. Heterogeneity was assessed using the I-squared statistic (I 2 ). Four preference-based PROMs were identified from eight studies: Health Utilities Index-Mark 2 and 3 (HUI-2 and HUI-3, respectively), the Assessment Quality of Life-4 dimension (AQoL-4D) and the EuroQol-5 dimension 3 level (EQ-5D-3L). Only the HUI system was primarily developed for application with children/adolescents though health-state values for scoring the PROM were elicited from adults. The HUI-3 covered the most relevant constructs though it excludes important modules of health-related quality of life (HRQOL) such as activity limitations and participation restrictions. In terms of psychometric properties, evidence was presented for only five of COSMIN measurement properties: reliability (HUI3), measurement error (HUI-3), content validity (HUI-2 and HUI-3), Hypotheses testing (HUI-3 and AQoL-4D) and criterion validity (HUI-3). No papers reported on internal consistency, structural validity, cross-cultural validity or responsiveness of the preference-based measures in children and adolescents with cerebral palsy. This review highlights the dearth in studies using preference-based PROMs to measure HRQOL associated with cerebral palsy in children and adolescents. The HUI-3 demonstrated the strongest psychometric properties, though it does not cover all dimensions relevant to this population.

Assessing the multidimensional and hierarchical structure of SERVQUAL.

PubMed

Ma, Jun; Harvey, Milton E; Hu, Michael Y

2007-10-01

Parasuraman, Zeithaml, and Berry introduced SERVQUAL in 1998 as a scale to measure service quality. Since then, researchers have proposed several variations. This study examines the development of the tool. Marketing researchers have first challenged the conceptualization of a perceptions-expectations gap and have concluded that the performance-based measures are adequate to capture consumers' perception of service quality. Some researchers have argued that the five dimensions of the SERVQUAL scale only focus on the process of service delivery and have extended the SERVQUAL scale into six dimensions by including the service outcome dimension. Others have proposed that service quality is a multilevel construct and should be measured accordingly. From a sample of 467 undergraduate students data on service quality toward up-scale restaurants were collected. Using the structural equation approach, two measurement models of service quality were compared, the extended SERVQUAL model and the restructured multilevel SERVQUAL model. Analysis suggested that the latter model fits the data better than the extended one.

Measurement of Quality of Life II. From the Philosophy of Life to Science

PubMed Central

Ventegodt, Soren; Merrick, Joav; Andersen, Niels Jorgen

2003-01-01

We believe it should be possible to make operational the philosophical ideas of the good life in order to make it the object of scientific research. The Quality of Life Research Center in Copenhagen, Denmark has therefore spent the last several years with these questions and tried to find practical and evidence-based scientific solutions.This paper describes the theoretical road taken in moving from the abstract philosophy of life to the actual questionnaire. It presents an important aspect of our work with the quality-of-life (QOL) concept though the last decade. We have developed the quality-of-life philosophy; the SEQOL, QOL5, and QOL1 questionnaires; the quality-of-life theory; and the quality-of-life research methodology. We carried out quality-of-life population surveys and developed techniques for improving quality of life with the chronically sick patient. This paper presents the struggle to create a rating scale for the generic measurement of the global quality of life, based on quality-of-life theory, derived from quality-of-life philosophy. The developed rating scale is a ratio scale combining a Likert scale, a visual analogue scale, and a numerical scale, to a reduced combination scale. This allows for the extraction of as much information from the respondents as possible without exhausting them unduly or demanding more than can be reasonably expected. PMID:14570987

Measurement of quality of life II. From the philosophy of life to science.

PubMed

Ventegodt, Søren; Merrick, Joav; Andersen, Niels Jørgen

2003-10-13

We believe it should be possible to make operational the philosophical ideas of the good life in order to make it the object of scientific research. The Quality of Life Research Center in Copenhagen, Denmark has therefore spent the last several years with these questions and tried to find practical and evidence-based scientific solutions. This paper describes the theoretical road taken in moving from the abstract philosophy of life to the actual questionnaire. It presents an important aspect of our work with the quality-of-life (QOL) concept though the last decade. We have developed the quality-of-life philosophy; the SEQOL, QOL5, and QOL1 questionnaires; the quality-of-life theory; and the quality-of-life research methodology. We carried out quality-of-life population surveys and developed techniques for improving quality of life with the chronically sick patient. This paper presents the struggle to create a rating scale for the generic measurement of the global quality of life, based on quality-of-life theory, derived from quality-of-life philosophy. The developed rating scale is a ratio scale combining a Likert scale, a visual analogue scale, and a numerical scale, to a reduced combination scale. This allows for the extraction of as much information from the respondents as possible without exhausting them unduly or demanding more than can be reasonably expected.

NASA Tropospheric Composition Program field campagins as prototypes to advance the Integrated Observing System for Air Quality

NASA Astrophysics Data System (ADS)

Lefer, B. L.; Crawford, J. H.; Pierce, R. B.; Berkoff, T.; Swap, R.; Janz, S. J.; Ahn, J.; Al-Saadi, J. A.

2017-12-01

With the launch over the virtual constellation of earth observing satellites for atmospheric composition (e.g., TROPOMI, GEMS, TEMPO, and Sentinel-4) over the next several years, we have a unique opportunity to develop an Integrated Observing System (IOS) for air quality in the northern hemisphere. Recently, NASA's Tropospheric Composition Program (TCP) has participated in several different air quality related field campaigns as an effort to explore various prototypes of the IOS for Air Quality. The IOS for air quality could be a system were space-based observations of air quality (generally, column abundances of NO2, HCHO, O3, SO2, and AOD) are given added "value" by being integrated with: a) long-term ground-based observations;b) regional and global air quality and chemical transport models; as well as c) measurements from targeted airborne field campaigns. The recent Korea-US Air Quality Study (KORUS-AQ), the Lake Michigan Ozone Study 2017 (LMOS), and the Ozone Water-Land Environmental Transition Study (OWLETS) field campaigns were held in different locations and made measurements over different scale. However, all of these provide an opportunity to learn about how a future integrated air quality observing system can be implemented to serve a variety of air quality related objectives. NASA TCP is also exploring enchancements to our routine observations to strengthen the IOS for air quality in the future.

Distributed sensor architecture for intelligent control that supports quality of control and quality of service.

PubMed

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-02-25

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems.

Distributed Sensor Architecture for Intelligent Control that Supports Quality of Control and Quality of Service

PubMed Central

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-01-01

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems. PMID:25723145

A sound quality model for objective synthesis evaluation of vehicle interior noise based on artificial neural network

NASA Astrophysics Data System (ADS)

Wang, Y. S.; Shen, G. Q.; Xing, Y. F.

2014-03-01

Based on the artificial neural network (ANN) technique, an objective sound quality evaluation (SQE) model for synthesis annoyance of vehicle interior noises is presented in this paper. According to the standard named GB/T18697, firstly, the interior noises under different working conditions of a sample vehicle are measured and saved in a noise database. Some mathematical models for loudness, sharpness and roughness of the measured vehicle noises are established and performed by Matlab programming. Sound qualities of the vehicle interior noises are also estimated by jury tests following the anchored semantic differential (ASD) procedure. Using the objective and subjective evaluation results, furthermore, an ANN-based model for synthetical annoyance evaluation of vehicle noises, so-called ANN-SAE, is developed. Finally, the ANN-SAE model is proved by some verification tests with the leave-one-out algorithm. The results suggest that the proposed ANN-SAE model is accurate and effective and can be directly used to estimate sound quality of the vehicle interior noises, which is very helpful for vehicle acoustical designs and improvements. The ANN-SAE approach may be extended to deal with other sound-related fields for product quality evaluations in SQE engineering.

Methodology for assessing exposure and impacts of air pollutants in school children: Data collection, analysis and health effects - A literature review

NASA Astrophysics Data System (ADS)

Mejía, Jaime F.; Choy, Samantha Low; Mengersen, Kerrie; Morawska, Lidia

2011-02-01

The aim of this review is to explore the methodologies employed to assess the exposure of children to air pollutants, in particular traffic emissions, at school, and how these methodologies influence the assessment of the impact of this exposure on the children's health. This involves four main steps: the measurement of air quality at school level, the association between measured air quality and children's exposure, the association between children's exposure and health; and source identification. The comparative advantages and disadvantages of the methods used at each of these steps are discussed. Air quality in schools can be measured at three scales: broad scale, across several city blocks using remote monitors; school-based scale, through ground-level monitors installed within the schools or their immediate surroundings (i.e. only a few metres outside the school); and personal exposure scale using portable monitors attached to a sample of children. Although studies have reported high exposure to PAHs (polycyclic aromatic hydrocarbons), submicrometre (<1.0 μm) and ultrafine particles (<100 nm) at school, no study has investigated the formation of new particles in school facilities and only a handful of studies have analysed children's exposure at school. Associating air quality measurements at the broad and medium scale with children's exposure is challenging: there is spatial and temporal heterogeneity in the distribution of air quality within a school, indoor measurements can often exceed outdoor measurements; and exposure in the classroom is affected by the penetration of outdoor pollutants, wall absorption, emissions from furniture and other materials, level and length of occupancy, and quality of ventilation. This is further exacerbated by the fact that children move around during their school day. Quantifying the contribution of school exposure with observed health symptoms presents further challenges. In addition to ascertaining the impact of non-school-based exposures and co-morbidities, the air pollutant dose intake is affected by daily patterns of physical and traffic activity during and outside school hours which make it difficult to compare the contribution of school-based and non-school-based exposures to the health effect under investigation. Finally, there is strong evidence that low socioeconomic level is highly correlated with the proximity of the school to pollution sources, yet this area of socioeconomic research has been largely unexplored in the assessment of traffic emission exposure.

Validation of UARS Microwave Limb Sounder ClO Measurements

NASA Technical Reports Server (NTRS)

Waters, J. W.; Read, W. G.; Froidevaux, L.; Lungu, T. A.; Perun, V. S.; Stachnik, R. A.; Jarnot, R. F.; Cofield, R. E.; Fishbein, E. F.; Flower, D. A.;

[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

PubMed

Birkner, B

2000-09-01

The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

Measuring the impact of computer resource quality on the software development process and product

NASA Technical Reports Server (NTRS)

Mcgarry, Frank; Valett, Jon; Hall, Dana

1985-01-01

The availability and quality of computer resources during the software development process was speculated to have measurable, significant impact on the efficiency of the development process and the quality of the resulting product. Environment components such as the types of tools, machine responsiveness, and quantity of direct access storage may play a major role in the effort to produce the product and in its subsequent quality as measured by factors such as reliability and ease of maintenance. During the past six years, the NASA Goddard Space Flight Center has conducted experiments with software projects in an attempt to better understand the impact of software development methodologies, environments, and general technologies on the software process and product. Data was extracted and examined from nearly 50 software development projects. All were related to support of satellite flight dynamics ground-based computations. The relationship between computer resources and the software development process and product as exemplified by the subject NASA data was examined. Based upon the results, a number of computer resource-related implications are provided.

Home-based anthropometric, blood pressure and pulse measurements in young children by trained data collectors in the National Children's Study.

PubMed

Zimowski, Michele; Moye, Jack; Dugoni, Bernard; Heim Viox, Melissa; Cohen, Hildie; Winfrey, Krishna

2017-02-01

The current study assessed whether home-based data collection by trained data collectors can produce high-quality physical measurement data in young children. The study assessed the quality of intra-examiner measurements of blood pressure, pulse rate and anthropometric dimensions using intra-examiner reliability and intra-examiner technical error of measurement (TEM). Non-clinical, primarily private homes of National Children's Study participants in twenty-two study locations across the USA. Children in four age groups: 5-7 months (n 91), 11-16 months (n 393), 23-28 months (n 1410) and 35-40 months (n 800). Absolute TEM ranged in value from 0·09 to 16·21, varying widely by age group and measure, as expected. Relative TEM spanned from 0·27 to 13·71 across age groups and physical measures. Reliabilities for anthropometric measurements by age group and measure ranged from 0·46 to >0·99 with most exceeding 0·90, suggesting that the large majority of anthropometric measures can be collected in a home-based setting on young children by trained data collectors. Reliabilities for blood pressure and pulse rate measurements by age group ranged from 0·21 to 0·74, implying these are less reliably measured with young children when taken in the data collection context described here. Reliability estimates >0·95 for weight, length, height, and thigh, waist and head circumference, and >0·90 for triceps and subscapular skinfolds, indicate that these measures can be collected in the field by trained data collectors without compromising data quality. These estimates can be used for interim evaluations of data collector training and measurement protocols.

School Opportunity Hoarding? Racial Segregation and Access to High Growth Schools

PubMed Central

Fiel, Jeremy E.

2017-01-01

Abstract Persistent school segregation may allow advantaged groups to hoard educational opportunities and consign minority students to lower-quality educational experiences. Although minority students are concentrated in low-achieving schools, relatively little previous research directly links segregation to measures of school quality based on student achievement growth, which more plausibly reflect learning opportunities. Using a dataset of public elementary schools in California, this study provides the first analysis detailing the distribution of a growth-based measure of school quality using standard inequality indices, allowing disparities to be decomposed across geographic and organizational scales. We find mixed support for the school opportunity hoarding hypothesis. We find small White and Asian advantages in access to high-growth schools, but most of the inequality in exposure to school growth is within racial groups. Growth-based disparities both between and within groups tend to be on a more local scale than disparities in absolute achievement levels, focusing attention on within-district policies to mitigate school-based inequalities in opportunities to learn. PMID:28607527

An Auditory-Masking-Threshold-Based Noise Suppression Algorithm GMMSE-AMT[ERB] for Listeners with Sensorineural Hearing Loss

NASA Astrophysics Data System (ADS)

Natarajan, Ajay; Hansen, John H. L.; Arehart, Kathryn Hoberg; Rossi-Katz, Jessica

2005-12-01

This study describes a new noise suppression scheme for hearing aid applications based on the auditory masking threshold (AMT) in conjunction with a modified generalized minimum mean square error estimator (GMMSE) for individual subjects with hearing loss. The representation of cochlear frequency resolution is achieved in terms of auditory filter equivalent rectangular bandwidths (ERBs). Estimation of AMT and spreading functions for masking are implemented in two ways: with normal auditory thresholds and normal auditory filter bandwidths (GMMSE-AMT[ERB]-NH) and with elevated thresholds and broader auditory filters characteristic of cochlear hearing loss (GMMSE-AMT[ERB]-HI). Evaluation is performed using speech corpora with objective quality measures (segmental SNR, Itakura-Saito), along with formal listener evaluations of speech quality rating and intelligibility. While no measurable changes in intelligibility occurred, evaluations showed quality improvement with both algorithm implementations. However, the customized formulation based on individual hearing losses was similar in performance to the formulation based on the normal auditory system.

A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

PubMed Central

Xie, Anping; Carayon, Pascale

2014-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

A systematic review of questionnaires measuring the health of resettling refugee women.

PubMed

Gagnon, Anita J; Tuck, Jodi; Barkun, Laurie

2004-02-01

Because many ethnically diverse refugee women resettle in industrialized countries, several biopsychosocial factors need to be considered in caring for them. This systematic review of studies conducted with female refugees, asylum-seekers, or "unspecified" immigrants based on six electronic databases was conducted to determine which questionnaires best measure relevant variables. Questionnaires were reviewed for measurement properties, application of translation theory, and quality of representation. Studies must have included > or = 1 measure of the following: general health; torture, abuse, sex-and-gender-based violence (SGBV); depression; stress; posttraumatic stress disorder (PTSD); anxiety; somatization; migration history; social support; socioeconomic status; discrimination; or mother-child interactions. Fifty-six studies using 47 questionnaires were identified; only five had strong evidence for use with resettling refugee women. Thus, few high-quality tools are available to measure concepts relevant to resettling refugee women's health.

Knowledge of quality performance measures associated with endoscopy among gastroenterology trainees and the impact of a web-based intervention.

PubMed

Thompson, Jennifer S; Lebwohl, Benjamin; Syngal, Sapna; Kastrinos, Fay

2012-07-01

Knowledge of quality measures in endoscopy among trainees is unknown. To assess knowledge of endoscopy-related quality indicators among U.S. trainees and determine whether it improves with a Web-based intervention. Randomized, controlled study. Multicenter. This study involved trainees identified from the American Society for Gastrointestinal Endoscopy membership database. Participants were invited to complete an 18-question online test. Respondents were randomized to receive a Web-based tutorial (intervention) or not. The test was readministered 6 weeks after randomization to determine the intervention's impact. Baseline knowledge of endoscopy-related quality indicators and impact of the tutorial. A total of 347 of 1220 trainees (28%) completed the test; the mean percentage of correct responses was 55%. For screening colonoscopy, 44% knew the adenoma detection rate benchmark, 42% identified the cecal intubation rate goal, and 74% knew the recommended minimum withdrawal time. A total of 208 of 347 trainees (59%) completed the second test; baseline scores were similar for the tutorial (n = 106) and no tutorial (n = 102) groups (56.4% vs 56.9%, respectively). Scores improved after intervention for the tutorial group (65%, P = .003) but remained unchanged in the no tutorial group. On multivariate analysis, each additional year in training (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.5-3.4), training at an academic institution (OR 2.6; 95% CI, 1.1-6.3), and receiving the tutorial (OR 3.2; 95% CI, 1.7-5.9) were associated with scores in the upper tertile. Low response rate. Knowledge of endoscopy-related quality performance measures is low among trainees but can improve with a Web-based tutorial. Gastroenterology training programs may need to incorporate a formal didactic curriculum to supplement practice-based learning of quality standards in endoscopy. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Quality Measurements in Radiology: A Systematic Review of the Literature and Survey of Radiology Benefit Management Groups.

PubMed

Narayan, Anand; Cinelli, Christina; Carrino, John A; Nagy, Paul; Coresh, Josef; Riese, Victoria G; Durand, Daniel J

2015-11-01

As the US health care system transitions toward value-based reimbursement, there is an increasing need for metrics to quantify health care quality. Within radiology, many quality metrics are in use, and still more have been proposed, but there have been limited attempts to systematically inventory these measures and classify them using a standard framework. The purpose of this study was to develop an exhaustive inventory of public and private sector imaging quality metrics classified according to the classic Donabedian framework (structure, process, and outcome). A systematic review was performed in which eligibility criteria included published articles (from 2000 onward) from multiple databases. Studies were double-read, with discrepancies resolved by consensus. For the radiology benefit management group (RBM) survey, the six known companies nationally were surveyed. Outcome measures were organized on the basis of standard categories (structure, process, and outcome) and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy yielded 1,816 citations; review yielded 110 reports (29 included for final analysis). Three of six RBMs (50%) responded to the survey; the websites of the other RBMs were searched for additional metrics. Seventy-five unique metrics were reported: 35 structure (46%), 20 outcome (27%), and 20 process (27%) metrics. For RBMs, 35 metrics were reported: 27 structure (77%), 4 process (11%), and 4 outcome (11%) metrics. The most commonly cited structure, process, and outcome metrics included ACR accreditation (37%), ACR Appropriateness Criteria (85%), and peer review (95%), respectively. Imaging quality metrics are more likely to be structural (46%) than process (27%) or outcome (27%) based (P < .05). As national value-based reimbursement programs increasingly emphasize outcome-based metrics, radiologists must keep pace by developing the data infrastructure required to collect outcome-based quality metrics. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Evaluating the quality of a cell counting measurement process via a dilution series experimental design.

PubMed

Sarkar, Sumona; Lund, Steven P; Vyzasatya, Ravi; Vanguri, Padmavathy; Elliott, John T; Plant, Anne L; Lin-Gibson, Sheng

2017-12-01

Cell counting measurements are critical in the research, development and manufacturing of cell-based products, yet determining cell quantity with accuracy and precision remains a challenge. Validating and evaluating a cell counting measurement process can be difficult because of the lack of appropriate reference material. Here we describe an experimental design and statistical analysis approach to evaluate the quality of a cell counting measurement process in the absence of appropriate reference materials or reference methods. The experimental design is based on a dilution series study with replicate samples and observations as well as measurement process controls. The statistical analysis evaluates the precision and proportionality of the cell counting measurement process and can be used to compare the quality of two or more counting methods. As an illustration of this approach, cell counting measurement processes (automated and manual methods) were compared for a human mesenchymal stromal cell (hMSC) preparation. For the hMSC preparation investigated, results indicated that the automated method performed better than the manual counting methods in terms of precision and proportionality. By conducting well controlled dilution series experimental designs coupled with appropriate statistical analysis, quantitative indicators of repeatability and proportionality can be calculated to provide an assessment of cell counting measurement quality. This approach does not rely on the use of a reference material or comparison to "gold standard" methods known to have limited assurance of accuracy and precision. The approach presented here may help the selection, optimization, and/or validation of a cell counting measurement process. Published by Elsevier Inc.

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

PubMed

Xie, Anping; Carayon, Pascale

2015-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

Measuring quality of dental care: Caries prevention services for children.

PubMed

Herndon, Jill Boylston; Tomar, Scott L; Catalanotto, Frank A; Rudner, Nancy; Huang, I-Chan; Aravamudhan, Krishna; Shenkman, Elizabeth A; Crall, James J

2015-08-01

The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride. Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children's Health Insurance Programs and from national commercial dental benefit plans. Data were extracted from 414 randomly selected dental office records to validate the use of administrative data to accurately calculate the measures. The authors also assessed statistically significant variations in overall measure performance. Agreement between administrative data and dental records was 95% for sealants (κ = 0.82) and 90% for topical fluoride (κ = 0.78). Sensitivity and specificity were 90.7% and 88.5% for topical fluoride and 77.8% and 98.8% for sealants, respectively. Variation in overall measure performance was greatest for topical fluoride (χ(2) = 5,887.1; P < .01); 18% to 37% of children with an elevated risk of experiencing caries received at least 2 topical fluoride applications during the reporting year. Although there was greater variation in performance for sealants for 6- to 9-year-olds (range, 21.0-31.3%; χ(2) = 548.6; P < .01) compared with sealants for 10- to 14-year-olds (range, 8.4-11.1%; χ(2) = 22.7; P < .01), overall sealant placement rates were lower for 10- to 14-year-olds. These evidence-based, caries prevention process-of-care quality measures can be implemented feasibly and validly using administrative claims data. The measures can be used to assess, monitor, and improve the proportion of children with an elevated risk of experiencing dental caries who receive evidence-based caries prevention services. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

PubMed

Rocco, Gaetano; Brunelli, Alessandro

2012-11-01

Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care. Copyright © 2012 Elsevier Inc. All rights reserved.

Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report.

PubMed

Karlen, Emily; McCathie, Becky

2015-12-01

The current state of health care demands higher-value care. Due to many barriers, clinicians routinely do not implement evidence-based care even though it is known to improve quality and reduce cost of care. The purpose of this case report is to describe a theory-based, multitactic implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain. Patients were treated from January 2010 through December 2014 in 1 of 32 outpatient physical therapy clinics within an academic health care system. Data were examined from 47,755 patients (mean age=50.3 years) entering outpatient physical therapy for management of nonspecific low back pain, with or without radicular pain. Development and implementation tactics were constructed from adult learning and change management theory to enhance adherence to best practice care among 130 physical therapists. A quality improvement team implemented 4 tactics: establish care delivery expectations, facilitate peer-led clinical and operational teams, foster a learning environment focused on meeting a population's needs, and continuously collect and analyze outcomes data. Physical therapy utilization and change in functional disability were measured to assess relative cost and quality of care. Secondarily, charge data assessed change in physical therapists' application of evidence-based care. Implementation of a quality improvement process was measured by year-over-year improved clinical outcomes, decreased utilization, and increased adherence to evidence-based physical therapy, which was associated with higher-value care. When adult learning and change management theory are combined in quality improvement efforts, common barriers to implementing evidence-based care can be overcome, creating an environment supportive of delivering higher-value physical therapy for patients with low back pain. © 2015 American Physical Therapy Association.

A Data Quality Filter for PMU Measurements: Description, Experience, and Examples

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

Follum, James D.; Amidan, Brett G.

Networks of phasor measurement units (PMUs) continue to grow, and along with them, the amount of data available for analysis. With so much data, it is impractical to identify and remove poor quality data manually. The data quality filter described in this paper was developed for use with the Data Integrity and Situation Awareness Tool (DISAT), which analyzes PMU data to identify anomalous system behavior. The filter operates based only on the information included in the data files, without supervisory control and data acquisition (SCADA) data, state estimator values, or system topology information. Measurements are compared to preselected thresholds tomore » determine if they are reliable. Along with the filter's description, examples of data quality issues from application of the filter to nine months of archived PMU data are provided. The paper is intended to aid the reader in recognizing and properly addressing data quality issues in PMU data.« less

Using SERVQUAL in health libraries across Somerset, Devon and Cornwall.

PubMed

Martin, Susan

2003-03-01

This study provides the results of a survey conducted in the autumn of 2001 by ten NHS library services across Somerset, Devon and Cornwall. The aim of the project was to measure the service quality of each individual library and to provide an overall picture of the quality of library services within the south-west peninsula. The survey was based on SERVQUAL, a diagnostic tool developed in the 1980s, which measures service quality in terms of customer expectations and perceptions of service. The survey results have provided the librarians with a wealth of information about service quality. The service as a whole is perceived to be not only meeting but also exceeding expectations in terms of reliability, responsiveness, empathy and assurance. For the first time, the ten health library services can measure their own service quality as well as benchmark themselves against others.

Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates.

PubMed

Salinas, Stanley R

To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 "Would you recommend this hospital to your friends and family?" was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care. A statistically significant relationship was found between patient experience and actual quality outcomes. The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.

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

NASA Astrophysics Data System (ADS)

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

2017-05-01

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

Quality of College Life (QCL) of Students: Developing and Validating a Measure of Well-Being

ERIC Educational Resources Information Center

Sirgy, M. Joseph; Grzeskowiak, Stephan; Rahtz, Don

2007-01-01

This paper reports a study designed to develop and validate a measure of quality of college life (QCL) of students. Using a theoretical model based on a build-up approach to QCL, the authors provide an empirical examination of various hierarchical components and their properties. The method is executed in two stages. The first stage is used to…

Outcome-centered antiepileptic therapy: Rate, rhythm and relief.: Implementing AAN Epilepsy Quality Measures in clinical practice.

PubMed

D'Cruz, O'Neill

2015-12-01

Clinicians who manage patients with epilepsy are expected to assess the relevance of clinical trial results to their practice, integrate new treatments into the care algorithm, and implement epilepsy quality measures, with the overall goal of improving patient outcomes. A disease-based clinical framework that helps with choice and combinations of interventions facilitates provision of efficient, cost-effective, and high-quality care. This article addresses the current conceptual framework that informs clinical evaluation of epilepsy, explores gaps between development of treatment options, quality measures and clinical goals, and proposes an outcome-centered approach that bridges these gaps with the aim of improving patient and population-level clinical outcomes in epilepsy. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

Competency-Based Degree Programs in the U.S.: Postsecondary Credentials for Measurable Student Learning and Performance

ERIC Educational Resources Information Center

Klein-Collins, Rebecca

2012-01-01

Today the U.S. higher education system is facing a crisis regarding its perceived quality. One model for improving quality is competency-based education, in which an institution clearly defines the specific competencies expected of its graduates. A key challenge is how to help more people, particularly adults, succeed at the post¬secondary level…

Auditorium acoustics evaluation based on simulated impulse response

NASA Astrophysics Data System (ADS)

Wu, Shuoxian; Wang, Hongwei; Zhao, Yuezhe

2004-05-01

The impulse responses and other acoustical parameters of Huangpu Teenager Palace in Guangzhou were measured. Meanwhile, the acoustical simulation and auralization based on software ODEON were also made. The comparison between the parameters based on computer simulation and measuring is given. This case study shows that auralization technique based on computer simulation can be used for predicting the acoustical quality of a hall at its design stage.

Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol.

PubMed

Khadjesari, Zarnie; Vitoratou, Silia; Sevdalis, Nick; Hull, Louise

2017-10-08

Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures. The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored. Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for reviewers of papers and grants to determine the psychometric quality of the measures used in implementation research. International Prospective Register of Systematic Reviews (PROSPERO): CRD42017065348. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Integrating Measurement Based New Knowledge on Wildland Fire Emissions and Chemistry into the AIRPACT Air Quality Forecasting for the Pacific Northwest

NASA Astrophysics Data System (ADS)

Nergui, T.; Lee, Y.; Chung, S. H.; Lamb, B. K.; Yokelson, R. J.; Barsanti, K.

2017-12-01

A number of chamber and field measurements have shown that atmospheric organic aerosols and their precursors produced from wildfires are significantly underestimated in the emission inventories used for air quality models for various applications such as regulatory strategy development, impact assessments of air pollutants, and air quality forecasting for public health. The AIRPACT real-time air quality forecasting system consistently underestimates surface level fine particulate matter (PM2.5) concentrations in the summer at both urban and rural locations in the Pacific Northwest, primarily result of errors in organic particulate matter. In this work, we implement updated chemical speciation and emission factors based on FLAME-IV (Fourth Fire Lab at Missoula Experiment) and other measurements in the Blue-Sky fire emission model and the SMOKE emission preprocessor; and modified parameters for the secondary organic aerosol (SOA) module in CMAQ chemical transport model of the AIRPACT modeling system. Simulation results from CMAQ version 5.2 which has a better treatment for anthropogenic SOA formation (as a base case) and modified parameterization used for fire emissions and chemistry in the model (fire-soa case) are evaluated against airborne measurements downwind of the Big Windy Complex Fire and the Colockum Tarps Fire, both of which occurred in the Pacific Northwest in summer 2013. Using the observed aerosol chemical composition and mass loadings for organics, nitrate, sulfate, ammonium, and chloride from aircraft measurements during the Studies of Emissions and Atmospheric Composition, Clouds, and Climate Coupling by Regional Surveys (SEAC4RS) and the Biomass Burning Observation Project (BBOP), we assess how new knowledge gained from wildfire measurements improve model predictions for SOA and its contribution to the total mass of PM2.5 concentrations.

On quality control procedures for solar radiation and meteorological measures, from subhourly to montly average time periods

NASA Astrophysics Data System (ADS)

Espinar, B.; Blanc, P.; Wald, L.; Hoyer-Klick, C.; Schroedter-Homscheidt, M.; Wanderer, T.

2012-04-01

Meteorological data measured by ground stations are often a key element in the development and validation of methods exploiting satellite images. These data are considered as a reference against which satellite-derived estimates are compared. Long-term radiation and meteorological measurements are available from a large number of measuring stations. However, close examination of the data often reveals a lack of quality, often for extended periods of time. This lack of quality has been the reason, in many cases, of the rejection of large amount of available data. The quality data must be checked before their use in order to guarantee the inputs for the methods used in modelling, monitoring, forecast, etc. To control their quality, data should be submitted to several conditions or tests. After this checking, data that are not flagged by any of the test is released as a plausible data. In this work, it has been performed a bibliographical research of quality control tests for the common meteorological variables (ambient temperature, relative humidity and wind speed) and for the usual solar radiometrical variables (horizontal global and diffuse components of the solar radiation and the beam normal component). The different tests have been grouped according to the variable and the average time period (sub-hourly, hourly, daily and monthly averages). The quality test may be classified as follows: • Range checks: test that verify values are within a specific range. There are two types of range checks, those based on extrema and those based on rare observations. • Step check: test aimed at detecting unrealistic jumps or stagnation in the time series. • Consistency checks: test that verify the relationship between two or more time series. The gathered quality tests are applicable for all latitudes as they have not been optimized regionally nor seasonably with the aim of being generic. They have been applied to ground measurements in several geographic locations, what result in the detection of some control tests that are no longer adequate, due to different reasons. After the modification of some test, based in our experience, a set of quality control tests is now presented, updated according to technology advances and classified. The presented set of quality tests allows radiation and meteorological data to be tested in order to know their plausibility to be used as inputs in theoretical or empirical methods for scientific research. The research leading to those results has partly receive funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement no. 262892 (ENDORSE project).

Using satellite observations in performance evaluation for regulatory air quality modeling: Comparison with ground-level measurements

NASA Astrophysics Data System (ADS)

Odman, M. T.; Hu, Y.; Russell, A.; Chai, T.; Lee, P.; Shankar, U.; Boylan, J.

2012-12-01

Regulatory air quality modeling, such as State Implementation Plan (SIP) modeling, requires that model performance meets recommended criteria in the base-year simulations using period-specific, estimated emissions. The goal of the performance evaluation is to assure that the base-year modeling accurately captures the observed chemical reality of the lower troposphere. Any significant deficiencies found in the performance evaluation must be corrected before any base-case (with typical emissions) and future-year modeling is conducted. Corrections are usually made to model inputs such as emission-rate estimates or meteorology and/or to the air quality model itself, in modules that describe specific processes. Use of ground-level measurements that follow approved protocols is recommended for evaluating model performance. However, ground-level monitoring networks are spatially sparse, especially for particulate matter. Satellite retrievals of atmospheric chemical properties such as aerosol optical depth (AOD) provide spatial coverage that can compensate for the sparseness of ground-level measurements. Satellite retrievals can also help diagnose potential model or data problems in the upper troposphere. It is possible to achieve good model performance near the ground, but have, for example, erroneous sources or sinks in the upper troposphere that may result in misleading and unrealistic responses to emission reductions. Despite these advantages, satellite retrievals are rarely used in model performance evaluation, especially for regulatory modeling purposes, due to the high uncertainty in retrievals associated with various contaminations, for example by clouds. In this study, 2007 was selected as the base year for SIP modeling in the southeastern U.S. Performance of the Community Multiscale Air Quality (CMAQ) model, at a 12-km horizontal resolution, for this annual simulation is evaluated using both recommended ground-level measurements and non-traditional satellite retrievals. Evaluation results are assessed against recommended criteria and peer studies in the literature. Further analysis is conducted, based upon these assessments, to discover likely errors in model inputs and potential deficiencies in the model itself. Correlations as well as differences in input errors and model deficiencies revealed by ground-level measurements versus satellite observations are discussed. Additionally, sensitivity analyses are employed to investigate errors in emission-rate estimates using either ground-level measurements or satellite retrievals, and the results are compared against each other considering observational uncertainties. Recommendations are made for how to effectively utilize satellite retrievals in regulatory air quality modeling.

The skill-divide in job quality: a cross-national analysis of 28 countries.

PubMed

Stier, Haya

2015-01-01

This study focuses on the skill divide in job quality and the role of social institutions in structuring the relation of workers' qualifications to the attributes of their jobs. Four measures of job quality are examined: job security, job achievement, job content and work schedule flexibility. The study is based on the 2005 ISSP module on work orientations and encompasses 28 countries. Obtained through multilevel modeling, the findings show that low-skilled workers are disadvantaged in all aspects of job quality. However, skill inequality in the quality of employment depends on countries' characteristics, with declining inequality in countries at higher levels of technological development and to some extent also in times of technological growth. At times of high unemployment, skill disparities in job security widen while on other measures of job quality they decline. Under high market regulation, the low skilled enjoy better job security but on other measures, skill inequalities increase. Copyright © 2014 Elsevier Inc. All rights reserved.

Development and Pilot Testing of Caregiver-Reported Pediatric Quality Measures for Transitions Between Sites of Care.

PubMed

Desai, Arti D; Burkhart, Q; Parast, Layla; Simon, Tamara D; Allshouse, Carolyn; Britto, Maria T; Leyenaar, JoAnna K; Gidengil, Courtney A; Toomey, Sara L; Elliott, Marc N; Schneider, Eric C; Mangione-Smith, Rita

Few measures exist to assess pediatric transition quality between care settings. The study objective was to develop and pilot test caregiver-reported quality measures for pediatric hospital and emergency department (ED) to home transitions. On the basis of an evidence review, we developed draft caregiver-reported quality measures for transitions between sites of care. Using the RAND-UCLA Modified Delphi method, a multistakeholder panel endorsed measures for further development. Measures were operationalized into 2 surveys, which were administered to caregivers of patients (n = 2839) discharged from Seattle Children's Hospital between July 1 and September 1, 2014. Caregivers were randomized to mail or telephone survey mode. Measure scores were computed as a percentage of eligible caregivers who endorsed receiving the indicated care. Differences in scores were examined according to survey mode and caregiver characteristics. The Delphi panel endorsed 6 of 8 hospital to home transition measures and 2 of 3 ED to home transitions measures. Scores differed significantly according to mode for 1 measure. Caregivers with lower levels of educational attainment and/or Spanish-speaking caregivers reported significantly higher scores on 3 of the measures. The largest difference was reported for the measure that assessed whether caregivers received assistance with scheduling follow-up appointments; 92% score for caregivers with lower educational attainment versus 79% for caregivers with higher educational attainment (P < .001). We developed 8 new, evidence-based quality measures to assess transition quality from the perspective of caregivers. Pilot testing of these measures in a single institution yielded valuable insights for future testing and implementation of these measures. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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.

Individual Cognitive Stimulation Therapy for dementia (iCST): study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Improving the quality of care for people with dementia and their carers has become a national priority in many countries. Cognitive Stimulation Therapy (CST) groups can be beneficial in improving cognition and quality of life for people with dementia. The aim of the current study is to develop and evaluate a home-based individual Cognitive Stimulation Therapy (iCST) programme for people with dementia which can be delivered by their family carer. Methods This multi-centre, pragmatic randomised controlled trial (RCT) will compare the effectiveness and cost-effectiveness of iCST for people with dementia with a treatment as usual control group. The intervention consists of iCST sessions delivered by a carer for 30 minutes, 3 times a week over 25 weeks. For people with dementia the primary outcome measures are cognition assessed by the ADAS-Cog, and quality of life assessed by QoL-AD. For carers, quality of life using the SF-12 is the primary outcome measure. Using a 5% significance level, comparison of 306 participants will yield 80% power to detect an effect size of 0.35 for cognition as measured by the ADAS-Cog, and quality of life as measured by the QoL-AD. Quality of life for the carer will be measured using the SF-12. The trial will include a cost-effectiveness analysis from a public sector perspective. Discussion The UK Department of Health has recently stressed that improving access to psychological therapies is a national priority, but many people with dementia are unable to access psychological interventions. The development of a home-based individual version of CST will provide an easy to use, widely available therapy package that will be evaluated for effectiveness and cost-effectiveness in a multi centre RCT. PMID:22998983

Is continence status associated with quality of life in young children with spina bifida?

PubMed

Freeman, Kurt A; Smith, Kathryn; Adams, Elizabeth; Mizokawa, Stacey; Neville-Jan, Ann

2013-01-01

To evaluate the relationship between child- and parent-reported quality of life (QOL) and bowel and bladder continence among young children with spina bifida (SB). 104 children ages 5-12 years and one of their parents/guardians completed the Pediatric Quality of Life Inventory - Generic Form (PedsQL; parent and child) and the Quality of Life in Spina Bifida Questionnaire (QOLSBQ, parent only). Data on continence, child age, and condition-specific variables were obtained by chart review. Parent and child QOL scores (on all measures of QOL) were positively correlated; parents rated child QOL lower than children's self report. QOL scores did not differ based on continence status. Total PedsQL scores were associated with age and mobility based on child report and with mobility based on parent report. QOL may not be affected by continence status among young children with SB, though demographic (i.e., age) and condition-specific (i.e., functional mobility status) variables appear relevant. Additional research is needed to further evaluate condition-specific variables, other protective variables, and possible measurement issues that influence QOL in young children with SB.

A no-reference video quality assessment metric based on ROI

NASA Astrophysics Data System (ADS)

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

2015-01-01

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

The ProQOL-21: A revised version of the Professional Quality of Life (ProQOL) scale based on Rasch analysis

PubMed Central

Rees, Clare S.; Hegney, Desley G.

2018-01-01

The Professional Quality of Life scale is a measure intended to provide practitioners and researchers with an indication of a caring professional’s compassion satisfaction, burnout, and secondary traumatic stress. While this measure has been used extensively in nursing research, owing to the relevancy of patient-care associated satisfaction and fatigue within this profession, information regarding the construct validity of this measure is less well represented in the literature. We examined the construct validity of the Professional Quality of Life scale using a Rasch analysis procedure on each of its three scales, as a means of substantiating their measurement adequacy. Responses on the Professional Quality of Life scale from 1615 registered nurses (age x̅ = 46.48 years, SD = 11.78) were analysed. While support for the measurement adequacy (invariance, person/item fit, and unidimensionality) of the compassion satisfaction scale was found, the burnout and secondary traumatic stress scales did not demonstrate adequate measurement properties. We instead present an alternative measurement model of these subscales, involving items from each, to form a robust measure of compassion fatigue, and provide recoding, scoring, and normed scores for both measures. Our findings indicate that use of the Professional Quality of Life scale’s burnout and secondary traumatic stress scales may require caution, while our revised compassion satisfaction and fatigue scales provide robust measurement options for practitioners and researchers. PMID:29489875

The ProQOL-21: A revised version of the Professional Quality of Life (ProQOL) scale based on Rasch analysis.

PubMed

Heritage, Brody; Rees, Clare S; Hegney, Desley G

2018-01-01

The Professional Quality of Life scale is a measure intended to provide practitioners and researchers with an indication of a caring professional's compassion satisfaction, burnout, and secondary traumatic stress. While this measure has been used extensively in nursing research, owing to the relevancy of patient-care associated satisfaction and fatigue within this profession, information regarding the construct validity of this measure is less well represented in the literature. We examined the construct validity of the Professional Quality of Life scale using a Rasch analysis procedure on each of its three scales, as a means of substantiating their measurement adequacy. Responses on the Professional Quality of Life scale from 1615 registered nurses (age x̅ = 46.48 years, SD = 11.78) were analysed. While support for the measurement adequacy (invariance, person/item fit, and unidimensionality) of the compassion satisfaction scale was found, the burnout and secondary traumatic stress scales did not demonstrate adequate measurement properties. We instead present an alternative measurement model of these subscales, involving items from each, to form a robust measure of compassion fatigue, and provide recoding, scoring, and normed scores for both measures. Our findings indicate that use of the Professional Quality of Life scale's burnout and secondary traumatic stress scales may require caution, while our revised compassion satisfaction and fatigue scales provide robust measurement options for practitioners and researchers.

Measurement of M²-Curve for Asymmetric Beams by Self-Referencing Interferometer Wavefront Sensor.

PubMed

Du, Yongzhao

2016-11-29

For asymmetric laser beams, the values of beam quality factor M x 2 and M y 2 are inconsistent if one selects a different coordinate system or measures beam quality with different experimental conditionals, even when analyzing the same beam. To overcome this non-uniqueness, a new beam quality characterization method named as M²-curve is developed. The M²-curve not only contains the beam quality factor M x 2 and M y 2 in the x -direction and y -direction, respectively; but also introduces a curve of M x α 2 versus rotation angle α of coordinate axis. Moreover, we also present a real-time measurement method to demonstrate beam propagation factor M²-curve with a modified self-referencing Mach-Zehnder interferometer based-wavefront sensor (henceforth SRI-WFS). The feasibility of the proposed method is demonstrated with the theoretical analysis and experiment in multimode beams. The experimental results showed that the proposed measurement method is simple, fast, and a single-shot measurement procedure without movable parts.

Measurement of M2-Curve for Asymmetric Beams by Self-Referencing Interferometer Wavefront Sensor

PubMed Central

Du, Yongzhao

2016-01-01

For asymmetric laser beams, the values of beam quality factor Mx2 and My2 are inconsistent if one selects a different coordinate system or measures beam quality with different experimental conditionals, even when analyzing the same beam. To overcome this non-uniqueness, a new beam quality characterization method named as M2-curve is developed. The M2-curve not only contains the beam quality factor Mx2 and My2 in the x-direction and y-direction, respectively; but also introduces a curve of Mxα2 versus rotation angle α of coordinate axis. Moreover, we also present a real-time measurement method to demonstrate beam propagation factor M2-curve with a modified self-referencing Mach-Zehnder interferometer based-wavefront sensor (henceforth SRI-WFS). The feasibility of the proposed method is demonstrated with the theoretical analysis and experiment in multimode beams. The experimental results showed that the proposed measurement method is simple, fast, and a single-shot measurement procedure without movable parts. PMID:27916845

Ranking Surgical Residency Programs: Reputation Survey or Outcomes Measures?

PubMed

Wilson, Adam B; Torbeck, Laura J; Dunnington, Gary L

2015-01-01

The release of general surgery residency program rankings by Doximity and U.S. News & World Report accentuates the need to define and establish measurable standards of program quality. This study evaluated the extent to which program rankings based solely on peer nominations correlated with familiar program outcomes measures. Publicly available data were collected for all 254 general surgery residency programs. To generate a rudimentary outcomes-based program ranking, surgery programs were rank-ordered according to an average percentile rank that was calculated using board pass rates and the prevalence of alumni publications. A Kendall τ-b rank correlation computed the linear association between program rankings based on reputation alone and those derived from outcomes measures to validate whether reputation was a reasonable surrogate for globally judging program quality. For the 218 programs with complete data eligible for analysis, the mean board pass rate was 72% with a standard deviation of 14%. A total of 60 programs were placed in the 75th percentile or above for the number of publications authored by program alumni. The correlational analysis reported a significant correlation of 0.428, indicating only a moderate association between programs ranked by outcomes measures and those ranked according to reputation. Seventeen programs that were ranked in the top 30 according to reputation were also ranked in the top 30 based on outcomes measures. This study suggests that reputation alone does not fully capture a representative snapshot of a program's quality. Rather, the use of multiple quantifiable indicators and attributes unique to programs ought to be given more consideration when assigning ranks to denote program quality. It is advised that the interpretation and subsequent use of program rankings be met with caution until further studies can rigorously demonstrate best practices for awarding program standings. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Determinants of Quality Perception in Educational Administration: Potential Conflict between the Requirements of Internal and External Customers.

ERIC Educational Resources Information Center

Galloway, R. L.; Wearn, Katrina

1998-01-01

Attempts to measure perceived quality, based on customers' views within the context of a (British) university faculty office, using a modified SERVQUAL instrument. Internal customers demonstrated that perceived quality is driven by task-focused issues, stressing clarity, accuracy, and reliability. External customers, whose usage is more casual,…

A Value-Added Estimate of Higher Education Quality of US States

ERIC Educational Resources Information Center

Zhang, Lei

2009-01-01

States differ substantially in higher education policies. Little is known about the effects of state policies on the performance of public colleges and universities, largely because no clear measures of college quality exist. In this paper, I estimate the average quality of public colleges of US states based on the value-added to individuals'…

The Quest for Quality: How YoungStar Is Affecting Child Care in Milwaukee County

ERIC Educational Resources Information Center

Mueller, Betsy; Peterangelo, Joe; Henken, Rob

2016-01-01

The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and…

How Do Management Students Perceive the Quality of Education in Public Institutions?

ERIC Educational Resources Information Center

Narang, Ritu

2012-01-01

Purpose: Keeping in mind the urgent need to deliver quality education in higher education institutes, the current paper seeks to measure the quality perception of management students in India. Design/methodology/approach: Based on an exploratory study a modified version of SERVQUAL was employed as the research instrument. Data were collected from…

A Quality-Based Payment Strategy for Nursing Home Care in Minnesota

ERIC Educational Resources Information Center

Kane, Robert L.; Arling, Greg; Mueller, Christine; Held, Robert; Cooke, Valerie

2007-01-01

This article describes a pay-for-performance system developed for Minnesota nursing homes. In effect, nursing homes can retain a greater proportion of the difference between their costs and the average costs on the basis of their quality scores. The quality score is a derived and weighted composite measure currently composed of five elements:…

Building Quality Foundations: Indicators and Instruments to Measure the Quality of Vocational Education and Training

ERIC Educational Resources Information Center

Coates, Hamish

2009-01-01

Vocational education and training plays a major and increasing role in developing the knowledge and skills that underpin Australia's economy and society. It is vital, accordingly, that training outcomes are of high quality. This paper reports work undertaken to develop a new evidence-based and outcomes-focused national approach to monitoring and…

Computer vision-based analysis of foods: a non-destructive colour measurement tool to monitor quality and safety.

PubMed

Mogol, Burçe Ataç; Gökmen, Vural

2014-05-01

Computer vision-based image analysis has been widely used in food industry to monitor food quality. It allows low-cost and non-contact measurements of colour to be performed. In this paper, two computer vision-based image analysis approaches are discussed to extract mean colour or featured colour information from the digital images of foods. These types of information may be of particular importance as colour indicates certain chemical changes or physical properties in foods. As exemplified here, the mean CIE a* value or browning ratio determined by means of computer vision-based image analysis algorithms can be correlated with acrylamide content of potato chips or cookies. Or, porosity index as an important physical property of breadcrumb can be calculated easily. In this respect, computer vision-based image analysis provides a useful tool for automatic inspection of food products in a manufacturing line, and it can be actively involved in the decision-making process where rapid quality/safety evaluation is needed. © 2013 Society of Chemical Industry.

Value-based insurance design: benefits beyond cost and utilization.

PubMed

Gibson, Teresa B; Maclean, Ross J; Chernew, Michael E; Fendrick, A Mark; Baigel, Colin

2015-01-01

As value-based insurance design (VBID) programs proliferate, evidence is emerging on the impact of VBID. To date, studies have largely measured VBID impact on utilization, and a few studies have assessed its impact on quality, outcomes, and cost. In this commentary we discuss these domains, summarize evidence, and propose the extension of measurement of VBID impact into areas including workplace productivity and quality of life, employee and patient engagement, and talent attraction and retention. We contend that VBID evaluations should consider a broad variety of programmatic dividends on both humanistic and health-related outcomes.

An integrated probe design for measuring food quality in a microwave environment

NASA Astrophysics Data System (ADS)

O'Farrell, M.; Sheridan, C.; Lewis, E.; Zhao, W. Z.; Sun, T.; Grattan, K. T. V.

2007-07-01

The work presented describes the development of a novel integrated optical sensor system for the simultaneous and online measurement of the colour and temperature of food as it cooks in a large-scale microwave and hybrid oven systems. The integrated probe contains two different sensor concepts, one to monitor temperature and based on Fibre Bragg Grating (FBG) technology and a second for meat quality, based on reflection spectroscopy in the visible wavelength range. The combination of the two sensors into a single probe requires a careful configuration of the sensor approaches in the creation of an integrated probe design.

A Laser-Based Measuring System for Online Quality Control of Car Engine Block

PubMed Central

Li, Xing-Qiang; Wang, Zhong; Fu, Lu-Hua

2016-01-01

For online quality control of car engine production, pneumatic measurement instrument plays an unshakeable role in measuring diameters inside engine block because of its portability and high-accuracy. To the limitation of its measuring principle, however, the working space between the pneumatic device and measured surface is too small to require manual operation. This lowers the measuring efficiency and becomes an obstacle to perform automatic measurement. In this article, a high-speed, automatic measuring system is proposed to take the place of pneumatic devices by using a laser-based measuring unit. The measuring unit is considered as a set of several measuring modules, where each of them acts like a single bore gauge and is made of four laser triangulation sensors (LTSs), which are installed on different positions and in opposite directions. The spatial relationship among these LTSs was calibrated before measurements. Sampling points from measured shaft holes can be collected by the measuring unit. A unified mathematical model was established for both calibration and measurement. Based on the established model, the relative pose between the measuring unit and measured workpiece does not impact the measuring accuracy. This frees the measuring unit from accurate positioning or adjustment, and makes it possible to realize fast and automatic measurement. The proposed system and method were finally validated by experiments. PMID:27834839

75 FR 31709 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Reasonable Further...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

... Emission Inventory, Contingency Measures, Reasonably Available Control Measures, and Transportation... Implementation Plan (SIP) to meet the 2002 base year emissions inventory, the reasonable further progress (RFP) plan, RFP contingency measure, and reasonably available control measure (RACM) requirements of the...

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

PubMed Central

Profit, J; Zupancic, JAF; Gould, JB; Pietz, K; Kowalkowski, MA; Draper, D; Hysong, SJ; Petersen, LA

2014-01-01

Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P < .05). Correlations between pairs of quality measures were strong (ρ > .5) for 1 pair, moderate (.3 < |ρ| < .5) for 8 pairs, weak (.1 < |ρ| < .3) for 5 pairs and negligible (|ρ| < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest. PMID:23403539

Quality dependent fusion of intramodal and multimodal biometric experts

NASA Astrophysics Data System (ADS)

Kittler, J.; Poh, N.; Fatukasi, O.; Messer, K.; Kryszczuk, K.; Richiardi, J.; Drygajlo, A.

2007-04-01

We address the problem of score level fusion of intramodal and multimodal experts in the context of biometric identity verification. We investigate the merits of confidence based weighting of component experts. In contrast to the conventional approach where confidence values are derived from scores, we use instead raw measures of biometric data quality to control the influence of each expert on the final fused score. We show that quality based fusion gives better performance than quality free fusion. The use of quality weighted scores as features in the definition of the fusion functions leads to further improvements. We demonstrate that the achievable performance gain is also affected by the choice of fusion architecture. The evaluation of the proposed methodology involves 6 face and one speech verification experts. It is carried out on the XM2VTS data base.

Assessment of the Impact of The East Asian Summer Monsoon on the Air Quality Over China

NASA Astrophysics Data System (ADS)

Hao, Nan; Ding, Aijun; Safieddine, Sarah; Valks, Pieter; Clerbaux, Cathy; Trautmann, Thomas

2016-04-01

Air pollution is one of the most important environmental problems in developing Asian countries like China. In this region, studies showed that the East Asian monsoon plays a significant role in characterizing the temporal variation and spatial patterns of air pollution, since monsoon is a major atmospheric system affecting air mass transport, convection, and precipitation. Knowledge gaps still exist in the understanding of Asian monsoon impact on the air quality in China under the background of global climate change. For the first time satellite observations of tropospheric ozone and its precursors will be integrated with the ground-based, aircraft measurements of air pollutants and model simulations to study the impact of the East Asian monsoon on air quality in China. We apply multi-platform satellite observations by the GOME-2, IASI, and MOPITT instruments to analyze tropospheric ozone and CO, precursors of ozone (NO2, HCHO and CHOCHO) and other related trace gases over China. Two years measurements of air pollutants including NO2, HONO, SO2, HCHO and CHOCHO at a regional back-ground site in the western part of the Yangtze River Delta (YRD) in eastern China will be presented. The potential of using the current generation of satellite instruments, ground-based instruments and aircraft to monitor air quality changes caused by the East Asian monsoon circulation will be presented. Preliminary comparison results between satellite measurement and limited but valuable ground-based and aircraft measurements will also be showed.

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.

Measurement properties of tools measuring mental health knowledge: a systematic review.

PubMed

Wei, Yifeng; McGrath, Patrick J; Hayden, Jill; Kutcher, Stan

2016-08-23

Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties. We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown". We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools. Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.

A method to incorporate the effect of beam quality on image noise in a digitally reconstructed radiograph (DRR) based computer simulation for optimisation of digital radiography

NASA Astrophysics Data System (ADS)

Moore, Craig S.; Wood, Tim J.; Saunderson, John R.; Beavis, Andrew W.

2017-09-01

The use of computer simulated digital x-radiographs for optimisation purposes has become widespread in recent years. To make these optimisation investigations effective, it is vital simulated radiographs contain accurate anatomical and system noise. Computer algorithms that simulate radiographs based solely on the incident detector x-ray intensity (‘dose’) have been reported extensively in the literature. However, while it has been established for digital mammography that x-ray beam quality is an important factor when modelling noise in simulated images there are no such studies for diagnostic imaging of the chest, abdomen and pelvis. This study investigates the influence of beam quality on image noise in a digital radiography (DR) imaging system, and incorporates these effects into a digitally reconstructed radiograph (DRR) computer simulator. Image noise was measured on a real DR imaging system as a function of dose (absorbed energy) over a range of clinically relevant beam qualities. Simulated ‘absorbed energy’ and ‘beam quality’ DRRs were then created for each patient and tube voltage under investigation. Simulated noise images, corrected for dose and beam quality, were subsequently produced from the absorbed energy and beam quality DRRs, using the measured noise, absorbed energy and beam quality relationships. The noise images were superimposed onto the noiseless absorbed energy DRRs to create the final images. Signal-to-noise measurements in simulated chest, abdomen and spine images were within 10% of the corresponding measurements in real images. This compares favourably to our previous algorithm where images corrected for dose only were all within 20%.

Assessment of health benefits related to air quality improvement strategies in urban areas: An Impact Pathway Approach.

PubMed

Silveira, Carlos; Roebeling, Peter; Lopes, Myriam; Ferreira, Joana; Costa, Solange; Teixeira, João P; Borrego, Carlos; Miranda, Ana I

2016-12-01

Air pollution is, increasingly, a concern to our society given the threats to human health and the environment. Concerted actions to improve air quality have been taken at different levels, such as through the development of Air Quality Plans (AQPs). However, air quality impacts associated with the implementation of abatement measures included in AQPs are often neglected. In order to identify the major gaps and strengths in current knowledge, a literature review has been performed on existing methodologies to estimate air pollution-related health impacts and subsequent external costs. Based on this review, the Impact Pathway Approach was adopted and applied within the context of the MAPLIA research project to assess the health impacts and benefits (or avoided external costs) derived from improvements in air quality. Seven emission abatement scenarios, based on individual and combined abatement measures, were tested for the major activity sectors (traffic, residential and industrial combustion and production processes) of a Portuguese urban area (Grande Porto) with severe particular matter (PM10) air pollution problems. Results revealed a strong positive correlation between population density and health benefits obtained from the assessed reduction scenarios. As a consequence, potential health benefits from reduction scenarios are largest in densely populated areas with high anthropic activity and, thus, where air pollution problems are most alarming. Implementation of all measures resulted in a reduction in PM10 emissions by almost 8%, improving air quality by about 1% and contributing to a benefit of 8.8 million €/year for the entire study domain. The introduction of PM10 reduction technologies in industrial units was the most beneficial abatement measure. This study intends to contribute to policy support for decision-making on air quality management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Montessori-based activities among persons with late-stage dementia: Evaluation of mental and behavioral health outcomes.

PubMed

Wilks, Scott E; Boyd, P August; Bates, Samantha M; Cain, Daphne S; Geiger, Jennifer R

2017-01-01

Objectives Literature regarding Montessori-based activities with older adults with dementia is fairly common with early stages of dementia. Conversely, research on said activities with individuals experiencing late-stage dementia is limited because of logistical difficulties in sampling and data collection. Given the need to understand risks and benefits of treatments for individuals with late-stage dementia, specifically regarding their mental and behavioral health, this study sought to evaluate the effects of a Montessori-based activity program implemented in a long-term care facility. Method Utilizing an interrupted time series design, trained staff completed observation-based measures for 43 residents with late-stage dementia at three intervals over six months. Empirical measures assessed mental health (anxiety, psychological well-being, quality of life) and behavioral health (problem behaviors, social engagement, capacity for activities of daily living). Results Group differences were observed via repeated measures ANOVA and paired-samples t-tests. The aggregate, longitudinal results-from baseline to final data interval-for the psychological and behavioral health measures were as follows: problem behaviors diminished though not significantly; social engagement decreased significantly; capacities for activities of daily living decreased significantly; quality of life increased slightly but not significantly; anxiety decreased slightly but not significantly; and psychological well-being significantly decreased. Conclusion Improvements observed for quality of life and problem behaviors may yield promise for Montessori-based activities and related health care practices. The rapid physiological and cognitive deterioration from late-stage dementia should be considered when interpreting these results.

A Unified Approach for Reporting ARM Measurement Uncertainties Technical Report

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

Campos, E; Sisterson, Douglas

The U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility is observationally based, and quantifying the uncertainty of its measurements is critically important. With over 300 widely differing instruments providing over 2,500 datastreams, concise expression of measurement uncertainty is quite challenging. The ARM Facility currently provides data and supporting metadata (information about the data or data quality) to its users through a number of sources. Because the continued success of the ARM Facility depends on the known quality of its measurements, the Facility relies on instrument mentors and the ARM Data Quality Office (DQO) to ensure, assess,more » and report measurement quality. Therefore, an easily accessible, well-articulated estimate of ARM measurement uncertainty is needed. Note that some of the instrument observations require mathematical algorithms (retrievals) to convert a measured engineering variable into a useful geophysical measurement. While those types of retrieval measurements are identified, this study does not address particular methods for retrieval uncertainty. As well, the ARM Facility also provides engineered data products, or value-added products (VAPs), based on multiple instrument measurements. This study does not include uncertainty estimates for those data products. We propose here that a total measurement uncertainty should be calculated as a function of the instrument uncertainty (calibration factors), the field uncertainty (environmental factors), and the retrieval uncertainty (algorithm factors). The study will not expand on methods for computing these uncertainties. Instead, it will focus on the practical identification, characterization, and inventory of the measurement uncertainties already available in the ARM community through the ARM instrument mentors and their ARM instrument handbooks. As a result, this study will address the first steps towards reporting ARM measurement uncertainty: 1) identifying how the uncertainty of individual ARM measurements is currently expressed, 2) identifying a consistent approach to measurement uncertainty, and then 3) reclassifying ARM instrument measurement uncertainties in a common framework.« less

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.

The impact of socio-economic status on health related quality of life for children and adolescents with heart disease.

PubMed

Cassedy, Amy; Drotar, Dennis; Ittenbach, Richard; Hottinger, Shawna; Wray, Jo; Wernovsky, Gil; Newburger, Jane W; Mahony, Lynn; Mussatto, Kathleen; Cohen, Mitchell I; Marino, Bradley S

2013-06-18

Socioeconomic status (SES) is known to influence children's health-related quality of life. Many SES indicators assess distinct dimensions of a family's position rather than measuring the same underlying construct. Many researchers, however, see SES indicators as interchangeable. The primary aim of this study was to determine which measure of SES had the strongest impact on health-related quality of life. This is a secondary analysis of the Pediatric Cardiac Quality of Life Inventory Validation Study. The SES variables were family income, Hollingshead Index (occupational prestige), and highest parent educational attainment level. Health-related quality of life was measured using the Pediatric Cardiac Quality of Life Inventory. Correlations tested the relationship among the three SES indicators. Regression-based modeling was used to calculate the strength of the association between SES measures and the Pediatric Cardiac Quality of Life Inventory. The correlations among the SES measures were moderately high, with the correlation between the Hollingshead Index and parental education being r = 0.62 (95% CI = 0.56-0.65). There were equally high correlations between family income and the Hollingshead (r = 0.61, 95% CI = 0.57-0.65) and a slightly lower correlation between family income and parental education (r = 0.55, 95% CI = 0.52-0.59). Family income had the highest explanatory value compared to the Hollingshead Index or parental educational attainment, while controlling for sex, race, current cardiac status, and original diagnosis, accounting for 4-5% of the variation in patient and parent Pediatric Cardiac Quality of Life Inventory Total score, respectively, compared to the other SES measures. Family income as an SES measure demonstrated the greatest fidelity with respect to health-related quality of life as measured by the Pediatric Cardiac Quality of Life Inventory across respondent groups and explained more of the variation compared to the Hollingshead Index or highest parental educational attainment.

The impact of socio-economic status on health related quality of life for children and adolescents with heart disease

PubMed Central

2013-01-01

Background Socioeconomic status (SES) is known to influence children’s health-related quality of life. Many SES indicators assess distinct dimensions of a family’s position rather than measuring the same underlying construct. Many researchers, however, see SES indicators as interchangeable. The primary aim of this study was to determine which measure of SES had the strongest impact on health-related quality of life. Methods This is a secondary analysis of the Pediatric Cardiac Quality of Life Inventory Validation Study. The SES variables were family income, Hollingshead Index (occupational prestige), and highest parent educational attainment level. Health-related quality of life was measured using the Pediatric Cardiac Quality of Life Inventory. Correlations tested the relationship among the three SES indicators. Regression-based modeling was used to calculate the strength of the association between SES measures and the Pediatric Cardiac Quality of Life Inventory. Results The correlations among the SES measures were moderately high, with the correlation between the Hollingshead Index and parental education being r = 0.62 (95% CI = 0.56-0.65). There were equally high correlations between family income and the Hollingshead (r = 0.61, 95% CI = 0.57-0.65) and a slightly lower correlation between family income and parental education (r = 0.55, 95% CI = 0.52-0.59). Family income had the highest explanatory value compared to the Hollingshead Index or parental educational attainment, while controlling for sex, race, current cardiac status, and original diagnosis, accounting for 4-5% of the variation in patient and parent Pediatric Cardiac Quality of Life Inventory Total score, respectively, compared to the other SES measures. Conclusion Family income as an SES measure demonstrated the greatest fidelity with respect to health-related quality of life as measured by the Pediatric Cardiac Quality of Life Inventory across respondent groups and explained more of the variation compared to the Hollingshead Index or highest parental educational attainment. PMID:23777248

Are you good enough for your patients? The European certification model in laparoscopic surgery

PubMed Central

Campo, R.; Molinas, C.R.; De Wilde, R.L.; Brolmann, H.; Brucker, S.; Mencaglia, L.; Odonovan, P.; Wallwiener, D.; Wattiez, A.

2012-01-01

Quality control, training and education in gynaecological surgery are challenged and urgent measures are emerging. The implementation of a structured and validated program for training and quality control seems the most urgent measurement to be taken. The European Academy of Gynaecological Surgery has made a first attempt to do so. Through a practical and theoretical tests system, the skills of an individual surgeon is measured and the conditions to enter the different level of expertise are clearly defined. This certification system based on the best possible level of scientific evidence provides a first practical tool, universally implementable for a decent quality control and structured training program in Gynaecological laparoscopic surgery. PMID:24753896

Validating a Web-based Diabetes Education Program in continuing nursing education: knowledge and competency change and user perceptions on usability and quality

PubMed Central

2014-01-01

Background Nurses as the members of health care professionals need to improve their knowledge and competencies particularly in diabetes mellitus through continuing nursing education programs. E-learning is an indirect method of training that can meet nurses’ educational needs. This study is aimed at validating a web-based diabetes education program through measurement of nurses’ knowledge and clinical competency in diabetes and nurses’ perception about its usability and quality. Methods This Quasi-experimental research was conducted on a single group of 31 nurses employed in hospitals affiliated with Shiraz University of Medical Sciences. We used a 125 MCQ knowledge test and Objective Structured Clinical Exam (OSCE) to measure knowledge and clinical competency of nurses in diabetes before and after intervention. A Learning Management System (LMS) was designed to provide educational content in the form of 12 multimedia electronic modules, interactive tests; a forum and learning activities. Nurses were trained for two months in this system after which the post-test was administered. Each nurse completed two questionnaires for measurement of their perceptions on usability and quality. We used descriptive statistics for demographic and descriptive data analysis. Paired t-test was used to compare pre- and post-data using SPSS. Results The findings showed significant differences in knowledge scores (p < 0.001), total score of clinical competencies (p < 0.001), and all ten assessed clinical competencies. The range of ratings given by participants varied on the six usability variables of Web-based training (2.96-4.23 from 5) and eight quality variables of Web-based training (3.58-4.37 from 5). Conclusion Web-based education increased nurses’ knowledge and competencies in diabetes. They positively evaluated Web-based learning usability and quality. It is hoped that this course will have a positive clinical outcomes. PMID:26086025

Validating a Web-based Diabetes Education Program in continuing nursing education: knowledge and competency change and user perceptions on usability and quality.

PubMed

Moattari, Marzieh; Moosavinasab, Elham; Dabbaghmanesh, Mohammad Hossein; ZarifSanaiey, Nahid

2014-01-01

Nurses as the members of health care professionals need to improve their knowledge and competencies particularly in diabetes mellitus through continuing nursing education programs. E-learning is an indirect method of training that can meet nurses' educational needs. This study is aimed at validating a web-based diabetes education program through measurement of nurses' knowledge and clinical competency in diabetes and nurses' perception about its usability and quality. This Quasi-experimental research was conducted on a single group of 31 nurses employed in hospitals affiliated with Shiraz University of Medical Sciences. We used a 125 MCQ knowledge test and Objective Structured Clinical Exam (OSCE) to measure knowledge and clinical competency of nurses in diabetes before and after intervention. A Learning Management System (LMS) was designed to provide educational content in the form of 12 multimedia electronic modules, interactive tests; a forum and learning activities. Nurses were trained for two months in this system after which the post-test was administered. Each nurse completed two questionnaires for measurement of their perceptions on usability and quality. We used descriptive statistics for demographic and descriptive data analysis. Paired t-test was used to compare pre- and post-data using SPSS. The findings showed significant differences in knowledge scores (p < 0.001), total score of clinical competencies (p < 0.001), and all ten assessed clinical competencies. The range of ratings given by participants varied on the six usability variables of Web-based training (2.96-4.23 from 5) and eight quality variables of Web-based training (3.58-4.37 from 5). Web-based education increased nurses' knowledge and competencies in diabetes. They positively evaluated Web-based learning usability and quality. It is hoped that this course will have a positive clinical outcomes.

Two approaches to improving mental health care: positivist/quantitative versus skill-based/qualitative.

PubMed

Luchins, Daniel

2012-01-01

The quality improvement model currently used in medicine and mental health was adopted from industry, where it developed out of early 20th-century efforts to apply a positivist/quantitative agenda to improving manufacturing. This article questions the application of this model to mental health care. It argues that (1) developing "operational definitions" for something as value-laden as "quality" risks conflating two realms, what we measure with what we value; (2) when measurements that are tied to individuals are aggregated to establish benchmarks and goals, unwarranted mathematical assumptions are made; (3) choosing clinical outcomes is problematic; (4) there is little relationship between process measures and clinical outcomes; and (5) since changes in quality indices do not relate to improved clinical care, management's reliance on such indices provides an illusory sense of control. An alternative model is the older, skill-based/qualitative approach to knowing, which relies on "implicit/ expert" knowledge. These two approaches offer a series of contrasts: quality versus excellence, competence versus expertise, management versus leadership, extrinsic versus intrinsic rewards. The article concludes that we need not totally dispense with the current quality improvement model, but rather should balance quantitative efforts with the older qualitative approach in a mixed methods model.

Palliative care consultation, quality-of-life measurements, and bereavement for end-of-life care in patients with lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).

PubMed

Griffin, John P; Koch, Kathryn A; Nelson, Judith E; Cooley, Mary E

2007-09-01

To develop clinical practice guidelines for application of palliative care consultation, quality-of-life measurements, and appropriate bereavement activities for patients with lung cancer. To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary discussions with authorities in these areas, and evolving written guidelines for end-of-life care of these patients. Palliative care consultation has developed into a new specialty with credentialing of experts in this field based on extensive experience with patients in end-of-life circumstances including those with lung cancer. Bereavement studies of the physical and emotional morbidity of family members and caregivers before, during, and after the death of a cancer patient have supported truthful communication, consideration of psychological problems, effective palliative care, understanding of the patient's spiritual and cultural background, and sufficient forewarning of impending death. Multidisciplinary investigations and experiences, with emphasis on consultation and delivery of palliative care, timely use of quality-of-life measurements for morbidities of treatment modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement process, have clarified additional responsibilities of the attending physician.

Machine vision system for measuring conifer seedling morphology

NASA Astrophysics Data System (ADS)

Rigney, Michael P.; Kranzler, Glenn A.

1995-01-01

A PC-based machine vision system providing rapid measurement of bare-root tree seedling morphological features has been designed. The system uses backlighting and a 2048-pixel line- scan camera to acquire images with transverse resolutions as high as 0.05 mm for precise measurement of stem diameter. Individual seedlings are manually loaded on a conveyor belt and inspected by the vision system in less than 0.25 seconds. Designed for quality control and morphological data acquisition by nursery personnel, the system provides a user-friendly, menu-driven graphical interface. The system automatically locates the seedling root collar and measures stem diameter, shoot height, sturdiness ratio, root mass length, projected shoot and root area, shoot-root area ratio, and percent fine roots. Sample statistics are computed for each measured feature. Measurements for each seedling may be stored for later analysis. Feature measurements may be compared with multi-class quality criteria to determine sample quality or to perform multi-class sorting. Statistical summary and classification reports may be printed to facilitate the communication of quality concerns with grading personnel. Tests were conducted at a commercial forest nursery to evaluate measurement precision. Four quality control personnel measured root collar diameter, stem height, and root mass length on each of 200 conifer seedlings. The same seedlings were inspected four times by the machine vision system. Machine stem diameter measurement precision was four times greater than that of manual measurements. Machine and manual measurements had comparable precision for shoot height and root mass length.

Definition, measurement, and correlates of quality of life in nursing homes: toward a reasonable practice, research, and policy agenda.

PubMed

Kane, Rosalie A

2003-04-01

This article identifies challenges in defining, measuring, and studying quality of life of nursing home residents. A theoretical analysis was conducted based on literature and the author's own large-scale studies of quality of life of nursing home residents. Measuring quality of life is a relatively low priority in nursing homes because of focus on markers of poor quality of care, pervasive sense that nursing homes are powerless to influence quality of life, and impatience with research among those dedicated to culture change. The research argues that the resident voice must be sought in reaching operational definitions for quality of life and as reporters on the quality of their own lives, and that resident burden is a spurious concern that should not deter direct interviews with residents. Five challenges in measuring quality of life were identified: (a) designing questions with appropriate response categories and time frames, (b) developing a sampling strategy, (c) aggregating information at the individual and facility level, (d) validating what are ultimately subjective constructs, and (e) developing an approach using observations and proxies to assess quality of life for approximately the 40% of the residents who will be impossible to interview. Although residents' perceived quality of life is partly a product of their health, social supports, and personalities, nursing homes can directly influence quality of life through their policies, practices, and environments, and, indirectly, through their approaches to family and community. A research agenda is needed, which includes both methodological research and studies of the correlates of quality of life.

Qualification process of CR system and quantification of digital image quality

NASA Astrophysics Data System (ADS)

Garnier, P.; Hun, L.; Klein, J.; Lemerle, C.

2013-01-01

CEA Valduc uses several X-Ray generators to carry out many inspections: void search, welding expertise, gap measurements, etc. Most of these inspections are carried out on silver based plates. For several years, the CEA/Valduc has decided to qualify new devices such as digital plates or CCD/flat panel plates. On one hand, the choice of this technological orientation is to forecast the assumed and eventual disappearance of silver based plates; on the other hand, it is also to keep our skills mastering up-to-date. The main improvement brought by numerical plates is the continuous progress of the measurement accuracy, especially with image data processing. It is now common to measure defects thickness or depth position within a part. In such applications, data image processing is used to obtain complementary information compared to scanned silver based plates. This scanning procedure is harmful for measurements which imply a data corruption of the resolution, the adding of numerical noise and is time expensive. Digital plates enable to suppress the scanning procedure and to increase resolution. It is nonetheless difficult to define, for digital images, single criteria for the image quality. A procedure has to be defined in order to estimate quality of the digital data itself; the impact of the scanning device and the configuration parameters are also to be taken into account. This presentation deals with the qualification process developed by CEA/Valduc for digital plates (DUR-NDT) based on the study of quantitative criteria chosen to define a direct numerical image quality that could be compared with scanned silver based pictures and the classical optical density. The versatility of the X-Ray parameters is also discussed (X-ray tension, intensity, time exposure). The aim is to be able to transfer the year long experience of CEA/Valduc with silver-based plates inspection to these new digital plates supports. This is an industrial stake.

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

Physical activity is Associated with Reduced Fatigue in Adults Living with HIV/AIDS

PubMed Central

Perazzo, Joe; Decker, Michael; Horvat-Davey, Christine; Sattar, Abdus; Voss, Joachim

2016-01-01

Aims To describe the relationships among home-based physical activity, fatigue, sleep, gender and quality of life in people living with HIV/AIDS Background Fatigue is a common and distressing symptom among people living with HIV/AIDS. Few interventions exist that effectively reduce fatigue in this population. Physical activity has shown promise to reduce fatigue in other populations, but its impact on fatigue in HIV/AIDS has not yet been explored. Design This study was conducted using a prospective, descriptive cohort design. Methods Overall, 90 adults living with HIV/AIDS completed cross-sectional measures. Home-based physical activity was measured using a seven-day self-report diary. Fatigue was measured using the self-reported HIV-Related Fatigue Scale. Sleep was assessed using wrist actigraphy and quality of life was assessed using the HIV-Associated Quality of Life Scale. Data were collected from December 2012 – April 2013 and analyzed using correlations and multiple linear regression. Results The number of minutes of home-based physical activity was significantly associated with reduced fatigue among people living with HIV/AIDS. Additionally, increased fatigue was associated with decreased quality of life. No associations were found among fatigue, sleep or gender. Conclusions Our study demonstrates that physical activity in the home setting is an effective strategy to reduce fatigue among people living with HIV/AIDS. Future work developing and testing interventions to improve home-based physical activity in this population is needed. PMID:27485463

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

PubMed

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

2014-08-01

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

Aspects of Quality of Life in Adults Diagnosed with Autism in Childhood: A Population-Based Study

ERIC Educational Resources Information Center

Billstedt, Eva; Gillberg, I. Carina; Gillberg, Christopher

2011-01-01

The present study is a long-term prospective follow-up study of a population-based cohort of 120 individuals diagnosed with autism in childhood, followed into late adolescence/early adulthood. Specific aims of the study were to attempt to measure and study social aspects/quality of life in those 108 individuals with autism alive and available for…

Selenium transport and bioaccumulation in aquatic ecosystems: a proposal for water quality criteria based on hydrological units.

Treesearch

A. Dennis Lemly

1999-01-01

Local water quality criteria for selenium should be based on an assessment of the degree of toxicological hazard to fish and wildlife, which is influenced by the spatial and temporal variation of the selenium cycle at the site under consideration. The physical area from which measurements are taken to evaluate selenium residues and biological effects, i.e., the...

Investigating the Quality of Project-Based Science and Technology Learning Environments in Elementary School: A Critical Review of Instruments

ERIC Educational Resources Information Center

Thys, Miranda; Verschaffel, Lieven; Van Dooren, Wim; Laevers, Ferre

2016-01-01

This paper provides a systematic review of instruments that have the potential to measure the quality of project-based science and technology (S&T) learning environments in elementary school. To this end, a comprehensive literature search was undertaken for the large field of S&T learning environments. We conducted a horizontal bottom-up…

Development of a cloud-based application for the Fracture Liaison Service model of care.

PubMed

Holzmueller, C G; Karp, S; Zeldow, D; Lee, D B; Thompson, D A

2016-02-01

The aims of this study are to develop a cloud-based application of the Fracture Liaison Service for practitioners to coordinate the care of osteoporotic patients after suffering primary fractures and provide a performance feedback portal for practitioners to determine quality of care. The application provides continuity of care, improved patient outcomes, and reduced medical costs. The purpose of this study is to describe the content development and functionality of a cloud-based application to broadly deploy the Fracture Liaison Service (FLS) to coordinate post-fracture care for osteoporotic patients. The Bone Health Collaborative developed the FLS application in 2013 to support practitioners' access to information and management of patients and provide a feedback portal for practitioners to track their performance in providing quality care. A five-step protocol (identify, inform, initiate, investigate, and iterate) organized osteoporotic post-fracture care-related tasks and timelines for the application. A range of descriptive data about the patient, their medical condition, therapies and care, and current providers can be collected. Seven quality of care measures from the National Quality Forum, The Joint Commission, and the Centers for Medicare and Medicaid Services can be tracked through the application. There are five functional areas including home, tasks, measures, improvement, and data. The home, tasks, and data pages are used to enter patient information and coordinate care using the five-step protocol. Measures and improvement pages are used to enter quality measures and provide practitioners with continuous performance feedback. The application resides within a portal, running on a multitenant, private cloud-based Avedis enterprise registry platform. All data are encrypted in transit and users access the application using a password from any common web browser. The application could spread the FLS model of care across the US health care system, provide continuity of care, effectively manage osteoporotic patients, improve outcomes, and reduce medical costs.

Cloud Properties Derived from Surface-Based Near-Infrared Spectral Transmission

NASA Technical Reports Server (NTRS)

Pilewskie, Peter; Twomey, S.; Gore, Warren J. Y. (Technical Monitor)

1996-01-01

Surface based near-infrared cloud spectral transmission measurements from a recent precipitation/cloud physics field study are used to determine cloud physical properties and relate them to other remote sensing and in situ measurements. Asymptotic formulae provide an effective means of closely approximating the qualitative and quantitative behavior of transmission computed by more laborious detailed methods. Relationships derived from asymptotic formulae are applied to measured transmission spectra to test objectively the internal consistency of data sets acquired during the field program and they confirmed the quality of the measurements. These relationships appear to be very useful in themselves, not merely as a quality control measure, but also a potentially valuable remote-sensing technique in its own right. Additional benefits from this analysis have been the separation of condensed water (cloud) transmission and water vapor transmission and the development of a method to derive cloud liquid water content.

How Can We Improve Outcomes for Patients and Families Under Palliative Care? Implementing Clinical Audit for Quality Improvement in Resource Limited Settings

PubMed Central

Selman, Lucy; Harding, Richard

2010-01-01

Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach). The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step. PMID:20859465

Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

PubMed Central

Winblad, Neal E.; Changaris, Michael; Stein, Phyllis K.

2018-01-01

Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE®) is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS) dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life) and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat. Materials and Methods: This within-groups, longitudinal study assessed students (N = 18) over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF), psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS), as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire). The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning. Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p < 0.001) and somatization symptoms (PHQ15, p < 0.001). Health-related quality of life (a measure of physical well-being) and social quality of life (a measure of interpersonal well-being) both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046). Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant improvement in self-reported measures associated with resiliency including: quality of life (well-being) and psychological symptoms (anxiety and somatization). Our results support the importance of future research in a larger sample and support the exploration, cross-sectionally and prospectively, of the relationship of clinician resiliency and changes in clinician resiliency with SE® training and clinical outcomes. These data have implications for other professions at risk of exposure to vicarious trauma (VT) including nurses, medical providers, and paramedics. PMID:29503607

Quality of service routing in the differentiated services framework

NASA Astrophysics Data System (ADS)

Oliveira, Marilia C.; Melo, Bruno; Quadros, Goncalo; Monteiro, Edmundo

2001-02-01

In this paper we present a quality of service routing strategy for network where traffic differentiation follows the class-based paradigm, as in the Differentiated Services framework. This routing strategy is based on a metric of quality of service. This metric represents the impact that delay and losses verified at each router in the network have in application performance. Based on this metric, it is selected a path for each class according to the class sensitivity to delay and losses. The distribution of the metric is triggered by a relative criterion with two thresholds, and the values advertised are the moving average of the last values measured.

QA/QC in the laboratory

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

Hood, F.C.

1992-05-01

Quality assurance and quality control (QA/QC) of analytical chemistry laboratory activities are essential to the validity and usefulness of resultant data. However, in themselves, conventional QA/QC measures will not always ensure that fraudulent data are not generated. Conventional QA/QC measures are based on the assumption that work will be done in good faith; to assure against fraudulent practices, QA/QC measures must be tailored to specific analyses protocols in anticipation of intentional misapplication of those protocols. Application of specific QA/QC measures to ensure against fraudulent practices result in an increased administrative burden being placed on the analytical process; accordingly, in keepingmore » with graded QA philosophy, data quality objectives must be used to identify specific points of concern for special control to minimize the administrative impact.« less

QA/QC in the laboratory. Session F

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

Hood, F.C.

1992-05-01

Quality assurance and quality control (QA/QC) of analytical chemistry laboratory activities are essential to the validity and usefulness of resultant data. However, in themselves, conventional QA/QC measures will not always ensure that fraudulent data are not generated. Conventional QA/QC measures are based on the assumption that work will be done in good faith; to assure against fraudulent practices, QA/QC measures must be tailored to specific analyses protocols in anticipation of intentional misapplication of those protocols. Application of specific QA/QC measures to ensure against fraudulent practices result in an increased administrative burden being placed on the analytical process; accordingly, in keepingmore » with graded QA philosophy, data quality objectives must be used to identify specific points of concern for special control to minimize the administrative impact.« less

Derivation of freshwater quality criteria for zinc using interspecies correlation estimation models to protect aquatic life in China.

PubMed

Feng, C L; Wu, F C; Dyer, S D; Chang, H; Zhao, X L

2013-01-01

Species sensitivity distributions (SSDs) are usually used in the development of water quality criteria and require a large number of toxicity values to define a hazard level to protect the majority of species. However, some toxicity data for certain chemicals are limited, especially for endangered and threatened species. Thus, it is important to predict the unknown species toxicity data using available toxicity data. To address this need, interspecies correlation estimation (ICE) models were developed by US EPA to predict acute toxicity of chemicals to diverse species based on a more limited data set of surrogate species toxicity data. Use of SSDs generated from ICE models allows for the prediction of protective water quality criteria, such as the HC5 (hazard concentration, 5th percentile). In the present study, we tested this concept using toxicity data collected for zinc. ICE-based-SSDs were generated using three surrogate species (common carp (Cyprinus carpio), rainbow trout (Oncorhynchus mykiss), and Daphnia magna) and compared with the measured-based SSD and corresponding HC5. The results showed that no significant differences were observed between the ICE- and the measured-based SSDs and HC5s. Furthermore, the examination of species placements within the SSDs indicated that the most sensitive species to zinc were invertebrates, especially crustaceans. Given the similarity of SSD and HC5s for zinc, the use of ICE to derive potential water quality criteria for diverse chemicals in China is proposed. Further, a combination of measured and ICE-derived data will prove useful for assessing water quality and chemical risks in the near future. Copyright © 2012 Elsevier Ltd. All rights reserved.

Development of pig welfare assessment protocol integrating animal-, environment-, and management-based measures.

PubMed

Renggaman, Anriansyah; Choi, Hong L; Sudiarto, Sartika Ia; Alasaarela, Laura; Nam, Ok S

2015-01-01

Due to increased interest in animal welfare, there is now a need for a comprehensive assessment protocol to be used in intensive pig farming systems. There are two current welfare assessment protocols for pigs: Welfare Quality® Assessment Protocols (applicable in the Europe Union), that mostly focuses on animal-based measures, and the Swine Welfare Assurance Program (applicable in the United States), that mostly focuses on management- and environment-based measures. In certain cases, however, animal-based measures might not be adequate for properly assessing pig welfare status. Similarly, welfare assessment that relies only on environment- and management-based measures might not represent the actual welfare status of pigs. Therefore, the objective of this paper was to develop a new welfare protocol by integrating animal-, environment-, and management-based measures. The background for selection of certain welfare criteria and modification of the scoring systems from existing welfare assessment protocols are described. The developed pig welfare assessment protocol consists of 17 criteria that are related to four main principles of welfare (good feeding, good housing, good health, and appropriate behavior). Good feeding, good housing, and good health were assessed using a 3-point scale: 0 (good welfare), 1 (moderate welfare), and 2 (poor welfare). In certain cases, only a 2-point scale was used: 0 (certain condition is present) or 2 (certain condition is absent). Appropriate behavior was assessed by scan sampling of positive and negative social behaviors based on qualitative behavior assessment and human-animal relationship tests. Modification of the body condition score into a 3-point scale revealed pigs with a moderate body condition (score 1). Moreover, additional criteria such as feed quality confirmed that farms had moderate (score 1) or poor feed quality (score 2), especially those farms located in a high relative humidity region. The developed protocol can be utilized to assess welfare status in an intensive pig farming system. Although further improvements are still needed, this study is a first step in developing a pig welfare assessment protocol that combines animal-, environment-, and management-based measures.

British Thoracic Society quality standards for the investigation and management of pulmonary nodules.

PubMed

Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian

2018-01-01

The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations.