Performance of biometric quality measures.
Grother, Patrick; Tabassi, Elham
2007-04-01
We document methods for the quantitative evaluation of systems that produce a scalar summary of a biometric sample's quality. We are motivated by a need to test claims that quality measures are predictive of matching performance. We regard a quality measurement algorithm as a black box that converts an input sample to an output scalar. We evaluate it by quantifying the association between those values and observed matching results. We advance detection error trade-off and error versus reject characteristics as metrics for the comparative evaluation of sample quality measurement algorithms. We proceed this with a definition of sample quality, a description of the operational use of quality measures. We emphasize the performance goal by including a procedure for annotating the samples of a reference corpus with quality values derived from empirical recognition scores.
Chief Complaint-Based Performance Measures: A New Focus For Acute Care Quality Measurement
Griffey, Richard T; Pines, Jesse M.; Farley, Heather L.; Phelan, Michael P; Beach, Christopher; Schuur, Jeremiah D; Venkatesh, Arjun K.
2014-01-01
Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Disease Classification (ICD)-9 codes in administrative claims data. While the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care which involves diagnosing, risk-stratifying, and treating patients’ potentially life-threatening conditions based on symptoms (i.e. chief complaints). In this paper we propose chief complaint-based quality measures as a means to enhance the evaluation of quality and value in emergency care. We discuss the potential benefits of chief-complaint based measures, describe opportunities to mitigate challenges, propose an example measure set, and present several recommendations to advance this paradigm in ED-based performance measurement. PMID:25443989
Performance measurement in surgery through the National Quality Forum.
Hyder, Joseph A; Roy, Nathalie; Wakeam, Elliot; Hernandez, Roland; Kim, Simon P; Bader, Angela M; Cima, Robert R; Nguyen, Louis L
2014-11-01
Performance measurement has become central to surgical practice. We systematically reviewed all endorsed performance measures from the National Quality Forum, the national clearing house for performance measures in health care, to identify measures relevant to surgical practice and describe measure stewardship, measure types, and identify gaps in measurement. Performance measures current to June 2014 were categorized by denominator statement as either assessing surgical practice in specific or as part of a mixed medical and surgical population. Measures were further classified by surgical specialty, Donabedian measure type, patients, disease and events targeted, reporting eligibility, and measure stewards. Of 637 measures, 123 measures assessed surgical performance in specific and 123 assessed surgical performance in aggregate. Physician societies (51 of 123, 41.5%) were more common than government agencies (32 of 123, 26.0%) among measure stewards for surgical measures, in particular, the Society for Thoracic Surgery (n = 32). Outcomes measures rather than process measures were common among surgical measures (62 of 123, 50.4%) compared with aggregate medical/surgical measures (46 of 123, 37.4%). Among outcomes measures, death alone was the most commonly specified outcome (24 of 62, 38.7%). Only 1 surgical measure addressed patient-centered care and only 1 measure addressed hospital readmission. We found 7 current surgical measures eligible for value-based purchasing. Surgical society stewards and outcomes measure types, particularly for cardiac surgery, were well represented in the National Quality Forum. Measures addressing patient-centered outcomes and the value of surgical decision-making were not well represented and may be suitable targets for measure innovation. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G
2010-01-01
Objective To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. PMID:20403064
A proteomics performance standard to support measurement quality in proteomics.
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.
National Quality Forum Colon Cancer Quality Metric Performance: How Are Hospitals Measuring Up?
Mason, Meredith C; Chang, George J; Petersen, Laura A; Sada, Yvonne H; Tran Cao, Hop S; Chai, Christy; Berger, David H; Massarweh, Nader N
2017-12-01
To evaluate the impact of care at high-performing hospitals on the National Quality Forum (NQF) colon cancer metrics. The NQF endorses evaluating ≥12 lymph nodes (LNs), adjuvant chemotherapy (AC) for stage III patients, and AC within 4 months of diagnosis as colon cancer quality indicators. Data on hospital-level metric performance and the association with survival are unclear. Retrospective cohort study of 218,186 patients with resected stage I to III colon cancer in the National Cancer Data Base (2004-2012). High-performing hospitals (>75% achievement) were identified by the proportion of patients achieving each measure. The association between hospital performance and survival was evaluated using Cox shared frailty modeling. Only hospital LN performance improved (15.8% in 2004 vs 80.7% in 2012; trend test, P < 0.001), with 45.9% of hospitals performing well on all 3 measures concurrently in the most recent study year. Overall, 5-year survival was 75.0%, 72.3%, 72.5%, and 69.5% for those treated at hospitals with high performance on 3, 2, 1, and 0 metrics, respectively (log-rank, P < 0.001). Care at hospitals with high metric performance was associated with lower risk of death in a dose-response fashion [0 metrics, reference; 1, hazard ratio (HR) 0.96 (0.89-1.03); 2, HR 0.92 (0.87-0.98); 3, HR 0.85 (0.80-0.90); 2 vs 1, HR 0.96 (0.91-1.01); 3 vs 1, HR 0.89 (0.84-0.93); 3 vs 2, HR 0.95 (0.89-0.95)]. Performance on metrics in combination was associated with lower risk of death [LN + AC, HR 0.86 (0.78-0.95); AC + timely AC, HR 0.92 (0.87-0.98); LN + AC + timely AC, HR 0.85 (0.80-0.90)], whereas individual measures were not [LN, HR 0.95 (0.88-1.04); AC, HR 0.95 (0.87-1.05)]. Less than half of hospitals perform well on these NQF colon cancer metrics concurrently, and high performance on individual measures is not associated with improved survival. Quality improvement efforts should shift focus from individual measures to defining composite measures
The Development of Quality Measures for the Performance and Interpretation of Esophageal Manometry
Yadlapati, Rena; Gawron, Andrew J.; Keswani, Rajesh N.; Bilimoria, Karl; Castell, Donald O.; Dunbar, Kerry B.; Gyawali, Chandra P.; Jobe, Blair A.; Katz, Philip O.; Katzka, David A.; Lacy, Brian E.; Massey, Benson T.; Richter, Joel E.; Schnoll-Sussman, Felice; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.
2016-01-01
Background and Aims Esophageal manometry (EM) is the gold standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of EM result in discrepant diagnoses and unnecessary repeated procedures, and may negatively impact patient outcomes. A method to benchmark the procedural quality of EM is needed. The primary aim of this study was to develop quality measures for performing and interpreting EM. Methods The RAND/University of California, Los Angeles Appropriateness Methodology (RAM) was utilized. Fifteen experts in esophageal manometry were invited to be a part of the panel. Potential quality measures were identified through a literature search and interviews with experts. The expert panel ranked the proposed quality measures for appropriateness via a two-round process on the basis of RAM. Results Fourteen experts participated in all processes. A total of 29 measures were considered; 17 of these measures were ranked as appropriate and related to competency (2), pre-procedure (2), procedure (3) and interpretation (10). The latter 10 were integrated into a single composite measure. Thus, 8 final measures were determined to be appropriate quality measures for EM. Five strong recommendations were also endorsed by the experts, however they were not ranked as appropriate quality measures. Conclusions Eight formally validated quality measures for the performance and interpretation of EM were developed on the basis of RAM. These measures represent key aspects of a high-quality EM study and should be uniformly adopted. Evaluation of these measures in clinical practice is needed to assess their impact on outcomes. PMID:26499925
Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul
2016-02-01
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.
Performance measurement: integrating quality management and activity-based cost management.
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.
Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul
2016-01-01
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients. © Georg Thieme Verlag KG Stuttgart · New York.
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
Health Care Quality: Measuring Obesity in Performance Frameworks.
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.
Schmaltz, Stephen P; Williams, Scott C; Chassin, Mark R; Loeb, Jerod M; Wachter, Robert M
2011-01-01
BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458–465. © 2011 Society of Hospital Medicine PMID:21990175
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
Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care
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
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…
Performance measures and criteria for hydrologic and water quality models
USDA-ARS?s Scientific Manuscript database
Performance measures and criteria are essential for model calibration and validation. This presentation will include a summary of one of the papers that will be included in the 2014 Hydrologic and Water Quality Model Calibration & Validation Guidelines Special Collection of the ASABE Transactions. T...
Correlation of neonatal intensive care unit performance across multiple measures of quality of care.
Profit, Jochen; Zupancic, John A F; Gould, Jeffrey B; Pietz, Kenneth; Kowalkowski, Marc A; Draper, David; Hysong, Sylvia J; Petersen, Laura A
2013-01-01
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. 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. Twenty-two regional NICUs in California. In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. 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. The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (ρ < .05). Correlations between pairs of measures of quality of care were strong (ρ ≥ .5) for 1 pair, moderate (range, ρ ≥ .3 to ρ < .5) for 8 pairs, weak (range, ρ ≥ .1 to 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. In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.
Friedberg, Mark W; Coltin, Kathryn L; Safran, Dana Gelb; Dresser, Marguerite; Zaslavsky, Alan M; Schneider, Eric C
2009-10-06
Recent proposals to reform primary care have encouraged physician practices to adopt such structural capabilities as performance feedback and electronic health records. Whether practices with these capabilities have higher performance on measures of primary care quality is unknown. To measure associations between structural capabilities of primary care practices and performance on commonly used quality measures. Cross-sectional analysis. Massachusetts. 412 primary care practices. During 2007, 1 physician from each participating primary care practice (median size, 4 physicians) was surveyed about structural capabilities of the practice (responses representing 308 practices were obtained). Data on practice structural capabilities were linked to multipayer performance data on 13 Healthcare Effectiveness Data and Information Set (HEDIS) process measures in 4 clinical areas: screening, diabetes, depression, and overuse. Frequently used multifunctional electronic health records were associated with higher performance on 5 HEDIS measures (3 in screening and 2 in diabetes), with statistically significant differences in performance ranging from 3.1 to 7.6 percentage points. Frequent meetings to discuss quality were associated with higher performance on 3 measures of diabetes care (differences ranging from 2.3 to 3.1 percentage points). Physician awareness of patient experience ratings was associated with higher performance on screening for breast cancer and cervical cancer (1.9 and 2.2 percentage points, respectively). No other structural capabilities were associated with performance on more than 1 measure. No capabilities were associated with performance on depression care or overuse. Structural capabilities of primary care practices were assessed by physician survey. Among the investigated structural capabilities of primary care practices, electronic health records were associated with higher performance across multiple HEDIS measures. Overall, the modest magnitude and
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.
ITS data quality control and the calculation of mobility performance measures
DOT National Transportation Integrated Search
2000-09-01
This report describes the results of research on the use of intelligent transportation system (ITS) data in calculating mobility performance measures for ITS operations. The report also describes a data quality control process developed for the Trans...
Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager
2013-08-09
Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and
What can the national quality forum tell us about performance measurement in anesthesiology?
Hyder, Joseph A; Niconchuk, Jonathan; Glance, Laurent G; Neuman, Mark D; Cima, Robert R; Dutton, Richard P; Nguyen, Louis L; Fleisher, Lee A; Bader, Angela M
2015-02-01
Anesthesiologists face increasing pressure to demonstrate the value of the care they provide, whether locally or nationally through public reporting and payor requirements. In this article, we describe the current state of performance measurement in anesthesia care at the national level and highlight gaps and opportunities in performance measurement for anesthesiologists. We evaluated all endorsed performance measures in the National Quality Forum (NQF), the clearinghouse for all federal performance measures, and classified all measures as follows: (1) anesthesia-specific; (2) surgery-specific; (3) jointly attributable; or (4) other. We used NQF-provided descriptors to characterize measures in terms of (1) structure, process, outcome, or efficiency; (2) patients, disease, and events targeted; (3) procedural specialty; (4) reporting eligibility; (5) measures stewards; and (6) timing in the care stream. Of the 637 endorsed performance measures, few (6, 1.0%) were anesthesia-specific. An additional 39 measures (6.1%) were surgery-specific, and 67 others (10.5%) were jointly attributable. "Anesthesia-specific" measures addressed preoperative antibiotic timing (n = 4), normothermia (n = 1), and protocol use for the placement of central venous catheter (n = 1). Jointly attributable measures included outcome measures (n = 49/67, 73.1%), which were weighted toward mortality alone (n = 24) and cardiac surgery (n = 14). Other jointly attributable measures addressed orthopedic surgery (n = 4), general surgical oncologic resections (n = 12), or nonspecified surgeries (n = 15), but none specifically addressed anesthesia care outside the operating room such as for endoscopy. Only 4 measures were eligible for value-based purchasing. No named anesthesiology professional groups were among measure stewards, but surgical professional groups (n = 33/67, 47%) were frequent measure stewards. Few NQF performance measures are specific to anesthesia practice, and none of these appears to
Tarkkanen, Jussi; Geagea, Antoine; Nieminen, Pekka; Anttila, Ahti
2003-01-01
We conducted a quality improvement project in a cervical cancer screening programme in Helsinki in order to see if detection of precancerous lesions could be influenced by external (participation rate) and internal (laboratory praxis) quality measures. In order to increase the participation rate, a second personal invitation to Pap-test was mailed to nonparticipants of the first call. In order to improve the quality of screening, the cytotechnicians monitored their performance longitudinally by recording the number of slides reviewed per day, the pick-up rate of abnormal smears, the report of the consulting cytopathologist, and the number of histologically verified lesions detected from the cases that they had screened. Regular sessions were held to compare the histological findings with the cytological findings of all cases referred for colposcopy. No pressure was applied on the cytotechnicians to ensure that they felt comfortable with their daily workload. A total of 110 000 smears were screened for cervical cancer at the Helsinki City Hospital during 1996-99. Initially, the overall participation rate increased from 62% to 71%. The number of histologically confirmed precancerous lesions (CIN 1-3) more than doubled and their detection rate increased from 0.32% to 0.72%. Continuous education and feedback from daily work performance were important, yet rather inexpensive means in increasing laboratory performance. Additional measures are needed to further increase the participation rate. Impact of the quality measures on cancer incidence needs to be assessed later on.
Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard
2016-04-01
The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.
Soltani, S Abolfazi; Ingolfsson, Armann; Zygun, David A; Stelfox, Henry T; Hartling, Lisa; Featherstone, Robin; Opgenorth, Dawn; Bagshaw, Sean M
2015-11-12
The matching of critical care service supply with demand is fundamental for the efficient delivery of advanced life support to patients in urgent need. Mismatch in this supply/demand relationship contributes to "intensive care unit (ICU) capacity strain," defined as a time-varying disruption in the ability of an ICU to provide well-timed and high-quality intensive care support to any and all patients who are or may become critically ill. ICU capacity strain leads to suboptimal quality of care and may directly contribute to heightened risk of adverse events, premature discharges, unplanned readmissions, and avoidable death. Unrelenting strain on ICU capacity contributes to inefficient health resource utilization and may negatively impact the satisfaction of patients, their families, and frontline providers. It is unknown how to optimally quantify the instantaneous and temporal "stress" an ICU experiences due to capacity strain. We will perform a systematic review to identify, appraise, and evaluate quality and performance measures of strain on ICU capacity and their association with relevant patient-centered, ICU-level, and health system-level outcomes. Electronic databases (i.e., MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and the Agency of Healthcare Research and Quality (AHRQ) - National Quality Measures Clearinghouse (NQMC)) will be searched for original studies of measures of ICU capacity strain. Selected gray literature sources will be searched. Search themes will focus on intensive care, quality, operations management, and capacity. Analysis will be primarily narrative. Each identified measure will be defined, characterized, and evaluated using the criteria proposed by the US Strategic Framework Board for a National Quality Measurement and Reporting System (i.e., importance, scientific acceptability, usability, feasibility). Our systematic review will comprehensively
2013-01-01
Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Methods Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. Results A number of articles addresses this study’s objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, “patients left without being seen” (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. Conclusions A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study’s results allow for advancement
Diagnostic colonoscopy: performance measurement study.
Kuznets, Naomi
2002-07-01
This is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profit quality improvement subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC) (Performance Measurement Initiative, 1999a, 1999b, 2000a, 2000b). The IQI was created to offer clinical performance measurement and improvement opportunities to ambulatory health care organizations and others interested in quality patient care. The purpose of the study was to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure and use this information for clinical quality improvement. This article provides performance measurement information on how organizations that have demonstrated and validated differences in clinical practice can have similar outcomes, but at a dramatically lower cost. The intent of the article is to provide organizations with alternatives in practice to provide a better value to their patients.
NASA Technical Reports Server (NTRS)
Carr, James L.; Madani, Houria
2007-01-01
Geostationary Operational Environmental Satellite (GOES) Image Navigation and Registration (INR) performance is specified at the 3- level, meaning that 99.7% of a collection of individual measurements must comply with specification thresholds. Landmarks are measured by the Replacement Product Monitor (RPM), part of the operational GOES ground system, to assess INR performance and to close the INR loop. The RPM automatically discriminates between valid and invalid measurements enabling it to run without human supervision. In general, this screening is reliable, but a small population of invalid measurements will be falsely identified as valid. Even a small population of invalid measurements can create problems when assessing performance at the 3-sigma level. This paper describes an additional layer of quality control whereby landmarks of the highest quality ("platinum") are identified by their self-consistency. The platinum screening criteria are not simple statistical outlier tests against sigma values in populations of INR errors. In-orbit INR performance metrics for GOES-12 and GOES-13 are presented using the platinum landmark methodology.
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.
Inra, Jennifer A; Nayor, Jennifer; Rosenblatt, Margery; Mutinga, Muthoka; Reddy, Sarathchandra I; Syngal, Sapna; Kastrinos, Fay
2017-04-01
Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown. We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics. This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection. Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p < 0.0001). Preparation quality varied with good/excellent results in 70.6, 88.3, and 92% of TCH, CBH, and PPG cases, respectively (p < 0.0001). Male ADRs, cecal intubation, and WT exceeded recommended benchmarks despite variable results at each site; female ADRs were <15% at the PPG which screened the fewest females. Performance remained unchanged following scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting. Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.
Quality improvement in neurology: AAN Parkinson disease quality measures
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
Daskivich, Timothy J; Houman, Justin; Fuller, Garth; Black, Jeanne T; Kim, Hyung L; Spiegel, Brennan
2018-04-01
Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores. Across ratings platforms, multivariable models showed no significant association between mean consumer ratings and specialty-specific performance scores (β-coefficient range, -0.04, 0.04), primary care physician scores (β-coefficient range, -0.01, 0.3), and administrator scores (β-coefficient range, -0.2, 0.1). There was no association between ratings and score subdomains addressing quality or value-based care. Among physicians in the lowest quartile of specialty-specific performance scores, only 5%-32% had consumer ratings in the lowest quartile across platforms. Ratings were consistent across platforms; a physician's score on one platform significantly predicted his/her score on another in 5 of 10 comparisons. Online ratings of specialist physicians do not predict objective measures of quality of care or peer assessment of clinical performance. Scores are consistent across platforms, suggesting that they jointly measure a latent construct that is unrelated to performance. Online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance.
Pardasaney, Poonam K; Deutsch, Anne; Iriondo-Perez, Jeniffer; Ingber, Melvin J; McMullen, Tara
2018-06-01
To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016. Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability. IRFs. Medicare FFS patients aged ≥21 years (N=4769). Not applicable. Facility-level discharge self-care quality measure performance score. A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%-100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91. The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs. Published by Elsevier Inc.
More quality measures versus measuring what matters: a call for balance and parsimony
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.
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.
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
Measuring Up: Implementing a Dental Quality Measure in the Electronic Health Record Context
Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F
2015-01-01
Background Quality improvement requires quality measures that are validly implementable. In this work, we assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure (percentage of children who received fluoride varnish). Methods We defined how to implement the automated measure queries in a dental electronic health record (EHR). Within records identified through automated query, we manually reviewed a subsample to assess the performance of the query. Results The automated query found 71.0% of patients to have had fluoride varnish compared to 77.6% found using the manual chart review. The automated quality measure performance was 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. Conclusions Our findings support the feasibility of automated dental quality measure queries in the context of sufficient structured data. Information noted only in the free text rather than in structured data would require natural language processing approaches to effectively query. Practical Implications To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation in order to support near-term automated calculation of quality measures. PMID:26562736
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
Quality measurement and improvement in liver transplantation.
Mathur, Amit K; Talwalkar, Jayant
2018-06-01
There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centres. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models. We outline the status quo including the current regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
PERFORMING QUALITY FLOW MEASUREMENTS AT MINE SITES
Accurate flow measurement data is vital to research, monitoring, and remediation efforts at mining sites. This guidebook has been prepared to provide a summary of information relating to the performance of low measurements, and how this information can be applied at mining sites....
Rankin, Kristin M.; Gavin, Loretta; Moran, John W.; Kroelinger, Charlan D.; Vladutiu, Catherine J.; Goodman, David A.; Sappenfield, William M.
2018-01-01
Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists’ contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. PMID:27423235
Rankin, Kristin M; Gavin, Loretta; Moran, John W; Kroelinger, Charlan D; Vladutiu, Catherine J; Goodman, David A; Sappenfield, William M
2016-11-01
Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.
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
Poisson, Sharon N.; Josephson, S. Andrew
2011-01-01
Stroke is a major public health burden, and accounts for many hospitalizations each year. Due to gaps in practice and recommended guidelines, there has been a recent push toward implementing quality measures to be used for improving patient care, comparing institutions, as well as for rewarding or penalizing physicians through pay-for-performance. This article reviews the major organizations involved in implementing quality metrics for stroke, and the 10 major metrics currently being tracked. We also discuss possible future metrics and the implications of public reporting and using metrics for pay-for-performance. PMID:23983840
Cook, T M; Coupe, M; Ku, T
2012-06-01
Measuring outcomes and quality in anaesthesia is challenging. In the UK, there is increased focus on these as a result of changes in Department of Health strategy and the imminent introduction of mandatory revalidation for all doctors. A definition of quality may differ according to the observer's standpoint and numerous performance measures may contribute to overall quality. Patients, surgeons, anaesthetic assistants, recovery nurses, managers, and anaesthetic peers are each likely to have their own perspective on 'anaesthetic quality' and would perhaps suggest different metrics to measure it. Speed, efficiency, cost, interpersonal skills, complication rates, patient recorded outcome measures, and satisfaction are all valid as quality measures, but none alone captures anaesthetic quality. Performance data are frequently presented as single-dimension measurements (e.g. pain, postoperative nausea and vomiting, patient satisfaction), but this does not address the fact that two or more domains may be closely related (e.g. use of regional anaesthesia and quality of analgesia) or in opposition (e.g. use of regional anaesthesia and speed). We introduce the concept of a 'performance polygon' as a tool to represent multidimensional performance assessment. This method of data presentation encourages balanced appraisal of anaesthetic quality. Performance polygons may be used to compare individual performance with peers, published outcome norms, trends in performance over time, to explore aspects of team performance and potentially capture data that are required for medical revalidation. Performance polygons enable easy comparison with any relevant data set and are a visual tool that potentially has wider applications in healthcare quality improvement.
Tkacz, Joseph; Ellis, Lorie A; Meyer, Roxanne; Bolge, Susan C; Brady, Brenna L; Ruetsch, Charles
2015-02-01
Health care quality problems are reflected in the underuse, overuse, and misuse of health care services. There is evidence suggesting that the quality of rheumatoid arthritis (RA) patient care is suboptimal, which has spurred the development of a number of systematic quality improvement metrics. To investigate a quality process measurement set in a sample of commercially insured RA patients. Medical, pharmacy, and laboratory claims for members with an RA diagnosis (ICD-9-CM 714.x) during calendar years 2008 through 2012 were extracted from the Optum Clinformatics Data Mart database. Eight process quality measures focused on RA patient response and tolerance to therapy were examined in the claims database. Measures were calculated for individual calendar years from 2009 to 2012, inclusive. The majority of adult RA patients received at least 1 prescription for a disease-modifying antirheumatic drug (DMARD) across the 4 measurement years: range = 78.5%-81.6%. Erythrocyte sedimentation rate and C-reactive protein testing were also evident in the majority of the sample, with 67.1%-72.2% of newly diagnosed RA patients receiving baseline testing, and 56.0%-58.7% of existing RA patients receiving annual testing. Among methotrexate users, liver function tests were performed in 74.5%-75.7% of treated patients, serum creatinine tests in 70.1%-72.6% of patients, and complete blood count tests in 74.5%-76.0% of patients. Additionally, most patients initiating a new DMARD had a claim for a baseline serum creatinine test (68.0%-70.3%) and baseline liver function test (69.3%-71.0%). Findings suggest that a majority of RA patients are attaining patient quality process measures, although a considerable proportion of patients (approximately 25%) may be receiving suboptimal care. Further studies are warranted to understand whether attainment of these measures translates into better outcomes.
Measuring health care process quality with software quality measures.
Yildiz, Ozkan; Demirörs, Onur
2012-01-01
Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations.
Timbie, Justin W; Bogart, Andy; Damberg, Cheryl L; Elliott, Marc N; Haas, Ann; Gaillot, Sarah J; Goldstein, Elizabeth H; Paddock, Susan M
2017-12-01
To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs. Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9 million beneficiaries living in California, New York, and Florida. We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations. Case mix-adjusted analyses (for measures not typically adjusted) were used to explore the effect of case mix on MA/FFS differences. Performance measures were submitted by MA organizations, obtained from the nationwide fielding of the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Survey, or derived from claims. Overall, MA outperformed FFS on all 16 clinical quality measures. Differences were large for HEDIS measures and small for Part D measures and remained after case mix adjustment. MA enrollees reported better experiences overall, but FFS beneficiaries reported better access to care. Relative to FFS, performance gaps were much wider for HMOs than PPOs. Excluding HEDIS measures, MA/FFS differences were much smaller in contract-level comparisons. Medicare Advantage/Fee-for-Service differences are often large but vary in important ways across types of measures and contracts. © Health Research and Educational Trust.
DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES FOR RESEARCH PROJECTS
The paper provides assistance with systematic planning using measurement quality objectives to those working on research projects. These performance criteria are more familiar to researchers than data quality objectives because they are more closely associated with the measuremen...
Measuring surgical performance: A risky game?
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.
Measuring Software Product Quality: The ISO 25000 Series and CMMI
2004-06-14
performance objectives” covers objectives and requirements for product quality, service quality , and process performance. Process performance objectives...such that product quality, service quality , and process performance attributes are measurable and controlled throughout the project (internal and
The performance measurement manifesto.
Eccles, R G
1991-01-01
The leading indicators of business performance cannot be found in financial data alone. Quality, customer satisfaction, innovation, market share--metrics like these often reflect a company's economic condition and growth prospects better than its reported earnings do. Depending on an accounting department to reveal a company's future will leave it hopelessly mired in the past. More and more managers are changing their company's performance measurement systems to track nonfinancial measures and reinforce new competitive strategies. Five activities are essential: developing an information architecture; putting the technology in place to support this architecture; aligning bonuses and other incentives with the new system; drawing on outside resources; and designing an internal process to ensure the other four activities occur. New technologies and more sophisticated databases have made the change to nonfinancial performance measurement systems possible and economically feasible. Industry and trade associations, consulting firms, and public accounting firms that already have well-developed methods for assessing market share and other performance metrics can add to the revolution's momentum--as well as profit from the business opportunities it presents. Every company will have its own key measures and distinctive process for implementing the change. But making it happen will always require careful preparation, perseverance, and the conviction of the CEO that it must be carried through. When one leading company can demonstrate the long-term advantage of its superior performance on quality or innovation or any other nonfinancial measure, it will change the rules for all its rivals forever.
Measuring up: Implementing a dental quality measure in the electronic health record context.
Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F
2016-01-01
Quality improvement requires using quality measures that can be implemented in a valid manner. Using guidelines set forth by the Meaningful Use portion of the Health Information Technology for Economic and Clinical Health Act, the authors assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure to determine the percentage of children who received fluoride varnish. The authors defined how to implement the automated measure queries in a dental electronic health record. Within records identified through automated query, the authors manually reviewed a subsample to assess the performance of the query. The automated query results revealed that 71.0% of patients had fluoride varnish compared with the manual chart review results that indicated 77.6% of patients had fluoride varnish. The automated quality measure performance results indicated 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. The authors' findings support the feasibility of using automated dental quality measure queries in the context of sufficient structured data. Information noted only in free text rather than in structured data would require using natural language processing approaches to effectively query electronic health records. To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation to support near-term automated calculation of quality measures. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.
Composite Quality Measures for Common Inpatient Medical Conditions
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
Evaluating health service quality: using importance performance analysis.
Izadi, Azar; Jahani, Younes; Rafiei, Sima; Masoud, Ali; Vali, Leila
2017-08-14
Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.
Measurement uncertainty analysis techniques applied to PV performance measurements
NASA Astrophysics Data System (ADS)
Wells, C.
1992-10-01
The purpose of this presentation is to provide a brief introduction to measurement uncertainty analysis, outline how it is done, and illustrate uncertainty analysis with examples drawn from the PV field, with particular emphasis toward its use in PV performance measurements. The uncertainty information we know and state concerning a PV performance measurement or a module test result determines, to a significant extent, the value and quality of that result. What is measurement uncertainty analysis? It is an outgrowth of what has commonly been called error analysis. But uncertainty analysis, a more recent development, gives greater insight into measurement processes and tests, experiments, or calibration results. Uncertainty analysis gives us an estimate of the interval about a measured value or an experiment's final result within which we believe the true value of that quantity will lie. Why should we take the time to perform an uncertainty analysis? A rigorous measurement uncertainty analysis: Increases the credibility and value of research results; allows comparisons of results from different labs; helps improve experiment design and identifies where changes are needed to achieve stated objectives (through use of the pre-test analysis); plays a significant role in validating measurements and experimental results, and in demonstrating (through the post-test analysis) that valid data have been acquired; reduces the risk of making erroneous decisions; demonstrates quality assurance and quality control measures have been accomplished; define Valid Data as data having known and documented paths of: Origin, including theory; measurements; traceability to measurement standards; computations; uncertainty analysis of results.
Governing Healthcare through Performance Measurement in Massachusetts and the Netherlands
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
[Quality measurement using administrative data in mandatory quality assurance].
Heller, Günther; Szecsenyi, Joachim; Willms, Gerald; Broge, Björn
2014-01-01
For several years, the use of administrative data in mandatory quality measurement has been requested by several stakeholders in Germany. Main advantages of using administrative data include the reduction of documentary expenditures and the possibility to perform longitudinal quality analyses across different healthcare units. After a short introduction, a brief overview of the current use of administrative data for mandatory quality assurance as well as current developments is given, which will then be further exemplified by decubital ulcer prophylaxis. By using administrative data coding expenditures in this clinical area could be reduced by nine million data fields. At the same time the population analysed was expanded resulting in a more than tenfold increase in potentially quality-relevant events. Finally, perspectives, further developments, possibilities as well as limits of quality measurement with administrative data are discussed. Copyright © 2014. Published by Elsevier GmbH.
Cellular-enabled water quality measurements
NASA Astrophysics Data System (ADS)
Zhao, Y.; Kerkez, B.
2013-12-01
While the past decade has seen significant improvements in our ability to measure nutrients and other water quality parameters, the use of these sensors has yet to gain traction due to their costprohibitive nature and deployment expertise required on the part of researchers. Furthermore, an extra burden is incurred when real-time data access becomes an experimental requirement. We present an open-source hardware design to facilitate the real-time, low-cost, and robust measurements of water quality across large urbanized areas. Our hardware platform interfaces an embedded, vastly configurable, high-precision, ultra-low power measurement system, with a low-power cellular module. Each sensor station is configured with an IP address, permitting reliable streaming of sensor data to off-site locations as measurements are made. We discuss the role of high-quality hardware components during extreme event scenarios, and present preliminary performance metrics that validate the ability of the platform to provide streaming access to sensor measurements.
Next day discharge rate has little use as a quality measure for individual physician performance.
Inabnit, Christopher; Markwell, Stephen; Gruwell, Jack; Jaeger, Cassie; Millburg, Lance; Griffen, David
2018-06-18
Emergency Department (ED) physicians' next day discharge rate (NDDR), the percentage of patients who were admitted from the ED and subsequently discharged within the next calendar day was hypothesized as a potential measure for unnecessary admissions. The objective was to determine if NDDR has validity as a measure for quality of individual ED physician performance. Hospital admission data was obtained for thirty-six ED physicians for calendar year 2015. Funnel plots were used to identify NDDR outliers beyond 95% control limits. A mixed model logistic regression was built to investigate factors contributing to NDDR. To determine yearly variation, data from calendar years 2014 and 2016 were analyzed, again by funnel plots and logistic regression. Intraclass correlation coefficient was used to estimate the percent of total variation in NDDR attributable to individual ED physicians. NDDR varied significantly among ED physicians. Individual ED physician outliers in NDDR varied year to year. Individual ED physician contribution to NDDR variation was minimal, accounting for 1%. Years of experience in Emergency Medicine practice was not correlated with NDDR. NDDR does not appear to be a reliable independent quality measure for individual ED physician performance. The percent of variance attributable to the ED physician was 1%. Copyright © 2018. Published by Elsevier Inc.
Child-Report Measures of Occupational Performance: A Systematic Review
Totino, Rebekah; Doma, Kenji; Leicht, Anthony; Brown, Nicole; Cuomo, Belinda
2016-01-01
Introduction Improving occupational performance is a key service of occupational therapists and client-centred approach to care is central to clinical practice. As such it is important to comprehensively evaluate the quality of psychometric properties reported across measures of occupational performance; in order to guide assessment and treatment planning. Objective To systematically review the literature on the psychometric properties of child-report measures of occupational performance for children ages 2–18 years. Methods A systematic search of the following six electronic databases was conducted: CINAHL; PsycINFO; EMBASE; PubMed; the Health and Psychosocial Instruments (HAPI) database; and Google Scholar. The quality of the studies was evaluated against the COSMIN taxonomy of measurement properties and the overall quality of psychometric properties was evaluated using pre-set psychometric criteria. Results Fifteen articles and one manual were reviewed to assess the psychometric properties of the six measures–the PEGS, MMD, CAPE, PAC, COSA, and OSA- which met the inclusion criteria. Most of the measures had conducted good quality studies to evaluate the psychometric properties of measures (PEGS, CAPE, PAC, OSA); however, the quality of the studies for two of these measures was relatively weak (MMD, COSA). When integrating the quality of the psychometric properties of the measures with the quality of the studies, the PAC stood out as having superior psychometric qualities. Conclusions The overall quality of the psychometric properties of most measures was limited. There is a need for continuing research into the psychometric properties of child-report measures of occupational performance, and to revise and improve the psychometric properties of existing measures. PMID:26808674
Rapid core measure improvement through a "business case for quality".
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.
Nurses critical to quality, safety, and now financial performance.
Kohlbrenner, Janis; Whitelaw, George; Cannaday, Denise
2011-03-01
Preventable hospital errors are the accepted impetus to the establishment of quality measures and served as a catalyst for the ongoing evolution of healthcare reform. Nurses are crucial members of the hospital quality team, and their actions are integral to the hospital's quality performance. The authors explore some of the practical challenges created by quality performance standards, specifically around venous thromboembolism, and the contribution nurses can make, to patient safety, quality of care, and the institutions financial performance.
Tang, Paul C; Ralston, Mary; Arrigotti, Michelle Fernandez; Qureshi, Lubna; Graham, Justin
2007-01-01
New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR. The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.
Myers, B; Petersen Williams, P; Johnson, K; Govender, R; Manderscheid, R; Koch, J R
2017-01-30
A performance measurement system - the Service Quality Measures (SQM) initiative - has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.
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.
Organizational Attributes Associated With Medicare ACO Quality Performance.
Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton
2018-05-08
To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.
Benchmarking and Performance Measurement.
ERIC Educational Resources Information Center
Town, J. Stephen
This paper defines benchmarking and its relationship to quality management, describes a project which applied the technique in a library context, and explores the relationship between performance measurement and benchmarking. Numerous benchmarking methods contain similar elements: deciding what to benchmark; identifying partners; gathering…
Candidate Quality Measures for Hand Surgery.
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
Facility-level outcome performance measures for nursing homes.
Porell, F; Caro, F G
1998-12-01
Risk-adjusted nursing home performance scores were developed for four health outcomes and five quality indicators from resident-level longitudinal case-mix reimbursement data for Medicaid residents of more than 500 nursing homes in Massachusetts. Facility performance was measured by comparing actual resident outcomes with expected outcomes derived from quarterly predictions of resident-level econometric models over a 3-year period (1991-1994). Performance measures were tightly distributed among facilities in the state. The intercorrelations among the nine outcome performance measures were relatively low and not uniformly positive. Performance measures were not highly associated with various structural facility attributes. For most outcomes, longitudinal analyses revealed only modest correlations between a facility's performance score from one time period to the next. Relatively few facilities exhibited consistent superior or inferior performance over time. The findings have implications toward the practical use of facility outcome performance measures for quality assurance and reimbursement purposes in the near future.
Eight essentials of performance measurement.
Moullin, Max
2004-01-01
A well-designed performance measurement system is vital for ensuring that organisations deliver cost-effective, high-quality services that meet the needs of service users. Without feedback on all important aspects and a system for ensuring that the organisation acts on that information, managers are struggling in the dark to improve services. However, performance measurement is not easy, particularly in health and public services where a wide range of stakeholders is involved. This article discusses what the author considers to be the eight essentials of performance measurement. Though described in the context of health and social care, they are important for organisations in all sectors.
Engaging clinical nurses in quality and performance improvement activities.
Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C
2010-01-01
Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.
Backman, Chantal; Vanderloo, Saskia; Forster, Alan John
2016-09-01
Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Nurse Reported Quality of Care: A Measure of Hospital Quality
McHugh, Matthew D.; Stimpfel, Amy Witkoski
2013-01-01
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. PMID:22911102
Leong, Tiong Kung; Zakuan, Norhayati; Mat Saman, Muhamad Zameri; Ariff, Mohd Shoki Md; Tan, Choy Soon
2014-01-01
This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings.
Leong, Tiong Kung; Ariff, Mohd. Shoki Md.
2014-01-01
This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings. PMID:24701182
Venous Thromboembolism Quality Measures Fail to Accurately Measure Quality.
Lau, Brandyn D; Streiff, Michael B; Pronovost, Peter J; Haut, Elliott R
2018-03-20
Venous thromboembolism (VTE) is 1 of the most common causes of preventable harm for patients in hospitals. Consequently, the Joint Commission, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the United Kingdom Care Quality Commission, the Australian Commission on Safety and Quality in Health Care, the Maryland Health Services Cost Review Commission, and the American College of Surgeons have prioritized measuring and reporting VTE outcomes with the goal of reducing the incidence of and preventable harm from VTE. We developed a rubric for defect-free VTE prevention, graded each organizational VTE quality measure, and found that none of the current VTE-related quality measures adequately characterizes VTE prevention efforts or outcomes in hospitalized patients. Effective VTE prevention is multifactorial: clinicians must assess patients' risk for VTE and prescribe therapy appropriate for each patient's risk profile, patients must accept the prescribed therapy, and nurses must administer the therapy as prescribed. First, an ideal, defect-free VTE prevention process measure requires: (1) documentation of a standardized VTE risk assessment; (2) prescription of optimal, risk-appropriate VTE prophylaxis; and (3) administration of all risk-appropriate VTE prophylaxis as prescribed. Second, an ideal VTE outcome measure should define potentially preventable VTE as VTE that developed in patients who experienced any VTE prevention process failures. © 2018 American Heart Association, Inc.
Does Nursing Facility Use of Habilitation Therapy Improve Performance on Quality Measures?
Fitzler, Sandra; Raia, Paul; Buckley, Fredrick O; Wang, Mei
2016-12-01
The purpose of the project, Centers for Medicare & Medicaid Services (CMS) Innovation study, was to evaluate the impact on 12 quality measures including 10 Minimum Data Set (MDS) publicly reported measures and 2 nursing home process measures using habilitation therapy techniques and a behavior team to manage dementia-related behaviors. A prospective design was used to assess the changes in the measures. A total of 30 Massachusetts nursing homes participated in the project over a 12-month period. Project participation required the creation of an interdisciplinary behavior team, habilitation therapy training, facility visit by the program coordinator, attendance at bimonthly support and sharing calls, and monthly collection of process measure data. Participating facilities showed improvement in 9 of the 12 reported measures. Findings indicate potential quality improvement in having nursing homes learn habilitation therapy techniques and know how to use the interdisciplinary team to manage problem behaviors. © The Author(s) 2016.
42 CFR 438.240 - Quality assessment and performance improvement program.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement... Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and performance improvement program. (a) General rules. (1) The State must require, through its contracts, that each MCO and...
Dong, Gang Nathan
2015-02-01
Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance. Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports. There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs. The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
Physician performance assessment using a composite quality index.
Liu, Kaibo; Jain, Shabnam; Shi, Jianjun
2013-07-10
Assessing physician performance is important for the purposes of measuring and improving quality of service and reducing healthcare delivery costs. In recent years, physician performance scorecards have been used to provide feedback on individual measures; however, one key challenge is how to develop a composite quality index that combines multiple measures for overall physician performance evaluation. A controversy arises over establishing appropriate weights to combine indicators in multiple dimensions, and cannot be easily resolved. In this study, we proposed a generic unsupervised learning approach to develop a single composite index for physician performance assessment by using non-negative principal component analysis. We developed a new algorithm named iterative quadratic programming to solve the numerical issue in the non-negative principal component analysis approach. We conducted real case studies to demonstrate the performance of the proposed method. We provided interpretations from both statistical and clinical perspectives to evaluate the developed composite ranking score in practice. In addition, we implemented the root cause assessment techniques to explain physician performance for improvement purposes. Copyright © 2012 John Wiley & Sons, Ltd.
Measuring Rural Hospital Quality
ERIC Educational Resources Information Center
Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid
2004-01-01
Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…
Smith, Laura M; Anderson, Wayne L; Lines, Lisa M; Pronier, Cristalle; Thornburg, Vanessa; Butler, Janelle P; Teichman, Lori; Dean-Whittaker, Debra; Goldstein, Elizabeth
2017-01-01
We examined the effects of provider characteristics on home health agency performance on patient experience of care (Home Health CAHPS) and process (OASIS) measures. Descriptive, multivariate, and factor analyses were used. While agencies score high on both domains, factor analyses showed that the underlying items represent separate constructs. Freestanding and Visiting Nurse Association agencies, higher number of home health aides per 100 episodes, and urban location were statistically significant predictors of lower performance. Lack of variation in composite measures potentially led to counterintuitive results for effects of organizational characteristics. This exploratory study showed the value of having separate quality domains.
Comparing Alternative Instruments to Measure Service Quality in Higher Education
ERIC Educational Resources Information Center
Brochado, Ana
2009-01-01
Purpose: The purpose of this paper is to examine the performance of five alternative measures of service quality in the high education sector--service quality (SERVQUAL), importance-weighted SERVQUAL, service performance (SERVPERF), importance-weighted SERVPERF, and higher education performance (HEdPERF). Design/methodology/approach: Data were…
Vélez-González, Heltie; Pradhan, Rohit; Weech-Maldonado, Robert
2011-01-01
Non-financial measures have found increasing acceptance in the business world--however, their application in the health care industry remains limited. The purpose of this article is to understand the influence of non-financial measures (efficiency, productivity, and quality) on the financial performance of for-profit system hospitals. The sample consists of 499 for-profit system hospitals in the United States from 1999 to 2002. Data analyzed include the American Hospital Association's Annual Survey, Medicare Cost Reports, Joint Commission's quality scores, and the Centers for Medicare & Medicaid Services' Hospital Case Mix Index. Dependent variables consist of financial measures (operating and total margins), while independent variables include measures of efficiency, productivity, and quality. Our results suggest the influence of non-financial performance measures on financial performance; occupancy rate positively influences financial performance while greater labor intensity may have negative implications for financial performance. In addition, we show that quality positively influences financial performance thereby offering a potential business case for quality. This result has important managerial and policy implications as it may incentivize capital and human resource investments required to improve hospital quality of care.
Does adding clinical data to administrative data improve agreement among hospital quality measures?
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 Clinical Data Standards to Measure Quality: A New Approach.
D'Amore, John D; Li, Chun; McCrary, Laura; Niloff, Jonathan M; Sittig, Dean F; McCoy, Allison B; Wright, Adam
2018-04-01
Value-based payment for care requires the consistent, objective calculation of care quality. Previous initiatives to calculate ambulatory quality measures have relied on billing data or individual electronic health records (EHRs) to calculate and report performance. New methods for quality measure calculation promoted by federal regulations allow qualified clinical data registries to report quality outcomes based on data aggregated across facilities and EHRs using interoperability standards. This research evaluates the use of clinical document interchange standards as the basis for quality measurement. Using data on 1,100 patients from 11 ambulatory care facilities and 5 different EHRs, challenges to quality measurement are identified and addressed for 17 certified quality measures. Iterative solutions were identified for 14 measures that improved patient inclusion and measure calculation accuracy. Findings validate this approach to improving measure accuracy while maintaining measure certification. Organizations that report care quality should be aware of how identified issues affect quality measure selection and calculation. Quality measure authors should consider increasing real-world validation and the consistency of measure logic in respect to issues identified in this research. Schattauer GmbH Stuttgart.
López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis
2015-11-01
Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
[Comparative quality measurements part 3: funnel plots].
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.
Linking Quality and Spending to Measure Value for People with Serious Illness.
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
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
COMPUTERIZED NEEDS-ORIENTED QUALITY MEASUREMENT EVALUATION SYSTEM (CONQUEST)
CONQUEST is an easy-to-use quality improvement software tool that uses a common structure and language to help users identity, understand, compare, evaluate, and select among 1,200 clinical performance measures that can be used to assess and improve quality of care. CONQUEST's in...
Quality Measures for Dialysis: Time for a Balanced Scorecard.
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.
Quality Measures for Dialysis: Time for a Balanced Scorecard
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
42 CFR 425.502 - Calculating the ACO quality performance score.
Code of Federal Regulations, 2014 CFR
2014-10-01
... four domains: (i) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... a point scale for the measures. (2)(i) CMS will define the quality benchmarks using fee-for-service...
Human voice quality measurement in noisy environments.
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.
Kahn, Jeremy M; Gould, Michael K; Krishnan, Jerry A; Wilson, Kevin C; Au, David H; Cooke, Colin R; Douglas, Ivor S; Feemster, Laura C; Mularski, Richard A; Slatore, Christopher G; Wiener, Renda Soylemez
2014-05-01
Many health care performance measures are either not based on high-quality clinical evidence or not tightly linked to patient-centered outcomes, limiting their usefulness in quality improvement. In this report we summarize the proceedings of an American Thoracic Society workshop convened to address this problem by reviewing current approaches to performance measure development and creating a framework for developing high-quality performance measures by basing them directly on recommendations from well-constructed clinical practice guidelines. Workshop participants concluded that ideally performance measures addressing care processes should be linked to clinical practice guidelines that explicitly rate the quality of evidence and the strength of recommendations, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. Under this framework, process-based performance measures would only be developed from strong recommendations based on high- or moderate-quality evidence. This approach would help ensure that clinical processes specified in performance measures are both of clear benefit to patients and supported by strong evidence. Although this approach may result in fewer performance measures, it would substantially increase the likelihood that quality-improvement programs based on these measures actually improve patient care.
Sustainability of quality improvement following removal of pay-for-performance incentives.
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.
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...
Performance measurement for ambulatory care: moving towards a new agenda.
Roski, J; Gregory, R
2001-12-01
Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.
Adair, Carol E; Simpson, Elizabeth; Casebeer, Ann L; Birdsell, Judith M; Hayden, Katharine A; Lewis, Steven
2006-07-01
This paper summarizes findings of a comprehensive, systematic review of the peer-reviewed and grey literature on performance measurement according to each stage of the performance measurement process--conceptualization, selection and development, data collection, and reporting and use. It also outlines implications for practice. Six hundred sixty-four articles about organizational performance measurement from the health and business literature were reviewed after systematic searches of the literature, multi-rater relevancy ratings, citation checks and expert author nominations. Key themes were extracted and summarized from the most highly rated papers for each performance measurement stage. Despite a virtually universal consensus on the potential benefits of performance measurement, little evidence currently exists to guide practice in healthcare. Issues in conceptualizing systems include strategic alignment and scope. There are debates on the criteria for selecting measures and on the types and quality of measures. Implementation of data collection and analysis systems is complex and costly, and challenges persist in reporting results, preventing unintended effects and putting findings for improvement into action. There is a need for further development and refinement of performance measures and measurement systems, with a particular focus on strategies to ensure that performance measurement leads to healthcare improvement.
Performance Measurement and Target-Setting in California's Safety Net Health Systems.
Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala
Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.
42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.
Code of Federal Regulations, 2013 CFR
2013-10-01
... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...
42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.
Code of Federal Regulations, 2012 CFR
2012-10-01
... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...
42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.
Code of Federal Regulations, 2014 CFR
2014-10-01
... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...
Composite Measures of Health Care Provider Performance: A Description of Approaches
Shwartz, Michael; Restuccia, Joseph D; Rosen, Amy K
2015-01-01
Context Since the Institute of Medicine’s 2001 report Crossing the Quality Chasm, there has been a rapid proliferation of quality measures used in quality-monitoring, provider-profiling, and pay-for-performance (P4P) programs. Although individual performance measures are useful for identifying specific processes and outcomes for improvement and tracking progress, they do not easily provide an accessible overview of performance. Composite measures aggregate individual performance measures into a summary score. By reducing the amount of data that must be processed, they facilitate (1) benchmarking of an organization’s performance, encouraging quality improvement initiatives to match performance against high-performing organizations, and (2) profiling and P4P programs based on an organization’s overall performance. Methods We describe different approaches to creating composite measures, discuss their advantages and disadvantages, and provide examples of their use. Findings The major issues in creating composite measures are (1) whether to aggregate measures at the patient level through all-or-none approaches or the facility level, using one of the several possible weighting schemes; (2) when combining measures on different scales, how to rescale measures (using z scores, range percentages, ranks, or 5-star categorizations); and (3) whether to use shrinkage estimators, which increase precision by smoothing rates from smaller facilities but also decrease transparency. Conclusions Because provider rankings and rewards under P4P programs may be sensitive to both context and the data, careful analysis is warranted before deciding to implement a particular method. A better understanding of both when and where to use composite measures and the incentives created by composite measures are likely to be important areas of research as the use of composite measures grows. PMID:26626986
Downhole steam quality measurement
Lee, D.O.; Montoya, P.C.; Muir, J.F.; Wayland, J.R. Jr.
1985-06-19
The present invention relates to an empirical electrical method for remote sensing of steam quality utilizing flow-through grids which allow measurement of the electrical properties of a flowing two-phase mixture. The measurement of steam quality in the oil field is important to the efficient application of steam assisted recovery of oil. Because of the increased energy content in higher quality steam it is important to maintain the highest possible steam quality at the injection sandface. The effectiveness of a steaming operation without a measure of steam quality downhole close to the point of injection would be difficult to determine. Therefore, a need exists for the remote sensing of steam quality.
NASA Astrophysics Data System (ADS)
Betta, G.; Capriglione, D.; Ferrigno, L.; Laracca, M.
2009-10-01
Power line telecommunication (PLT) technology offers cheap and fast ways for providing in-home broadband services and local area networking. Its main advantage is due to the possibility of using the pre-existing electrical grid as a communication channel. Nevertheless, technical challenges arise from the difficulty of operating on a hostile medium, not designed for communication purposes, characterized by complex channel modeling and by varying time response. These aspects put practical problems for designers and testers in the assessment of network quality of service performance parameters such as the throughput, the latency, the jitter, and the reliability. The measurement of these parameters has not yet been standardized so that there do not exist reference test set-ups and measurement methodologies (i.e. the type of isolation from the ac main, the observation time and the number of experiments, the measurement uncertainty and so on). Consequently, experiments executed by adopting different methods may lead to incompatible measurement results, thus making it also impossible to have reliable comparisons of different PLT modems. Really, the development of standard procedures is a very difficult task because the scenarios in which the PLT modems can work are very wide and then the application of an exhaustive approach (in which all the parameters influencing the PLT performance should be considered) would be very complex and time consuming, thus making the modem characterization very expensive. In this paper, the authors propose a methodological approach to develop an efficient measurement procedure able to reliably assess the performance of PLT modems (in terms of network quality of service parameters) with a minimum number of experiments. It is based on both creating a reconfigurable grid to which real disturbing loads are connected and implementing an original design of the experiment technique based on the effects of the uncertainty of the measurement results
ERIC Educational Resources Information Center
Riccardi, Mark T.
2009-01-01
Continuous Quality Improvement (CQI) measures such as Total Quality Management (TQM), Strategic Planning, Six Sigma, and the Balanced Scorecard are often met with skepticism among leaders of higher education. This study attempts to fill a gap in the literature regarding the study of relationships among specific variables, or building blocks,…
Redefining Quality Measurement in Cancer Care.
Nardi, Elizabeth A; McCanney, James; Winckworth-Prejsnar, Katy; Schatz, Alyssa A; Adelson, Kerin; Neubauer, Marcus; Smith, Mary Lou; Walters, Ronald; Carlson, Robert W
2018-05-01
Quality measurement in oncology is increasing in significance as payment schemes shift from volume to value. As demand for quality measures increases, challenges in the development of quality measures, standardization across measures, and the limitations of health information technology have become apparent. Moreover, the time and financial burden associated with developing, tracking, and reporting quality measures are substantial. Despite these challenges, best practices and leaders in the field of quality measurement in oncology have emerged. To understand the current challenges and promising practices in quality measurement and to explore future considerations for measure development and measure reporting in oncology, NCCN convened the NCCN Policy Summit: Redefining Quality Measurement in Oncology. The summit included discussion of the current quality landscape and efforts to develop quality measures, use of quality measures in various programs, patient perspective of quality, and challenges and best practices for quality reporting. Copyright © 2018 by the National Comprehensive Cancer Network.
Landercasper, Jeffrey; Fayanju, Oluwadamilola M; Bailey, Lisa; Berry, Tiffany S; Borgert, Andrew J; Buras, Robert; Chen, Steven L; Degnim, Amy C; Froman, Joshua; Gass, Jennifer; Greenberg, Caprice; Mautner, Starr Koslow; Krontiras, Helen; Ramirez, Luis D; Sowden, Michelle; Wexelman, Barbara; Wilke, Lee; Rao, Roshni
2018-02-01
Nine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance. Surgeons entered QM data into an electronic registry. For each QM, aggregate "performance met" (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method. A total of 1,286,011 QM encounters were captured from 2011-2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a "never should occur" event. Surgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded "perfect" performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.
Performance measurement for people with multiple chronic conditions: conceptual model.
Giovannetti, Erin R; Dy, Sydney; Leff, Bruce; Weston, Christine; Adams, Karen; Valuck, Tom B; Pittman, Aisha T; Blaum, Caroline S; McCann, Barbara A; Boyd, Cynthia M
2013-10-01
Improving quality of care for people with multiple chronic conditions (MCCs) requires performance measures reflecting the heterogeneity and scope of their care. Since most existing measures are disease specific, performance measures must be refined and new measures must be developed to address the complexity of care for those with MCCs. To describe development of the Performance Measurement for People with Multiple Chronic Conditions (PM-MCC) conceptual model. Framework development and a national stakeholder panel. We used reviews of existing conceptual frameworks of performance measurement, review of the literature on MCCs, input from experts in the multistakeholder Steering Committee, and public comment. The resulting model centers on the patient and family goals and preferences for care in the context of multiple care sites and providers, the type of care they are receiving, and the national priority domains for healthcare quality measurement. This model organizes measures into a comprehensive framework and identifies areas where measures are lacking. In this context, performance measures can be prioritized and implemented at different levels, in the context of patients' overall healthcare needs.
The quality of systematic reviews of health-related outcome measurement instruments.
Terwee, C B; Prinsen, C A C; Ricci Garotti, M G; Suman, A; de Vet, H C W; Mokkink, L B
2016-04-01
Systematic reviews of outcome measurement instruments are important tools for the selection of instruments for research and clinical practice. Our aim was to assess the quality of systematic reviews of health-related outcome measurement instruments and to determine whether the quality has improved since our previous study in 2007. A systematic literature search was performed in MEDLINE and EMBASE between July 1, 2013, and June 19, 2014. The quality of the reviews was rated using a study-specific checklist. A total of 102 reviews were included. In many reviews the search strategy was considered not comprehensive; in only 59 % of the reviews a search was performed in EMBASE and in about half of the reviews there was doubt about the comprehensiveness of the search terms used for type of measurement instruments and measurement properties. In 41 % of the reviews, compared to 30 % in our previous study, the methodological quality of the included studies was assessed. In 58 %, compared to 55 %, the quality of the included instruments was assessed. In 42 %, compared to 7 %, a data synthesis was performed in which the results from multiple studies on the same instrument were somehow combined. Despite a clear improvement in the quality of systematic reviews of outcome measurement instruments in comparison with our previous study in 2007, there is still room for improvement with regard to the search strategy, and especially the quality assessment of the included studies and the included instruments, and the data synthesis.
Performance measures for a dialysis setting.
Gu, Xiuzhu; Itoh, Kenji
2018-03-01
This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views. Two surveys were conducted using self-administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded. Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient-centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient-centred health care and employee development. However, dialysis managers' usefulness perceptions were significantly higher than staff. Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Ryan, Andrew; Sutton, Matthew; Doran, Tim
2014-01-01
Objective To test whether receiving a financial bonus for quality in the Premier Hospital Quality Incentive Demonstration (HQID) stimulated subsequent quality improvement. Data Hospital-level data on process-of-care quality from Hospital Compare for the treatment of acute myocardial infarction (AMI), heart failure, and pneumonia for 260 hospitals participating in the HQID from 2004 to 2006; receipt of quality bonuses in the first 3 years of HQID from the Premier Inc. website; and hospital characteristics from the 2005 American Hospital Association Annual Survey. Study Design Under the HQID, hospitals received a 1 percent bonus on Medicare payments for scoring between the 80th and 90th percentiles on a composite quality measure, and a 2 percent bonus for scoring at the 90th percentile or above. We used a regression discontinuity design to evaluate whether hospitals with quality scores just above these payment thresholds improved more in the subsequent year than hospitals with quality scores just below the thresholds. In alternative specifications, we examined samples of hospitals scoring within 3, 5, and 10 percentage point “bandwidths” of the thresholds. We used a Generalized Linear Model to estimate whether the relationship between quality and lagged quality was discontinuous at the lagged thresholds required for quality bonuses. Principal Findings There were no statistically significant associations between receipt of a bonus and subsequent quality performance, with the exception of the 2 percent bonus for AMI in 2006 using the 5 percentage point bandwidth (0.8 percentage point increase, p < .01), and the 1 percent bonus for pneumonia in 2005 using all bandwidths (3.7 percentage point increase using the 3 percentage point bandwidth, p < .05). Conclusions We found little evidence that hospitals' receipt of quality bonuses was associated with subsequent improvement in performance. This raises questions about whether winning in pay-for-performance programs
Albright, Benjamin B.; Lewis, Valerie A.; Ross, Joseph S.; Colla, Carrie H.
2015-01-01
Background Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. Objectives To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Design Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Results Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. Conclusions ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration. PMID:26759974
Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H
2016-03-01
Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.
2013-01-01
Background We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. Methods Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek’s p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps ′guideline – perform - falsify – reform′. Results 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. Conclusions The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity. PMID:24074151
NASA Astrophysics Data System (ADS)
Byun, D. W.; Rappenglueck, B.; Lefer, B.
2007-12-01
Accurate meteorological and photochemical modeling efforts are necessary to understand the measurements made during the Texas Air Quality Study (TexAQS-II). The main objective of the study is to understand the meteorological and chemical processes of high ozone and regional haze events in the Eastern Texas, including the Houston-Galveston metropolitan area. Real-time and retrospective meteorological and photochemical model simulations were performed to study key physical and chemical processes in the Houston Galveston Area. In particular, the Vertical Mixing Experiment (VME) at the University of Houston campus was performed on selected days during the TexAQS-II. Results of the MM5 meteorological model and CMAQ air quality model simulations were compared with the VME and other TexAQS-II measurements to understand the interaction of the boundary layer dynamics and photochemical evolution affecting Houston air quality.
Mohebifar, Rafat; Hasani, Hana; Barikani, Ameneh; Rafiei, Sima
2016-08-01
Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance-performance analysis matrix. A descriptive-analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance-performance analysis matrix. The results showed a significant gap between importance and performance in all five dimensions of service quality (p < 0.05). In reviewing the gap, "reliability" (2.36) and "assurance" (2.24) dimensions had the highest quality gap and "responsiveness" had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance-performance matrix. The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance-performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.
Sparks, Rachel; Salskov, Alex H; Chang, Anita S; Wentworth, Kelly L; Gupta, Pritha P; Staiger, Thomas O; Anawalt, Bradley D
2015-01-01
Complete documentation of patient comorbidities in the medical record is important for clinical care, hospital reimbursement, and quality performance measures. We designed a pocket card reminder and brief educational intervention aimed at hospitalists with the goal of improving documentation of 6 common comorbidities present on admission: coagulation abnormalities, metastatic cancer, anemia, fluid and electrolyte abnormalities, malnutrition, and obesity. Two internal medicine inpatient teams led by 10 hospitalist physicians at an academic medical center received the educational intervention and pocket card reminder (n = 520 admissions). Two internal medicine teams led by nonhospitalist physicians served as a control group (n = 590 admissions). Levels of documentation of 6 common comorbidities, expected length of stay, and expected mortality were measured at baseline and during the 9-month study period. The intervention was associated with increased documentation of anemia, fluid and electrolyte abnormalities, malnutrition, and obesity in the intervention group, both compared to baseline and compared to the control group during the study period. The expected length of stay increased in the intervention group during the study period. A simple educational intervention and pocket card reminder were associated with improved documentation and hospital quality measures at an academic medical center.
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.
Manager traits and quality-of-care performance in hospitals.
Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke
2015-07-06
This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha < 0.05) between lean (intermediate-) and low-performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.
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.…
Downhole steam quality measurement
Lee, David O.; Montoya, Paul C.; Muir, James F.; Wayland, Jr., J. Robert
1987-01-01
An empirical method for the remote sensing of steam quality that can be easily adapted to downhole steam quality measurements by measuring the electrical properties of two-phase flow across electrode grids at low frequencies.
Benchmarking: your performance measurement and improvement tool.
Senn, G F
2000-01-01
Many respected professional healthcare organizations and societies today are seeking to establish data-driven performance measurement strategies such as benchmarking. Clinicians are, however, resistant to "benchmarking" that is based on financial data alone, concerned that it may be adverse to the patients' best interests. Benchmarking of clinical procedures that uses physician's codes such as Current Procedural Terminology (CPTs) has greater credibility with practitioners. Better Performers, organizations that can perform procedures successfully at lower cost and in less time, become the "benchmark" against which other organizations can measure themselves. The Better Performers' strategies can be adopted by other facilities to save time or money while maintaining quality patient care.
Clinical Quality Performance in U.S. Health Centers
Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen
2012-01-01
Objective To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. Data Sources National data from the 2009 Uniform Data System. Data Collection/Extraction Methods Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Study Design Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Principal Findings Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Conclusions Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. PMID:22594465
Richardson, Marina; Campbell, Nerissa; Allen, Laura; Meyer, Matthew; Teasell, Robert
2016-07-01
The objective of this study was to assess the psychometric properties of the Stroke Impact Scale (SIS). Data was derived from a study assessing a community-based stroke rehabilitation program. Patients were administered the SIS and Euroqol-5D (EQ-5D-5L) on admission to the study, and at six month and 12 month follow-up. The psychometric performance of each domain of the SIS was assessed at each time point. A total of 164 patients completed outcome measures at baseline, 108 patients at six months and 37 patients at 12 months. Correlation of the SIS domains with the EQ-5D-5L suggested that the dimensions of health contributing to a patient's perception of health-related quality of life changes over time. The SIS performed well in a sample of patients undergoing stroke rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor rehabilitation interventions to target the dimensions of health that are most important to a patient's overall health and perceived quality of life over time. Implications for Rehabilitation There is an increased need for valid and reliable measures to evaluate the outcomes of patients recovering from stroke in the community. The Stroke Impact Scale (SIS) measures multiple domains of health and is well-suited for use in patients recovering from stroke in the community. There is a high level of internal consistency in the eight SIS domains with no evidence of floor effects; ceiling effects were noted for several domains. Correlation of the SIS with the Euroqol-5D suggested that the dimensions of health contributing to a patient's perception of health related quality of life changes over time.
Community Health Centers and Private Practice Performance on Ambulatory Care Measures
Goldman, L. Elizabeth; Chu, Philip W.; Tran, Huong; Stafford, Randall S.
2013-01-01
Background The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHC) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and efficiency. Purpose To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures. Methods The study was a cross-sectional analysis of visits in the 2006–2008 National Ambulatory Medical Care Survey. Performance of FQHCs and Look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011. Results Compared to private practice PCPs, FQHCs and look-alikes performed better on 6 measures (p<0.05), worse on diet counseling in at-risk adolescents (26 % vs. 36%, p=0.05), and no differently on 11 measures. Higher performance occurred in: ACE inhibitors use for congestive heart failure (51% vs. 37%, p=0.004); aspirin use in coronary artery disease (CAD) (57% vs. 44%, p=0.004); beta blocker use for CAD (59% vs. 47%, p=0.01); no use of benzodiazepines in depression (91% vs. 84%, p=0.008); blood pressure screening (90% vs. 86%, p<0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs. 93%, p<0.001). Adjusting for patient characteristics yielded similar results except private practice PCPs no longer performed better on any measures. Conclusions FQHCs and look-alikes demonstrated equal or better performance than private practice primary care physicians on select quality measures despite serving patients with more chronic disease and socioeconomic complexity. These findings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualified Health Centers and Federally Qualified Health Center look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals. PMID:22813678
The measurement of quality of care in the Veterans Health Administration.
Halpern, J
1996-03-01
The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the
Quality measurement in diabetes care.
Leas, Brian F; Berman, Bettina; Kash, Kathryn M; Crawford, Albert G; Toner, Richard W; Goldfarb, Neil I; Nash, David B
2009-10-01
This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes.
42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.
Code of Federal Regulations, 2013 CFR
2013-10-01
...) Access to care. (ii) Patient satisfaction. (iii) Staff performance. (iv) Complaints and grievances. (v... following: (i) Define quality assessment and performance improvement measures. (ii) Describe and outline...) Inform all patients, in writing, of the scope and responsibilities of the quality assessment and...
42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.
Code of Federal Regulations, 2014 CFR
2014-10-01
...) Access to care. (ii) Patient satisfaction. (iii) Staff performance. (iv) Complaints and grievances. (v... following: (i) Define quality assessment and performance improvement measures. (ii) Describe and outline...) Inform all patients, in writing, of the scope and responsibilities of the quality assessment and...
42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.
Code of Federal Regulations, 2012 CFR
2012-10-01
...) Access to care. (ii) Patient satisfaction. (iii) Staff performance. (iv) Complaints and grievances. (v... following: (i) Define quality assessment and performance improvement measures. (ii) Describe and outline...) Inform all patients, in writing, of the scope and responsibilities of the quality assessment and...
42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.
Code of Federal Regulations, 2011 CFR
2011-10-01
...) Access to care. (ii) Patient satisfaction. (iii) Staff performance. (iv) Complaints and grievances. (v... following: (i) Define quality assessment and performance improvement measures. (ii) Describe and outline...) Inform all patients, in writing, of the scope and responsibilities of the quality assessment and...
Tools for Measuring and Improving Performance.
ERIC Educational Resources Information Center
Jurow, Susan
1993-01-01
Explains the need for meaningful performance measures in libraries and the Total Quality Management (TQM) approach to data collection. Five tools representing different stages of a TQM inquiry are covered (i.e., the Shewhart Cycle, flowcharts, cause-and-effect diagrams, Pareto charts, and control charts), and benchmarking is addressed. (Contains…
42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.
Code of Federal Regulations, 2011 CFR
2011-10-01
... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... patient safety by using quality indicators or performance measures associated with improved health... that includes care and services furnished in the ASC. (b) Standard: Program data. (1) The program must...
[Supply services at health facilities: measuring performance].
Dacosta Claro, I
2001-01-01
Performance measurement, in their different meanings--either balance scorecard or outputs measurement--have become an essential tool in today's organizations (World-Class organizations) to improve service quality and reduce costs. This paper presents a performance measurement system for the hospital supply chain. The system is organized in different levels and groups of indicators in order to show a hierarchical, coherent and integrated vision of the processes. Thus, supply services performance is measured according to (1) financial aspects, (2) customers satisfaction aspects and (3) internal aspects of the processes performed. Since the informational needs of the managers vary within the administrative structure, the performance measurement system is defined in three hierarchical levels. Firstly, the whole supply chain, with the different interrelation of activities. Secondly, the three main processes of the chain--physical management of products, purchasing and negotiation processes and the local storage units. And finally, the performance measurement of each activity involved. The system and the indicators have been evaluated with the participation of 17 health services of Quebec (Canada), however, and due to the similarities of the operation, could be equally implemented in Spanish hospitals.
A National Initiative to Advance School Mental Health Performance Measurement in the US
ERIC Educational Resources Information Center
Connors, Elizabeth Halsted; Stephan, Sharon Hoover; Lever, Nancy; Ereshefsky, Sabrina; Mosby, Amanda; Bohnenkamp, Jill
2016-01-01
Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring…
Effect of e-learning on quality of cervical-length measurements.
van Os, M A; van der Ven, A J; Bloemendaal, P M; Pajkrt, E; de Groot, C J M; Mol, B W J; Haak, M C
2015-09-01
To assess the effect of implementation of a newly developed e-learning module on the quality of cervical-length measurements. With the introduction of cervical-length (CL) measurement in a research setting, a CL measurement e-learning module (CLEM) was developed with the purpose to enhance the knowledge and skills of experienced ultrasonographers. CLEM was designed specifically for ultrasonographers who perform ultrasound in a general obstetrical practice but who do not regularly perform CL measurements. CLEM consists of five theoretical questions and three caliper-placement tests to learn the CL measurement technique. The quality of the CL measurements of CLEM participants was compared with images of non-participants using a CL measurement image score (CIS), defined as the sum of six items which assess the quality of the image. Each CLEM participant submitted five CL images and the images of non-CLEM participants were selected randomly from an ultrasound database. The CIS of the CLEM participants (n = 61) were significantly higher than those of non-CLEM participants (n = 23) (164.9 vs 155.6, respectively; P = 0.03). Visualization of the internal os and positioning of the calipers on the internal and external ora were found to have significantly higher CIS among the CLEM participants than among the non-CLEM participants (P = 0.001 and P < 0.001, respectively). Introducing CLEM may improve the quality of CL measurements obtained by trained and untrained sonographers. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Measuring quality in anatomic pathology.
Raab, Stephen S; Grzybicki, Dana Marie
2008-06-01
This article focuses mainly on diagnostic accuracy in measuring quality in anatomic pathology, noting that measuring any quality metric is complex and demanding. The authors discuss standardization and its variability within and across areas of care delivery and efforts involving defining and measuring error to achieve pathology quality and patient safety. They propose that data linking error to patient outcome are critical for developing quality improvement initiatives targeting errors that cause patient harm in addition to using methods of root cause analysis, beyond those traditionally used in cytologic-histologic correlation, to assist in the development of error reduction and quality improvement plans.
A research agenda to advance quality measurement and improvement.
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.
Giesbers, A P M Suzanne; Schouteten, Roel L J; Poutsma, Erik; van der Heijden, Beatrice I J M; van Achterberg, Theo
2016-12-01
Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses' well-being and performance. Building on the Job Demands-Resources model this study explores: (1) whether and how nurses' perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses' well-being and performance; and (2) whether and how team reflection influences nurses' perceptions. An embedded case study. Four surgical wards within three different acute teaching-hospital settings in the Netherlands. During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards. The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses' well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses' well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the
Diet Quality and Academic Performance
ERIC Educational Resources Information Center
Florence, Michelle D.; Asbridge, Mark; Veugelers, Paul J.
2008-01-01
Background: Although the effects of nutrition on health and school performance are often cited, few research studies have examined the effect of diet quality on the academic performance of children. This study examines the association between overall diet quality and academic performance. Methods: In 2003, 5200 grade 5 students in Nova Scotia,…
Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy
2016-02-22
In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.
Information quality measurement of medical encoding support based on usability.
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
Measuring Quality in Ethics Consultation.
Bliss, Sally E; Oppenlander, Jane; Dahlke, Jacob M; Meyer, Gordon J; Williford, Eva M; Macauley, Robert C
2016-01-01
For all of the emphasis on quality improvement-as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics-the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation1 identified four domains of ethics quality: (1) ethicality, (2) stakeholders' satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.
Accounting for quality in the measurement of hospital performance: evidence from Costa Rica.
Arocena, Pablo; García-Prado, Ariadna
2007-07-01
This paper provides insights into how Costa Rican public hospitals responded to the pressure for increased efficiency and quality introduced by the reforms carried out over the period 1997-2001. To that purpose we compute a generalized output distance function by means of non-parametric mathematical programming to construct a productivity index, which accounts for productivity changes while controlling for quality of care. Our results show an improvement in hospital performance mainly driven by quality increases. The adoption of management contracts seems to have contributed to such enhancement, more notably for small hospitals. Further, productivity growth is primarily due to technical and scale efficiency change rather than technological change. A number of policy implications are drawn from these results. Copyright (c) 2006 John Wiley & Sons, Ltd.
Earnings Quality Measures and Excess Returns
Perotti, Pietro; Wagenhofer, Alfred
2014-01-01
This paper examines how commonly used earnings quality measures fulfill a key objective of financial reporting, i.e., improving decision usefulness for investors. We propose a stock-price-based measure for assessing the quality of earnings quality measures. We predict that firms with higher earnings quality will be less mispriced than other firms. Mispricing is measured by the difference of the mean absolute excess returns of portfolios formed on high and low values of a measure. We examine persistence, predictability, two measures of smoothness, abnormal accruals, accruals quality, earnings response coefficient and value relevance. For a large sample of US non-financial firms over the period 1988–2007, we show that all measures except for smoothness are negatively associated with absolute excess returns, suggesting that smoothness is generally a favorable attribute of earnings. Accruals measures generate the largest spread in absolute excess returns, followed by smoothness and market-based measures. These results lend support to the widespread use of accruals measures as overall measures of earnings quality in the literature. PMID:26300582
Earnings Quality Measures and Excess Returns.
Perotti, Pietro; Wagenhofer, Alfred
2014-06-01
This paper examines how commonly used earnings quality measures fulfill a key objective of financial reporting, i.e., improving decision usefulness for investors. We propose a stock-price-based measure for assessing the quality of earnings quality measures. We predict that firms with higher earnings quality will be less mispriced than other firms. Mispricing is measured by the difference of the mean absolute excess returns of portfolios formed on high and low values of a measure. We examine persistence, predictability, two measures of smoothness, abnormal accruals, accruals quality, earnings response coefficient and value relevance. For a large sample of US non-financial firms over the period 1988-2007, we show that all measures except for smoothness are negatively associated with absolute excess returns, suggesting that smoothness is generally a favorable attribute of earnings. Accruals measures generate the largest spread in absolute excess returns, followed by smoothness and market-based measures. These results lend support to the widespread use of accruals measures as overall measures of earnings quality in the literature.
Towards a balanced performance measurement system in a public health care organization.
Yuen, Peter P; Ng, Artie W
2012-01-01
This article attempts to devise an integrated performance measurement framework to assess the Hong Kong Hospital Authority (HA) management system by harnessing previous performance measurement systems. An integrated evaluative framework based on the balanced score card (BSC) was developed and applied using the case study method and longitudinal data to evaluate the HA's performance management system. The authors unveil evolving HA performance indicators (P1). Despite the HA staffs explicit quality emphasis, cost control remains the primary focus in their performance measurements. RESEARCH LHNITATIONS/IMPLICATIONS: Data used in this study are from secondary sources, disclosed mostly by HA staff. This study shows public sector staff often attach too much importance to cost control and easily measurable activities at the expense of quality and other less easily measurable attributes'. A balanced performance measurement system, linked to health targets, with a complementary budgeting process that supports pertinent resource allocation is yet to be implemented in Hong Kong's public hospitals.
Quality improvement in neurology: dementia management quality measures.
Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry
2014-03-01
Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support
The impact of leadership and quality climate on hospital performance.
Shipton, Helen; Armstrong, Claire; West, Michael; Dawson, Jeremy
2008-12-01
To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance-Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. A total of 17,949 employees were randomly surveyed (41% of the total sample). Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (beta = 0.42, P < 0.05; beta = 0.37, P < 0.05, respectively), and lower patient complaints (beta = -0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area-patient complaints-may be a valid measure to consider when assessing leadership and quality in a health-care context.
Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"?
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
Curtright, J W; Stolp-Smith, S C; Edell, E S
2000-01-01
Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.
New paradigms for measuring clinical performance using electronic health records.
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.
NASA Astrophysics Data System (ADS)
Lambert, Larry D.
The study by the American Productivity & Quality Center (APQC) was commissioned by Loral Space Information Systems, Inc. and the National Aeronautics and Space Administration (NASA) to evaluate internal assessment systems. APQC benchmarked approaches to the internal assessment of quality management systems in three phases. The first phase included work conducted for the International Benchmarking Clearinghouse (IBC) and consisted of an in-depth analysis of the 1991 Malcolm Baldrige National Quality Award criteria. The second phase was also performed for the IBC and compared the 1991 award criteria among the following quality awards: Deming Prize, Malcolm Baldrige National Quality Award, The President's Award for Quality and Productivity Improvement, The NASA Excellence Award (The George M. Lowe Trophy) for Quality and Productivity Improvement and the Shigeo Shingo Award for Excellence in Manufacturing. The third phase compared the internal implementation approaches of 23 companies selected from American industry for their recognized, formal assessment systems.
NASA Technical Reports Server (NTRS)
Lambert, Larry D.
1992-01-01
The study by the American Productivity & Quality Center (APQC) was commissioned by Loral Space Information Systems, Inc. and the National Aeronautics and Space Administration (NASA) to evaluate internal assessment systems. APQC benchmarked approaches to the internal assessment of quality management systems in three phases. The first phase included work conducted for the International Benchmarking Clearinghouse (IBC) and consisted of an in-depth analysis of the 1991 Malcolm Baldrige National Quality Award criteria. The second phase was also performed for the IBC and compared the 1991 award criteria among the following quality awards: Deming Prize, Malcolm Baldrige National Quality Award, The President's Award for Quality and Productivity Improvement, The NASA Excellence Award (The George M. Lowe Trophy) for Quality and Productivity Improvement and the Shigeo Shingo Award for Excellence in Manufacturing. The third phase compared the internal implementation approaches of 23 companies selected from American industry for their recognized, formal assessment systems.
Water quality parameter measurement using spectral signatures
NASA Technical Reports Server (NTRS)
White, P. E.
1973-01-01
Regression analysis is applied to the problem of measuring water quality parameters from remote sensing spectral signature data. The equations necessary to perform regression analysis are presented and methods of testing the strength and reliability of a regression are described. An efficient algorithm for selecting an optimal subset of the independent variables available for a regression is also presented.
Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan
NASA Astrophysics Data System (ADS)
Jardim, Kevin P.
Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.
Shahian, David M; He, Xia; Jacobs, Jeffrey P; Kurlansky, Paul A; Badhwar, Vinay; Cleveland, Joseph C; Fazzalari, Frank L; Filardo, Giovanni; Normand, Sharon-Lise T; Furnary, Anthony P; Magee, Mitchell J; Rankin, J Scott; Welke, Karl F; Han, Jane; O'Brien, Sean M
2015-10-01
Previous composite performance measures of The Society of Thoracic Surgeons (STS) were estimated at the STS participant level, typically a hospital or group practice. The STS Quality Measurement Task Force has now developed a multiprocedural, multidimensional composite measure suitable for estimating the performance of individual surgeons. The development sample from the STS National Database included 621,489 isolated coronary artery bypass grafting procedures, isolated aortic valve replacement, aortic valve replacement plus coronary artery bypass grafting, mitral, or mitral plus coronary artery bypass grafting procedures performed by 2,286 surgeons between July 1, 2011, and June 30, 2014. Each surgeon's composite score combined their aggregate risk-adjusted mortality and major morbidity rates (each weighted inversely by their standard deviations) and reflected the proportion of case types they performed. Model parameters were estimated in a Bayesian framework. Composite star ratings were examined using 90%, 95%, or 98% Bayesian credible intervals. Measure reliability was estimated using various 3-year case thresholds. The final composite measure was defined as 0.81 × (1 minus risk-standardized mortality rate) + 0.19 × (1 minus risk-standardized complication rate). Risk-adjusted mortality (median, 2.3%; interquartile range, 1.7% to 3.0%), morbidity (median, 13.7%; interquartile range, 10.8% to 17.1%), and composite scores (median, 95.4%; interquartile range, 94.4% to 96.3%) varied substantially across surgeons. Using 98% Bayesian credible intervals, there were 207 1-star (lower performance) surgeons (9.1%), 1,701 2-star (as-expected performance) surgeons (74.4%), and 378 3-star (higher performance) surgeons (16.5%). With an eligibility threshold of 100 cases over 3 years, measure reliability was 0.81. The STS has developed a multiprocedural composite measure suitable for evaluating performance at the individual surgeon level. Copyright © 2015 The Society of
Hussain, Husniza; Khalid, Norhayati Mustafa; Selamat, Rusidah; Wan Nazaimoon, Wan Mohamud
2013-09-01
The urinary iodine micromethod (UIMM) is a modification of the conventional method and its performance needs evaluation. UIMM performance was evaluated using the method validation and 2008 Iodine Deficiency Disorders survey data obtained from four urinary iodine (UI) laboratories. Method acceptability tests and Sigma quality metrics were determined using total allowable errors (TEas) set by two external quality assurance (EQA) providers. UIMM obeyed various method acceptability test criteria with some discrepancies at low concentrations. Method validation data calculated against the UI Quality Program (TUIQP) TEas showed that the Sigma metrics were at 2.75, 1.80, and 3.80 for 51±15.50 µg/L, 108±32.40 µg/L, and 149±38.60 µg/L UI, respectively. External quality control (EQC) data showed that the performance of the laboratories was within Sigma metrics of 0.85-1.12, 1.57-4.36, and 1.46-4.98 at 46.91±7.05 µg/L, 135.14±13.53 µg/L, and 238.58±17.90 µg/L, respectively. No laboratory showed a calculated total error (TEcalc)
Hospital performance measures and 30-day readmission rates.
Stefan, Mihaela S; Pekow, Penelope S; Nsa, Wato; Priya, Aruna; Miller, Lauren E; Bratzler, Dale W; Rothberg, Michael B; Goldberg, Robert J; Baus, Kristie; Lindenauer, Peter K
2013-03-01
Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results. To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery. We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims. Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors. Among patients aged ≥ 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates. Hospitals with greater adherence to recommended care processes did not achieve
Flight performance measurement utilizing a figure of merit (FOM)
NASA Technical Reports Server (NTRS)
Mosier, Kathleen L.; Zacharias, Greg L.
1993-01-01
One of the goals of the NASA Strategic Behavior/Workload Management Program is to develop standardized procedures for constructing figures of merit (FOMs) that describe minimal criteria for flight task performance, as well as summarize overall performance quality. Such a measure could be utilized for evaluating flight crew performance, for assessing the effectiveness of new equipment or technological innovations, or for measuring performance at a particular airport. In this report, we describe the initial phases in the creation of a FOM to be employed in examining crew performance in NASA-Ames Air Ground Compatibility and Strategic Behavior/Workload Management programs.
Comparative evaluation of two asthma care quality measures among Medicaid beneficiaries.
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.
Quantifying the physical demands of a musical performance and their effects on performance quality.
Drinkwater, Eric J; Klopper, Christopher J
2010-06-01
This study investigated the effects of fatigue on performance quality induced by a prolonged musical performance. Ten participants prepared 10 min of repertoire for their chosen wind instrument that they played three times consecutively. Prior to the performance and within short breaks between performances, researchers collected heart rate, respiratory rate, blood pressure, blood lactate concentration, rating of perceived exertion (RPE), and rating of anxiety. All performances were audio recorded and later analysed for performance errors. Reliability in assessing performance errors was assessed by typical error of measure (TEM) of 15 repeat performances. Results indicate all markers of physical stress significantly increased by a moderate to large amount (4.6 to 62.2%; d = 0.50 to 1.54) once the performance began, while heart rate, respirations, and RPE continued to rise by a small to large amount (4.9 to 23.5%; d = 0.28 to 0.93) with each performance. Observed changes in performance between performances were well in excess of the TEM of 7.4%. There was a significant small (21%, d = 0.43) decrease in errors after the first performance; after the second performance, there was a significant large increase (70.4%, d = 1.14). The initial increase in physiological stress with corresponding decrease in errors after the first performance likely indicates "warming up," while the continued increase in markers of physical stress with dramatic decrement in performance quality likely indicates fatigue. Musicians may consider the relevance of physical fitness to maintaining performance quality over the duration of a performance.
Measuring quality in maternal-newborn care: developing a clinical dashboard.
Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N
2013-01-01
Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.
Measuring the performance of maintenance service outsourcing.
Cruz, Antonio Miguel; Rincon, Adriana Maria Rios; Haugan, Gregory L
2013-01-01
The aims of this paper are (1) to identify the characteristics of maintenance service providers that directly impact maintenance service quality, using 18 independent covariables; (2) to quantify the change in risk these covariables present to service quality, measured in terms of equipment turnaround time (TAT). A survey was applied to every maintenance service provider (n = 19) for characterization purposes. The equipment inventory was characterized, and the TAT variable recorded and monitored for every work order of each service provider (N = 1,025). Finally, the research team conducted a statistical analysis to accomplish the research objectives. The results of this study offer strong empirical evidence that the most influential variables affecting the quality of maintenance service performance are the following: type of maintenance, availability of spare parts in the country, user training, technological complexity of the equipment, distance between the company and the hospital, and the number of maintenance visits performed by the company. The strength of the results obtained by the Cox model built are supported by the measure of the Rp,e(2) = 0.57 with a value of Rp,e= 0.75. Thus, the model explained 57% of the variation in equipment TAT, with moderate high positive correlation between the dependent variable (TAT) and independent variables.
Effect of quality metric monitoring and colonoscopy performance.
Razzak, Anthony; Smith, Dineen; Zahid, Maliha; Papachristou, Georgios; Khalid, Asif
2016-10-01
Background and aims: Adenoma detection rate (ADR) and cecal withdrawal time (CWT) have been identified as measures of colonoscopy quality. This study evaluates the impact of monitoring these measures on provider performance. Methods: Six blinded gastroenterologists practicing at a Veterans Affairs Medical Center were prospectively monitored over 9 months. Data for screening, adenoma surveillance, and fecal occult blood test positive (FOBT +) indicated colonoscopies were obtained, including exam preparation quality, cecal intubation rate, CWT, ADR, adenomas per colonoscopy (APC), and adverse events. Metrics were continuously monitored after a period of informed CWT monitoring and informed CWT + ADR monitoring. The primary outcome was impact on ADR and APC. Results: A total of 1671 colonoscopies were performed during the study period with 540 before informed monitoring, 528 during informed CWT monitoring, and 603 during informed CWT + ADR monitoring. No statistically significant impact on ADR was noted across each study phase. Multivariate regression revealed a trend towards fewer adenomas removed during the CWT monitoring phase (OR = 0.79; 95 %CI 0.62 - 1.02, P = 0.065) and a trend towards more adenomas removed during the CWT + ADR monitoring phase when compared to baseline (OR = 1.26; 95 %CI 0.99 - 1.61, P = 0.062). Indication for examination and provider were significant predictors for higher APC. Provider-specific data demonstrated a direct relationship between high ADR performers and increased CWT. Conclusions: Monitoring quality metrics did not significantly alter colonoscopy performance across a small heterogeneous group of providers. Non-significant trends towards higher APC were noted with CWT + ADR monitoring. Providers with a longer CWT had a higher ADR. Further studies are needed to determine the impact of monitoring on colonoscopy performance.
Distributor- Retailer Interface in Pharmaceutical Supply Chain: Service Quality Measurement Scale.
Mehralian, Gholamhossein; Babapour, Jafar; Peiravian, Farzad
2016-01-01
In the current competitive market, service quality management is the key to the survival and success of businesses. SERVQUAL is a popular service quality measurement scale (SQMS) that has served as a basis for subsequent research on service quality; it has been used for testing different aspects of service quality in a market. The purpose of our study is, therefore, to develop a service quality measurement scale (SQMS) for the distributor-retailer interface of Pharm supply chains (PSC) in Iran. A survey was performed to collect data from pharmacies located in Tehran. A valid and reliable questionnaire delivered to pharmacies, and 400 pharmacies were intended to participate in our survey. Confirmatory factor analysis (CFA) was used to develop an SQMS in this study. Sufficient sampling was undertaken to do CFA. Consistent with other service quality studies, this Res developed an SQMS with five dimensions and 20 items for PSC, and contributes to mangers to regularly measure service quality. This is an initial study to develop a framework for measuring service quality in Iranian PCS. The framework can be used effectively to achieve competitive advantage at the distributor-retailer interface.
Distributor– Retailer Interface in Pharmaceutical Supply Chain: Service Quality Measurement Scale
Mehralian, Gholamhossein; Babapour, Jafar; peiravian, farzad
2016-01-01
In the current competitive market, service quality management is the key to the survival and success of businesses. SERVQUAL is a popular service quality measurement scale (SQMS) that has served as a basis for subsequent research on service quality; it has been used for testing different aspects of service quality in a market. The purpose of our study is, therefore, to develop a service quality measurement scale (SQMS) for the distributor–retailer interface of Pharm supply chains (PSC) in Iran. A survey was performed to collect data from pharmacies located in Tehran. A valid and reliable questionnaire delivered to pharmacies, and 400 pharmacies were intended to participate in our survey. Confirmatory factor analysis (CFA) was used to develop an SQMS in this study. Sufficient sampling was undertaken to do CFA. Consistent with other service quality studies, this Res developed an SQMS with five dimensions and 20 items for PSC, and contributes to mangers to regularly measure service quality. This is an initial study to develop a framework for measuring service quality in Iranian PCS. The framework can be used effectively to achieve competitive advantage at the distributor–retailer interface. PMID:28243297
A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes.
Driessen, Sara R C; Van Zwet, Erik W; Haazebroek, Pascal; Sandberg, Evelien M; Blikkendaal, Mathijs D; Twijnstra, Andries R H; Jansen, Frank Willem
2016-12-01
The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and
42 CFR 486.348 - Condition: Quality assessment and performance improvement (QAPI).
Code of Federal Regulations, 2010 CFR
2010-10-01
... improvement (QAPI). 486.348 Section 486.348 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Coverage: Organ Procurement Organizations Organ Procurement Organization Process Performance Measures § 486.348 Condition: Quality assessment and performance improvement (QAPI). The OPO must develop, implement...
Useful measures and models for analytical quality management in medical laboratories.
Westgard, James O
2016-02-01
The 2014 Milan Conference "Defining analytical performance goals 15 years after the Stockholm Conference" initiated a new discussion of issues concerning goals for precision, trueness or bias, total analytical error (TAE), and measurement uncertainty (MU). Goal-setting models are critical for analytical quality management, along with error models, quality-assessment models, quality-planning models, as well as comprehensive models for quality management systems. There are also critical underlying issues, such as an emphasis on MU to the possible exclusion of TAE and a corresponding preference for separate precision and bias goals instead of a combined total error goal. This opinion recommends careful consideration of the differences in the concepts of accuracy and traceability and the appropriateness of different measures, particularly TAE as a measure of accuracy and MU as a measure of traceability. TAE is essential to manage quality within a medical laboratory and MU and trueness are essential to achieve comparability of results across laboratories. With this perspective, laboratory scientists can better understand the many measures and models needed for analytical quality management and assess their usefulness for practical applications in medical laboratories.
Impact of image quality on OCT angiography based quantitative measurements.
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.
Inmate Recidivism as a Measure of Private Prison Performance
ERIC Educational Resources Information Center
Spivak, Andrew L.; Sharp, Susan F.
2008-01-01
The growth of the private corrections industry has elicited interest in the comparative performance of state and private prisons. One way to measure the service quality of private prisons is to examine inmates' postrelease performance. Current empirical evidence is limited to four studies, all conducted in Florida. This analysis replicates and…
PERFORMANCE MEASUREMENT IN TRIBAL HOME VISITING: CHALLENGES AND OPPORTUNITIES.
Morales, Julie R; Ferron, Cathy; Whitmore, Corrie; Reifel, Nancy; Geary, Erin; Anderson, Cyndi; Mcdaniel, Judy
2018-05-01
Over the last several decades, performance measurement has become an increasingly prevalent requirement among human services agencies for demonstrating program progress and achieving outcomes. In the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV), performance measurement was one of the central components of the Administration for Children and Families' cooperative agreements to tribes, urban Indian organizations, and tribal organizations. Since the inception of the Tribal MIECHV Program in 2010, the benchmark requirement was intended to be a mechanism to systematically monitor program progress and performance toward improving the quality of home-visiting programs that serve vulnerable American Indian or Alaska Native families. In this article, we examine performance measurement in the context of Tribal MIECHV, providing an overview of performance measurement, the Tribal MIECHV requirement, and how grantees experienced the requirement; we describe the existing literature on performance measurement challenges and benefits, and the specific challenges and advantages experienced by tribal grantees; and provide recommendations for performance measurement in tribal home-visiting contexts based on grantees' own experiences. This article contributes to the literature by examining performance measurement challenges and opportunities in the context of tribal communities, and provides recommendations that may inform future policy on performance measurement design and implementation in tribal communities. © 2018 Michigan Association for Infant Mental Health.
Performance measurement in cancer care: uses and challenges.
Lazar, G S; Desch, C E
1998-05-15
Unnecessary, inappropriate, and futile care are given in all areas of health care including cancer care. Not only does such care increase costs and waste precious resources, but patients may have adverse outcomes when the wrong care is given. One of the ways to address this issue is to measure performance with the use of administrative data sets. Through performance measurement, the best providers can be chosen, providers can be rewarded on the basis of the quality of their performance, opportunities for improvement can be identified, and variation in practice can be minimized. Purchasers should take leadership role in creating data sets that will enhance, clinical performance. Specifically, purchasers should require the following from payers: 1) staging information; 2) requirements and/or incentives for proper International Classification of Diseases coding, including other important (comorbid) conditions; 3) incentives or requirements for proper data collection if the payer is using a reimbursement strategy that places the risk on the provider; and 4) a willingness to collect and report information to providers of care, with a view toward increasing quality and decreasing the costs of cancer care. Demanding better clinical performance can lead to better outcomes. Once good data is presented to patients and providers, better clinical behavior and improved cancer care systems will quickly follow.
ERIC Educational Resources Information Center
Condon, Christopher; Clifford, Matthew
2010-01-01
This brief reviews the publicly available principal assessments and points superintendents and policy makers toward strong instruments to measure principal performance. Specifically, the measures included in this review are expressly intended to evaluate principal performance and have varying degrees of publicly available evidence of psychometric…
Autonomous Quality Control of Joint Orientation Measured with Inertial Sensors.
Lebel, Karina; Boissy, Patrick; Nguyen, Hung; Duval, Christian
2016-07-05
Clinical mobility assessment is traditionally performed in laboratories using complex and expensive equipment. The low accessibility to such equipment, combined with the emerging trend to assess mobility in a free-living environment, creates a need for body-worn sensors (e.g., inertial measurement units-IMUs) that are capable of measuring the complexity in motor performance using meaningful measurements, such as joint orientation. However, accuracy of joint orientation estimates using IMUs may be affected by environment, the joint tracked, type of motion performed and velocity. This study investigates a quality control (QC) process to assess the quality of orientation data based on features extracted from the raw inertial sensors' signals. Joint orientation (trunk, hip, knee, ankle) of twenty participants was acquired by an optical motion capture system and IMUs during a variety of tasks (sit, sit-to-stand transition, walking, turning) performed under varying conditions (speed, environment). An artificial neural network was used to classify good and bad sequences of joint orientation with a sensitivity and a specificity above 83%. This study confirms the possibility to perform QC on IMU joint orientation data based on raw signal features. This innovative QC approach may be of particular interest in a big data context, such as for remote-monitoring of patients' mobility.
Performance Evaluation of Phasor Measurement Systems
DOE Office of Scientific and Technical Information (OSTI.GOV)
Huang, Zhenyu; Kasztenny, Bogdan; Madani, Vahid
2008-07-20
After two decades of phasor network deployment, phasor measurements are now available at many major substations and power plants. The North American SynchroPhasor Initiative (NASPI), supported by both the US Department of Energy and the North American Electricity Reliability Council (NERC), provides a forum to facilitate the efforts in phasor technology in North America. Phasor applications have been explored and some are in today’s utility practice. IEEE C37.118 Standard is a milestone in standardizing phasor measurements and defining performance requirements. To comply with IEEE C37.118 and to better understand the impact of phasor quality on applications, the NASPI Performance andmore » Standards Task Team (PSTT) initiated and accomplished the development of two important documents to address characterization of PMUs and instrumentation channels, which leverage prior work (esp. in WECC) and international experience. This paper summarizes the accomplished PSTT work and presents the methods for phasor measurement evaluation.« less
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
Measuring Quality in Special Libraries: Lessons from Service Marketing.
ERIC Educational Resources Information Center
White, Marilyn Domas; Abels, Eileen G.
1995-01-01
Surveys the service marketing literature for models and data-gathering instruments measuring service quality, particularly the instruments SERVQUAL and SERVPERF, and assesses their applicability to special libraries and information centers. Topics include service characteristics and definitions of service; performance-minus-expectations and…
What Is Nursing Home Quality and How Is It Measured?
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
Deufel, Christopher L; Mullins, John P; Zakhary, Mark J
2018-05-17
Nasobiliary high-dose-rate (HDR) brachytherapy has emerged as an effective tool to boost the radiation dose for patients with unresectable perihilar cholangiocarcinoma. This work describes a quality assurance (QA) tool for measuring the HDR afterloader's performance, including the transit dose, when the source wire travels through a tortuous nasobiliary catheter path. The nasobiliary QA device was designed to mimic the anatomical path of a nasobiliary catheter, including the nasal, stomach, duodenum, and bile duct loops. Two of these loops, the duodenum and bile duct loops, have adjustable radii of curvature, resulting in the ability to maximize stress on the source wire in transit. The device was used to measure the performance over time for the HDR afterloader and the differences between intraluminal catheter lots. An upper limit on the transit dose was also measured using radiochromic film and compared with a simple theoretical model. The QA device was capable of detecting performance variations among nasobiliary catheter lots and following radioactive source replacement. The transit dose from a nasobiliary treatment increased by up to one order of magnitude when the source wire encountered higher than normal friction. Three distinct travel speeds of the source wire were observed: 5.2, 17.4, and 54.7 cm/s. The maximum transit dose was 0.3 Gy at a radial distance of 5 mm from a 40.3 kU 192 Ir source. The source wire encounters substantially greater friction when it navigates through the nasobiliary brachytherapy catheter. A QA tool that mimics the nasal, stomach, duodenum, and bile duct loops may be used to evaluate transit dose and the afterloader's performance over time. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Härkönen, Kati; Kivekäs, Ilkka; Rautiainen, Markus; Kotti, Voitto; Sivonen, Ville; Vasama, Juha-Pekka
2015-05-01
This prospective study shows that working performance, quality of life (QoL), and quality of hearing (QoH) are better with two compared with a single cochlear implant (CI). The impact of the second CI on the patient's QoL is as significant as the impact of the first CI. To evaluate the benefits of sequential bilateral cochlear implantation in working, QoL, and QoH. We studied working performance, work-related stress, QoL, and QoH with specific questionnaires in 15 patients with unilateral CI scheduled for sequential CI of another ear. Sound localization performance and speech perception in noise were measured with specific tests. All questionnaires and tests were performed before the second CI surgery and 6 and 12 months after its activation. Bilateral CIs increased patients' working performance and their work-related stress and fatigue decreased. Communication with co-workers was easier and patients were more active in their working environment. Sequential bilateral cochlear implantation improved QoL, QoH, sound localization, and speech perception in noise statistically significantly.
Bowling, Ann; Stenner, Paul
2011-03-01
Most measures of quality of life (QoL) are based on 'expert' opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Data were taken from three surveys of older people living at home in Britain in 2007-2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure--19 items (CASP-19), World Health Organization Quality of Life questionnaire--version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting.
UK key performance indicators and quality assurance standards for colonoscopy.
Rees, Colin J; Thomas Gibson, Siwan; Rutter, Matt D; Baragwanath, Phil; Pullan, Rupert; Feeney, Mark; Haslam, Neil
2016-12-01
Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Petersen, Laura A; Woodard, Lechauncy D; Henderson, Louise M; Urech, Tracy H; Pietz, Kenneth
2009-06-16
There is concern that performance measures, patient ratings of their care, and pay-for-performance programs may penalize healthcare providers of patients with multiple chronic coexisting conditions. We examined the impact of coexisting conditions on the quality of care for hypertension and patient perception of overall quality of their health care. We classified 141 609 veterans with hypertension into 4 condition groups: those with hypertension-concordant (diabetes mellitus, ischemic heart disease, dyslipidemia) and/or -discordant (arthritis, depression, chronic obstructive pulmonary disease) conditions or neither. We measured blood pressure control at the index visit, overall good quality of care for hypertension, including a follow-up interval, and patient ratings of satisfaction with their care. Associations between condition type and number of coexisting conditions on receipt of overall good quality of care were assessed with logistic regression. The relationship between patient assessment and objective measures of quality was assessed. Of the cohort, 49.5% had concordant-only comorbidities, 8.7% had discordant-only comorbidities, 25.9% had both, and 16.0% had none. Odds of receiving overall good quality after adjustment for age were higher for those with concordant comorbidities (odds ratio, 1.78; 95% confidence interval, 1.70 to 1.87), discordant comorbidities (odds ratio, 1.32; 95% confidence interval, 1.23 to 1.41), or both (odds ratio, 2.25; 95% confidence interval, 2.13 to 2.38) compared with neither. Findings did not change after adjustment for illness severity and/or number of primary care and specialty care visits. Patient assessment of quality did not vary by the presence of coexisting conditions and was not related to objective ratings of quality of care. Contrary to expectations, patients with greater complexity had higher odds of receiving high-quality care for hypertension. Subjective ratings of care did not vary with the presence or absence of
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.
Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H
2018-01-31
To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.
Emergency medical services key performance measurement in Asian cities.
Rahman, Nik Hisamuddin; Tanaka, Hideharu; Shin, Sang Do; Ng, Yih Yng; Piyasuwankul, Thammapad; Lin, Chih-Hao; Ong, Marcus Eng Hock
2015-01-01
One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.
Quality measures for nurse practitioner practice evaluation.
Kleinpell, Ruth; Kapu, April N
2017-08-01
Evaluating the impact of nurse practitioner (NP) practice has become a priority area of focus for demonstrating outcomes. A number of quality measures are available to enable practice-specific evaluation of NP roles and initiatives. This article reviews sources of quality measures that can be used to facilitate quantifying the outcomes of NP practice as part of an overall evaluation agenda. National resources and published literature on NP quality measures were reviewed. Various resources and toolkits exist to assist NPs in identifying outcomes of practice using quality measures. The need to demonstrate outcomes of NP practice remains an ongoing priority area regardless of the clinical practice setting. A variety of sources of quality measures exist that can be used to showcase the effect of NP care. The use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact, and enhance the conduct of an NP outcomes assessment. The use of organizational, NP-specific, and national-related quality measures can help to showcase how NP care improves the quality, safety, and costs of health care. ©2017 American Association of Nurse Practitioners.
A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.
Hysong, Sylvia J; Amspoker, Amber B; Petersen, Laura A
2016-04-01
Clinical-performance measurement has helped improve the quality of health-care; yet success in attaining high levels of quality across multiple domains simultaneously still varies considerably. Although many sources of variability in care quality have been studied, the difficulty required to complete the clinical work itself has received little attention. We present a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs) by assessing the complexity of their component requisite tasks. Using Functional Job Analysis (FJA), subject-matter experts (SMEs) generated task lists for 17 CPMs; task lists were rated on ten dimensions of complexity, and then aggregated into difficulty composites. Eleven outpatient work SMEs; 133 VA Medical Centers nationwide. Clinical Performance: 17 outpatient CPMs (2000-2008) at 133 VA Medical Centers nationwide. Measure Difficulty: for each CPM, the number of component requisite tasks and the average rating across ten FJA complexity scales for the set of tasks comprising the measure. Measures varied considerably in the number of component tasks (M = 10.56, SD = 6.25, min = 5, max = 25). Measures of chronic care following acute myocardial infarction exhibited significantly higher measure difficulty ratings compared to diabetes or screening measures, but not to immunization measures ([Formula: see text] = 0.45, -0.04, -0.05, and -0.06 respectively; F (3, 186) = 3.57, p = 0.015). Measure difficulty ratings were not significantly correlated with the number of component tasks (r = -0.30, p = 0.23). Evaluating the difficulty of achieving recommended CPM performance levels requires more than simply counting the tasks involved; using FJA to assess the complexity of CPMs' component tasks presents an alternate means of assessing the difficulty of primary-care CPMs and accounting for performance variation among measures and performers. This in turn could be used in designing
Butler, Javed; McCoin, Nicole S; Feurer, Irene D; Speroff, Theodore; Davis, Stacy F; Chomsky, Don B; Wilson, John R; Merrill, Walter H; Drinkwater, Davis C; Pierson, Richard N; Pinson, C Wright
2003-10-01
Health-related quality of life and functional performance are important outcome measures following heart transplantation. This study investigates the impact of pre-transplant functional performance and post-transplant rejection episodes, obesity and osteopenia on post-transplant health-related quality of life and functional performance. Functional performance and health-related quality of life were measured in 70 adult heart transplant recipients. A composite health-related quality of life outcome measure was computed via principal component analysis. Iterative, multiple regression-based path analysis was used to develop an integrated model of variables that affect post-transplant functional performance and health-related quality of life. Functional performance, as measured by the Karnofsky scale, improved markedly during the first 6 months post-transplant and was then sustained for up to 3 years. Rejection Grade > or =2 was negatively associated with health-related quality of life, measured by Short Form-36 and reversed Psychosocial Adjustment to Illness Scale scores. Patients with osteopenia had lower Short Form-36 physical scores and obese patients had lower functional performance. Path analysis demonstrated a negative direct effect of obesity (beta = - 0.28, p < 0.05) on post-transplant functional performance. Post-transplant functional performance had a positive direct effect on the health-related quality of life composite score (beta = 0.48, p < 0.001), and prior rejection episodes grade > or =2 had a negative direct effect on this measure (beta = -0.29, p < 0.05). Either directly or through effects mediated by functional performance, moderate-to-severe rejection, obesity and osteopenia negatively impact health-related quality of life. These findings indicate that efforts should be made to devise immunosuppressive regimens that reduce the incidence of acute rejection, weight gain and osteopenia after heart transplantation.
Demers, Marika; Levin, Mindy F
2017-07-01
Movement is described in terms of task-related end point characteristics in external space and movement quality (joint rotations in body space). Assessment of upper-limb (UL) movement quality can assist therapists in designing effective treatment approaches for retraining lost motor elements and provide more detailed measurements of UL motor improvements over time. To determine the extent to which current activity level outcome measures used in neurological practice assess UL movement quality. Outcome measures assessing arm/hand function at the International Classification of Function activity level recommended by neurological clinical practice guidelines were reviewed. Measures assessing the UL as part of a general mobility assessment, those strictly evaluating body function/structure or participation, and paediatric measures were excluded. In all, 15 activity level outcome measures were identified; 9 measures assess how movement is performed by measuring either end point characteristics or movement quality. However, except for the Reaching Performance Scale for Stroke and the Motor Evaluation Scale for Upper Extremity in Stroke Patients, these measures only account for deficits indirectly by giving a partial score if movements are slower or if the person experiences difficulties. Six outcome measures neither assess any parameters related to movement quality, nor distinguish between improvements resulting from motor compensation or recovery of desired movement strategies. Current activity measures may not distinguish recovery from compensation and adequately track changes in movement quality over time. Movement quality may be incorporated into clinical assessment using observational kinematics with or without low-cost motion tracking technology.
In-Hospital Quality-of-Care Measures for Pediatric Sepsis Syndrome.
Odetola, Folafoluwa O; Freed, Gary; Shevrin, Caroline; Madden, Brian; McCormick, Julie; Dombkowski, Kevin
2017-07-24
Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome. Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts. The measures were tested for reliability and validity among children 0 to 18 years of age hospitalized with sepsis syndrome from January 1, 2012, to June 30, 2013. Of 27 hospitals, 59% had no protocol for the identification and treatment of pediatric sepsis syndrome. Blood culture was performed in only 70% of patients with pediatric sepsis syndrome. Antibiotics were administered within 1 hour of diagnosis in 70% of patients with pediatric severe sepsis or septic shock, and timely fluid resuscitation was performed in 50% of patients with severe sepsis or septic shock. Documentation of heart rate during fluid resuscitation of children with severe sepsis or septic shock was observed in 18% of cases. Two measures could not be rigorously tested for validity and reliability given the rarity of septic shock and were deemed infeasible. This multisite study to develop and validate measures of the quality of hospital care of children with sepsis syndrome highlights the existence of important gaps in delivery of care. Copyright © 2017 by the American Academy of Pediatrics.
QNOTE: an instrument for measuring the quality of EHR clinical notes.
Burke, Harry B; Hoang, Albert; Becher, Dorothy; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; Sessums, Laura L; O'Malley, Patrick; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W
2014-01-01
The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss κ. The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument. 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.
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
An empirically derived figure of merit for the quality of overall task performance
NASA Technical Reports Server (NTRS)
Lemay, Moira
1989-01-01
The need to develop an operationally relevant figure of merit for the quality of performance of a complex system such as an aircraft cockpit stems from a hypothesized dissociation between measures of performance and those of workload. Performance can be measured in terms of time, errors, or a combination of these. In most tasks performed by expert operators, errors are relatively rare and often corrected in time to avoid consequences. Moreover, perfect performance is seldom necessary to accomplish a particular task. Moreover, how well an expert performs a complex task consisting of a series of discrete cognitive tasks superimposed on a continuous task, such as flying an aircraft, does not depend on how well each discrete task is performed, but on their smooth sequencing. This makes the amount of time spent on each subtask of paramount importance in measuring overall performance, since smooth sequencing requires a minimum amount of time spent on each task. Quality consists in getting tasks done within a crucial time interval while maintaining acceptable continuous task performance. Thus, a figure of merit for overall quality of performance should be primarily a measure of time to perform discrete subtasks combined with a measure of basic vehicle control. Thus, the proposed figure of merit requires doing a task analysis on a series of performance, or runs, of a particular task, listing each discrete task and its associated time, and calculating the mean and standard deviation of these times, along with the mean and standard deviation of tracking error for the whole task. A set of simulator data on 30 runs of a landing task was obtained and a figure of merit will be calculated for each run. The figure of merit will be compared for voice and data link, so that the impact of this technology on total crew performance (not just communication performance) can be assessed. The effect of data link communication on other cockpit tasks will also be considered.
Image Quality Performance Measurement of the microPET Focus 120
NASA Astrophysics Data System (ADS)
Ballado, Fernando Trejo; López, Nayelli Ortega; Flores, Rafael Ojeda; Ávila-Rodríguez, Miguel A.
2010-12-01
The aim of this work is to evaluate the characteristics involved in the image reconstruction of the microPET Focus 120. For this evaluation were used two different phantoms; a miniature hot-rod Derenzo phantom and a National Electrical Manufacturers Association (NEMA) NU4-2008 image quality (IQ) phantom. The best image quality was obtained when using OSEM3D as the reconstruction method reaching a spatial resolution of 1.5 mm with the Derenzo phantom filled with 18F. Image quality test results indicate a superior image quality for the Focus 120 when compared to previous microPET models.
Issues in Evaluating Importance Weighting in Quality of Life Measures
ERIC Educational Resources Information Center
Hsieh, Chang-ming
2013-01-01
For most empirical research investigating the topic of importance weighting in quality of life (QoL) measures, the prevailing approach has been to use (1) a limited choice of global QoL measures as criterion variables (often a single one) to determine the performance of importance weighting, (2) a limited option of weighting methods to develop…
Quality control of measurements made on fixed-area sample plots
Ola Lindgren
2000-01-01
The paper describes results from a large program for quality control of forest measurements. The performance of 87 surveyors was evaluated. Tree heights were usually measured well, whereas the counting of tree-rings on increment cores was a source of considerable bias for many surveyors. During tree count on sample plots, many surveyors had a tendency to forget trees,...
Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures
Rokoske, Franziska S.; Durham, Danielle; Cagle, John G.; Hanson, Laura C.
2014-01-01
Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162
Josephson, Erik; Gergen, Jessica; Coe, Martha; Ski, Samantha; Madhavan, Supriya; Bauhoff, Sebastian
2017-01-01
Abstract This paper seeks to systematically describe the length and content of quality checklists used in performance-based financing programmes, their similarities and differences, and how checklists have evolved over time. We compiled a list of supply-side, health facility-based performance-based financing (PBF) programmes in low- and lower middle-income countries based on a document review. We then solicited PBF manuals and quality checklists from implementers and donors of these PBF mechanisms. We entered each indicator from each quality checklist into a database verbatim in English, and translated into English from French where appropriate, and categorized each indicator according to the Donabedian framework and an author-derived categorization. We extracted 8,490 quality indicators from 68 quality checklists across 32 PBF implementations in 28 countries. On average, checklists contained 125 indicators; within the same program, checklists tend to grow as they are updated. Using the Donabedian framework, 80% of indicators were structure-type, 19% process-type, and less than 1% outcome-type. The author-derived categorization showed that 57% of indicators relate to availability of resources, 24% to managing the facility and 17% assess knowledge and effort. There is a high degree of similarity in a narrow set of indicators used in checklists for common service types such as maternal, neonatal and child health. We conclude that performance-based financing offers an appealing approach to targeting specific quality shortfalls and advancing toward the Sustainable Development Goals of high quality coverage. Currently most indicators focus on structural issues and resource availability. There is scope to rationalize and evolve the quality checklists of these programs to help achieve national and global goals to improve quality of care. PMID:28549142
Quality Assurance of Chemical Measurements.
ERIC Educational Resources Information Center
Taylor, John K.
1981-01-01
Reviews aspects of quality control (methods to control errors) and quality assessment (verification that systems are operating within acceptable limits) including an analytical measurement system, quality control by inspection, control charts, systematic errors, and use of SRMs, materials for which properties are certified by the National Bureau…
Measuring quality of dental care: Caries prevention services for children.
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
Eckstein, Donna A; Wu, Rebecca L; Akinbiyi, Takintope; Silver, Lester; Taub, Peter J
2011-11-01
Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.
Stenner, Paul
2010-01-01
Background Most measures of quality of life (QoL) are based on ‘expert’ opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Methods Data were taken from three surveys of older people living at home in Britain in 2007–2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure - 19 items (CASP-19), World Health Organization Quality of Life questionnaire - version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Results Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. Conclusion The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting. PMID:20719807
Rural relevant quality measures for critical access hospitals.
Casey, Michelle M; Moscovice, Ira; Klingner, Jill; Prasad, Shailendra
2013-01-01
To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting. © 2012 National Rural Health Association.
Financial incentives and measurement improved physicians' quality of care in the Philippines.
Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville
2011-04-01
The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.
Assessing quality of care for migraineurs: a model health plan measurement set.
Leas, Brian F; Gagne, Joshua J; Goldfarb, Neil I; Rupnow, Marcia F T; Silberstein, Stephen
2008-08-01
Quality of care measures are increasingly important to health plans, purchasers, physicians, and patients. Appropriate measures can be used to assess quality and evaluate improvement and are necessary components of pay-for-performance programs. Despite the broad scope of activity in the development of quality measures, migraine headache has received little attention. Given the enormous costs associated with migraine, especially in terms of lost productivity and preventable health care utilization, health plans could gain from a structured approach to measuring the quality of migraine care their beneficiaries receive. A potential migraine quality measurement set was developed through a review of migraine care literature and guidelines, interviews with leaders in migraine care, health care purchasing, and managed care, and the assembly of an advisory board. The board discussed candidate measures and established consensus on a testable measurement set. Twenty measures were developed, focused primarily on diagnosis and utilization. Areas of utilization include physician visits, emergency department visits, hospitalizations, and imaging. Use of both acute and preventive medications is included. More complex aspects of migraine care are also addressed, including triptan overuse, the relationship between acute and preventive medications, and follow-up after emergency department visits. The measures are currently being tested in health plans to assess their feasibility and value. A compelling case can be made for the development of migraine-specific quality measures for health plans. This effort to develop and test a starter set of measures should lead to new and innovative efforts to assess and improve quality of care for migraineurs.
Quality of life : assessment for transportation performance measures.
DOT National Transportation Integrated Search
2013-01-01
Quality of life (QOL) is a commonly used term. Defining QOL, however, is an ongoing challenge that experts : often take on with minimal input from citizens. This groundbreaking research sought citizen input on what : comprised QOL and what role trans...
Performance Assessment Examples from the Quality Performance Assessment Network
ERIC Educational Resources Information Center
Kuriacose, Christina
2017-01-01
In this brief article, Christina Kuriacose provides four sample performance assessments. Spanning grade levels, these assessments are strong examples of teacher-developed performance assessments from schools within the Center for Collaborative Education's Quality Performance Assessment network. These performance tasks demonstrate the pedagogical…
Performance of electrolyte measurements assessed by a trueness verification program.
Ge, Menglei; Zhao, Haijian; Yan, Ying; Zhang, Tianjiao; Zeng, Jie; Zhou, Weiyan; Wang, Yufei; Meng, Qinghui; Zhang, Chuanbao
2016-08-01
In this study, we analyzed frozen sera with known commutabilities for standardization of serum electrolyte measurements in China. Fresh frozen sera were sent to 187 clinical laboratories in China for measurement of four electrolytes (sodium, potassium, calcium, and magnesium). Target values were assigned by two reference laboratories. Precision (CV), trueness (bias), and accuracy [total error (TEa)] were used to evaluate measurement performance, and the tolerance limit derived from the biological variation was used as the evaluation criterion. About half of the laboratories used a homogeneous system (same manufacturer for instrument, reagent and calibrator) for calcium and magnesium measurement, and more than 80% of laboratories used a homogeneous system for sodium and potassium measurement. More laboratories met the tolerance limit of imprecision (coefficient of variation [CVa]) than the tolerance limits of trueness (biasa) and TEa. For sodium, calcium, and magnesium, the minimal performance criterion derived from biological variation was used, and the pass rates for total error were approximately equal to the bias (<50%). For potassium, the pass rates for CV and TE were more than 90%. Compared with the non homogeneous system, the homogeneous system was superior for all three quality specifications. The use of commutable proficiency testing/external quality assessment (PT/EQA) samples with values assigned by reference methods can monitor performance and provide reliable data for improving the performance of laboratory electrolyte measurement. The homogeneous systems were superior to the non homogeneous systems, whereas accuracy of assigned values of calibrators and assay stability remained challenges.
Sayegh, Philip; Arentoft, Alyssa; Thaler, Nicholas S.; Dean, Andy C.; Thames, April D.
2014-01-01
The current study examined whether self-rated education quality predicts Wide Range Achievement Test-4th Edition (WRAT-4) Word Reading subtest and neurocognitive performance, and aimed to establish this subtest's construct validity as an educational quality measure. In a community-based adult sample (N = 106), we tested whether education quality both increased the prediction of Word Reading scores beyond demographic variables and predicted global neurocognitive functioning after adjusting for WRAT-4. As expected, race/ethnicity and education predicted WRAT-4 reading performance. Hierarchical regression revealed that when including education quality, the amount of WRAT-4's explained variance increased significantly, with race/ethnicity and both education quality and years as significant predictors. Finally, WRAT-4 scores, but not education quality, predicted neurocognitive performance. Results support WRAT-4 Word Reading as a valid proxy measure for education quality and a key predictor of neurocognitive performance. Future research should examine these findings in larger, more diverse samples to determine their robust nature. PMID:25404004
Quality measurement and benchmarking of HPV vaccination services: a new approach.
Maurici, Massimo; Paulon, Luca; Campolongo, Alessandra; Meleleo, Cristina; Carlino, Cristiana; Giordani, Alessandro; Perrelli, Fabrizio; Sgricia, Stefano; Ferrante, Maurizio; Franco, Elisabetta
2014-01-01
A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort. The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively. With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage. The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders' points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a "standard" to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.
The five traps of performance measurement.
Likierman, Andrew
2009-10-01
Evaluating a company's performance often entails wading through a thicket of numbers produced by a few simple metrics, writes the author, and senior executives leave measurement to those whose specialty is spreadsheets. To take ownership of performance assessment, those executives should find qualitative, forward-looking measures that will help them avoid five common traps: Measuring against yourself. Find data from outside the company, and reward relative, rather than absolute, performance. Enterprise Rent-A-Car uses a service quality index to measure customers' repeat purchase intentions. Looking backward. Use measures that lead rather than lag the profits in your business. Humana, a health insurer, found that the sickest 10% of its patients account for 80% of its costs; now it offers customers incentives for early screening. Putting your faith in numbers. The soft drinks company Britvic evaluates its executive coaching program not by trying to assign it an ROI number but by tracking participants' careers for a year. Gaming your metrics. The law firm Clifford Chance replaced its single, easy-to-game metric of billable hours with seven criteria on which to base bonuses. Sticking to your numbers too long. Be precise about what you want to assess and explicit about what metrics are assessing it. Such clarity would have helped investors interpret the AAA ratings involved in the financial meltdown. Really good assessment will combine finance managers' relative independence with line managers' expertise.
Quality Measures in Orthopaedic Sports Medicine: A Systematic Review.
Abrams, Geoffrey D; Greenberg, Daniel R; Dragoo, Jason L; Safran, Marc R; Kamal, Robin N
2017-10-01
To report the current quality measures that are applicable to orthopaedic sports medicine physicians. Six databases were searched with a customized search term to identify quality measures relevant to orthopaedic sports medicine surgeons: MEDLINE/PubMed, EMBASE, the National Quality Forum (NQF) Quality Positioning System (QPS), the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC), the Physician Quality Reporting System (PQRS) database, and the American Academy of Orthopaedic Surgeons (AAOS) website. Results were screened by 2 Board-certified orthopaedic surgeons with fellowship training in sports medicine and dichotomized based on sports medicine-specific or general orthopaedic (nonarthroplasty) categories. Hip and knee arthroplasty measures were excluded. Included quality measures were further categorized based on Donabedian's domains and the Center for Medicare and Medicaid (CMS) National Quality Strategy priorities. A total of 1,292 quality measures were screened and 66 unique quality measures were included. A total of 47 were sports medicine-specific and 19 related to the general practice of orthopaedics for a fellowship-trained sports medicine specialist. Nineteen (29%) quality measures were collected within PQRS, with 5 of them relating to sports medicine and 14 relating to general orthopaedics. AAOS Clinical Practice Guidelines (CPGs) comprised 40 (60%) of the included measures and were all within sports medicine. Five (8%) additional measures were collected within AHRQ and 2 (3%) within NQF. Most quality measures consist of process rather than outcome or structural measures. No measures addressing concussions were identified. There are many existing quality measures relating to the practice of orthopaedic sports medicine. Most quality measures are process measures described within PQRS or AAOS CPGs. Knowledge of quality measures are important as they may be used to improve care, are increasingly being used to
Relationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality.
Sacks, Greg D; Lawson, Elise H; Dawes, Aaron J; Russell, Marcia M; Maggard-Gibbons, Melinda; Zingmond, David S; Ko, Clifford Y
2015-09-01
The Centers for Medicare and Medicaid Services include patient experience as a core component of its Value-Based Purchasing program, which ties financial incentives to hospital performance on a range of quality measures. However, it remains unclear whether patient satisfaction is an accurate marker of high-quality surgical care. To determine whether hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality. Retrospective observational study of participating American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) hospitals. We used data from a linked database of Medicare inpatient claims, ACS NSQIP, the American Hospital Association annual survey, and Hospital Compare from December 2, 2004, through December 31, 2008. A total of 103 866 patients older than 65 years undergoing inpatient surgery were included. Hospitals were grouped by quartile based on their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Controlling for preoperative risk factors, we created hierarchical logistic regression models to predict the occurrence of adverse postoperative outcomes based on a hospital's patient satisfaction scores. Thirty-day postoperative mortality, major and minor complications, failure to rescue, and hospital readmission. Of the 180 hospitals, the overall mean patient satisfaction score was 68.0% (first quartile mean, 58.7%; fourth quartile mean, 76.7%). Compared with patients treated at hospitals in the lowest quartile, those at the highest quartile had significantly lower risk-adjusted odds of death (odds ratio = 0.85; 95% CI, 0.73-0.99), failure to rescue (odds ratio = 0.82; 95% CI, 0.70-0.96), and minor complication (odds ratio = 0.87; 95% CI, 0.75-0.99). This translated to relative risk reductions of 11.1% (P = .04), 12.6% (P = .02), and 11.5% (P = .04), respectively. No significant relationship was noted between patient satisfaction
Organizational citizenship behavior and the quantity and quality of work group performance.
Podsakoff, P M; Ahearne, M; MacKenzie, S B
1997-04-01
Despite the widespread interest in the topic of organizational citizenship behaviors (OCBs), little empirical research has tested the fundamental assumption that these forms of behavior improve the effectiveness of work groups or organizations in which they are exhibited. In the present study, the effects of OCBs on the quantity and quality of the performance of 218 people working in 40 machine crews in a paper mill located in the Northeastern United States were examined. The results indicate that helping behavior and sportsmanship had significant effects on performance quantity and that helping behavior had a significant impact on performance quality. However, civic virtue had no effect on either performance measure.
Quality/Performance Circles Three Years after Implementation.
ERIC Educational Resources Information Center
Ladwig, Dennis J.
An overview is provided of the development of quality/performance circles at Lakeshore Technical Institute (LTI), Wisconsin, and of the projects undertaken through the quality/performance circle program during its 3-year history. First, background information is provided on the use of quality circles in Japan and the United States, including…
MTF measurements on real time for performance analysis of electro-optical systems
NASA Astrophysics Data System (ADS)
Stuchi, Jose Augusto; Signoreto Barbarini, Elisa; Vieira, Flavio Pascoal; dos Santos, Daniel, Jr.; Stefani, Mário Antonio; Yasuoka, Fatima Maria Mitsue; Castro Neto, Jarbas C.; Linhari Rodrigues, Evandro Luis
2012-06-01
The need of methods and tools that assist in determining the performance of optical systems is actually increasing. One of the most used methods to perform analysis of optical systems is to measure the Modulation Transfer Function (MTF). The MTF represents a direct and quantitative verification of the image quality. This paper presents the implementation of the software, in order to calculate the MTF of electro-optical systems. The software was used for calculating the MTF of Digital Fundus Camera, Thermal Imager and Ophthalmologic Surgery Microscope. The MTF information aids the analysis of alignment and measurement of optical quality, and also defines the limit resolution of optical systems. The results obtained with the Fundus Camera and Thermal Imager was compared with the theoretical values. For the Microscope, the results were compared with MTF measured of Microscope Zeiss model, which is the quality standard of ophthalmological microscope.
Quality factor concept in piezoceramic transformer performance description.
Mezheritsky, Alex V
2006-02-01
A new general approach based on the quality factor concept to piezoceramic transformer (PT) performance description is proposed. The system's quality factor, material elastic anisotropy, and coupling factors of the input and output sections of an electrically excited and electrically loaded PT fully characterize its resonance and near-resonance behavior. The PT efficiency, transformation ratio, and input and output power were analytically analyzed and simulated as functions of the load and frequency for the simplest classical Langevin-type and Rosen-type PT designs. A new formulation of the electrical input impedance allows one to separate the power consumed by PT from the power transferred into the load. The system's PT quality factor takes into account losses in each PT "input-output-load" functional components. The loading process is changing PT input electrical impedance on the way that under loading the minimum series impedance is increasing and the maximum parallel impedance is decreasing coincidentally. The quality-factors ratio, between the states of fully loaded and nonloaded PT, is one of the best measures of PTs dynamic performance--practically, the lower the ratio is, the better PT efficiency. A simple and effective method for the loaded PT quality factor determination is proposed. As was found, a piezoceramic with low piezoelectric anisotropy is required to provide maximum PT efficiency and higher corresponding voltage gain. Limitations on the PT output voltage and power, caused by nonlinear effects in piezoceramics, were established.
Roberts, Rebecca M; Hicks, Lauri A; Bartoces, Monina
2016-08-01
Antibiotic prescribing has become increasingly viewed as an issue related to patient safety and quality of care. The objective of this study was to better understand the differences between health plan reporting and the geographic variation seen in quality measures related to antibiotic use. We focused on 3 measures from the Healthcare Effectiveness Data and Information Set (HEDIS) related to antibiotic prescribing and testing to guide antibiotic prescribing. We analyzed data for 3 relevant measures for the years 2008 to 2012, including only commercial health plans. We analyzed the following 3 HEDIS measures: 1) "Appropriate Testing for Children With Pharyngitis," 2) "Appropriate Treatment for Children With Upper Respiratory Infections," and 3) "Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis." Out of these 3 measures, health plans consistently performed poorly on the adult bronchitis measure. Performance was better on the 2 measures focused on the pediatric population. We also saw geographic variation between measures when looking at Census divisions across all years. There is wide variation between individual health plan performance on the measures related to antibiotic use. Geographic differences were also observed on these measures, with health plans in the South Central Census division performing worse than other parts of the country. Stakeholders, such as public health, advocacy groups, foundations, and professional societies, interested in improving the quality of care that patients receive related to antibiotic use in the outpatient setting should consider how existing measures and working with health plans could be used to improve prescribing.
Measuring performance improvement: total organizational commitment or clinical specialization.
Caron, Aleece; Jones, Paul; Neuhauser, Duncan; Aron, David C
2004-01-01
Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.
Sleep quality and duration are associated with performance in maximal incremental test.
Antunes, B M; Campos, E Z; Parmezzani, S S; Santos, R V; Franchini, E; Lira, F S
2017-08-01
Inadequate sleep patterns may be considered a trigger to development of several metabolic diseases. Additionally, sleep deprivation and poor sleep quality can negatively impact performance in exercise training. However, the impact of sleep duration and sleep quality on performance during incremental maximal test performed by healthy men is unclear. Therefore, the purpose of the study was to analyze the association between sleep pattern (duration and quality) and performance during maximal incremental test in healthy male individuals. A total of 28 healthy males volunteered to take part in the study. Sleep quality, sleep duration and physical activity were subjectively assessed by questionnaires. Sleep pattern was classified by sleep duration (>7h or <7h of sleep per night) and sleep quality according to the sum of measured points and/or scores by the Pittsburgh Sleep Quality Index (PSQI). Incremental exercise test was performed at 35 watts for untrained subjects, 70 watts for physically active subjects and 105 watts for well-trained subjects. HR max was correlated with sleep quality (r=0.411, p=0.030) and sleep duration (r=-0.430, p=0.022). Participants reporting good sleep quality presented higher values of W max , VO 2max and lower values of HR max when compared to participants with altered sleep. Regarding sleep duration, only W max was influenced by the amount of sleeping hours per night and this association remained significant even after adjustment by VO 2max . Sleep duration and quality are associated, at least in part, with performance during maximal incremental test among healthy men, with losses in W max and HR max . In addition, our results suggest that the relationship between sleep patterns and performance, mainly in W max , is independent of fitness condition. Copyright © 2017 Elsevier Inc. All rights reserved.
Quality measures and pediatric radiology: suggestions for the transition to value-based payment.
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.
Seibert, Julie; Fields, Suzanne; Fullerton, Catherine Anne; Mark, Tami L; Malkani, Sabrina; Walsh, Christine; Ehrlich, Emily; Imshaug, Melina; Tabrizi, Maryam
2015-06-01
The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. Data were collected by reviewing online documents related to Medicaid managed care contracts for behavioral health, quality strategies, quality improvement plans, quality and performance indicators data, annual outcomes reports, performance measure specification manuals, legislative reports, and Medicaid waiver requests for proposals. Information was publicly available for 29 states. Most states relied on process measures, along with some structure and outcome measures. Although all states reported on at least one process measure of behavioral health quality, 52% of states did not use any outcomes measures and 48% of states had no structure measures. A majority of the states (69%) used behavioral health measures from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set, and all but one state in the sample (97%) used consumer experience-of-care surveys. Many states supplemented these data with locally developed behavioral health indicators that rely on administrative and nonadministrative data. State Medicaid agencies are using nationally recognized as well as local measures to assess quality of behavioral health care. Findings indicate a need for additional nationally endorsed measures in the area of substance use disorders and treatment outcomes.
Dobson, F; Hinman, R S; Hall, M; Terwee, C B; Roos, E M; Bennell, K L
2012-12-01
To systematically review the measurement properties of performance-based measures to assess physical function in people with hip and/or knee osteoarthritis (OA). Electronic searches were performed in MEDLINE, CINAHL, Embase, and PsycINFO up to the end of June 2012. Two reviewers independently rated measurement properties using the consensus-based standards for the selection of health status measurement instrument (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings. Twenty-four out of 1792 publications were eligible for inclusion. Twenty-one performance-based measures were evaluated including 15 single-activity measures and six multi-activity measures. Measurement properties evaluated included internal consistency (three measures), reliability (16 measures), measurement error (14 measures), validity (nine measures), responsiveness (12 measures) and interpretability (three measures). A positive rating was given to only 16% of possible measurement ratings. Evidence for the majority of measurement properties of tests reported in the review has yet to be determined. On balance of the limited evidence, the 40 m self-paced test was the best rated walk test, the 30 s-chair stand test and timed up and go test were the best rated sit to stand tests, and the Stratford battery, Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures. Further good quality research investigating measurement properties of performance measures, including responsiveness and interpretability in people with hip and/or knee OA, is needed. Consensus on which combination of measures will best assess physical function in people with hip/and or knee OA is urgently required. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
Rapert, M I; Babakus, E
1996-01-01
Many organizations are not convinced a quality orientation pays off and are looking for ways to link quality with performance. The authors' exploratory study found that a quality orientation is a differentiating factor between low-performing and high-performing general service hospitals. They also developed a quality scale to assess the performance implications of quality-based strategies in the health care industry. Successful health care organizations (1) develop a strategic quality orientation at the management level, (2) support the pursuit of quality at the contact level, and (3) monitor external customers' perceptions of quality.
Pitt, Victoria; Powis, David; Levett-Jones, Tracy; Hunter, Sharyn
2014-05-01
Research conducted primarily with psychology and medical students has highlighted that personal qualities play an important role in students' academic performance. In nursing there has been limited investigation of the relationship between personal qualities and performance. Yet, reports of student incivility and a lack of compassion have prompted appeals to integrate the assessment of personal qualities into pre-registration nursing student selection. Before this can be done research is needed to explore the influence of students' personal qualities on programme performance and progression. This study explores the relationships between students' personal qualities and their academic and clinical performance, behaviours and progression through a pre-registration nursing programme in Australia. This longitudinal descriptive correlational study was undertaken with a sample of Australian pre-registration nursing students (n=138). Students' personal qualities were assessed using three personal qualities assessment (PQA) instruments. Outcome measures included grades in nursing theory and clinical courses, yearly grade point average, final clinical competency, progression (completion), class attendance and levels of life event stress. Significant correlations were found between academic performance and PQA scores for self-control, resilience and traits of aloofness, confidence and involvement. Final clinical competence was predicted by confidence and self-control scores. Students with higher empathy had higher levels of life event stress in their first year and class attendance had a positive correlation with self-control. Completing the programme in three years was weakly predicted by the measure of resilience. No difference was noted between extreme or non-extreme scorers on the PQA scales with respect to performance or progression. This sample of students' personal qualities was found to influence their academic and clinical performance and their ability to complete a
The interaction between sleep quality and academic performance.
Ahrberg, K; Dresler, M; Niedermaier, S; Steiger, A; Genzel, L
2012-12-01
Sleep quality has significant effects on cognitive performance and is influenced by multiple factors such as stress. Contrary to the ideal, medical students and residents suffer from sleep deprivation and stress at times when they should achieve the greatest amount of learning. In order to examine the relationship between sleep quality and academic performance, 144 medical students undertaking the pre-clinical board exam answered a survey regarding their subjective sleep quality (Pittsburgh sleep quality index, PSQI), grades and subjective stress for three different time points: semester, pre- and post-exam. Academic performance correlated with stress and sleep quality pre-exam (r = 0.276, p < 0.001 and r = 0.158, p < 0.03, note that low performance meant low sleep quality and high stress), however not with the stress or sleep quality during the semester and post-exam. 59% of all participants exhibited clinically relevant sleep disturbances (PSQI > 5) during exam preparation compared to 29% during the semester and 8% post-exam. This study shows that in medical students it is not the generally poor sleepers, who perform worse in the medical board exams. Instead students who will perform worse on their exams seem to be more stressed and suffer from poor sleep quality. However, poor sleep quality may negatively impact test performance as well, creating a vicious circle. Furthermore, the rate of sleep disturbances in medical students should be cause for intervention. Copyright © 2012 Elsevier Ltd. All rights reserved.
Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.
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.
Using performance measurement to drive improvement: a road map for change.
Galvin, Robert S; McGlynn, Elizabeth A
2003-01-01
Performance measures and reporting have not been adopted throughout the US health care system despite their central role in encouraging increased participation by consumers in decision-making. Understanding whether the failure of measurement and reporting to diffuse throughout the health system can be overcome is critical for determining future policy in this area. To create a conceptual framework for analyzing the current rate of adoption and evaluating alternatives for accelerating adoption, and to recommend a set of concrete steps that can be taken to increase the use of performance measurement and reporting. Review of three theoretic models (Rogers, Prochaska/DiClemente, Gladwell), examination of the literature on previous experiences with quality measurement and reporting, and interviews with select stakeholders. The three theoretic models provide a valuable framework for understanding why the use of performance measures is stalled ("the circle of unaccountability") and for generating ideas about concrete steps that could be taken to accelerate adoption. Six steps are recommended: (1) raise public awareness, (2) redesign measures and reports, (3) make the delivery of information timely, (4) require public reporting, (5) develop and implement systems to reward quality, and (6) actively court leaders. The recommended six steps are interconnected; action on all will be required to drive significant acceleration in rates of adoption of performance measurement and reporting. Leadership and coordination are necessary to ensure these steps are taken and that they work in concert with one another.
Exploring individual quality: Basal metabolic rate and reproductive performance in storm-petrels
Blackmer, A.L.; Mauck, R.A.; Ackerman, Joshua T.; Huntington, C.E.; Nevitt, G.A.; Williams, J.B.
2005-01-01
Despite evidence that some individuals achieve both superior reproductive performance and high survivorship, the factors underlying variation in individual quality are not well understood. The compensation and increased-intake hypotheses predict that basal metabolic rate (BMR) influences reproductive performance; if so, variation in BMR may be related to differences in individual quality. We evaluated whether BMR measured during the incubation period provides a proximate explanation for variation in individual quality by measuring the BMRs and reproductive performance of Leach's storm-petrels (Oceanodroma leucorhoa) breeding on Kent Island, New Brunswick, Canada, during 2000 and 2001. We statistically controlled for internal (body mass, breeding age, sex) and external (year, date, time of day) effects on BMR. We found that males with relatively low BMRs hatched their eggs earlier in the season and that their chicks' wing growth rates were faster compared to males with relatively high BMRs. Conversely, BMR was not related to egg volume, hatching date, or chick growth rate for females or to lifetime (???23 years) hatching success for either sex. Thus, for males but not for females, our results support the compensation hypothesis. This hypothesis predicts that animals with low BMRs will achieve better reproductive performance than animals with high BMRs because they have lower self-maintenance costs and therefore can apportion more energy to reproduction. These results provide evidence that intraspecific variation in reproductive performance is related to BMR and suggest that BMR may influence individual quality in males. ?? The Author 2005. Published by Oxford University Press on behalf of the International Society for Behavioral Ecology. All rights reserved.
History and background of quality measurement.
Chun, Jonathan; Bafford, Andrea Chao
2014-03-01
Health care quality measurement has become increasingly emphasized, as providers and administrators respond to public and government demands for improved patient care. This article will review the evolution of surgical quality measurement and improvement from its infancy in the 1850s to the vast efforts being undertaken today.
Evaluating supplier quality performance using analytical hierarchy process
NASA Astrophysics Data System (ADS)
Kalimuthu Rajoo, Shanmugam Sundram; Kasim, Maznah Mat; Ahmad, Nazihah
2013-09-01
This paper elaborates the importance of evaluating supplier quality performance to an organization. Supplier quality performance evaluation reflects the actual performance of the supplier exhibited at customer's end. It is critical in enabling the organization to determine the area of improvement and thereafter works with supplier to close the gaps. Success of the customer partly depends on supplier's quality performance. Key criteria as quality, cost, delivery, technology support and customer service are categorized as main factors in contributing to supplier's quality performance. 18 suppliers' who were manufacturing automotive application parts evaluated in year 2010 using weight point system. There were few suppliers with common rating which led to common ranking observed by few suppliers'. Analytical Hierarchy Process (AHP), a user friendly decision making tool for complex and multi criteria problems was used to evaluate the supplier's quality performance challenging the weight point system that was used for 18 suppliers'. The consistency ratio was checked for criteria and sub-criteria. Final results of AHP obtained with no overlap ratings, therefore yielded a better decision making methodology as compared to weight point rating system.
Healthcare quality measurement in orthopaedic surgery: current state of the art.
Auerbach, Andrew
2009-10-01
Improving quality of care in arthroplasty is of increasing importance to payors, hospitals, surgeons, and patients. Efforts to compel improvement have traditionally focused measurement and reporting of data describing structural factors, care processes (or 'quality measures'), and clinical outcomes. Reporting structural measures (eg, surgical case volume) has been used with varying degrees of success. Care process measures, exemplified by initiatives such as the Surgical Care Improvement Project measures, are chosen based on the strength of randomized trial evidence linking the process to improved outcomes. However, evidence linking improved performance on Surgical Care Improvement Project measures with improved outcomes is limited. Outcome measures in surgery are of increasing importance as an approach to compel care improvement with prominent examples represented by the National Surgical Quality Improvement Project. Although outcomes-focused approaches are often costly, when linked to active benchmarking and collaborative activities, they may improve care broadly. Moreover, implementation of computerized data systems collecting information formerly collected on paper only will facilitate benchmarking. In the end, care will only be improved if these data are used to define methods for innovating care systems that deliver better outcomes at lower or equivalent costs.
Measurement properties of continuous text reading performance tests.
Brussee, Tamara; van Nispen, Ruth M A; van Rens, Ger H M B
2014-11-01
Measurement properties of tests to assess reading acuity or reading performance have not been extensively evaluated. This study aims to provide an overview of the literature on available continuous text reading tests and their measurement properties. A literature search was performed in PubMed, Embase and PsycInfo. Subsequently, information on design and content of reading tests, study design and measurement properties were extracted using consensus-based standards for selection of health measurement instruments. Quality of studies, reading tests and measurement properties were systematically assessed using pre-specified criteria. From 2334 identified articles, 20 relevant articles were found on measurement properties of three reading tests in various languages: IReST, MNread Reading Test and Radner Reading Charts. All three reading tests scored high on content validity. Reproducibility studies (repeated measurements between different testing sessions) of the IReST and MNread of commercially available reading tests in different languages were missing. The IReST scored best on inter-language comparison, the MNread scored well in repeatability studies (repeated measurements under the same conditions) and the Radner showed good reproducibility in studies. Although in daily practice there are other continuous text reading tests available meeting the criteria of this review, measurement properties were described in scientific studies for only three of them. Of the few available studies, the quality and content of study design and methodology used varied. For testing existing reading tests and the development of new ones, for example in other languages, we make several recommendations, including careful description of patient characteristics, use of objective and subjective lighting levels, good control of working distance, documentation of the number of raters and their training, careful documentation of scoring rules and the use of Bland-Altman analyses or similar for
Performance Indicators and Quality Review in Australian Universities.
ERIC Educational Resources Information Center
Stanley, Gordon; Reynolds, Pat
1995-01-01
A study examined the relationship between quantitative performance and diversity indicators and the quality rankings of Australian universities made by the Commission for Quality Assurance in Higher Education. Correlations between three performance factors (traditional research university performance, teaching performance, competitive research…
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lstiburek, Joseph
2017-01-01
The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lstiburek, Joseph
The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less
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.
Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.
Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S
2012-01-01
Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. Copyright © 2011 Wiley-Liss, Inc.
Performance indicators used to assess the quality of primary dental care.
González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M
2006-12-01
An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.
Objective measures for quality assessment of automatic skin enhancement algorithms
NASA Astrophysics Data System (ADS)
Ciuc, Mihai; Capata, Adrian; Florea, Corneliu
2010-01-01
Automatic portrait enhancement by attenuating skin flaws (pimples, blemishes, wrinkles, etc.) has received considerable attention from digital camera manufacturers thanks to its impact on the public. Subsequently, a number of algorithms have been developed to meet this need. One central aspect to developing such an algorithm is quality assessment: having a few numbers that precisely indicate the amount of beautification brought by an algorithm (as perceived by human observers) is of great help, as it works on circumvent time-costly human evaluation. In this paper, we propose a method to numerically evaluate the quality of a skin beautification algorithm. The most important aspects we take into account and quantize to numbers are the quality of the skin detector, the amount of smoothing performed by the method, the preservation of intrinsic skin texture, and the preservation of facial features. We combine these measures into two numbers that assess the quality of skin detection and beautification. The derived measures are highly correlated with human perception, therefore they constitute a helpful tool for tuning and comparing algorithms.
Personal Career Orientation. Performance Objectives. Criterion Measures. Home Economics.
ERIC Educational Resources Information Center
Allen, Alveta; And Others
Several intermediate performance objectives and corresponding criterion measures are listed for each of six terminal objectives for a personal career orientation course for seventh grade students. This 6- to 9-week course is designed to acquaint the student with personal qualities and characteristics necessary for success in the world of work.…
Evaluating the Psychometric Quality of Social Skills Measures: A Systematic Review
Brown, Ted; Bourke-Taylor, Helen; Doma, Kenji; Leicht, Anthony
2015-01-01
Introduction Impairments in social functioning are associated with an array of adverse outcomes. Social skills measures are commonly used by health professionals to assess and plan the treatment of social skills difficulties. There is a need to comprehensively evaluate the quality of psychometric properties reported across these measures to guide assessment and treatment planning. Objective To conduct a systematic review of the literature on the psychometric properties of social skills and behaviours measures for both children and adults. Methods A systematic search was performed using four electronic databases: CINAHL, PsycINFO, Embase and Pubmed; the Health and Psychosocial Instruments database; and grey literature using PsycExtra and Google Scholar. The psychometric properties of the social skills measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results Thirty-Six studies and nine manuals were included to assess the psychometric properties of thirteen social skills measures that met the inclusion criteria. Most measures obtained excellent overall methodological quality scores for internal consistency and reliability. However, eight measures did not report measurement error, nine measures did not report cross-cultural validity and eleven measures did not report criterion validity. Conclusions The overall quality of the psychometric properties of most measures was satisfactory. The SSBS-2, HCSBS and PKBS-2 were the three measures with the most robust evidence of sound psychometric quality in at least seven of the eight psychometric properties that were appraised. A universal working definition of social functioning as an overarching construct is recommended. There is a need for ongoing research in the area of the psychometric properties of social skills and behaviours instruments. PMID:26151362
Evaluating the Psychometric Quality of Social Skills Measures: A Systematic Review.
Cordier, Reinie; Speyer, Renée; Chen, Yu-Wei; Wilkes-Gillan, Sarah; Brown, Ted; Bourke-Taylor, Helen; Doma, Kenji; Leicht, Anthony
2015-01-01
Impairments in social functioning are associated with an array of adverse outcomes. Social skills measures are commonly used by health professionals to assess and plan the treatment of social skills difficulties. There is a need to comprehensively evaluate the quality of psychometric properties reported across these measures to guide assessment and treatment planning. To conduct a systematic review of the literature on the psychometric properties of social skills and behaviours measures for both children and adults. A systematic search was performed using four electronic databases: CINAHL, PsycINFO, Embase and Pubmed; the Health and Psychosocial Instruments database; and grey literature using PsycExtra and Google Scholar. The psychometric properties of the social skills measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Thirty-Six studies and nine manuals were included to assess the psychometric properties of thirteen social skills measures that met the inclusion criteria. Most measures obtained excellent overall methodological quality scores for internal consistency and reliability. However, eight measures did not report measurement error, nine measures did not report cross-cultural validity and eleven measures did not report criterion validity. The overall quality of the psychometric properties of most measures was satisfactory. The SSBS-2, HCSBS and PKBS-2 were the three measures with the most robust evidence of sound psychometric quality in at least seven of the eight psychometric properties that were appraised. A universal working definition of social functioning as an overarching construct is recommended. There is a need for ongoing research in the area of the psychometric properties of social skills and behaviours instruments.
Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.
Burke, Robert E; Glorioso, Thomas; Barón, Anna K; Kaboli, Peter J; Ho, P Michael
Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.
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
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
Duckworth, Angela L.; Yeager, David Scott
2016-01-01
There has been perennial interest in personal qualities other than cognitive ability that determine success, including self-control, grit, growth mindset, and many others. Attempts to measure such qualities for the purposes of educational policy and practice, however, are more recent. In this article, we identify serious challenges to doing so. We first address confusion over terminology, including the descriptor “non-cognitive.” We conclude that debate over the optimal name for this broad category of personal qualities obscures substantial agreement about the specific attributes worth measuring. Next, we discuss advantages and limitations of different measures. In particular, we compare self-report questionnaires, teacher-report questionnaires, and performance tasks, using self-control as an illustrative case study to make the general point that each approach is imperfect in its own way. Finally, we discuss how each measure’s imperfections can affect its suitability for program evaluation, accountability, individual diagnosis, and practice improvement. For example, we do not believe any available measure is suitable for between-school accountability judgments. In addition to urging caution among policymakers and practitioners, we highlight medium-term innovations that may make measures of these personal qualities more suitable for educational purposes. PMID:27134288
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.
Validity and reliability of a novel measure of activity performance and participation.
Murgatroyd, Phil; Karimi, Leila
2016-01-01
To develop and evaluate an innovative clinician-rated measure, which produces global numerical ratings of activity performance and participation. Repeated measures study with 48 community-dwelling participants investigating clinical sensibility, comprehensiveness, practicality, inter-rater reliability, responsiveness, sensitivity and concurrent validity with Barthel Index. Important clinimetric characteristics including comprehensiveness and ease of use were rated >8/10 by clinicians. Inter-rater reliability was excellent on the summary scores (intraclass correlation of 0.95-0.98). There was good evidence that the new outcome measure distinguished between known high and low functional scoring groups, including both responsiveness to change and sensitivity at the same time point in numerous tests. Concurrent validity with the Barthel Index was fair to high (Spearman Rank Order Correlation 0.32-0.85, p > 0.05). The new measure's summary scores were nearly twice as responsive to change compared with the Barthel Index. Other more detailed data could also be generated by the new measure. The Activity Performance Measure is an innovative outcome instrument that showed good clinimetric qualities in this initial study. Some of the results were strong, given the sample size, and further trial and evaluation is appropriate. Implications for Rehabilitation The Activity Performance Measure is an innovative outcome measure covering activity performance and participation. In an initial evaluation, it showed good clinimetric qualities including responsiveness to change, sensitivity, practicality, clinical sensibility, item coverage, inter-rater reliability and concurrent validity with the Barthel Index. Further trial and evaluation is appropriate.
Performance criteria and quality indicators for the post-analytical phase.
Sciacovelli, Laura; Aita, Ada; Padoan, Andrea; Pelloso, Michela; Antonelli, Giorgia; Piva, Elisa; Chiozza, Maria Laura; Plebani, Mario
2016-07-01
Quality indicators (QIs) used as performance measurements are an effective tool in accurately estimating quality, identifying problems that may need to be addressed, and monitoring the processes over time. In Laboratory Medicine, QIs should cover all steps of the testing process, as error studies have confirmed that most errors occur in the pre- and post-analytical phase of testing. Aim of the present study is to provide preliminary results on QIs and related performance criteria in the post-analytical phase. This work was conducted according to a previously described study design based on the voluntary participation of clinical laboratories in the project on QIs of the Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Overall, data collected highlighted an improvement or stability in performances over time for all reported indicators thus demonstrating that the use of QIs is effective in the quality improvement strategy. Moreover, QIs data are an important source for defining the state-of-the-art concerning the error rate in the total testing process. The definition of performance specifications based on the state-of-the-art, as suggested by consensus documents, is a valuable benchmark point in evaluating the performance of each laboratory. Laboratory tests play a relevant role in the monitoring and evaluation of the efficacy of patient outcome thus assisting clinicians in decision-making. Laboratory performance evaluation is therefore crucial to providing patients with safe, effective and efficient care.
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 tests and quality control of cathode ray tube displays.
Roehrig, H; Blume, H; Ji, T L; Browne, M
1990-08-01
Spatial resolution, noise, characteristic curve, and absolute luminance are the essential parameters that describe physical image quality of a display. This paper presents simple procedures for assessing the performance of a cathode ray tube (CRT) in terms of these parameters as well as easy set up techniques. The procedures can be used in the environment where the CRT is used. The procedures are based on a digital representation of the Society of Motion Pictures and Television Engineers pattern plus a few simple other digital patterns. Additionally, measurement techniques are discussed for estimating brightness uniformity, veiling glare, and distortion. Apart from the absolute luminance, all performance features can be assessed with an uncalibrated photodetector and the eyes of a human observer. The measurement techniques especially enable the user to perform comparisons of different display systems.
Silva, Rívea Trindade da; Câmara, Saionara Maria Aires da; Moreira, Mayle Andrade; Nascimento, Rafaela Andrade do; Vieira, Mariana Carmem Apolinário; Morais, Maria Socorro Medeiros de; Maciel, Álvaro Campos Cavalcanti
2016-06-01
Introduction Some studies have investigated the influence of hormonal deficits and menopausal status in muscle disorders of women. However, it has not been investigated the relationship of both climacteric symptoms and the perception of quality of life with physical performance. Objective To evaluate the correlation of menopausal symptoms and quality of life with physical performance in middle-aged women. Methods This cross-sectional study was performed from April to November 2013 in the municipality of Parnamirim, in the Brazilian state, Rio Grande do Norte. The sample was composed of 497 women aged 40-65 years. The Menopause Rating Scale (MRS) and the Utian Quality of Life (UQOL) questionnaire were used to evaluate menopausal symptoms and quality of life respectively. Measures of physical performance included handgrip strength, knee extensor and flexor strengths (using an isometric dynamometer), gait speed, and chair stand test. The correlation between menopausal symptoms and quality of life with physical performance was assessed by Pearson's correlation coefficient with significance set at p < 0.05 and a confidence interval of 95%. Results There was a significant negative correlation between handgrip strength and somatic MRS score (p = 0.002) and total MRS score (p = 0.03). There was a significant correlation between knee flexor strength and sit-to-stand time and all menopausal symptom areas (p < 0.05), except psychological symptoms. There was a positive correlation between physical performance of the knee flexors and quality of life items including occupational (p = 0.001), emotional (p = 0.005), and total UQOL (p = 0.01), but a negative correlation with sit-to-stand time and all quality of life domains (p < 0.05). Conclusion A greater intensity of menopausal symptoms and worse quality of life were related with worse physical performance. Thus, preventive measures should be implemented to avoid adverse effects on
Performance testing accountability measurements
DOE Office of Scientific and Technical Information (OSTI.GOV)
Oldham, R.D.; Mitchell, W.G.; Spaletto, M.I.
The New Brunswick Laboratory (NBL) provides assessment support to the DOE Operations Offices in the area of Material Control and Accountability (MC and A). During surveys of facilities, the Operations Offices have begun to request from NBL either assistance in providing materials for performance testing of accountability measurements or both materials and personnel to do performance testing. To meet these needs, NBL has developed measurement and measurement control performance test procedures and materials. The present NBL repertoire of performance tests include the following: (1) mass measurement performance testing procedures using calibrated and traceable test weights, (2) uranium elemental concentration (assay)more » measurement performance tests which use ampulated solutions of normal uranyl nitrate containing approximately 7 milligrams of uranium per gram of solution, and (3) uranium isotopic measurement performance tests which use ampulated uranyl nitrate solutions with enrichments ranging from 4% to 90% U-235. The preparation, characterization, and packaging of the uranium isotopic and assay performance test materials were done in cooperation with the NBL Safeguards Measurements Evaluation Program since these materials can be used for both purposes.« less
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.
Development of quality measures for monitoring and improving care in gastroenterology.
Germansky, Katharine A; Leffler, Daniel A
2011-06-01
Over the past decade, most quality assurance (QA) efforts in gastroenterology have been aimed at endoscopy. Endoscopic quality improvement was the rational area to begin QA work in gastroenterology due to the relatively acute nature of complications and the high volume of procedures performed. While endoscopy is currently the focus of most quality assurance (QA) measures in gastroenterology, more recent efforts have begun to address clinical gastroenterology practices both in the outpatient and inpatient settings. Clinical outpatient and inpatient gastroenterology is laden with areas where standardization could benefit patient care. While data and experience in clinical gastroenterology QA is relatively limited, it is clear that inconsistent use of guidelines and practice variations in gastroenterology can lead to lower quality care. In this review, we review a variety of areas in clinical gastroenterology where existing guidelines and published data suggest both the need and practicality of active QA measures. Copyright © 2011 Elsevier Ltd. All rights reserved.
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
Haldiman, Kathryn L; Tzeng, Huey-Ming
2010-04-01
This exploratory study investigated the differences in the means of quality measures between for-profit and nonprofit Medicare-certified home health agencies in Michigan. The research question was: Do nonprofit agencies provide higher quality of care than for-profit agencies? Twelve publicly available quality measures were retrieved in May 2009 and used for analysis. Independent t tests found significant differences between for-profit and nonprofit agencies on 6 of the 12 measures, with for-profit agencies performing better on 5 measures. The relative value of both types of ownership should be recognized. Future research may focus on using standardized quality measures to explore further the impact of profit orientation on home health quality of care.
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.
Measures of rowing performance.
Smith, T Brett; Hopkins, Will G
2012-04-01
Accurate measures of performance are important for assessing competitive athletes in practi~al and research settings. We present here a review of rowing performance measures, focusing on the errors in these measures and the implications for testing rowers. The yardstick for assessing error in a performance measure is the random variation (typical or standard error of measurement) in an elite athlete's competitive performance from race to race: ∼1.0% for time in 2000 m rowing events. There has been little research interest in on-water time trials for assessing rowing performance, owing to logistic difficulties and environmental perturbations in performance time with such tests. Mobile ergometry via instrumented oars or rowlocks should reduce these problems, but the associated errors have not yet been reported. Measurement of boat speed to monitor on-water training performance is common; one device based on global positioning system (GPS) technology contributes negligible extra random error (0.2%) in speed measured over 2000 m, but extra error is substantial (1-10%) with other GPS devices or with an impeller, especially over shorter distances. The problems with on-water testing have led to widespread use of the Concept II rowing ergometer. The standard error of the estimate of on-water 2000 m time predicted by 2000 m ergometer performance was 2.6% and 7.2% in two studies, reflecting different effects of skill, body mass and environment in on-water versus ergometer performance. However, well trained rowers have a typical error in performance time of only ∼0.5% between repeated 2000 m time trials on this ergometer, so such trials are suitable for tracking changes in physiological performance and factors affecting it. Many researchers have used the 2000 m ergometer performance time as a criterion to identify other predictors of rowing performance. Standard errors of the estimate vary widely between studies even for the same predictor, but the lowest
Solon, Orville; Woo, Kimberly; Quimbo, Stella A; Shimkhada, Riti; Florentino, Jhiedon; Peabody, John W
2009-05-01
Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q was developed, implemented in hospitals in the Philippines and how it compares with typical measures. Q consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q. Q was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2(1/2) years. We found Q to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled USD2133 or USD305 per assessment per site. Q appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings.
A novel method for measuring health care system performance: experience from QIDS in the Philippines
Solon, Orville; Woo, Kimberly; Quimbo, Stella A; Shimkhada, Riti; Florentino, Jhiedon; Peabody, John W
2009-01-01
Objectives Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q*, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q* was developed, implemented in hospitals in the Philippines and how it compares with typical measures. Methods Q* consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q* using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q*. Results Q* was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2½ years. We found Q* to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled US$2133 or US$305 per assessment per site. Conclusion Q* appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings. PMID:19224955
Quality of blood pressure measurement in community health centres.
Sandoya-Olivera, Edgardo; Ferreira-Umpiérrez, Augusto; Machado-González, Federico
To determine the quality of the blood pressure measurements performed during routine care in community health centres. An observational, cross-sectional study was conducted in 5 private and public health centres in Maldonado, Uruguay, in July-August 2015. The observations were made during the measurements performed by health personnel, using the requirements established by the American Heart Association. An analysis was made on 36 variables that were grouped in categories related to environment, equipment, interrogation, patient, and observer. Statistical analysis was performed using Chi 2 test or Fisher test. Statistical significance was considered to be less than 5% (p<.05). The measurements were made by a registered nurse or nurse in 71% of cases, physician in 20%, and student nurse in 9%. An aneroid sphygmomanometer was used in 89%, and mercury 11%. Satisfactory results were found in variables related to environment (93%), equipment (99%), and patient attitude (82%), and intermediate in the attitudes of the operator (64%), and poor in relation to the interrogation (18%), with the mean of correct variables per measurement being 69%. The main flaws in the procedure were the operator. The measurement of blood pressure is a manoeuvre that healthcare professionals perform thousands of times a year. If the measurement is used for the diagnosis and/or chronic management of arterial hypertension, not systematically applying the established recommendations leads to an inappropriate care of a very significant number of patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Bell, E.J.; Takhar, S.S.; Beloff, J.R.; Schuur, J.D.; Landman, A.B.
2013-01-01
careful design, information technology can improve the completeness of ED patient discharge instructions and performance on the OP-19 quality measure. PMID:24454578
Measuring patient-perceived hospital service quality: a conceptual framework.
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.
Quality Measures for the Care of Patients with Insomnia
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
Lessons from Five States: Public Sector Use of Washington Circle Performance Measures
Garnick, Deborah W.; Lee, Margaret T.; Horgan, Constance; Acevedo, Andrea; Botticelli, Michael; Clark, Spencer; Davis, Steven; Gallati, Robert; Haberlin, Karin; Hanchett, Andrew; Lambert–Wacey, Dawn; Leeper, Tracy; Siemianowski, James; Tikoo, Minakshi
2011-01-01
Five states (Connecticut, Massachusetts, New York, North Carolina, and Oklahoma) have incorporated Washington Circle (WC) substance abuse performance measures in various ways into their quality improvement strategies. In this paper we focus on what other states and local providers might learn from these states’ experiences as they consider using WC performance measures. Using a case study approach, we report that the use of WC measures differs across these five states, although there are important common themes required for adoption and sustainability of performance measures which include: leadership, evaluation of specification and use of measures over time, state-specific adaptation of the WC measure specifications, collaboration with consultants and partners, inclusion of WC measures in the context of other initiatives, reporting to providers and the public, and data and resource requirements. As additional states adopt some of the WC measures, or adopt other performance measurement approaches, these states’ experiences could help them to develop implementations based on their particular needs. PMID:21257282
Timmermann, Carsten
2013-09-01
To use the history of the Karnofsky Performance Scale as a case study illustrating the emergence of interest in the measurement and standardisation of quality of life; to understand the origins of current-day practices. Articles referring to the Karnofsky scale and quality of life measurements published from the 1940s to the 1990s were identified by searching databases and screening journals, and analysed using close-reading techniques. Secondary literature was consulted to understand the context in which articles were written. The Karnofsky scale was devised for a different purpose than measuring quality of life: as a standardisation device that helped quantify effects of chemotherapeutic agents less easily measurable than survival time. Interest in measuring quality of life only emerged around 1970. When quality of life measurements were increasingly widely discussed in the medical press from the late 1970s onwards, a consensus emerged that the Karnofsky scale was not a very good tool. More sophisticated approaches were developed, but Karnofsky continued to be used. I argue that the scale provided a quick and simple, approximate assessment of the 'soft' effects of treatment by physicians, overlapping but not identical with quality of life.
Innovative United Kingdom Approaches To Measuring Service Quality.
ERIC Educational Resources Information Center
Winkworth, Ian
2001-01-01
Reports on approaches to measuring the service quality of academic libraries in the United Kingdom. Discusses the role of government and the national background of quality measurement; measurement frameworks; better use of statistics; benchmarking; measuring user satisfaction; and possible future development. (Author/LRW)
Relationship between quality improvement processes and clinical performance.
Damberg, Cheryl L; Shortell, Stephen M; Raube, Kristiana; Gillies, Robin R; Rittenhouse, Diane; McCurdy, Rodney K; Casalino, Lawrence P; Adams, John
2010-08-01
To examine the association between performance on clinical process measures and intermediate outcomes and the use of chronic care management processes (CMPs), electronic medical record (EMR) capabilities, and participation in external quality improvement (QI) initiatives. Cross-sectional analysis of linked 2006 clinical performance scores from the Integrated Healthcare Association's pay-for-performance program and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations (POs). Controlling for differences in PO size, organization type (medical group or independent practice association), and Medicaid revenue, we used ordinary least squares regression analysis to examine the association between the use of CMPs, EMR capabilities, and external QI initiatives and performance on the following 3 clinical composite measures: diabetes management, processes of care, and intermediate outcomes (diabetes and cardiovascular). Greater use of CMPs was significantly associated with clinical performance: among POs using more than 5 CMPs, we observed a 3.2-point higher diabetes management score on a performance scale with scores ranging from 0 to 100 (P <.001), while for each 1.0-point increase on the CMP index, we observed a 1.0-point gain in intermediate outcomes (P <.001). Participation in external QI initiatives was positively associated with improved delivery of clinical processes of care: a 1.0-point increase on the QI index translated into a 1.4-point gain in processes-of-care performance (P = .02). No relationship was observed between EMR capabilities and performance. Greater investments in CMPs and QI interventions may help POs raise clinical performance and achieve success under performance-based accountability schemes.
NASA Astrophysics Data System (ADS)
Berger, Roland; Hänze, Martin
2015-01-01
We assessed the impact of expert students' instructional quality on the academic performance of novice students in 12th-grade physics classes organized in an expert model of cooperative learning ('jigsaw classroom'). The instructional quality of 129 expert students was measured by a newly developed rating system. As expected, when aggregating across all four subtopics taught, regression analysis revealed that academic performance of novice students increases with the quality of expert students' instruction. The difficulty of subtopics, however, moderates this effect: higher instructional quality of more difficult subtopics did not lead to better academic performance of novice students. We interpret this finding in the light of Cognitive Load Theory. Demanding tasks cause high intrinsic cognitive load and hindered the novice students' learning.
Quantitative comparison of measurements of urgent care service quality.
Qin, Hong; Prybutok, Victor; Prybutok, Gayle
2016-01-01
Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.
Quality Measures for the Care of Patients with Narcolepsy
Krahn, Lois E.; Hershner, Shelley; Loeding, Lauren D.; Maski, Kiran P.; Rifkin, Daniel I.; Selim, Bernardo; Watson, Nathaniel F.
2015-01-01
The American Academy of Sleep Medicine (AASM) commissioned a Workgroup to develop quality measures for the care of patients with narcolepsy. Following a comprehensive literature search, 306 publications were found addressing quality care or measures. Strength of association was graded between proposed process measures and desired outcomes. Following the AASM process for quality measure development, we identified three outcomes (including one outcome measure) and seven process measures. The first desired outcome was to reduce excessive daytime sleepiness by employing two process measures: quantifying sleepiness and initiating treatment. The second outcome was to improve the accuracy of diagnosis by employing the two process measures: completing both a comprehensive sleep history and an objective sleep assessment. The third outcome was to reduce adverse events through three steps: ensuring treatment follow-up, documenting medical comorbidities, and documenting safety measures counseling. All narcolepsy measures described in this report were developed by the Narcolepsy Quality Measures Work-group 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 narcolepsy. Citation: Krahn LE, Hershner S, Loeding LD, Maski KP, Rifkin DI, Selim B, Watson NF. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med 2015;11(3):335–355. PMID:25700880
International Airline Quality Measurement
DOT National Transportation Integrated Search
1998-01-01
Historically, airline quality has been measured through the use of surveys that ask the consumers to make a comparison between expectations and outcomes. This method was informative but very cumbersome in a rapidly changing environment. This paper ou...
Adopting software quality measures for healthcare processes.
Yildiz, Ozkan; Demirörs, Onur
2009-01-01
In this study, we investigated the adoptability of software quality measures for healthcare process measurement. Quality measures of ISO/IEC 9126 are redefined from a process perspective to build a generic healthcare process quality measurement model. Case study research method is used, and the model is applied to a public hospital's Entry to Care process. After the application, weak and strong aspects of the process can be easily observed. Access audibility, fault removal, completeness of documentation, and machine utilization are weak aspects and these aspects are the candidates for process improvement. On the other hand, functional completeness, fault ratio, input validity checking, response time, and throughput time are the strong aspects of the process.
Measuring, managing and maximizing refinery performance
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bascur, O.A.; Kennedy, J.P.
1996-01-01
Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.
Machado-Duque, Manuel Enrique; Echeverri Chabur, Jorge Enrique; Machado-Alba, Jorge Enrique
2015-01-01
Quality of sleep and excessive daytime sleepiness (EDS) affect cognitive ability and performance of medical students. This study attempts to determine the prevalence of EDS, sleep quality, and assess their association with poor academic performance in this population. A descriptive, observational study was conducted on a random sample of 217 medical students from the Universidad Tecnológica de Pereira, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth sleepiness scale. Sociodemographic, clinic and academic variables were also measured. Multivariate analyses for poor academic performance were performed. The included students had a mean age of 21.7±3.3 years, of whom 59.4% were men. Almost half (49.8%) had EDS criteria, and 79.3% were poor sleepers (PSQI ≥ 5), while 43.3% had poor academic performance during the last semester. The bivariate analysis showed that having used tobacco or alcohol until intoxicated, fairly bad subjective sleep quality, sleep efficiency < 65%, and being a poor sleeper were associated with increased risk of low performance. Sleep efficiency < 65% was statistically associated with poor academic performance (P=.024; OR = 4.23; 95% CI, 1.12-15.42) in the multivariate analysis. A poor sleep quality determined by low efficiency was related to poor academic achievement at the end of semester in medical students. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Schmidtke, Kelly Ann; Poots, Alan J; Carpio, Juan; Vlaev, Ivo; Kandala, Ngianga-Bakwin; Lilford, Richard J
2017-01-01
Hospital board members are asked to consider large amounts of quality and safety data with a duty to act on signals of poor performance. However, in order to do so it is necessary to distinguish signals from noise (chance). This article investigates whether data in English National Health Service (NHS) acute care hospital board papers are presented in a way that helps board members consider the role of chance in their decisions. Thirty English NHS trusts were selected at random and their board papers retrieved. Charts depicting quality and safety were identified. Categorical discriminations were then performed to document the methods used to present quality and safety data in board papers, with particular attention given to whether and how the charts depicted the role of chance, that is, by including control lines or error bars. Thirty board papers, containing a total of 1488 charts, were sampled. Only 88 (6%) of these charts depicted the role of chance, and only 17 of the 30 board papers included any charts depicting the role of chance. Of the 88 charts that attempted to represent the role of chance, 16 included error bars and 72 included control lines. Only 6 (8%) of the 72 control charts indicated where the control lines had been set (eg, 2 vs 3 SDs). Hospital board members are expected to consider large amounts of information. Control charts can help board members distinguish signals from noise, but often boards are not using them. We discuss demand-side and supply-side barriers that could be overcome to increase use of control charts in healthcare. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M
2015-01-01
Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak
Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M
2015-05-11
To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains
Developing a Performance Measurement System for University Central Administrative Services
ERIC Educational Resources Information Center
Arena, Marika; Arnaboldi, Michela; Azzone, Giovanni; Carlucci, Paola
2009-01-01
Central administrative services have recently received increasing attention from practitioners and academics due to the challenging need to both manage scarce resources and provide high-quality services. In this context, performance measurement systems (PMSs) may assume a central role, although an unresolved debate remains on the claimed benefits…
Objective measurement of the optical image quality in the human eye
NASA Astrophysics Data System (ADS)
Navarro, Rafael M.
2001-05-01
This communication reviews some recent studies on the optical performance of the human eye. Although the retinal image cannot be recorded directly, different objective methods have been developed, which permit to determine optical quality parameters, such as the Point Spread Function (PSF), the Modulation Transfer Function (MTF), the geometrical ray aberrations or the wavefront distortions, in the living human eye. These methods have been applied in both basic and applied research. This includes the measurement of the optical performance of the eye across visual field, the optical quality of eyes with intraocular lens implants, the aberrations induced by LASIK refractive surgery, or the manufacture of customized phase plates to compensate the wavefront aberration in the eye.
Reed, G; Reed, D H
1999-05-01
When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data; (2) productivity data; (3) operational parameters; (4) clinical data; and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators; (2) implementation strategies chosen by each of the three medical centers; and (3) the results of those strategies as compared with baseline data.
Assessing decision quality in patient-centred care requires a preference-sensitive measure
Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack
2014-01-01
A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient
Crowding measures associated with the quality of emergency department care: a systematic review.
Stang, Antonia S; Crotts, Jennifer; Johnson, David W; Hartling, Lisa; Guttmann, Astrid
2015-06-01
Despite the substantial body of literature on emergency department (ED) crowding, to the best of our knowledge, there is no agreement on the measure or measures that should be used to quantify crowding. The objective of this systematic review was to identify existing measures of ED crowding that have been linked to quality of care as defined by the Institute of Medicine (IOM) quality domains (safe, effective, patient-centered, efficient, timely, and equitable). Six major bibliographic databases were searched from January 1980 to January 2012, and hand searches were conducted of relevant journals and conference proceedings. Observational studies (cross-sectional, cohort, and case-control), quality improvement studies, quasi-experimental (e.g., before/after) studies, and randomized controlled trials were considered for inclusion. Studies that did not provide measures of ED crowding were excluded. Studies that did not provide quantitative data on the link between crowding measures and quality of care were also excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality using the Newcastle-Ottawa Quality Assessment Scale (NOS) for observational studies and a modified version of the NOS for cross-sectional studies. The search identified 7,413 articles. Thirty-two articles were included in the review: six cross-sectional, one case-control, 23 cohort, and two retrospective reviews of performance improvement data. Methodologic quality was moderate, with weaknesses in the reporting of study design and methodology. Overall, 15 of the crowding measures studied had quantifiable links to quality of care. The three measures most frequently linked to quality of care were the number of patients in the waiting room, ED occupancy (percentage of overall ED beds filled), and the number of admitted patients in the ED awaiting inpatient beds. None of the articles provided data on the link between crowding measures and the IOM
Dichter, Martin Nikolaus; Schwab, Christian G G; Meyer, Gabriele; Bartholomeyczik, Sabine; Halek, Margareta
2016-02-01
For people with dementia, the concept of quality of life (Qol) reflects the disease's impact on the whole person. Thus, Qol is an increasingly used outcome measure in dementia research. This systematic review was performed to identify available dementia-specific Qol measurements and to assess the quality of linguistic validations and reliability studies of these measurements (PROSPERO 2013: CRD42014008725). The MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Methodology Register databases were systematically searched without any date restrictions. Forward and backward citation tracking were performed on the basis of selected articles. A total of 70 articles addressing 19 dementia-specific Qol measurements were identified; nine measurements were adapted to nonorigin countries. The quality of the linguistic validations varied from insufficient to good. Internal consistency was the most frequently tested reliability property. Most of the reliability studies lacked internal validity. Qol measurements for dementia are insufficiently linguistic validated and not well tested for reliability. None of the identified measurements can be recommended without further research. The application of international guidelines and quality criteria is strongly recommended for the performance of linguistic validations and reliability studies of dementia-specific Qol measurements. Copyright © 2016 Elsevier Inc. All rights reserved.
Cumulative uncertainty in measured streamflow and water quality data for small watersheds
Harmel, R.D.; Cooper, R.J.; Slade, R.M.; Haney, R.L.; Arnold, J.G.
2006-01-01
uncertainty in measured water quality data. The results and procedures presented should also assist modelers in quantifying the "quality"of calibration and evaluation data sets, determining model accuracy goals, and evaluating model performance.
Traffic Data Quality Measurement : Final Report
DOT National Transportation Integrated Search
2004-09-15
One of the foremost recommendations from the FHWA sponsored workshops on Traffic Data Quality (TDQ) in 2003 was a call for "guidelines and standards for calculating data quality measures." These guidelines and standards are expected to contain method...
The Comprehensive Care Project: Measuring Physician Performance in Ambulatory Practice
Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S
2010-01-01
Objective To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Data Sources/Study Setting Ambulatory-based general internists in 13 states participated in the assessment. Study Design We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Data Collection/Extraction Methods Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Principal Findings Performance on the individual and composite measures varied substantially within (range 5–86 percent compliance on 46 measures) and between physicians (ICC range 0.12–0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; p <.01), chronic care (r = 0.14, p = .04), and preventive services composites (r = 0.17, p = .01). Conclusions Our results suggest that reliable and valid comprehensive assessment of the quality of chronic and preventive care can be achieved by creating composite measures and by sampling feasible numbers of patients for each condition. PMID:20819110
The comprehensive care project: measuring physician performance in ambulatory practice.
Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S
2010-12-01
To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; p<.01), chronic care (r = 0.14, p = .04), and preventive services composites (r = 0.17, p = .01). Our results suggest that reliable and valid comprehensive assessment of the quality of chronic and preventive care can be achieved by creating composite measures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.
Phillips, Jane Louise; Lam, Lawrence; Luckett, Tim; Agar, Meera; Currow, David
2014-06-01
The spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a person's movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation. This exploratory study set out to test whether the Life-Space Assessment (LSA) would correlate with other commonly used palliative care outcome measures of function and quality of life. The baseline LSA, Australia-modified Karnofsky Performance Status Scale (AKPS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative (EORTC QLQ-C15-PAL) scores from two large clinical trials were used to calculate correlation coefficients between the measures. Convergent validity analysis was undertaken by comparing LSA scores between participants with higher (≥70) and lower (≤60) AKPS scores. The LSA was correlated significantly and positively with the AKPS, with a moderate correlation coefficient of 0.54 (P<0.001). There was a significant weak negative correlation between the LSA and the EORTC QLQ-C15-PAL, with a small coefficient of -0.22 (P=0.027), but a strong correlation between the LSA and the EORTC QLQ-C15-PAL item related to independent activities of daily living (r=-0.654, P<0.01). A significant difference in the LSA score between participants with higher (≥70) and lower (≤60) AKPS scores t(97)=-4.35, P<0.001) was found. The LSA appears applicable to palliative care populations given the convergent validity and capacity of this instrument to differentiate a person's ability to move through life-space zones by performance status. Further research is required to validate and apply the LSA within community palliative care populations. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights
Issues in Measuring and Improving Health Care Quality
Friedman, Maria A.
1995-01-01
This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882
Use of cancer performance measures in population health: a macro-level perspective.
Clauser, Steven B
2004-01-01
The use of performance measurement to inform macro-level studies of cancer control and quality of care is receiving increasing interest at the state, national, and international level. This article describes the use of these measures to inform health policy and monitor cancer disparities and disease burden. Applications are discussed in clinical and provider-reported outcomes such as cancer incidence, mortality and survival, and outcome-linked processes of care, and patient-reported outcomes such as health-related quality of life and patient satisfaction/experience with care. The use of economic measures to monitor and evaluate the burden of illness is also discussed. The growing demand for surveillance capability coupled with the need to expand both the quality and breadth of available measure sets, suggests that there is a need to supplement traditional clinical and provider-reported process and outcomes measures with patient-reported outcomes measures such as health-related quality of life and patient satisfaction and experience with care. In addition, there is also a need to broaden and standardize outcome-linked process-of-care measures to improve the ability to measure and monitor incremental progress in improving cancer care. Finally, better measures of indirect costs of cancer care, such as loss productivity and caregiver burden among the aged, would improve national estimates of the cost of illness associated with cancer.
Hogg, Lori Hoffman
2014-01-01
Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA.
Zhao, Hai-Jian; Zhang, Tian-Jiao; Zeng, Jie; Hu, Cui-Hua; Ma, Rong; Zhang, Chuan-Bao
2017-01-01
Background: Hemoglobin A1c (HbA1c) measurement is of great value for the diagnosis and monitoring of diabetes. Many manufacturers have developed various experiments to determine the HbA1c concentration. However, the longitudinal use of these tests requires strict quality management. This study aimed to analyze the quality of HbA1c measurement systems in China using six sigma techniques to help improve their performances. Methods: A total of 135 laboratories were involved in this investigation in 2015. Bias values and coefficients of variation were collected from an HbA1c trueness verification external quality assessment program and an internal quality control program organized by the National Center of Clinical Laboratories in China. The sigma (σ) values and the quality goal index (QGI) were used to evaluate the performances of different groups, which were divided according to principles and instruments. Results: The majority of participants (88, 65.2%) were scored as “improvement needed (σ < 3)”, suggesting that the laboratories needed to improve their measurement performance. Only 8.2% (11/135) of the laboratories were scored as “world class (σ ≥ 6)”. Among all the 88 laboratories whose σ values were below 3, 52 (59.1%) and 23 (26.1%) laboratories needed to improve measurement precision (QGI <8.0) and trueness (QGI >1.2), respectively; the remaining laboratories (13, 14.8%) needed to improve both measurement precision and trueness. In addition, 16.1% (5/31) and 15.0% (3/20) of the laboratories in “TOSOH” and “ARKRAY” groups, respectively, were scored as “world class”, whereas none of the laboratories in “BIO-RAD” group were scored as “world class”. Conclusions: This study indicated that, although participating laboratories were laboratories with better performance in China, the performances were still unsatisfactory. Actions should be taken to improve HbA1c measurement performance before we can include HbA1c assays in diabetes
42 CFR 475.103 - Requirements for performing quality improvement initiatives.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 4 2014-10-01 2014-10-01 false Requirements for performing quality improvement... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Quality Improvement Organizations § 475.103 Requirements for performing quality improvement initiatives...
Corbellini, Carlo; Andreoni, Bruno; Ansaloni, Luca; Sgroi, Giovanni; Martinotti, Mario; Scandroglio, Ildo; Carzaniga, Pierluigi; Longoni, Mauro; Foschi, Diego; Dionigi, Paolo; Morandi, Eugenio; Agnello, Mauro
2018-01-01
Measurement and monitoring of the quality of care using a core set of quality measures are increasing in health service research. Although administrative databases include limited clinical data, they offer an attractive source for quality measurement. The purpose of this study, therefore, was to evaluate the completeness of different administrative data sources compared to a clinical survey in evaluating rectal cancer cases. Between May 2012 and November 2014, a clinical survey was done on 498 Lombardy patients who had rectal cancer and underwent surgical resection. These collected data were compared with the information extracted from administrative sources including Hospital Discharge Dataset, drug database, daycare activity data, fee-exemption database, and regional screening program database. The agreement evaluation was performed using a set of 12 quality indicators. Patient complexity was a difficult indicator to measure for lack of clinical data. Preoperative staging was another suboptimal indicator due to the frequent missing administrative registration of tests performed. The agreement between the 2 data sources regarding chemoradiotherapy treatments was high. Screening detection, minimally invasive techniques, length of stay, and unpreventable readmissions were detected as reliable quality indicators. Postoperative morbidity could be a useful indicator but its agreement was lower, as expected. Healthcare administrative databases are large and real-time collected repositories of data useful in measuring quality in a healthcare system. Our investigation reveals that the reliability of indicators varies between them. Ideally, a combination of data from both sources could be used in order to improve usefulness of less reliable indicators.
Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim
2013-01-01
Objectives To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Design Retrospective longitudinal study. Setting Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. Participants All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Main outcome measures Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Results Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Conclusions Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system. PMID:23913774
NASA Astrophysics Data System (ADS)
Tharim, Asniza Hamimi Abdul; Samad, Muna Hanim Abdul; Ismail, Mazran
2017-10-01
An Indoor Environmental Quality (IEQ) fieldwork assessment was conducted in the Platinum-rated GBI office building located in Putrajaya Malaysia. The aim of the study is to determine the current indoor performance of the selected green office building. The field measurement consists of several IEQ parameters counted under the GBI Malaysia namely the Thermal Comfort of temperature, relative humidity, air movement and heat transfer as well as solar radiation. This field measurement also comprises of the measurement for the background noise, visual lighting and Indoor Air Quality (IAQ) focusing on the aspect of carbon dioxide concentration. All the selected indoor parameters were measured for the period of five working days and the results were compared to the Malaysian Standard. Findings of the field measurement show good indoor performance of the Platinum rated office building that complies with the GBI standard. It is hoped that the research findings will be beneficial for future design and construction of office building intended to be rated under the GBI Malaysia.
Exploratory study on performance measures as indicators of IS effectiveness
NASA Technical Reports Server (NTRS)
Bishop, Peter C.; Yoes, Cissy
1992-01-01
The Information Systems Directorate at JSC/NASA has undertaken the reevaluation of its performance measures process and measures. Under the direction of a quality approach it is essential to identify an external perspective of how well an organization is performing. This study was conducted with two major objectives: (1) survey and summarize the academic literature on performance measures as indicators of information systems (IS) effectiveness; and (2) survey organizations for their experience in measuring for IS effectiveness. Four approaches to measuring the effectiveness of IS performance were identified: (1) listen to the customer for the things they need; (2) align with corporate goals; (3) benchmark against well-respected organizations; and (4) ask yourself what critical factors lead to success. The list of known methods for soliciting customer feedback are as follows: (1) executive visit; (2) survey, interview, and focus group; (3) complaints and compliments; and (4) service level agreements. A common set of characteristics that satisfy customers was identified from the literature. The list includes elements such as the following: accuracy, timeliness, relevance, understandability, reliability, and completeness. Future research in this topic area should prove beneficial to determine the metrics for external validity.
Thomas-Gibson, Siwan; Bugajski, Marek; Bretthauer, Michael; Rees, Colin J; Dekker, Evelien; Hoff, Geir; Jover, Rodrigo; Suchanek, Stepan; Ferlitsch, Monika; Anderson, John; Roesch, Thomas; Hultcranz, Rolf; Racz, Istvan; Kuipers, Ernst J; Garborg, Kjetil; East, James E; Rupinski, Maciej; Seip, Birgitte; Bennett, Cathy; Senore, Carlo; Minozzi, Silvia; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Spada, Cristiano; Hassan, Cesare; Dinis-Ribeiro, Mario; Rutter, Matthew D
2017-01-01
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures. PMID:28507745
Phillips, Katherine W; Ansell, Jack
2008-01-01
Oral anticoagulation therapy with warfarin is the mainstay of prevention and treatment of thromboembolic disease. However, it remains one of the leading causes of harmful medication errors and medication-related adverse events. The beneficial outcomes of oral anticoagulation therapy are directly dependent upon the quality of dose and anticoagulation management, but the literature is not robust with regards to what constitutes such management. This review focuses on, and attempts to define, the parameters of high-quality anticoagulation management and identifies the appropriate outcome measures constituting high-quality management. Elements discussed include the most fundamental measure, time in therapeutic range, along with other parameters including therapy initiation, time to therapeutic range, dosing management when patients are not in therapeutic range, perioperative dosing management, patient education, and other important outcome measures. Healthcare providers who manage oral anticoagulation therapy should utilize these parameters as a measure of their performance in an effort to achieve high-quality anticoagulation management.
DOT National Transportation Integrated Search
2001-11-01
For concrete rehabilitation, application of fiber reinforced polymer composites continues to grow in popularity. However, performance and expected lifetime of such rehabilitation measures are greatly depending on quality of workmanship and are jeopar...
Dental Quality Measurement--A Practitioner Perspective.
Amundson, Craig W
2016-04-01
This article reviews the HealthPartners Dental Group's experience with clinical quality measurement and provides information on the administrative infrastructure that supports measurement within the group. Some examples of the role measurement plays in operations and clinical practice are also reviewed.
APPLICATION OF DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES TO RESEARCH PROJECTS
The paper assists systematic planning for research projects. It presents planning concepts in terms that have some utility for researchers. For example, measurement quality objectives are more familiar to researchers than data quality objectives because these quality criteria are...
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.
NASA Astrophysics Data System (ADS)
Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu
2015-02-01
This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.
Boyle, Diane K; Jayawardhana, Ananda; Burman, Mary E; Dunton, Nancy E; Staggs, Vincent S; Bergquist-Beringer, Sandra; Gajewski, Byron J
2016-11-01
Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index. Two-phase measure development study. 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors ® during the year 2013. The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. The Pressure Ulcer and Fall Rate Quality Composite Index=100-PUR-FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure
Jayawardhana, Ananda; Burman, Mary E.; Dunton, Nancy E.; Staggs, Vincent S.; Bergquist-Beringer, Sandra; Gajewski, Byron J.
2016-01-01
Background Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. Objective The study objective was to develop a unit-level inpatient composite nursing care quality performance index – the Pressure Ulcer and Fall Rate Quality Composite Index. Design Two-phase measure development study. Settings 5,144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013. Methods The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. Results The Pressure Ulcer and Fall Rate Quality Composite Index = 100 − PUR − FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of
Objective Situation Awareness Measurement Based on Performance Self-Evaluation
NASA Technical Reports Server (NTRS)
DeMaio, Joe
1998-01-01
The research was conducted in support of the NASA Safe All-Weather Flight Operations for Rotorcraft (SAFOR) program. The purpose of the work was to investigate the utility of two measurement tools developed by the British Defense Evaluation Research Agency. These tools were a subjective workload assessment scale, the DRA Workload Scale and a situation awareness measurement tool. The situation awareness tool uses a comparison of the crew's self-evaluation of performance against actual performance in order to determine what information the crew attended to during the performance. These two measurement tools were evaluated in the context of a test of innovative approach to alerting the crew by way of a helmet mounted display. The situation assessment data are reported here. The performance self-evaluation metric of situation awareness was found to be highly effective. It was used to evaluate situation awareness on a tank reconnaissance task, a tactical navigation task, and a stylized task used to evaluated handling qualities. Using the self-evaluation metric, it was possible to evaluate situation awareness, without exact knowledge the relevant information in some cases and to identify information to which the crew attended or failed to attend in others.
An exploratory survey of methods used to develop measures of performance
NASA Astrophysics Data System (ADS)
Hamner, Kenneth L.; Lafleur, Charles A.
1993-09-01
Nonmanufacturing organizations are being challenged to provide high-quality products and services to their customers, with an emphasis on continuous process improvement. Measures of performance, referred to as metrics, can be used to foster process improvement. The application of performance measurement to nonmanufacturing processes can be very difficult. This research explored methods used to develop metrics in nonmanufacturing organizations. Several methods were formally defined in the literature, and the researchers used a two-step screening process to determine the OMB Generic Method was most likely to produce high-quality metrics. The OMB Generic Method was then used to develop metrics. A few other metric development methods were found in use at nonmanufacturing organizations. The researchers interviewed participants in metric development efforts to determine their satisfaction and to have them identify the strengths and weaknesses of, and recommended improvements to, the metric development methods used. Analysis of participants' responses allowed the researchers to identify the key components of a sound metrics development method. Those components were incorporated into a proposed metric development method that was based on the OMB Generic Method, and should be more likely to produce high-quality metrics that will result in continuous process improvement.
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.
Indoor Air Quality in 24 California Residences Designed as High-Performance Homes
DOE Office of Scientific and Technical Information (OSTI.GOV)
Less, Brennan; Mullen, Nasim; Singer, Brett
2015-07-01
Today’s high performance green homes are reaching previously unheard of levels of airtightness and are using new materials, technologies and strategies, whose impacts on Indoor Air Quality (IAQ) cannot be fully anticipated from prior studies. This research study used pollutant measurements, home inspections, diagnostic testing and occupant surveys to assess IAQ in 24 new or deeply retrofitted homes designed to be high performance green buildings in California.
Mohamed, Salwa Attia
2014-01-01
Organization justice refers to the extent to which employees perceive workplace procedure, interactions, and outcomes to be fair in nature. So, this study aimed to investigate the relationship between organizational justice and quality performance among health care workers. The study was conducted at the Public Hospital in Fayoum, Egypt. The study included a convenience sample of 100 healthcare workers (60 nurses and 40 physicians) that were recruited. Tools used for data collection included (1) questionnaire sheet which is used to measure health workers' perception of organizational justices. It includes four types: distributive, procedural, interpersonal, and informational justice. (2) Quality performance questionnaire sheet: this tool was used to examine health workers' perception regarding their quality performance. It contained three types: information, value, and skill. The results revealed that a positive correlation was found between organizational justice components and quality performance among the various categories of health workers' perception (P ≤ 0.05). It has been recommended to replicate the study on a larger probability sample from different hospital settings to achieve more generalizable results and reinforce justice during organization of ministry centers in Egypt.
Sangtarash, F; Manshadi, F D; Sadeghi, A
2015-08-01
Thoracic kyphosis angle (TKA) increases with osteoporosis. This study aimed to investigate the relationship between magnitude of TKA and quality of life and gait performance in 34 osteoporotic women. Our results suggest that increasing TKA is significantly associated with decreasing quality of life (r = -0.48, p < 0.005) and gait performance (r = -0.74, p < 0.0005). Osteoporosis and its related effects are threatening health and quality of life especially in postmenopausal women. Increased thoracic kyphosis angle (TKA), as one of the most common adverse musculoskeletal changes, could be regarded as a quantitative index for osteoporotic patients' assessment. Dual digital inclinometer (DDI) is one of the latest tools for non-invasive TKA measurement. The main purpose of this study was to determine whether a relationship existed between the magnitude of TKA, gait performance, and quality of life in a group of osteoporotic women. Thirty-four osteoporotic women, aged 50-68, participated in this descriptive analytic study. The magnitude of TKA measured by using DDI and expressed as the kyphosis index (KI). Quality of life and gait performance were assessed using short form 36 (SF36) questionnaire and functional gait assessment test, respectively. Back extension range of motion (ROM) and back extensor strength were also assessed. Pearson's correlation test was used to analyze the data, with the significance level of p < 0.05. The findings revealed a statistically significant negative correlation between KI and quality of life (r = -0.48, p < 0.005) and KI and gait performance (r = -0.74, p < 0.0005). There was also a significantly negative relation between KI and back extension ROM and back extensor strength (p < 0.05). The results of this study demonstrated that increased thoracic kyphosis negatively affects gait performance and quality of life. This finding could be regarded as an important implication for therapist to pay more
Strategic Measures of Teacher Performance
ERIC Educational Resources Information Center
Milanowski, Anthony
2011-01-01
Managing the human capital in education requires measuring teacher performance. To measure performance, administrators need to combine measures of practice with measures of outcomes, such as value-added measures, and three measurement systems are needed: classroom observations, performance assessments or work samples, and classroom walkthroughs.…
Using collective expert judgements to evaluate quality measures of mass spectrometry images.
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
Using collective expert judgements to evaluate quality measures of mass spectrometry images
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
Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David
2018-01-03
Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.
Commentary: measuring quality of care in osteoporosis.
Silverman, Stuart L; Curtis, Jeffrey
2013-12-01
We know improving the quality of care in osteoporosis is an important goal. We have made some strides toward measuring quality of osteoporosis care, focusing on process measures regarding care that is provided. Unfortunately, improving care as measured by these process measures does not always yield improved outcomes. We need to hold health care providers and health care systems responsible not only for health care production but for production of health and well-being. However, there is a multiplicity of factors that will need to be considered to make this next step.
ERIC Educational Resources Information Center
Berger, Roland; Hänze, Martin
2015-01-01
We assessed the impact of expert students' instructional quality on the academic performance of novice students in 12th-grade physics classes organized in an expert model of cooperative learning ("jigsaw classroom"). The instructional quality of 129 expert students was measured by a newly developed rating system. As expected, when…
Measuring Work Environment and Performance in Nursing Homes
Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.
2008-01-01
Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892
Maher, Colleen; Mendonca, Rochelle J
We evaluated the impact of a 1-wk activity program on the health, quality of life (QOL), and occupational performance of community-living women diagnosed with cancer. A one-group pretest-posttest repeated-measures design was used. Participants completed a functional health measure (36-Item Short Form Health Survey [SF-36]), a QOL measure (World Health Organization Quality of Life-Brief version [WHOQOL-BREF]), and an occupational performance and satisfaction measure (Canadian Occupational Performance Measure [COPM]) before and 6 wk after program completion. The COPM was also administered on Day 5. Paired t tests for the SF-36 and WHOQOL-BREF showed no significant differences, except for the WHOQOL-BREF's Social Relationships subscale (p < .008). Repeated-measures analyses of variance showed a significant difference in COPM performance and satisfaction scores (p < .001). The activity program effectively improved occupational performance and satisfaction and social relationships of community-living women diagnosed with cancer. Copyright © 2018 by the American Occupational Therapy Association, Inc.
How to Measure and Interpret Quality Improvement Data.
McQuillan, Rory Francis; Silver, Samuel Adam; Harel, Ziv; Weizman, Adam; Thomas, Alison; Bell, Chaim; Chertow, Glenn M; Chan, Christopher T; Nesrallah, Gihad
2016-05-06
This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.
Abilleira, Sònia; Gallofré, Miquel; Ribera, Aida; Sánchez, Emília; Tresserras, Ricard
2009-04-01
Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care. Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, <150 admissions/yr; level 2, 150 to 350; and level 3, >350). We defined sampling weights that represented each patient's inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data. We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances >or=75%, 4 of which were more than 90%, and the remaining showed adherences
Measuring comparative hospital performance.
Griffith, John R; Alexander, Jeffrey A; Jelinek, Richard C
2002-01-01
Leading healthcare provider organizations now use a "balanced scorecard" of performance measures, expanding information reviewed at the governance level to include financial, customer, and internal performance information, as well as providing an opportunity to learn and grow to provide better strategic guidance. The approach, successfully used by other industries, uses competitor data and benchmarks to identify opportunities for improved mission achievement. This article evaluates one set of nine multidimensional hospital performance measures derived from Medicare reports (cash flow, asset turnover, mortality, complications, length of inpatient stay, cost per case, occupancy, change in occupancy, and percent of revenue from outpatient care). The study examines the content validity, reliability and sensitivity, validity of comparison, and independence and concludes that seven of the nine measures (all but the two occupancy measures) represent a potentially useful set for evaluating most U.S. hospitals. This set reflects correctable differences in performance between hospitals serving similar populations, that is, the measures reflect relative performance and identify opportunities to make the organization more successful.
Kerssens, Jan J; Groenewegen, Peter P; Sixma, Herman J; Boerma, Wienke G W; van der Eijk, Ingrid
2004-02-01
To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems.
Temporal evolution modeling of hydraulic and water quality performance of permeable pavements
NASA Astrophysics Data System (ADS)
Huang, Jian; He, Jianxun; Valeo, Caterina; Chu, Angus
2016-02-01
A mathematical model for predicting hydraulic and water quality performance in both the short- and long-term is proposed based on field measurements for three types of permeable pavements: porous asphalt (PA), porous concrete (PC), and permeable inter-locking concrete pavers (PICP). The model was applied to three field-scale test sites in Calgary, Alberta, Canada. The model performance was assessed in terms of hydraulic parameters including time to peak, peak flow and water balance and a water quality variable (the removal rate of total suspended solids). A total of 20 simulated storm events were used for model calibration and verification processes. The proposed model can simulate the outflow hydrographs with a coefficient of determination (R2) ranging from 0.762 to 0.907, and normalized root-mean-square deviation (NRMSD) ranging from 13.78% to 17.83%. Comparison of the time to peak flow, peak flow, runoff volume and TSS removal rates between the measured and modeled values in model verification phase had a maximum difference of 11%. The results demonstrate that the proposed model is capable of capturing the temporal dynamics of the pavement performance. Therefore, the model has great potential as a practical modeling tool for permeable pavement design and performance assessment.
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.
Measuring the Mathematical Quality of Instruction
ERIC Educational Resources Information Center
Journal of Mathematics Teacher Education, 2011
2011-01-01
In this article, we describe a framework and instrument for measuring the mathematical quality of mathematics instruction. In describing this framework, we argue for the separation of the "mathematical quality of instruction" (MQI), such as the absence of mathematical errors and the presence of sound mathematical reasoning, from pedagogical…
Introducing care pathway commissioning to primary dental care: measuring performance.
Harris, R; Bridgman, C; Ahmad, M; Bowes, L; Haley, R; Saleem, S; Singh, R; Taylor, S
2011-12-09
Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.
Measuring the performance of G2G services in Iran
NASA Astrophysics Data System (ADS)
Zarei, Behrouz; Safdari, Maryam
To highlight the growth of e-government and the importance of its services it is essential to evaluate the performance of the service delivery to customers. Research indicates that traditional performance indexes are not suitable for this evaluation; moreover, it is noticeable that the e-government services are intangible and invisible. Among different e-government services, measurement of quality government to government (G2G) services has been less attractive for researchers while crucial for government policy-makers. This calls for a better understanding of the specific needs of users of these services in order to provide appropriate type and level of services that meets those needs. In this paper, the performance of the G2G services is measured in the Iranian context. For this purpose, SERVQUAL, which is a well-known method for assessing service quality, is employed. This study proposes and tests a five-factor of SERVQUAL instrument to explain user satisfaction and gap analysis, between expectations and perceptions of its customers, consisting thirty ministries and main governmental organizations. Based on a Chi-square test, factor analysis, gap analysis and correlations, it is concluded the gap between expectations and perceptions of G2G customers is significant and customer satisfaction of G2G services is at low level.
Timmermann, Carsten
2013-01-01
Objectives: To use the history of the Karnofsky Performance Scale as a case study illustrating the emergence of interest in the measurement and standardisation of quality of life; to understand the origins of current-day practices. Methods: Articles referring to the Karnofsky scale and quality of life measurements published from the 1940s to the 1990s were identified by searching databases and screening journals, and analysed using close-reading techniques. Secondary literature was consulted to understand the context in which articles were written. Results: The Karnofsky scale was devised for a different purpose than measuring quality of life: as a standardisation device that helped quantify effects of chemotherapeutic agents less easily measurable than survival time. Interest in measuring quality of life only emerged around 1970. Discussion: When quality of life measurements were increasingly widely discussed in the medical press from the late 1970s onwards, a consensus emerged that the Karnofsky scale was not a very good tool. More sophisticated approaches were developed, but Karnofsky continued to be used. I argue that the scale provided a quick and simple, approximate assessment of the ‘soft’ effects of treatment by physicians, overlapping but not identical with quality of life. PMID:23239756
Community pharmacy owners' views of star ratings and performance measurement: In-depth interviews.
Teeter, Benjamin S; Fox, Brent I; Garza, Kimberly B; Harris, Stanley G; Nau, David P; Owensby, Justin K; Westrick, Salisa C
2016-01-01
The star rating system implemented by Medicare has the potential to positively affect patient health and may have financial implications for community pharmacies. Learning from owners of community pharmacies with high performance on these quality measures may help us to identify and further understand factors contributing to their success. This study described high-performing community pharmacy owners' current awareness and knowledge of star ratings, attitudes toward star ratings and performance measurement, and initiatives being offered in pharmacies that aim to improve the quality of care. Qualitative interviews with owners of independent community pharmacies were conducted in Spring 2015. Fifteen community pharmacies with high performance on the star rating measures were invited to participate. Recruitment did not end until the saturation point had been reached. All interviews were transcribed verbatim. Interview data were analyzed with the use of ATLAS.ti by 2 coders trained in thematic analysis. Krippendorf's alpha was calculated to assess intercoder reliability. Ten high-performing pharmacy owners participated. Analysis identified 8 themes, which were organized into the following categories: 1) current awareness and knowledge (i.e., superficial or advanced knowledge); 2) attitudes toward star ratings (positive perceptions, skeptical of performance rewards, and lack a feeling of control); and 3) pharmacy initiatives (personal patient relationships, collaborative employee relationships, and use of technology). Intercoder reliability was good overall. Interviews with high-performing pharmacies suggested that awareness of the star rating measures, overall positive attitudes toward the star ratings, the relationships that pharmacy owners have with their patients and their employees, and the use of technology as a tool to enhance patient care may contribute to high performance on the star rating measures. Future research is needed to determine if and how these
Stringham, James M.; Stringham, Nicole T.; O’Brien, Kevin J.
2017-01-01
The dramatic rise in the use of smartphones, tablets, and laptop computers over the past decade has raised concerns about potentially deleterious health effects of increased “screen time” (ST) and associated short-wavelength (blue) light exposure. We determined baseline associations and effects of 6 months’ supplementation with the macular carotenoids (MC) lutein, zeaxanthin, and mesozeaxanthin on the blue-absorbing macular pigment (MP) and measures of sleep quality, visual performance, and physical indicators of excessive ST. Forty-eight healthy young adults with at least 6 h of daily near-field ST exposure participated in this placebo-controlled trial. Visual performance measures included contrast sensitivity, critical flicker fusion, disability glare, and photostress recovery. Physical indicators of excessive screen time and sleep quality were assessed via questionnaire. MP optical density (MPOD) was assessed via heterochromatic flicker photometry. At baseline, MPOD was correlated significantly with all visual performance measures (p < 0.05 for all). MC supplementation (24 mg daily) yielded significant improvement in MPOD, overall sleep quality, headache frequency, eye strain, eye fatigue, and all visual performance measures, versus placebo (p < 0.05 for all). Increased MPOD significantly improves visual performance and, in turn, improves several undesirable physical outcomes associated with excessive ST. The improvement in sleep quality was not directly related to increases in MPOD, and may be due to systemic reduction in oxidative stress and inflammation. PMID:28661438
Stringham, James M; Stringham, Nicole T; O'Brien, Kevin J
2017-06-29
The dramatic rise in the use of smartphones, tablets, and laptop computers over the past decade has raised concerns about potentially deleterious health effects of increased "screen time" (ST) and associated short-wavelength (blue) light exposure. We determined baseline associations and effects of 6 months' supplementation with the macular carotenoids (MC) lutein, zeaxanthin, and mesozeaxanthin on the blue-absorbing macular pigment (MP) and measures of sleep quality, visual performance, and physical indicators of excessive ST. Forty-eight healthy young adults with at least 6 h of daily near-field ST exposure participated in this placebo-controlled trial. Visual performance measures included contrast sensitivity, critical flicker fusion, disability glare, and photostress recovery. Physical indicators of excessive screen time and sleep quality were assessed via questionnaire. MP optical density (MPOD) was assessed via heterochromatic flicker photometry. At baseline, MPOD was correlated significantly with all visual performance measures ( p < 0.05 for all). MC supplementation (24 mg daily) yielded significant improvement in MPOD, overall sleep quality, headache frequency, eye strain, eye fatigue, and all visual performance measures, versus placebo ( p < 0.05 for all). Increased MPOD significantly improves visual performance and, in turn, improves several undesirable physical outcomes associated with excessive ST. The improvement in sleep quality was not directly related to increases in MPOD, and may be due to systemic reduction in oxidative stress and inflammation.
Diffuse prior monotonic likelihood ratio test for evaluation of fused image quality measures.
Wei, Chuanming; Kaplan, Lance M; Burks, Stephen D; Blum, Rick S
2011-02-01
This paper introduces a novel method to score how well proposed fused image quality measures (FIQMs) indicate the effectiveness of humans to detect targets in fused imagery. The human detection performance is measured via human perception experiments. A good FIQM should relate to perception results in a monotonic fashion. The method computes a new diffuse prior monotonic likelihood ratio (DPMLR) to facilitate the comparison of the H(1) hypothesis that the intrinsic human detection performance is related to the FIQM via a monotonic function against the null hypothesis that the detection and image quality relationship is random. The paper discusses many interesting properties of the DPMLR and demonstrates the effectiveness of the DPMLR test via Monte Carlo simulations. Finally, the DPMLR is used to score FIQMs with test cases considering over 35 scenes and various image fusion algorithms.
NASA Astrophysics Data System (ADS)
Zhang, Xueliang; Feng, Xuezhi; Xiao, Pengfeng; He, Guangjun; Zhu, Liujun
2015-04-01
Segmentation of remote sensing images is a critical step in geographic object-based image analysis. Evaluating the performance of segmentation algorithms is essential to identify effective segmentation methods and optimize their parameters. In this study, we propose region-based precision and recall measures and use them to compare two image partitions for the purpose of evaluating segmentation quality. The two measures are calculated based on region overlapping and presented as a point or a curve in a precision-recall space, which can indicate segmentation quality in both geometric and arithmetic respects. Furthermore, the precision and recall measures are combined by using four different methods. We examine and compare the effectiveness of the combined indicators through geometric illustration, in an effort to reveal segmentation quality clearly and capture the trade-off between the two measures. In the experiments, we adopted the multiresolution segmentation (MRS) method for evaluation. The proposed measures are compared with four existing discrepancy measures to further confirm their capabilities. Finally, we suggest using a combination of the region-based precision-recall curve and the F-measure for supervised segmentation evaluation.
Impact on quality activities of measurement systems meeting an L:1 rule
DOE Office of Scientific and Technical Information (OSTI.GOV)
Hamada, M. S.; Burkhardt, J. H.
2016-04-01
This study considers the impact of a measurement system that meets an L:1 rule on various quality activities. These activities include inspection, acceptance sampling, and control charting. A measurement system that meets a 10:1 rule performs much better than one that meets a 4:1 rule. R code is provided so that the practitioner is able to evaluate these activities to his or her particular situation.
Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy.
Sandhu, Sharmila; Furniss, Jeremy; Metzler, Christina
As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection. Copyright © 2018 by the American Occupational Therapy Association, Inc.
Quality Measurement in Early Childhood Settings
ERIC Educational Resources Information Center
Zaslow, Martha, Ed.; Martinez-Beck, Ivelisse, Ed.; Tout, Kathryn, Ed.; Halle, Tamara, Ed.
2011-01-01
What constitutes quality in early childhood settings, and how can it best be measured with today's widely used tools and promising new approaches? Find authoritative answers in this book, a must-have for high-level administrators and policymakers as more and more states adopt early childhood Quality Rating and Improvement Systems. The most…
Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim
2013-08-02
To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Retrospective longitudinal study. Data for 2007-2008 to 2010-2011, extracted from the clinical computer systems of general practices in England. All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system.
LCD displays performance comparison by MTF measurement using the white noise stimulus method
NASA Astrophysics Data System (ADS)
Mitjà, Carles; Escofet, Jaume
2011-01-01
The amount of images produced to be viewed as soft copies on output displays are significantly increasing. This growing occurs at the expense of the images targeted to hard copy versions on paper or any other physical support. Even in the case of high quality hard copy production, people working in professional imaging uses different displays in selecting, editing, processing and showing images, from laptop screen to specialized high end displays. Then, the quality performance of these devices is crucial in the chain of decisions to be taken in image production. Metrics of this quality performance can help in the equipment acquisition. Different metrics and methods have been described to determine the quality performance of CRT and LCD computer displays in clinical area. One of most important metrics in this field is the device spatial frequency response obtained measuring the modulation transfer function (MTF). This work presents a comparison between the MTF of three different LCD displays, Apple MacBook Pro 15", Apple LED Cinema Display 24" and Apple iPhone4, measured by the white noise stimulus method, over vertical and horizontal directions. Additionally, different displays show particular pixels structure pattern. In order to identify this pixel structure, a set of high magnification images is taken from each display to be related with the respective vertical and horizontal MTF.
Kotecha, Dipak; Ahmed, Amar; Calvert, Melanie; Lencioni, Mauro; Terwee, Caroline B; Lane, Deirdre A
2016-01-01
Atrial fibrillation is a large and growing burden across all types of healthcare. Both incidence and prevalence are expected to double in the next 20 years, with huge impact on hospital admissions, costs and patient quality of life. Patient wellbeing determines the management strategy for atrial fibrillation, including the use of rhythm control therapy and the clinical success of heart rate control. Hence, evaluation of quality of life is an emerging and important part of the assessment of patients with atrial fibrillation. Although a number of questionnaires to assess quality of life in atrial fibrillation are available, a comprehensive overview of their measurement properties is lacking. We performed a systematic review of the measurement properties of atrial fibrillation-specific health-related quality of life questionnaires. Methodological quality was assessed using the Consensus based Standards for selection of health Measurement Instruments (COSMIN) checklist, with measurement properties rated for quality against optimal criteria and levels of evidence. We screened 2,216 articles, of which eight articles describing five questionnaires were eligible for inclusion: Atrial Fibrillation 6 (AF6), Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT), Atrial Fibrillation Quality of Life Questionnaire (AFQLQ), Atrial Fibrillation Quality of Life (AFQoL), and Quality of Life in Atrial Fibrillation (QLAF). Good reliability (internal consistency and test-retest reliability) was demonstrated for AF6, AFEQT, AFQLQ and AFQoL. Content, construct and criterion validity were positively rated only in AFEQT. Responsiveness was positively rated only in AFEQT, but with limited evidence. Overall, AFEQT showed strong positive evidence for 2 of 9 measurement properties, compared to one for AFQoL and none for the remaining questionnaires. Given the low ratings for many measurement properties, no single questionnaire can be recommended, although AFEQT performed strongest. Further
Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Wang, Xue; Adams, John L; Chow, Warren B; Lawson, Elise H; Bilimoria, Karl Y; Richards, Karen; Ko, Clifford Y
2013-03-01
To develop a reliable, robust, parsimonious, risk-adjusted 30-day composite colectomy outcome measure. A fundamental aspect in the pursuit of high-quality care is the development of valid and reliable performance measures in surgery. Colon resection is associated with appreciable morbidity and mortality and therefore is an ideal quality improvement target. From 2010 American College of Surgeons National Surgical Quality Improvement Program data, patients were identified who underwent colon resection for any indication. A composite outcome of death or any serious morbidity within 30 days of the index operation was established. A 6-predictor, parsimonious model was developed and compared with a more complex model with more variables. National caseload requirements were calculated on the basis of increasing reliability thresholds. From 255 hospitals, 22,346 patients were accrued who underwent a colon resection in 2010, most commonly for neoplasm (46.7%). A mortality or serious morbidity event occurred in 4461 patients (20.0%). At the hospital level, the median composite event rate was 20.7% (interquartile range: 15.8%-26.3%). The parsimonious model performed similarly to the full model (Akaike information criterion: 19,411 vs 18,988), and hospital-level performance comparisons were highly correlated (R = 0.97). At a reliability threshold of 0.4, 56 annual colon resections would be required and achievable at an estimated 42% of US and 69% of American College of Surgeons National Surgical Quality Improvement Program hospitals. This 42% of US hospitals performed approximately 84% of all colon resections in the country in 2008. It is feasible to design a measure with a composite outcome of death or serious morbidity after colon surgery that has a low burden for data collection, has substantial clinical importance, and has acceptable reliability.
Mohamed, Salwa Attia
2014-01-01
Organization justice refers to the extent to which employees perceive workplace procedure, interactions, and outcomes to be fair in nature. So, this study aimed to investigate the relationship between organizational justice and quality performance among health care workers. The study was conducted at the Public Hospital in Fayoum, Egypt. The study included a convenience sample of 100 healthcare workers (60 nurses and 40 physicians) that were recruited. Tools used for data collection included (1) questionnaire sheet which is used to measure health workers' perception of organizational justices. It includes four types: distributive, procedural, interpersonal, and informational justice. (2) Quality performance questionnaire sheet: this tool was used to examine health workers' perception regarding their quality performance. It contained three types: information, value, and skill. The results revealed that a positive correlation was found between organizational justice components and quality performance among the various categories of health workers' perception (P ≤ 0.05). It has been recommended to replicate the study on a larger probability sample from different hospital settings to achieve more generalizable results and reinforce justice during organization of ministry centers in Egypt. PMID:24982992
Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure.
Harvey, H Benjamin; Hassanzadeh, Elmira; Aran, Shima; Rosenthal, Daniel I; Thrall, James H; Abujudeh, Hani H
2016-01-01
Quality assurance (QA) is a fundamental component of every successful radiology operation. A radiology QA program must be able to efficiently and effectively monitor and respond to quality problems. However, as radiology QA has expanded into the depths of radiology operations, the task of defining and measuring quality has become more difficult. Key performance indicators (KPIs) are highly valuable data points and measurement tools that can be used to monitor and evaluate the quality of services provided by a radiology operation. As such, KPIs empower a radiology QA program to bridge normative understandings of health care quality with on-the-ground quality management. This review introduces the importance of KPIs in health care QA, a framework for structuring KPIs, a method to identify and tailor KPIs, and strategies to analyze and communicate KPI data that would drive process improvement. Adopting a KPI-driven QA program is both good for patient care and allows a radiology operation to demonstrate measurable value to other health care stakeholders. Copyright © 2015 Mosby, Inc. All rights reserved.
ERIC Educational Resources Information Center
Yildiz, Suleyman M.; Kara, Ali
2009-01-01
Purpose: HEdPERF (Higher Education PERFormance) is one of the most recently developed scales in the literature to measure service quality in higher education. However, HEdPERF is designed to measure service quality at a macro level (university level) and may be considered as a more generic measurement instrument. In higher education, new scales…
The interplay between academic performance and quality of life among preclinical students.
Shareef, Mohammad Abrar; AlAmodi, Abdulhadi A; Al-Khateeb, Abdulrahman A; Abudan, Zainab; Alkhani, Mohammed A; Zebian, Sanderlla I; Qannita, Ahmed S; Tabrizi, Mariam J
2015-10-31
The high academic performance of medical students greatly influences their professional competence in long term career. Meanwhile, medical students greatly demand procuring a good quality of life that can help them sustain their medical career. This study examines validity and reliability of the tool among preclinical students and testifies the influence of their scholastic performance along with gender and academic year on their quality of life. A cross sectional study was conducted by distributing World Health Organization Quality of Life, WHOQOL-BREF, survey among medical students of year one to three at Alfaisal University. For validity, item discriminate validity(IDV) and confirmatory factor analysis were measured and for reliability, Cronbach's α test and internal item consistency(IIC) were examined. The association of GPA, gender and academic year with all major domains was drawn using Pearson's correlation, independent samples t-test and one-way ANOVA, respectively. A total of 335 preclinical students have responded to this questionnaire. The construct has demonstrated an adequate validity and good reliability. The high academic performance of students positively correlated with physical (r = 0.23, p < 0.001), psychological health (r = 0.29, p < 0.001), social relations (r = 0.11, p = 0.03) and environment (r = 0.23, p < 0.001). Male student scored higher than female peers in physical and psychological health. This study has identified a direct relationship between the academic performance of preclinical students and their quality of life. The WHOQOL-BREF is a valid and reliable tool among preclinical students and the positive direction of high academic performance with greater QOL suggests that academic achievers procure higher satisfaction and poor achievers need a special attention for the improvement of their quality of life.
Developing Effective Performance Measures
2014-10-14
University When Performance Measurement Goes Bad Laziness Vanity Narcissism Too Many Pettiness Inanity 52 Developing Effective...Kasunic, October 14, 2014 © 2014 Carnegie Mellon University Narcissism Measuring performance from the organization’s point of view, rather than from
Quality measures and assurance for AI (Artificial Intelligence) software
NASA Technical Reports Server (NTRS)
Rushby, John
1988-01-01
This report is concerned with the application of software quality and evaluation measures to AI software and, more broadly, with the question of quality assurance for AI software. Considered are not only the metrics that attempt to measure some aspect of software quality, but also the methodologies and techniques (such as systematic testing) that attempt to improve some dimension of quality, without necessarily quantifying the extent of the improvement. The report is divided into three parts Part 1 reviews existing software quality measures, i.e., those that have been developed for, and applied to, conventional software. Part 2 considers the characteristics of AI software, the applicability and potential utility of measures and techniques identified in the first part, and reviews those few methods developed specifically for AI software. Part 3 presents an assessment and recommendations for the further exploration of this important area.
Advancing the use of community pharmacy quality measures: a qualitative study.
Shiyanbola, Olayinka O; Mort, Jane R; Lyons, Kayley
2013-01-01
To describe consumers' ability to interpret pharmacy quality measures data presented in a report card, to examine the tools that consumers require to interpret the information available in a pharmacy quality report card, and to determine whether pharmacy quality measures influence consumers' choice of a pharmacy. Qualitative study. Three semistructured focus groups conducted in a private meeting space at a public library in Sioux Falls, SD, from April 2011 to May 2011. 29 laypeople. Participants' skills interpreting and using pharmacy quality information were examined based on mock report cards containing the Pharmacy Quality Alliance (PQA) quality measures. Consumer perceptions of pharmacy quality data. Participants reported difficulty understanding quality measures because of knowledge deficits. They wanted supportive resources on drug class of their medications to help them understand the measures. Participants had different opinions on whether their pharmacies should be compared with other pharmacies based on specific quality measures. For example, they favored the use of drug-drug interactions as a quality measure for comparing pharmacies, while medication adherence was deemed of limited use for comparison. Participants stated that pharmacy report cards would be useful information but would not prompt a change in pharmacy. However, participants perceived that this information would be useful in selecting a new pharmacy. The results suggest that consumers require simplification of PQA quality measures and supportive resources to interpret the measures. Consumers may favor certain quality measures based on their perception of the role of the pharmacist. Education is required before full use of this quality-of-care information can be realized.
The evolving landscape of quality measurement for heart failure
Fitzgerald, Ashley A.; Allen, Larry A.; Masoudi, Frederick A.
2013-01-01
Heart failure (HF) is a major cause of mortality and morbidity, representing a leading cause of death and hospitalization among U.S. Medicare beneficiaries. Advances in science have generated effective interventions to reduce adverse outcomes in HF, particularly in patients with reduced left ventricular ejection fraction. Unfortunately, effective therapies for heart failure are often not utilized in an effective, safe, timely, equitable, patient-centered, and efficient manner. Further, the risk of adverse outcomes for HF remains high. The last decades have witnessed the growth of efforts to measure and improve the care and outcomes of patients with HF. This paper will review the evolution of quality measurement for HF, including a brief history of quality measurement in medicine; the measures that have been employed to characterize quality in heart failure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heart failure. PMID:22548579
Comparing clinical automated, medical record, and hybrid data sources for diabetes quality measures.
Kerr, Eve A; Smith, Dylan M; Hogan, Mary M; Krein, Sarah L; Pogach, Leonard; Hofer, Timothy P; Hayward, Rodney A
2002-10-01
Little is known about the relative reliability of medical record and clinical automated data, sources commonly used to assess diabetes quality of care. The agreement between diabetes quality measures constructed from clinical automated versus medical record data sources was compared, and the performance of hybrid measures derived from a combination of the two data sources was examined. Medical records were abstracted for 1,032 patients with diabetes who received care from 21 facilities in 4 Veterans Integrated Service Networks. Automated data were obtained from a central Veterans Health Administration diabetes registry containing information on laboratory tests and medication use. Success rates were higher for process measures derived from medical record data than from automated data, but no substantial differences among data sources were found for the intermediate outcome measures. Agreement for measures derived from the medical record compared with automated data was moderate for process measures but high for intermediate outcome measures. Hybrid measures yielded success rates similar to those of medical record-based measures but would have required about 50% fewer chart reviews. Agreement between medical record and automated data was generally high. Yet even in an integrated health care system with sophisticated information technology, automated data tended to underestimate the success rate in technical process measures for diabetes care and yielded different quartile performance rankings for facilities. Applying hybrid methodology yielded results consistent with the medical record but required less data to come from medical record reviews.
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.
Kalra, Ankur; Pokharel, Yashashwi; Hira, Ravi S; Risch, Samantha; Vicera, Veronique; Li, Qiong; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Glusenkamp, Nathan; Turakhia, Mintu P; Virani, Salim S
2015-01-01
Background India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India’s first national outpatient CVD quality-improvement program. Methods and Results In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin–angiotensin–aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation. Conclusions This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data
Sfantou, Danae F; Laliotis, Aggelos; Patelarou, Athina E; Sifaki-Pistolla, Dimitra; Matalliotakis, Michail; Patelarou, Evridiki
2017-10-14
Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004-2015. The research question that guided this review was posed as: "Is there any relationship between leadership style in healthcare settings and quality of care?" Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals.
Competency-Based Education: A Framework for Measuring Quality Courses
ERIC Educational Resources Information Center
Krause, Jackie; Dias, Laura Portolese; Schedler, Chris
2015-01-01
The growth of competency-based education in an online environment requires the development and measurement of quality competency-based courses. While quality measures for online courses have been developed and standardized, they do not directly align with emerging best practices and principles in the design of quality competency-based online…
Perceptual and Acoustic Analyses of Good Voice Quality in Male Radio Performers.
Warhurst, Samantha; Madill, Catherine; McCabe, Patricia; Ternström, Sten; Yiu, Edwin; Heard, Robert
2017-03-01
Good voice quality is an asset to professional voice users, including radio performers. We examined whether (1) voices could be reliably categorized as good for the radio and (2) these categories could be predicted using acoustic measures. Male radio performers (n = 24) and age-matched male controls performed "The Rainbow Passage" as if presenting on the radio. Voice samples were rated using a three-stage paired-comparison paradigm by 51 naive listeners and perceptual categories were identified (Study 1), and then analyzed for fundamental frequency, long-term average spectrum, cepstral peak prominence, and pause or spoken-phrase duration (Study 2). Study 1: Good inter-judge reliability was found for perceptual judgments of the best 15 voices (good for radio category, 14/15 = radio performers), but agreement on the remaining 33 voices (unranked category) was poor. Study 2: Discriminant function analyses showed that the SD standard deviation of sounded portion duration, equivalent sound level, and smoothed cepstral peak prominence predicted membership of categories with moderate accuracy (R 2 = 0.328). Radio performers are heterogeneous for voice quality; good voice quality was judged reliably in only 14 out of 24 radio performers. Current acoustic analyses detected some of the relevant signal properties that were salient in these judgments. More refined perceptual analysis and the use of other perceptual methods might provide more information on the complex nature of judging good voices. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Quality of Life. Volume I: Conceptualization and Measurement.
ERIC Educational Resources Information Center
Schalock, Robert L., Ed.; Siperstein, Gary N., Ed.
This volume deals with the conceptualization and measurement of quality of life for persons with mental retardation and developmental disabilities. Part 1, "The Conceptualization of Quality of Life," contains: "Self Advocacy: Foundation for Quality of Life" (Nancy A. Ward and Kenneth D. Keith); "Quality of Life and the Individual's Perspective"…
ERIC Educational Resources Information Center
Ballard, Paul J.
2013-01-01
Given growing interest in accountability and outcomes, the North Central Association's Higher Learning Commission developed a new path for accreditation, the Academic Quality Improvement Program (AQIP). The goal is to infuse continuous improvement and quality in the culture of higher education, and to blend traditional accreditation with the…
Quality assurance and control issues for HF radar wave and current measurements
NASA Astrophysics Data System (ADS)
Wyatt, Lucy
2015-04-01
HF radars are now widely used to provide surface current measurements over wide areas of the coastal ocean for scientific and operational applications. In general data quality is acceptable for these applications but there remain issues that impact on the quantity and quality of the data. These include problems with calibration and interference which impact on both phased array (e.g. WERA, Pisces) and direction-finding (e.g. SeaSonde) radars. These same issues and others (e.g. signal-to-noise, in-cell current variability, antenna sidelobes) also impact on the quality and quantity of wave data that can be obtained. These issues will be discussed in this paper, illustrated with examples from deployments of WERA, Pisces and SeaSonde radars in the UK, Europe, USA and Australia. These issues involve both quality assurance (making sure the radars perform to spec and the software is fully operational) and in quality control (identifying problems with the data due to radar hardware or software performance issues and flagging these in the provided data streams). Recommendations for the former, and current practice (of the author and within the Australian Coastal Ocean Radar Network, ACORN*) for the latter, will be discussed. The quality control processes for wave measurement are not yet as well developed as those for currents and data from some deployments can be rather noisy. Some new methods, currently under development by SeaView Sensing Ltd and being tested with ACORN data, will be described and results presented. *ACORN is a facility of the Australian Integrated Marine Observing System, IMOS. IMOS is a national collaborative research infrastructure, supported by Australian Government. It is led by University of Tasmania in partnership with the Australian marine and climate science community.
Quality performance measurement using the text of electronic medical records.
Pakhomov, Serguei; Bjornsen, Susan; Hanson, Penny; Smith, Steven
2008-01-01
Annual foot examinations (FE) constitute a critical component of care for diabetes. Documented evidence of FE is central to quality-of-care reporting; however, manual abstraction of electronic medical records (EMR) is slow, expensive, and subject to error. The objective of this study was to test the hypothesis that text mining of the EMR results in ascertaining FE evidence with accuracy comparable to manual abstraction. The text of inpatient and outpatient clinical reports was searched with natural-language (NL) queries for evidence of neurological, vascular, and structural components of FE. A manual medical records audit was used for validation. The reference standard consisted of 3 independent sets used for development (n=200 ), validation (n=118), and reliability (n=80). The reliability of manual auditing was 91% (95% confidence interval [CI]= 85-97) and was determined by comparing the results of an additional audit to the original audit using the records in the reliability set. The accuracy of the NL query requiring 1 of 3 FE components was 89% (95% CI=83-95). The accuracy of the query requiring any 2 of 3 components was 88% (95% CI=82-94). The accuracy of the query requiring all 3 components was 75% (95% CI= 68- 83). The free text of the EMR is a viable source of information necessary for quality of health care reporting on the evidence of FE for patients with diabetes. The low-cost methodology is scalable to monitoring large numbers of patients and can be used to streamline quality-of-care reporting.
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.
Instructional Alignment as a Measure of Teaching Quality
ERIC Educational Resources Information Center
Polikoff, Morgan S.; Porter, Andrew C.
2014-01-01
Recent years have seen the convergence of two major policy streams in U.S. K-12 education: standards/accountability and teacher quality reforms. Work in these areas has led to the creation of multiple measures of teacher quality, including measures of their instructional alignment to standards/assessments, observational and student survey measures…
42 CFR 460.136 - Internal quality assessment and performance improvement activities.
Code of Federal Regulations, 2014 CFR
2014-10-01
... in quality assessment and performance improvement activities, including providing information about... 42 Public Health 4 2014-10-01 2014-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460...
42 CFR 460.136 - Internal quality assessment and performance improvement activities.
Code of Federal Regulations, 2012 CFR
2012-10-01
... in quality assessment and performance improvement activities, including providing information about... 42 Public Health 4 2012-10-01 2012-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460...
42 CFR 460.136 - Internal quality assessment and performance improvement activities.
Code of Federal Regulations, 2013 CFR
2013-10-01
... in quality assessment and performance improvement activities, including providing information about... 42 Public Health 4 2013-10-01 2013-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460...
Quality management of nuchal translucency ultrasound measurement in Australia.
Nisbet, Debbie; Robertson, Ann; Mannil, Blessy; Pincham, Vanessa; Mclennan, Andrew
2018-02-22
Nuchal translucency measurement has an established role in first trimester screening. Accurate measurement requires that technical guidelines are followed. Performance can be monitored by auditing the distribution of measurements obtained in a series of cases. The primary aim is to develop an accessible, theory-based educational program for individuals whose distribution of measurements at audit falls outside an acceptable range, and assess operator performance following this intervention. Operators whose nuchal translucency measurement distributions fall outside a normal range (38-65% above the median) were expected to undergo a teleconference tutorial. Accessible from anywhere in Australia, the one hour tutorials were run by a senior sonographer (to explain technical ultrasound aspects) and the audit program manager (to explain the audit process). In 2011, 83 operators attended the teleconference tutorials. Compared to a random comparison group of operators meeting standard in 2011, teleconference tutorial attendees were significantly more likely to: (i) operate in rural or regional, rather than metropolitan, centres (P = 0.001); (ii) be less experienced (P < 0.0005); and (iii) have lower annual scan numbers (P = 0.0012). Improvement in nuchal translucency measurement quality was seen after one audit cycle and was maintained over subsequent years. The mean percentage of the study cohort reaching standard over the five-year audit was 77.8% which was not statistically different from the average for the comparison cohort of all other audited operators (79.3%; P = 0.61). Teleconference tutorials are a convenient, accessible and effective way to obtain immediate and sustained improvement in operator performance. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Barton, Spencer E; Campbell, Jeffrey W; Piatt, Joseph H
2013-04-01
The authors define and examine the properties of 2 new, practice-based quality measures for the management of hydrocephalus. The Surgical Activity Rate (SAR) is defined as the number of definitive operations for the treatment of hydrocephalus performed in a neurosurgical practice over the course of a year, divided by the number of patients with hydrocephalus seen in follow-up during that year. The Revision Quotient (RQ) is defined as the number of definitive revision operations performed in a neurosurgical practice in the course of a year, divided by the number of definitive initial operations during that year for patients with newly diagnosed hydrocephalus. Using published actuarial shunt survival data, the authors conducted Monte Carlo simulations of a pediatric neurosurgical practice to illustrate the properties and interpretations of the SAR and RQ. They used data from the Kids' Inpatient Database (KID) for 2009 to calculate RQs for hospitals accounting for more than 10 admissions coded for initial CSF shunt insertions. During the initial growth phase of a simulated neurosurgical practice, the SAR approached its steady-state value much earlier than the RQ. Both measures were sensitive to doubling or halving of monthly failure rates. In the 2009 KID, 117 hospitals reported more than 10 initial shunt insertions. The weighted mean (± standard deviation) RQ for these hospitals was 1.79 ± 0.69. Among hospitals performing 50 or more initial shunt insertions, the RQ ranged between 0.71 and 3.65. The SAR and RQ have attractive qualitative features as practice-based quality measures. The RQ, at least, exhibits clinically meaningful interhospital variation as applied to CSF shunt surgery. The SAR and RQ merit prospective field-testing as measures of quality in the management of childhood hydrocephalus.
The current state of nursing performance measurement, public reporting, and value-based purchasing.
Kurtzman, Ellen T; Dawson, Ellen M; Johnson, Jean E
2008-08-01
Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.
Bereskie, Ty; Haider, Husnain; Rodriguez, Manuel J; Sadiq, Rehan
2017-08-23
Traditional approaches for benchmarking drinking water systems are binary, based solely on the compliance and/or non-compliance of one or more water quality performance indicators against defined regulatory guidelines/standards. The consequence of water quality failure is dependent on location within a water supply system as well as time of the year (i.e., season) with varying levels of water consumption. Conventional approaches used for water quality comparison purposes fail to incorporate spatiotemporal variability and degrees of compliance and/or non-compliance. This can lead to misleading or inaccurate performance assessment data used in the performance benchmarking process. In this research, a hierarchical risk-based water quality performance benchmarking framework is proposed to evaluate small drinking water systems (SDWSs) through cross-comparison amongst similar systems. The proposed framework (R WQI framework) is designed to quantify consequence associated with seasonal and location-specific water quality issues in a given drinking water supply system to facilitate more efficient decision-making for SDWSs striving for continuous performance improvement. Fuzzy rule-based modelling is used to address imprecision associated with measuring performance based on singular water quality guidelines/standards and the uncertainties present in SDWS operations and monitoring. This proposed R WQI framework has been demonstrated using data collected from 16 SDWSs in Newfoundland and Labrador and Quebec, Canada, and compared to the Canadian Council of Ministers of the Environment WQI, a traditional, guidelines/standard-based approach. The study found that the R WQI framework provides an in-depth state of water quality and benchmarks SDWSs more rationally based on the frequency of occurrence and consequence of failure events.
Data-quality measures for stakeholder-implemented watershed-monitoring programs
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.
Courtright, Stephen H; McCormick, Brian W; Mistry, Sal; Wang, Jiexin
2017-10-01
Though prevalent in practice, team charters have only recently received scholarly attention. However, most of this work has been relatively devoid of theory, and consequently, key questions about why and under what conditions team charter quality affects team performance remain unanswered. To address these gaps, we draw on macro organizational control theory to propose that team charter quality serves as a team-level "behavior" control mechanism that builds task cohesion through a structured exercise. We then juxtapose team charter quality with an "input" team control mechanism that influences the emergence of task cohesion more organically: team conscientiousness. Given their redundant effects on task cohesion, we propose that the effects of team charter quality and team conscientiousness on team performance (through task cohesion) are substitutive such that team charter quality primarily impacts team performance for teams that are low (vs. high) on conscientiousness. We test and find support for our hypotheses in a sample of 239 undergraduate self-managing project teams. Our study contributes to the groups and teams literature in the following ways: first, relative to previous studies, we take a more theory-driven approach toward understanding team charters, and in doing so, uncover when and why team charter quality impacts team performance; second, we integrate two normally disparate perspectives on team effectiveness (team development and team selection) to offer a broader perspective on how teams are "built"; and third, we introduce team charter quality as a performance-enhancing mechanism for teams lower on conscientiousness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
A Structured-Grid Quality Measure for Simulated Hypersonic Flows
NASA Technical Reports Server (NTRS)
Alter, Stephen J.
2004-01-01
A structured-grid quality measure is proposed, combining three traditional measurements: intersection angles, stretching, and curvature. Quality assesses whether the grid generated provides the best possible tradeoffs in grid stretching and skewness that enable accurate flow predictions, whereas the grid density is assumed to be a constraint imposed by the available computational resources and the desired resolution of the flow field. The usefulness of this quality measure is assessed by comparing heat transfer predictions from grid convergence studies for grids of varying quality in the range of [0.6-0.8] on an 8'half-angle sphere-cone, at laminar, perfect gas, Mach 10 wind tunnel conditions.
Measuring Service Quality in a Tertiary Institution.
ERIC Educational Resources Information Center
Soutar, Geoffrey; McNeil, Margaret
1996-01-01
Measures service quality from the viewpoint of customers (students at an Australian university), using the SERVQUAL model. Obtains evaluations of academic and administrative aspects of the educational service. Makes significant negative evaluations of administrative service quality (resulting from communication problems). Satisfaction with the…
ERIC Educational Resources Information Center
General Accounting Office, Washington, DC. National Security and International Affairs Div.
The General Accounting Office (GAO) examined the impact of formal total quality management (TQM) practices on the performance of 20 selected U.S. companies that were among the highest-scoring applicants in 1988 and 1989 for the Malcolm Baldridge National Quality Award. Several key indicators used by companies to measure performance were analyzed.…
Norton, Peter G; Murray, Michael; Doupe, Malcolm B; Cummings, Greta G; Poss, Jeff W; Squires, Janet E; Teare, Gary F; Estabrooks, Carole A
2014-01-01
Objectives To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility. Design Calculation of adjusted Resident Assessment Instrument – Minimum Data Set 2.0 (RAI–MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2–4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts). Setting A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces. Measurements Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared. Results In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions. Conclusions Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI–MDS 2.0 data, and quite probably from any RAI measures. PMID:24523428
Systematic evidence-based quality measurement life-cycle approach to measure retirement in CHIPRA.
Dougherty, Denise; Mistry, Kamila B; Lindly, Olivia; Desoto, Maushami; LLanos, Karen; Chesley, Francis
2014-01-01
In 2009, Centers for Medicare and Medicaid Services (CMS) publicly released an initial child core set (CCS) of health care quality measures for voluntary reporting by state Medicaid and Children's Health Insurance Program (CHIP) programs. CMS is responsible for implementing the reporting program and for updating the CCS annually. We assessed selected CCS measures for potential retirement. We identified a 23-member external advisory group to provide relevant expertise. We worked with the group to identify 4 major criteria with multiple subcomponents for assessing the measures. We provided information corresponding to each criterion and subcriterion, using a variety of sources such as the 2009 Medicaid Analytic eXtract (MAX), state-level Medicaid and CHIP data submitted to the CMS, and summaries of published literature on clinical and quality improvement effectiveness related to the CCS topics. Using this information, the group: 1) used a modified Delphi process to score the measures in 2 anonymous scoring rounds (on a scale of 1 to 9 in each round); 2) voted on whether each measure should be retired; and 3) provided narrative explanations of their choices (which formed the basis of our qualitative findings). Recommendations were reviewed by CMS before promulgation to state programs. The Subcommittee of the National Advisory Council on Healthcare Research and Quality (SNAC) recommended that the 4 major criteria be importance, scientific acceptability, feasibility, and usability. The SNAC recommended 3 measures for retirement: access to primary care; testing for strep before recommending antibiotics for pharyngitis; and annual HbA1c testing of children with diabetes. Explanations for suggesting retirement of the measures included: views that the well-visit measures were a better measure of access than the primary care measure; a likely ceiling effect (pharyngitis); and the paucity of clinical evidence and low prevalence (both for HbA1c). CMS recommended that state
NASA Technical Reports Server (NTRS)
Tseng, Chris; Gupta, Pramod; Schumann, Johann
2006-01-01
The Cooper-Harper rating of Aircraft Handling Qualities has been adopted as a standard for measuring the performance of aircraft since it was introduced in 1966. Aircraft performance, ability to control the aircraft, and the degree of pilot compensation needed are three major key factors used in deciding the aircraft handling qualities in the Cooper- Harper rating. We formulate the Cooper-Harper rating scheme as a fuzzy rule-based system and use it to analyze the effectiveness of the aircraft controller. The automatic estimate of the system-level handling quality provides valuable up-to-date information for diagnostics and vehicle health management. Analyzing the performance of a controller requires a set of concise design requirements and performance criteria. Ir, the case of control systems fm a piloted aircraft, generally applicable quantitative design criteria are difficult to obtain. The reason for this is that the ultimate evaluation of a human-operated control system is necessarily subjective and, with aircraft, the pilot evaluates the aircraft in different ways depending on the type of the aircraft and the phase of flight. In most aerospace applications (e.g., for flight control systems), performance assessment is carried out in terms of handling qualities. Handling qualities may be defined as those dynamic and static properties of a vehicle that permit the pilot to fully exploit its performance in a variety of missions and roles. Traditionally, handling quality is measured using the Cooper-Harper rating and done subjectively by the human pilot. In this work, we have formulated the rules of the Cooper-Harper rating scheme as fuzzy rules with performance, control, and compensation as the antecedents, and pilot rating as the consequent. Appropriate direct measurements on the controller are related to the fuzzy Cooper-Harper rating system: a stability measurement like the rate of change of the cost function can be used as an indicator if the aircraft is under
Peled, Ronit; Porath, Avi; Wilf-Miron, Rachel
2016-11-21
Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units' current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003-2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.
Metric-driven harm: an exploration of unintended consequences of performance measurement.
Rambur, Betty; Vallett, Carol; Cohen, Judith A; Tarule, Jill Mattuck
2013-11-01
Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smith's 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed. © 2013.
Contractor Performed Quality Control on KyTC Projects.
DOT National Transportation Integrated Search
2002-08-01
This report addresses issues related to transferring the responsibility for quality control from the Kentucky Transportation Cabinet (KyTC) to construction contractors. : Several key topics related to Contractor Performed Quality Control (CPQC) are p...
The impact of the Internet on quality measurement.
Bates, D W; Gawande, A A
2000-01-01
Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measurement in several ways. First, quality information--including reputation--will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.
Sfantou, Danae F.; Patelarou, Athina E.; Sifaki- Pistolla, Dimitra; Patelarou, Evridiki
2017-01-01
Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care?” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals. PMID:29036901
Measuring Quality in Online Education: A Meta-Synthesis
ERIC Educational Resources Information Center
Esfijani, Azam
2018-01-01
This article presents a meta-synthesis review of quality of online education (QOE) measurement approaches. In order to survey the existing body of knowledge, a qualitative method was employed to investigate what quality of online education is comprised of and how the concept has been measured through the literature. To achieve this, a total of 112…
Ride qualities criteria validation/pilot performance study: Flight test results
NASA Technical Reports Server (NTRS)
Nardi, L. U.; Kawana, H. Y.; Greek, D. C.
1979-01-01
Pilot performance during a terrain following flight was studied for ride quality criteria validation. Data from manual and automatic terrain following operations conducted during low level penetrations were analyzed to determine the effect of ride qualities on crew performance. The conditions analyzed included varying levels of turbulence, terrain roughness, and mission duration with a ride smoothing system on and off. Limited validation of the B-1 ride quality criteria and some of the first order interactions between ride qualities and pilot/vehicle performance are highlighted. An earlier B-1 flight simulation program correlated well with the flight test results.
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…
Synchronizing MIDI and wireless EEG measurements during natural piano performance.
Zamm, Anna; Palmer, Caroline; Bauer, Anna-Katharina R; Bleichner, Martin G; Demos, Alexander P; Debener, Stefan
2017-07-08
Although music performance has been widely studied in the behavioural sciences, less work has addressed the underlying neural mechanisms, perhaps due to technical difficulties in acquiring high-quality neural data during tasks requiring natural motion. The advent of wireless electroencephalography (EEG) presents a solution to this problem by allowing for neural measurement with minimal motion artefacts. In the current study, we provide the first validation of a mobile wireless EEG system for capturing the neural dynamics associated with piano performance. First, we propose a novel method for synchronously recording music performance and wireless mobile EEG. Second, we provide results of several timing tests that characterize the timing accuracy of our system. Finally, we report EEG time domain and frequency domain results from N=40 pianists demonstrating that wireless EEG data capture the unique temporal signatures of musicians' performances with fine-grained precision and accuracy. Taken together, we demonstrate that mobile wireless EEG can be used to measure the neural dynamics of piano performance with minimal motion constraints. This opens many new possibilities for investigating the brain mechanisms underlying music performance. Copyright © 2017 Elsevier B.V. All rights reserved.
Alonso-Caneiro, David; Sampson, Danuta M.; Chew, Avenell L.; Collins, Michael J.; Chen, Fred K.
2018-01-01
Adaptive optics flood illumination ophthalmoscopy (AO-FIO) allows imaging of the cone photoreceptor in the living human retina. However, clinical interpretation of the AO-FIO image remains challenging due to suboptimal quality arising from residual uncorrected wavefront aberrations and rapid eye motion. An objective method of assessing image quality is necessary to determine whether an AO-FIO image is suitable for grading and diagnostic purpose. In this work, we explore the use of focus measure operators as a surrogate measure of AO-FIO image quality. A set of operators are tested on data sets acquired at different focal depths and different retinal locations from healthy volunteers. Our results demonstrate differences in focus measure operator performance in quantifying AO-FIO image quality. Further, we discuss the potential application of the selected focus operators in (i) selection of the best quality AO-FIO image from a series of images collected at the same retinal location and (ii) assessment of longitudinal changes in the diseased retina. Focus function could be incorporated into real-time AO-FIO image processing and provide an initial automated quality assessment during image acquisition or reading center grading. PMID:29552404
Alonso-Caneiro, David; Sampson, Danuta M; Chew, Avenell L; Collins, Michael J; Chen, Fred K
2018-02-01
Adaptive optics flood illumination ophthalmoscopy (AO-FIO) allows imaging of the cone photoreceptor in the living human retina. However, clinical interpretation of the AO-FIO image remains challenging due to suboptimal quality arising from residual uncorrected wavefront aberrations and rapid eye motion. An objective method of assessing image quality is necessary to determine whether an AO-FIO image is suitable for grading and diagnostic purpose. In this work, we explore the use of focus measure operators as a surrogate measure of AO-FIO image quality. A set of operators are tested on data sets acquired at different focal depths and different retinal locations from healthy volunteers. Our results demonstrate differences in focus measure operator performance in quantifying AO-FIO image quality. Further, we discuss the potential application of the selected focus operators in (i) selection of the best quality AO-FIO image from a series of images collected at the same retinal location and (ii) assessment of longitudinal changes in the diseased retina. Focus function could be incorporated into real-time AO-FIO image processing and provide an initial automated quality assessment during image acquisition or reading center grading.
Adeleye, J O; Kuti, M A
2017-02-01
The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA). The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records. The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL-C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C >8.0%, LDL-C >130 mg/dL, SBP >130 mmHg, and DBP >90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively. Although the organization of the outpatient services allowed for good performance with regards to "free" services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.
Theory and practice for measuring health care quality
Berwick, Donald M.; Knapp, Marian Gilbert
1987-01-01
As competition, cost control, and new modes of delivery emerge in health care, there is a need to reexamine both the traditional definitions of health care quality and the methods by which it is measured. Industries other than health care have much to teach regarding the methods for obtaining, analyzing, and displaying data; techniques for problem identification, problem solving, and reassessment; and ideas about organizational factors that produce a high quality product or service. The Quality-of-Care Measurement Department at the Harvard Community Health Plan has built a program that draws from a distinguished health care quality assurance tradition and incorporates techniques that have been successful in other industries. PMID:10312319
Air Quality Measurements for Science and Policy
Air quality measurements and the methods used to conduct them are vital to advancing our knowledge of the source-to-receptor-to-health effects continuum1-3. This information then forms the basis for evaluating and managing air quality to protect human health and welfa...
Measuring Indoor Air Quality of Hookah Lounges
Fiala, Steven C.; Pawlak, Rebecca L.
2012-01-01
Many states have implemented smoke-free workplace laws to protect employees and customers from exposure to secondhand smoke. However, exemptions in these laws have allowed indoor tobacco smoking in hookah lounges to proliferate in recent years. To describe the amount of secondhand smoke in hookah lounges, we measured the indoor air quality of 10 hookah lounges in Oregon. Air quality measurements ranged from “unhealthy” to “hazardous” according to Environmental Protection Agency standards, indicating a potential health risk for patrons and employees. PMID:22994168
Development of an Online Toolkit for Measuring Performance in Health Emergency Response Exercises.
Agboola, Foluso; Bernard, Dorothy; Savoia, Elena; Biddinger, Paul D
2015-10-01
Exercises that simulate emergency scenarios are accepted widely as an essential component of a robust Emergency Preparedness program. Unfortunately, the variability in the quality of the exercises conducted, and the lack of standardized processes to measure performance, has limited the value of exercises in measuring preparedness. In order to help health organizations improve the quality and standardization of the performance data they collect during simulated emergencies, a model online exercise evaluation toolkit was developed using performance measures tested in over 60 Emergency Preparedness exercises. The exercise evaluation toolkit contains three major components: (1) a database of measures that can be used to assess performance during an emergency response exercise; (2) a standardized data collection tool (form); and (3) a program that populates the data collection tool with the measures that have been selected by the user from the database. The evaluation toolkit was pilot tested from January through September 2014 in collaboration with 14 partnering organizations representing 10 public health agencies and four health care agencies from eight states across the US. Exercise planners from the partnering organizations were asked to use the toolkit for their exercise evaluation process and were interviewed to provide feedback on the use of the toolkit, the generated evaluation tool, and the usefulness of the data being gathered for the development of the exercise after-action report. Ninety-three percent (93%) of exercise planners reported that they found the online database of performance measures appropriate for the creation of exercise evaluation forms, and they stated that they would use it again for future exercises. Seventy-two percent (72%) liked the exercise evaluation form that was generated from the toolkit, and 93% reported that the data collected by the use of the evaluation form were useful in gauging their organization's performance during the
Toward an applied technology for quality measurement in health care.
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.
Comparison of the performance of intraoral X-ray sensors using objective image quality assessment.
Hellén-Halme, Kristina; Johansson, Curt; Nilsson, Mats
2016-05-01
The main aim of this study was to evaluate the performance of 10 individual sensors of the same make, using objective measures of key image quality parameters. A further aim was to compare 8 brands of sensors. Ten new sensors of 8 different models from 6 manufacturers (i.e., 80 sensors) were included in the study. All sensors were exposed in a standardized way using an X-ray tube voltage of 60 kVp and different exposure times. Sensor response, noise, low-contrast resolution, spatial resolution and uniformity were measured. Individual differences between sensors of the same brand were surprisingly large in some cases. There were clear differences in the characteristics of the different brands of sensors. The largest variations were found for individual sensor response for some of the brands studied. Also, noise level and low contrast resolution showed large variations between brands. Sensors, even of the same brand, vary significantly in their quality. It is thus valuable to establish action levels for the acceptance of newly delivered sensors and to use objective image quality control for commissioning purposes and periodic checks to ensure high performance of individual digital sensors. Copyright © 2016 Elsevier Inc. All rights reserved.
THE CONCEPT OF A COMMUNITY INFORMATION SYSTEM TO MEASURE THE QUALITY OF PUBLIC SERVICES,
The community information system would consist of the collection of data relevant to public service quality , the periodic reporting of this data in a summarized, sharply focused form, and the application of reliable performance measures to it. The primary purpose of the CIS...groups in forming balanced judgments and making decisions concerning the service they receive. A secondary purpose would be to increase service quality by making it more visible to the public. (Author)
The impact of pay-for-performance on quality of care for minority patients.
Epstein, Arnold M; Jha, Ashish K; Orav, E John
2014-10-01
To determine whether racial disparities in process quality and outcomes of care change under hospital pay-for-performance. Retrospective cohort study comparing the change in racial disparities in process quality and outcomes of care between 2004 and 2008 in hospitals participating in the Premier Hospital Quality Incentive Demonstration versus control hospitals. Using patient-level Hospital Quality Alliance (HQA) data, we identified 226,096 patients in Premier hospitals, which were subject to pay-for-performance (P4P) contracts and 1,607,575 patients at control hospitals who had process of care measured during hospitalization for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia. We additionally identified 123,241 Medicare patients in Premier hospitals and 995,107 in controls who were hospitalized for AMI, CHF, pneumonia, or coronary artery bypass graft (CABG) surgery. We then compared HQA process quality indicators for AMI, CHF, and pneumonia between P4P and control hospitals, as well as risk-adjusted mortality rates for AMI, CHF, pneumonia, and CABG. Black patients initially had lower performance on process quality indicators in both Premier and non-Premier hospitals. The racial gap decreased over time in both groups; the reduction in the gap in Premier hospitals was greater than the gap reduction in non-Premier hospitals for AMI patients. During the study period, mortality generally decreased for blacks relative to whites for AMI, CHF, and pneumonia in both Premier and non-Premier hospitals, with the relative reduction for blacks greatest in Premier hospitals for CHF. Our results show no evidence of a deleterious impact of P4P in the Premier HQID on racial disparities in process quality or outcomes.
Freight performance measures : approach analysis.
DOT National Transportation Integrated Search
2010-05-01
This report reviews the existing state of the art and also the state of the practice of freight performance measurement. Most performance measures at the state level have aimed at evaluating highway or transit infrastructure performance with an empha...
Implications of measures of quality of life for policy development.
Mosteller, F
1987-01-01
Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.
Adaptive measurements of urban runoff quality
NASA Astrophysics Data System (ADS)
Wong, Brandon P.; Kerkez, Branko
2016-11-01
An approach to adaptively measure runoff water quality dynamics is introduced, focusing specifically on characterizing the timing and magnitude of urban pollutographs. Rather than relying on a static schedule or flow-weighted sampling, which can miss important water quality dynamics if parameterized inadequately, novel Internet-enabled sensor nodes are used to autonomously adapt their measurement frequency to real-time weather forecasts and hydrologic conditions. This dynamic approach has the potential to significantly improve the use of constrained experimental resources, such as automated grab samplers, which continue to provide a strong alternative to sampling water quality dynamics when in situ sensors are not available. Compared to conventional flow-weighted or time-weighted sampling schemes, which rely on preset thresholds, a major benefit of the approach is the ability to dynamically adapt to features of an underlying hydrologic signal. A 28 km2 urban watershed was studied to characterize concentrations of total suspended solids (TSS) and total phosphorus. Water quality samples were autonomously triggered in response to features in the underlying hydrograph and real-time weather forecasts. The study watershed did not exhibit a strong first flush and intraevent concentration variability was driven by flow acceleration, wherein the largest loadings of TSS and total phosphorus corresponded with the steepest rising limbs of the storm hydrograph. The scalability of the proposed method is discussed in the context of larger sensor network deployments, as well the potential to improving control of urban water quality.
Air Quality Science and Regulatory Efforts Require Geostationary Satellite Measurements
NASA Technical Reports Server (NTRS)
Pickering, Kenneth E.; Allen, D. J.; Stehr, J. W.
2006-01-01
Air quality scientists and regulatory agencies would benefit from the high spatial and temporal resolution trace gas and aerosol data that could be provided by instruments on a geostationary platform. More detailed time-resolved data from a geostationary platform could be used in tracking regional transport and in evaluating mesoscale air quality model performance in terms of photochemical evolution throughout the day. The diurnal cycle of photochemical pollutants is currently missing from the data provided by the current generation of atmospheric chemistry satellites which provide only one measurement per day. Often peak surface ozone mixing ratios are reached much earlier in the day during major regional pollution episodes than during local episodes due to downward mixing of ozone that had been transported above the boundary layer overnight. The regional air quality models often do not simulate this downward mixing well enough and underestimate surface ozone in regional episodes. Having high time-resolution geostationary data will make it possible to determine the magnitude of this lower-and mid-tropospheric transport that contributes to peak eight-hour average ozone and 24-hour average PM2.5 concentrations. We will show ozone and PM(sub 2.5) episodes from the CMAQ model and suggest ways in which geostationary satellite data would improve air quality forecasting. Current regulatory modeling is typically being performed at 12 km horizontal resolution. State and regional air quality regulators in regions with complex topography and/or land-sea breezes are anxious to move to 4-km or finer resolution simulations. Geostationary data at these or finer resolutions will be useful in evaluating such models.
Rural southeast Texas air quality measurements during the 2006 Texas Air Quality Study.
Schade, Gunnar W; Khan, Siraj; Park, Changhyoun; Boedeker, Ian
2011-10-01
The authors conducted air quality measurements of the criteria pollutants carbon monoxide, nitrogen oxides, and ozone together with meteorological measurements at a park site southeast of College Station, TX, during the 2006 Texas Air Quality Study II (TexAQS). Ozone, a primary focus of the measurements, was above 80 ppb during 3 days and above 75 ppb during additional 8 days in summer 2006, suggestive of possible violations of the ozone National Ambient Air Quality Standard (NAAQS) in this area. In concordance with other air quality measurements during the TexAQS II, elevated ozone mixing ratios coincided with northerly flows during days after cold front passages. Ozone background during these days was as high as 80 ppb, whereas southerly air flows generally provided for an ozone background lower than 40 ppb. Back trajectory analysis shows that local ozone mixing ratios can also be strongly affected by the Houston urban pollution plume, leading to late afternoon ozone increases of as high as 50 ppb above background under favorable transport conditions. The trajectory analysis also shows that ozone background increases steadily the longer a southern air mass resides over Texas after entering from the Gulf of Mexico. In light of these and other TexAQS findings, it appears that ozone air quality is affected throughout east Texas by both long-range and regional ozone transport, and that improvements therefore will require at least a regionally oriented instead of the current locally oriented ozone precursor reduction policies.
Wilson, Kenneth C; Merli, Geno J
2011-10-01
Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.
3D MEMS in Standard Processes: Fabrication, Quality Assurance, and Novel Measurement Microstructures
NASA Technical Reports Server (NTRS)
Lin, Gisela; Lawton, Russell A.
2000-01-01
Three-dimensional MEMS microsystems that are commercially fabricated require minimal post-processing and are easily integrated with CMOS signal processing electronics. Measurements to evaluate the fabrication process (such as cross-sectional imaging and device performance characterization) provide much needed feedback in terms of reliability and quality assurance. MEMS technology is bringing a new class of microscale measurements to fruition. The relatively small size of MEMS microsystems offers the potential for higher fidelity recordings compared to macrosize counterparts, as illustrated in the measurement of muscle cell forces.
D'hondt, Norman E; Kiers, Henri; Pool, Jan J M; Hacquebord, Sijmen T; Terwee, Caroline B; Veeger, Dirkjan H E J
2017-01-01
Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar
Comparison of Prescribed and Measured Dialysate Sodium: A Quality Improvement Project.
Gul, Ambreen; Miskulin, Dana C; Paine, Susan S; Narsipur, Sriram S; Arbeit, Leonard A; Harford, Antonia M; Weiner, Daniel E; Schrader, Ronald; Horowitz, Bruce L; Zager, Philip G
2016-03-01
relationships of dialysate sodium concentrations to outcomes. Additional studies are needed to identify factors that contribute to differences between prescribed and measured dialysate sodium concentrations. Quality assurance and performance improvement (QAPI) programs should include measurements of dialysate sodium. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe
2008-07-08
Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.
Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study
Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe
2008-01-01
Background Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be
Assuring measurement quality in person-centred healthcare
NASA Astrophysics Data System (ADS)
Pendrill, L. R.
2018-03-01
Is it realistic to aspire to the same kind of quality-assurance of measurement in person-centred care, currently being implemented in healthcare globally, as is established in the physical sciences and engineering? Ensuring metrological comparability (‘traceability’) and reliably declaring measurement uncertainty when assessing patient ability or increased social capital are however challenging for subjective measurements often characterised by large dispersion. Drawing simple analogies between ‘instruments’ in the social sciences—questionnaires, ability tests, etc—and engineering instruments such as thermometers does not go far enough. A possible way forward, apparently equally applicable to both physical and social measurement, seems to be to model inferences in terms of performance metrics of a measurement system. Person-centred care needs person-centred measurement and a full picture of the measurement process when man acts as a measurement instrument is given in the present paper. This complements previous work by presenting the process, step by step, from the observed indication (e.g. probability of success, P success, of achieving a task), through restitution with Rasch measurement theory, to the measurand (e.g. task difficulty). Rasch invariant measure theory can yield quantities—‘latent’ (or ‘explanatory’) variables such as task challenge or person ability—with characteristics akin to those of physical quantities. Metrological references for comparability via traceability and reliable estimates of uncertainty and decision risks are then in reach even for perceptive measurements (and other qualitative properties). As a case study, the person-centred measurement of cognitive ability is examined, as part of the EU project EMPIR 15HLT04 NeuroMet, for Alzheimer’s, where better analysis of correlations with brain atrophy is enabled thanks to the Rasch metrological approach.
Measuring the quality of health care: state of the art.
Donaldson, M S; Nolan, K
1997-05-01
September 12-13, 1996, in Washington, DC, the Institute of Medicine, as part of its Special Initiative on Health Care Quality, held an invitational conference to illustrate exemplary quality measurement and to discuss the results. Patient reports, innovative uses of outcome measures for quality improvement, risk adjustment, assessment in integrated health plans and health care settings, clinical guidelines, and projects on disseminating information on quality measurement techniques and tools were among the topics represented. Brent James described studies undertaken to reduce adverse drug events (ADEs). When implementing any measurement system where error is a possible factor, it is important to emphasize identifying problems for the purpose of learning, not judgment. Lucian Leape agreed that staff involved must feel that the purpose of the study is to examine system problems, not individuals' mistakes. David Classen described a nonproprietary computerized disease-management program designed to reduce ADEs in infectious diseases. "A QUALITY VISION": Robert Brook said that the relationship between cost or resources devoted to care and quality is not well understood and is certainly not simple. He also said that although investments in measurement strategies are needed to make them better, that doesn't mean we shouldn't attempt to use the measurements we have now. Mark Chassin said that the presentations at the conference provided evidence that should allow us to conclude beyond a reasonable doubt that quality can be measured-with a degree of scientific precision equal to that of most of the measures used to take care of patients every day.
Software cost/resource modeling: Software quality tradeoff measurement
NASA Technical Reports Server (NTRS)
Lawler, R. W.
1980-01-01
A conceptual framework for treating software quality from a total system perspective is developed. Examples are given to show how system quality objectives may be allocated to hardware and software; to illustrate trades among quality factors, both hardware and software, to achieve system performance objectives; and to illustrate the impact of certain design choices on software functionality.
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)
ERIC Educational Resources Information Center
Condon, Christopher; Clifford, Matthew
2012-01-01
Assessing school principal performance is both necessary and challenging. During the past five years, many states have begun using validated measures in summative assessments of novice principal competency as a basis for certification decisions. Although standardized tests are used for certification purposes, other types of assessments are being…
Measuring quality in services for children with an intellectual disability.
Koornneef, Erik
2006-01-01
To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent). The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness. The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties. The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service. The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.
20 CFR 638.302 - Performance measurement.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Performance measurement. 638.302 Section 638... § 638.302 Performance measurement. The Job Corps Director shall establish a national performance measurement system for centers and other program components which shall include annual performance standards...
20 CFR 638.302 - Performance measurement.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Performance measurement. 638.302 Section 638... § 638.302 Performance measurement. The Job Corps Director shall establish a national performance measurement system for centers and other program components which shall include annual performance standards...
NASA Astrophysics Data System (ADS)
Walwyn-Salas, G.; Czap, L.; Gomola, I.; Tamayo-García, J. A.
2016-07-01
The cylindrical NE2575 and spherical PTW32002 chamber types were tested in this paper to determine their performance at different source-chamber distances, field sizes and two radiation qualities. To ensure an accurate measurement, there is a need to apply a correction factor to NE2575 measurements at different distances because of differences found between the reference point defined by the manufacturer and the effective point of measurements. This correction factor for NE2575 secondary standard from the Center for Radiation Protection and Hygiene of Cuba was assessed with a 0.3% uncertainty using the results of three methods. Those laboratories that use the NE2575 chambers should take into consideration the performance characteristics tested in this paper to obtain accurate measurements.
Dual redundant arm system operational quality measures and their applications - Static measures
NASA Technical Reports Server (NTRS)
Lee, Sukhan; Kim, Sungbok
1990-01-01
The authors present dual-arm system static operational quality measures which quantify the efficiency and capability of a dual-arm system in generating Cartesian velocities and static forces. First, they define and analyze the kinematic interactions between the two arms incurred by the various modes of dual-arm cooperation, such as transport, assembly, and grasping modes of cooperation, and specify the kinematic constraints imposed on individual arms in Cartesian space due to the kinematic interactions. Dual-arm static manipulability is presented. Finally, dual-arm operational quality is scaled by a task-oriented operational quality measure (TOQs) obtained by the comparison between the desired and actual static manipulabilities. TOQs is used in the optimization of dual-arm joint configurations. Simulation results are shown.
Westbrook, K W; Pedrick, D; Bush, V
1996-01-01
This study defines a company's quality orientation as "all process-related activities that can be discerned by customers." This even includes certain processes internal to the company that can be seen and evaluated by customers. One significant contribution this study provides is scale development centered on customer rather than employee perceptions. To generate scale items, input was gathered from experts involved in the study, senior managers employed with the target company, focus groups of employees working on the front line with customers, and users of the services. Because the sale measures customer perceptions of quality in comparison with the firm's closest competitor, it provides managers with information for benchmarking performance relative to others in the marketplace.
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.
42 CFR 460.136 - Internal quality assessment and performance improvement activities.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Internal quality assessment and performance improvement activities. 460.136 Section 460.136 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES....136 Internal quality assessment and performance improvement activities. (a) Quality assessment and...
Technique for Performing Dielectric Property Measurements at Microwave Frequencies
NASA Technical Reports Server (NTRS)
Barmatz, Martin B.; Jackson, Henry W.
2010-01-01
A paper discusses the need to perform accurate dielectric property measurements on larger sized samples, particularly liquids at microwave frequencies. These types of measurements cannot be obtained using conventional cavity perturbation methods, particularly for liquids or powdered or granulated solids that require a surrounding container. To solve this problem, a model has been developed for the resonant frequency and quality factor of a cylindrical microwave cavity containing concentric cylindrical samples. This model can then be inverted to obtain the real and imaginary dielectric constants of the material of interest. This approach is based on using exact solutions to Maxwell s equations for the resonant properties of a cylindrical microwave cavity and also using the effective electrical conductivity of the cavity walls that is estimated from the measured empty cavity quality factor. This new approach calculates the complex resonant frequency and associated electromagnetic fields for a cylindrical microwave cavity with lossy walls that is loaded with concentric, axially aligned, lossy dielectric cylindrical samples. In this approach, the calculated complex resonant frequency, consisting of real and imaginary parts, is related to the experimentally measured quantities. Because this approach uses Maxwell's equations to determine the perturbed electromagnetic fields in the cavity with the material(s) inserted, one can calculate the expected wall losses using the fields for the loaded cavity rather than just depending on the value of the fields obtained from the empty cavity quality factor. These additional calculations provide a more accurate determination of the complex dielectric constant of the material being studied. The improved approach will be particularly important when working with larger samples or samples with larger dielectric constants that will further perturb the cavity electromagnetic fields. Also, this approach enables the ability to have a
Rangachari, Pavani
2008-01-01
CONTEXT/PURPOSE: With the growing momentum toward hospital quality measurement and reporting by public and private health care payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding accuracy. This study explores the relationship between the organizational knowledge-sharing structure related to quality and hospital coding accuracy for quality measurement. Simultaneously, this study seeks to identify other leadership/management characteristics associated with coding for quality measurement. Drawing upon complexity theory, the literature on "professional complex systems" has put forth various strategies for managing change and turnaround in professional organizations. In so doing, it has emphasized the importance of knowledge creation and organizational learning through interdisciplinary networks. This study integrates complexity, network structure, and "subgoals" theories to develop a framework for knowledge-sharing network effectiveness in professional complex systems. This framework is used to design an exploratory and comparative research study. The sample consists of 4 hospitals, 2 showing "good coding" accuracy for quality measurement and 2 showing "poor coding" accuracy. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Findings of this study indicate that good coding performance is systematically associated with a knowledge-sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment), rather than in density (where everyone is directly connected to everyone else). It also implies that for the hospital organization to adapt to the changing environment of quality transparency, senior leaders must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and
Salinas, Maria; López-Garrigós, Maite; Gutiérrez, Mercedes; Lugo, Javier; Sirvent, Jose Vicente; Uris, Joaquin
2010-01-01
Laboratory performance can be measured using a set of model key performance indicators (KPIs). The design and implementation of KPIs are important issues. KPI results from 7 years are reported and their implementation, monitoring, objectives, interventions, result reporting and delivery are analyzed. The KPIs of the entire laboratory process were obtained using Laboratory Information System (LIS) registers. These were collected automatically using a data warehouse application, spreadsheets and external quality program reports. Customer satisfaction was assessed using surveys. Nine model laboratory KPIs were proposed and measured. The results of some examples of KPIs used in our laboratory are reported. Their corrective measurements or the implementation of objectives led to improvement in the associated KPIs results. Measurement of laboratory performance using KPIs and a data warehouse application that continuously collects registers and calculates KPIs confirmed the reliability of indicators, indicator acceptability and usability for users, and continuous process improvement.
The Aeroflex: A Bicycle for Mobile Air Quality Measurements
Elen, Bart; Peters, Jan; Van Poppel, Martine; Bleux, Nico; Theunis, Jan; Reggente, Matteo; Standaert, Arnout
2013-01-01
Fixed air quality stations have limitations when used to assess people's real life exposure to air pollutants. Their spatial coverage is too limited to capture the spatial variability in, e.g., an urban or industrial environment. Complementary mobile air quality measurements can be used as an additional tool to fill this void. In this publication we present the Aeroflex, a bicycle for mobile air quality monitoring. The Aeroflex is equipped with compact air quality measurement devices to monitor ultrafine particle number counts, particulate mass and black carbon concentrations at a high resolution (up to 1 second). Each measurement is automatically linked to its geographical location and time of acquisition using GPS and Internet time. Furthermore, the Aeroflex is equipped with automated data transmission, data pre-processing and data visualization. The Aeroflex is designed with adaptability, reliability and user friendliness in mind. Over the past years, the Aeroflex has been successfully used for high resolution air quality mapping, exposure assessment and hot spot identification. PMID:23262484
The Aeroflex: a bicycle for mobile air quality measurements.
Elen, Bart; Peters, Jan; Poppel, Martine Van; Bleux, Nico; Theunis, Jan; Reggente, Matteo; Standaert, Arnout
2012-12-24
Fixed air quality stations have limitations when used to assess people's real life exposure to air pollutants. Their spatial coverage is too limited to capture the spatial variability in, e.g., an urban or industrial environment. Complementary mobile air quality measurements can be used as an additional tool to fill this void. In this publication we present the Aeroflex, a bicycle for mobile air quality monitoring. The Aeroflex is equipped with compact air quality measurement devices to monitor ultrafine particle number counts, particulate mass and black carbon concentrations at a high resolution (up to 1 second). Each measurement is automatically linked to its geographical location and time of acquisition using GPS and Internet time. Furthermore, the Aeroflex is equipped with automated data transmission, data pre-processing and data visualization. The Aeroflex is designed with adaptability, reliability and user friendliness in mind. Over the past years, the Aeroflex has been successfully used for high resolution air quality mapping, exposure assessment and hot spot identification.
Nightingale, Julie M; Marshall, Gill
2013-09-01
The research-related performance of universities, as well as that of individual researchers, is increasingly evaluated through the use of objective measures, or metrics, which seek to support or in some cases even replace more traditional methods of peer review. In particular there is a growing awareness in research communities, government organisations and funding bodies around the concept of using evaluation metrics to analyse research citations. The tools available for 'citation analysis' are many and varied, enabling a quantification of scientific quality, academic impact and prestige. However there is increasing concern regarding the potential misuse of such tools, which have limitations in certain research disciplines.This article uses 'real world' examples from radiography research and scholarship to illustrate the range of currently available citation analysis tools. It explores the academic debate surrounding their strengths and limitations, and identifies the potential impact of citation analysis on the radiography research community.The article concludes that citation analysis is a valuable tool for researchers to use for personal reflection and research planning, yet there are inherent dangers if it is used inappropriately. Whilst citation analysis can give objective information regarding an individual, research group, journal or higher education institution, it should not be used as a total substitute for traditional qualitative review and peer assessment. Copyright © 2013 Elsevier Ltd. All rights reserved.
NASA Technical Reports Server (NTRS)
Li, Hui; Faruque, Fazlay; Williams, Worth; Al-Hamdan, Mohammad; Luvall, Jeffrey C.; Crosson, William; Rickman, Douglas; Limaye, Ashutosh
2009-01-01
Aerosol optical depth (AOD), an indirect estimate of particle matter using satellite observations, has shown great promise in improving estimates of PM 2.5 air quality surface. Currently, few studies have been conducted to explore the optimal way to apply AOD data to improve the model accuracy of PM 2.5 surface estimation in a real-time air quality system. We believe that two major aspects may be worthy of consideration in that area: 1) the approach to integrate satellite measurements with ground measurements in the pollution estimation, and 2) identification of an optimal temporal scale to calculate the correlation of AOD and ground measurements. This paper is focused on the second aspect on the identifying the optimal temporal scale to correlate AOD with PM2.5. Five following different temporal scales were chosen to evaluate their impact on the model performance: 1) within the last 3 days, 2) within the last 10 days, 3) within the last 30 days, 4) within the last 90 days, and 5) the time period with the highest correlation in a year. The model performance is evaluated for its accuracy, bias, and errors based on the following selected statistics: the Mean Bias, the Normalized Mean Bias, the Root Mean Square Error, Normalized Mean Error, and the Index of Agreement. This research shows that the model with the temporal scale of within the last 30 days displays the best model performance in this study area using 2004 and 2005 data sets.
Quality measures in applications of image restoration.
Kriete, A; Naim, M; Schafer, L
2001-01-01
We describe a new method for the estimation of image quality in image restoration applications. We demonstrate this technique on a simulated data set of fluorescent beads, in comparison with restoration by three different deconvolution methods. Both the number of iterations and a regularisation factor are varied to enforce changes in the resulting image quality. First, the data sets are directly compared by an accuracy measure. These values serve to validate the image quality descriptor, which is developed on the basis of optical information theory. This most general measure takes into account the spectral energies and the noise, weighted in a logarithmic fashion. It is demonstrated that this method is particularly helpful as a user-oriented method to control the output of iterative image restorations and to eliminate the guesswork in choosing a suitable number of iterations.
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 of care: measuring a neglected driver of improved health
Kruk, Margaret E
2017-01-01
Abstract The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact. PMID:28603313
Stelfox, Henry T; Straus, Sharon E
2013-12-01
In this article, we describe one approach for developing and evaluating quality indicators. We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices. Copyright © 2013 Elsevier Inc. All rights reserved.
Performance measurement for information systems: Industry perspectives
NASA Technical Reports Server (NTRS)
Bishop, Peter C.; Yoes, Cissy; Hamilton, Kay
1992-01-01
Performance measurement has become a focal topic for information systems (IS) organizations. Historically, IS performance measures have dealt with the efficiency of the data processing function. Today, the function of most IS organizations goes beyond simple data processing. To understand how IS organizations have developed meaningful performance measures that reflect their objectives and activities, industry perspectives on IS performance measurement was studied. The objectives of the study were to understand the state of the practice in IS performance techniques for IS performance measurement; to gather approaches and measures of actual performance measures used in industry; and to report patterns, trends, and lessons learned about performance measurement to NASA/JSC. Examples of how some of the most forward looking companies are shaping their IS processes through measurement is provided. Thoughts on the presence of a life-cycle to performance measures development and a suggested taxonomy for performance measurements are included in the appendices.
Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?
ERIC Educational Resources Information Center
Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira
2012-01-01
Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…
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.
Wright, F Virginia; Rosenbaum, Peter; Fehlings, Darcy; Mesterman, Ronit; Breuer, Ute; Kim, Marie
2014-08-01
Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)--a revision of the Gross Motor Performance Measure (GMPM)--evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM. Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation. QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05). The QFM is reliable and valid, making it possible to assess how well young people with CP move and what areas of function to target to enhance quality of motor control. © 2014 Mac Keith Press.
Zidarov, Diana; Visca, Regina; Gogovor, Amédé; Ahmed, Sara
2016-02-19
Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations' websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies, including 2 stakeholder meetings, publication and
Deans, Katherine J; Minneci, Peter C; Nacion, Kristine M; Leonhart, Karen; Cooper, Jennifer N; Scholle, Sarah Hudson; Kelleher, Kelly J
2018-02-22
Preventive quality measures for the foster care population are largely untested. The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. The AAP Recommendations for Preventive Pediatric Health Care served as the guideline for determining quality measures. Quality measures related to well child visits, developmental screenings, immunizations, trauma-related care, BMI measurements, sexually transmitted infections and depression were defined. Retrospective chart reviews were performed on a cohort of children in foster care from a single large pediatric institution and related county. Data available in the Ohio Statewide Automated Child Welfare Information System was compared to the same population studied in the electronic health record review. Quality measures were calculated as observed (received) to expected (recommended) ratios (O/E ratios) to describe the actual quantity of recommended health care that was received by individual children. Electronic health records and the Statewide Automated Child Welfare Information System data frequently lacked important information on foster care youth essential for calculating the measures. Although electronic health records were rich in encounter specific clinical data, they often lacked custodial information such as the dates of entry into and exit from foster care. In contrast, Statewide Automated Child Welfare Information System included robust data on custodial arrangements, but lacked detailed medical information. Despite these limitations, several quality measures were devised that attempted to accommodate these limitations. In this feasibility testing, neither the electronic health records at a single institution nor the county level Statewide
Measuring Acquisition Workforce Quality Through Dynamic Knowledge and Performance
2014-05-14
closeout • Regression: – 3 TK/EK measures (IV): PCOd , DAWIA, AXP – 7 CMMM measures (DV): 6 processes + mean 5 Summary Statistical Results Model Org T...Org R PCOd CMMM R2 = 0.36, p = 0.15 R2 = 0.41, p = 0.25 DAWIA CMMM R2 = 0.64, p = 0.03 R2 = 0.44, p = 0.22 AXP CMMM R2 = 0.59, p = 0.07 R2...0.27, p = 0.37 All CMMM R2 = 0.71, p = 0.24 R2 = 0.72, p = 0.64 6 Contributions • ID 3 TK/EK proxies: PCOd , DAWIA, AXP • Measure CMMM levels: 12 orgs
The Need for Comprehensive Health Care Quality Measures for Older Adults.
MacLeod, Stephanie; Schwebke, Kay; Hawkins, Kevin; Ruiz, Joann; Hoo, Emma; Yeh, Charlotte S
2017-10-24
Research indicates that older adults receive only about half of their recommended care, with varying quality and limited attention to social issues impacting their health through the most commonly used quality measures. Additionally, many existing measures neglect to address nonclinical social determinants of health. Evidence of the need for more comprehensive measures for seniors is growing. The primary purpose of this article, which is supported by a limited review of literature, is to describe gaps among current quality measures in addressing certain nonclinical needs of older adults, including key social determinants of health. In doing so, the authors describe their position on the need for expanded measures to incorporate these factors to improve care and quality of life. The authors conducted a limited review of the literature to inform this article, focusing specifically on selected measures for older adults rather than a broader systematic review of all measures. Most research identified was related to clinical practice guidelines rather than quality measures of care as applied to older adults. Furthermore, the literature reviewed reflected limited evidence of efforts to tailor quality measures for the unique social needs of older adults, confirming a potential gap in this area. A growing need exists for improved quality measures specifically designed to help providers address the unique social needs of older adults. Filling this gap will improve overall understanding of seniors and help them to achieve optimal health and successful aging.
ERIC Educational Resources Information Center
Merkel-Keller, Claudia; Streeter-Scrupski, Sandra
In 1992, adult education staff and adult literacy volunteer organizations developed 8 indicators of program quality to be used for evaluating adult basic education and English as a Second Language (ESL) programs in New Jersey. Performance standards were developed to match the standards. An evaluation was conducted to determine how the indicators…
Examining the Role of Patient Experience Surveys in Measuring Health Care Quality
Elliott, Marc N.; Zaslavsky, Alan M.; Hays, Ron D.; Lehrman, William G.; Rybowski, Lise; Edgman-Levitan, Susan; Cleary, Paul D.
2015-01-01
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs. PMID:25027409
Transit performance measures in California.
DOT National Transportation Integrated Search
2016-04-01
This research is the result of a California Department of Transportation (Caltrans) request to assess the most commonly : available transit performance measures in California. Caltrans wanted to understand performance measures and data used by : Metr...
An initial test of a normative Figure Of Merit for the quality of overall task performance
NASA Technical Reports Server (NTRS)
Lemay, Moira; Comstock, J. R., Jr.
1990-01-01
An overall indicator, or Figure Of Merit (FOM), of the quality of crew/vehicle system performance is needed to establish the effect of workload on efficiency and to identify overload conditions. A normative FOM is proposed in which performance is measured on a representative task and a normative data base obtained. FOMs for subsequent executions of the task are then reported in terms of weighted deviations from average task performance. Performance of discrete tasks is measured primarily in terms of subtask time and errors. Discrete task performance is then combined with a measure of continuous vehicle control. In order to test the normative FOM procedure, the technique was applied to an existing set of data from a simulated landing task in which standard communications with ATC was compared with a data link communications system. The results indicated that while mean task performance was not affected, task variability, as measured by the FOM, was significantly higher when data link communications were used. In order to establish the sensitivity of the normative FOM method, further testing of the measure is recommended.
Sá, Juliana P; Branco, Pedro T B S; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V
2017-05-31
Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO₂, CO, NO₂, O₃, CH₂O, total volatile organic compounds (VOC), PM₁, PM 2.5 , PM 10 , Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM 2.5 , PM 10 , CO₂ and CH₂O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO₂. However, mitigation measures were not always sufficient to decrease the pollutants' concentrations till values considered safe to protect human health.
The MAREDAT Global Database of High Performance Liquid Chromatography Marine Pigment Measurements
NASA Technical Reports Server (NTRS)
Peloquin, J.; Swan, C.; Gruber, N.; Vogt, M.; Claustre, H.; Ras, J.; Uitz, J.; Barlow, R.; Behrenfeld, M.; Bidigare, R.;
2013-01-01
A global pigment database consisting of 35 634 pigment suites measured by high performance liquid chromatography was assembled in support of the MARine Ecosytem DATa (MAREDAT) initiative. These data originate from 136 field surveys within the global ocean, were solicited from investigators and databases, compiled, and then quality controlled. Nearly one quarter of the data originates from the Laboratoire d'Oc´eanographie de Villefranche (LOV), with an additional 17% and 19% stemming from the US JGOFS and LTER programs, respectively. The MAREDAT pigment database provides high quality measurements of the major taxonomic pigments including chlorophylls a and b, 19'-butanoyloxyfucoxanthin, 19'- hexanoyloxyfucoxanthin, alloxanthin, divinyl chlorophyll a, fucoxanthin, lutein, peridinin, prasinoxanthin, violaxanthin and zeaxanthin, which may be used in varying combinations to estimate phytoplankton community composition. Quality control measures consisted of flagging samples that had a total chlorophyll a concentration of zero, had fewer than four reported accessory pigments, or exceeded two standard deviations of the log-linear regression of total chlorophyll a with total accessory pigment concentrations. We anticipate the MAREDAT pigment database to be of use in the marine ecology, remote sensing and ecological modeling communities, where it will support model validation and advance our global perspective on marine biodiversity. The original dataset together with quality control flags as well as the gridded MAREDAT pigment data may be downloaded from PANGAEA: http://doi.pangaea.de/10. 1594/PANGAEA.793246.
Quality control algorithms for rainfall measurements
NASA Astrophysics Data System (ADS)
Golz, Claudia; Einfalt, Thomas; Gabella, Marco; Germann, Urs
2005-09-01
One of the basic requirements for a scientific use of rain data from raingauges, ground and space radars is data quality control. Rain data could be used more intensively in many fields of activity (meteorology, hydrology, etc.), if the achievable data quality could be improved. This depends on the available data quality delivered by the measuring devices and the data quality enhancement procedures. To get an overview of the existing algorithms a literature review and literature pool have been produced. The diverse algorithms have been evaluated to meet VOLTAIRE objectives and sorted in different groups. To test the chosen algorithms an algorithm pool has been established, where the software is collected. A large part of this work presented here is implemented in the scope of the EU-project VOLTAIRE ( Validati on of mu ltisensors precipit ation fields and numerical modeling in Mediter ran ean test sites).
Quality and Performance Indicators in an Academic Department of Head and Neck Surgery
Weber, Randal S.; Lewis, Carol M.; Eastman, Scott D.; Hanna, Ehab Y.; Akiwumi, Olubumi; Hessel, Amy C.; Lai, Stephen Y.; Kian, Leslie; Kupferman, Michael E.; Roberts, Dianna B.
2018-01-01
Objective To create a method for assessing physician performance and care outcomes that are adjusted for procedure acuity and patient comorbidity. Design Between 2004 and 2008 surgical procedures performed by 10 surgeons were stratified into high-acuity procedures (HAPs) and low-acuity procedures (LAPs). Risk adjustment was made for comorbid conditions examined singly or in groups of 2 or more. Setting A tertiary care medical center. Patients A total of 2618 surgical patients. Main Outcome Measures Performance measures included length of stay; return to operating room within 7 days of surgery; and the occurrence of mortality, hospital readmission, transfusion, and wound infection within 30 days of surgery. Results The transfusion rate was 2.7% and 40.6% for LAPs and HAPs, respectively. Wound infection rates were 1.4% for LAPs vs 14.1% for HAPs, while 30-day mortality rate was 0.3% and 1.6% for LAPs and HAPs, respectively. The mean (SD) hospital stay for LAPs was 2.1 (3.6) vs 10.5 (7.0) days for HAPs. Negative performance factors were significantly higher for patients who underwent HAPs and had comorbid conditions. Differences among surgeons significantly affect the incidence of negative performance indicators. Factors affecting performance measures were procedure acuity, the surgeon, and comorbidity, in order of decreasing significance. Surgeons were ranked low, middle, and high based on negative performance indicators. Conclusions Performance measures following oncologic procedures were significantly affected by comorbid conditions and by procedure acuity. Although the latter most strongly affects quality and performance indicators, both should weigh heavily in physician comparisons. The incidence of negative performance indicators was also influenced by the individual surgeon. These data may serve as a tool to evaluate and improve physician performance and outcomes and to develop risk-adjusted benchmarks. Ultimately, reimbursement may be tied to quantifiable
Different paths to high-quality care: three archetypes of top-performing practice sites.
Feifer, Chris; Nemeth, Lynne; Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Roylance, Loraine; Ornstein, Steven M
2007-01-01
Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes. This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies. Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model. Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.
Miar, Younes; Plastow, Graham; Bruce, Heather; Moore, Stephen; Manafiazar, Ghader; Kemp, Robert; Charagu, Patrick; Huisman, Abe; van Haandel, Benny; Zhang, Chunyan; McKay, Robert; Wang, Zhiquan
2014-01-01
Genetic correlations between performance traits with meat quality and carcass traits were estimated on 6,408 commercial crossbred pigs with performance traits recorded in production systems with 2,100 of them having meat quality and carcass measurements. Significant fixed effects (company, sex and batch), covariates (birth weight, cold carcass weight, and age), random effects (additive, litter and maternal) were fitted in the statistical models. A series of pairwise bivariate analyses were implemented in ASREML to estimate heritability, phenotypic, and genetic correlations between performance traits (n = 9) with meat quality (n = 25) and carcass (n = 19) traits. The animals had a pedigree compromised of 9,439 animals over 15 generations. Performance traits had low-to-moderate heritabilities (±SE), ranged from 0.07±0.13 to 0.45±0.07 for weaning weight, and ultrasound backfat depth, respectively. Genetic correlations between performance and carcass traits were moderate to high. The results indicate that: (a) selection for birth weight may increase drip loss, lightness of longissimus dorsi, and gluteus medius muscles but may reduce fat depth; (b) selection for nursery weight can be valuable for increasing both quantity and quality traits; (c) selection for increased daily gain may increase the carcass weight and most of the primal cuts. These findings suggest that deterioration of pork quality may have occurred over many generations through the selection for less backfat thickness, and feed efficiency, but selection for growth had no adverse effects on pork quality. Low-to-moderate heritabilities for performance traits indicate that they could be improved using traditional selection or genomic selection. The estimated genetic parameters for performance, carcass and meat quality traits may be incorporated into the breeding programs that emphasize product quality in these Canadian swine populations. PMID:25350845
Miar, Younes; Plastow, Graham; Bruce, Heather; Moore, Stephen; Manafiazar, Ghader; Kemp, Robert; Charagu, Patrick; Huisman, Abe; van Haandel, Benny; Zhang, Chunyan; McKay, Robert; Wang, Zhiquan
2014-01-01
Genetic correlations between performance traits with meat quality and carcass traits were estimated on 6,408 commercial crossbred pigs with performance traits recorded in production systems with 2,100 of them having meat quality and carcass measurements. Significant fixed effects (company, sex and batch), covariates (birth weight, cold carcass weight, and age), random effects (additive, litter and maternal) were fitted in the statistical models. A series of pairwise bivariate analyses were implemented in ASREML to estimate heritability, phenotypic, and genetic correlations between performance traits (n = 9) with meat quality (n = 25) and carcass (n = 19) traits. The animals had a pedigree compromised of 9,439 animals over 15 generations. Performance traits had low-to-moderate heritabilities (±SE), ranged from 0.07±0.13 to 0.45±0.07 for weaning weight, and ultrasound backfat depth, respectively. Genetic correlations between performance and carcass traits were moderate to high. The results indicate that: (a) selection for birth weight may increase drip loss, lightness of longissimus dorsi, and gluteus medius muscles but may reduce fat depth; (b) selection for nursery weight can be valuable for increasing both quantity and quality traits; (c) selection for increased daily gain may increase the carcass weight and most of the primal cuts. These findings suggest that deterioration of pork quality may have occurred over many generations through the selection for less backfat thickness, and feed efficiency, but selection for growth had no adverse effects on pork quality. Low-to-moderate heritabilities for performance traits indicate that they could be improved using traditional selection or genomic selection. The estimated genetic parameters for performance, carcass and meat quality traits may be incorporated into the breeding programs that emphasize product quality in these Canadian swine populations.
Coutinho, V; Câmara-Costa, H; Kemlin, I; Billette de Villemeur, T; Rodriguez, D; Dellatolas, G
2017-01-01
In clinical outcome assessment, the relation between performance-based measures and questionnaire ratings of the same domain is weak, but correlations between questionnaires proposed for the evaluation of different domains are strong. The present study aims to illustrate these phenomena in a group of patients with neurofibromatosis type 1 (NF1) and to propose an explanatory hypothesis. A single neuropsychologist interviewed the parents about the child's situation and current difficulties and then assessed this parental view as overall positive or overall negative. The same assessor then administered the Wechsler Intelligence Scales and neuropsychological tests to 78 children and adolescents with NF1 (5-18 years). Parents then completed the Child Behavioral Checklist (CBCL), the Conners' Parent Rating Scale, the Behavior Rating Inventory of Executive Function (BRIEF), as well as questionnaires assessing quality of life, impact of the medical disorder, and their own difficulties. All questionnaires were inter-correlated (r = 0.29 - 0.84) and associated with the overall positive or negative parental view of the child's progress (effect size = 0.41-1.46). Conversely, questionnaires were weakly or not significantly related to intelligence, cognitive measures, or clinical severity. In conclusion, the parental view of the child's progress was related to the answers to questionnaires assessing quality of life or strengths and difficulties of patients with a neurological disorder. This factor should be assessed independently and taken into account when assessing clinical outcome.
Patients’ perceived value of pharmacy quality measures: a mixed-methods study
Shiyanbola, Olayinka O; Mort, Jane R
2015-01-01
Objective To describe patients’ perceived value and use of quality measures in evaluating and choosing community pharmacies. Design Focus group methodology was combined with a survey tool. During the focus groups, participants assessed the value of the Pharmacy Quality Alliance's quality measures in evaluating and choosing a pharmacy. Also, participants completed questionnaires rating their perceived value of quality measures in evaluating a pharmacy (1 being low value and 5 being high) or choosing a pharmacy (yes/no). Thematic analysis and descriptive statistics were used to analyse the focus groups and surveys, respectively. Setting Semistructured focus groups were conducted in a private meeting space of an urban and a rural area of a Mid-western State in the USA. Participants Thirty-four adults who filled prescription medications in community pharmacies for a chronic illness were recruited in community pharmacies, senior centres and public libraries. Results While comments indicated that all measures were important, medication safety measures (eg, drug-drug interactions) were valued more highly than others. Rating of quality measure utility in evaluating a pharmacy ranged from a mean of 4.88 (‘drug-drug interactions’) to a mean of 4.0 (‘absence of controller therapy for patients with asthma’). Patients were hesitant to use quality information in choosing a pharmacy (depending on the participant's location) but might consider if moving to a new area or having had a negative pharmacy experience. Use of select quality measures to choose a pharmacy ranged from 97.1% of participants using ‘drug-drug interactions’ (medication safety measure) to 55.9% using ‘absence of controller therapy for patients with asthma’. Conclusions The study participants valued quality measures in evaluating and selecting a community pharmacy, with medication safety measures valued highest. The participants reported that the quality measures would not typically cause a
Gajewski, Byron J; Dunton, Nancy
2013-04-01
Almost a decade ago Morton and Torgerson indicated that perceived medical benefits could be due to "regression to the mean." Despite this caution, the regression to the mean "effects on the identification of changes in institutional performance do not seem to have been considered previously in any depth" (Jones and Spiegelhalter). As a response, Jones and Spiegelhalter provide a methodology to adjust for regression to the mean when modeling recent changes in institutional performance for one-variable quality indicators. Therefore, in our view, Jones and Spiegelhalter provide a breakthrough methodology for performance measures. At the same time, in the interests of parsimony, it is useful to aggregate individual quality indicators into a composite score. Our question is, can we develop and demonstrate a methodology that extends the "regression to the mean" literature to allow for composite quality indicators? Using a latent variable modeling approach, we extend the methodology to the composite indicator case. We demonstrate the approach on 4 indicators collected by the National Database of Nursing Quality Indicators. A simulation study further demonstrates its "proof of concept."
Phelps, R P
2001-08-01
This article describes the education quality control systems (for mathematics) used by those countries that performed best on the Third International Mathematics and Science Study (TIMSS). Enforced quality control measures are defined as "decision points"--where adherence to the curriculum and instruction system can be reinforced. Most decision points involve stakes for the student, teacher, or school. They involve potential consequences for failure to adhere to the system and to follow the program at a reasonable pace. Generally, countries with more decision points perform better on the TIMSS. When the number of decision points and TIMSS test scores are adjusted for country wealth, the relationship between the degree of (enforced) quality control and student achievement appears to be positive and exponential. The more (enforced) quality control measures employed in an education system, the greater is students' academic achievement.
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
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.
Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting
2012-11-21
No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems.
Measuring migraine-related quality of care across 10 health plans.
Pracilio, Valerie P; Silberstein, Stephen; Couto, Joseph; Bumbaugh, Jon; Hopkins, Mary; Ng-Mak, Daisy; Sennett, Cary; Goldfarb, Neil I
2012-08-01
To refine a previously published standardized quality and utilization measurement set for migraine care and to establish performance benchmarks. Retrospective application of the migraine measurement set to health plan data in order to assess patterns of health service utilization. Measurement specifications were applied to data from 10 health plans for measurement year 2009. Of the 2.9 million continuously enrolled members of the health plans, 138,004 (4.7%) met inclusion criteria for the migraine population. Of these, 26% did not have a migraine diagnosis, but were utilizing migraine drugs; 12% had a computed tomography scan within the year (range 8%-25% across plans); and 8% had magnetic resonance imaging (range 6%-11%). Nearly 18% of the migraineurs had 1 or more visits to an emergency department/urgent care center for migraine; few (6%) were followed up with primary care visits. Approximately one-fourth of the migraineurs were not being routinely monitored by a physician. Medication utilization also was examined for members of the migraine population with pharmacy benefits. A significant proportion (42%) were given a migraine preventive, 38% had at least 1 prescription for a triptan, and 2% of those on triptans were potentially overutilizing the medication. Among patients aged 18 to 49 years who were given triptans, 3% had a cardiac contraindication; this percentage rose to 7% for patients aged 50 to 64 years. This study demonstrates the value of standardized measures in identifying potential quality issues for migraine care, including underdiagnosis, overutilization of imaging, and underutilization of preventive drugs.
Measuring, managing and maximizing performance of mineral processing plants
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bascur, O.A.; Kennedy, J.P.
1995-12-31
The implementation of continuous quality improvement is the confluence of Total Quality Management, People Empowerment, Performance Indicators and Information Engineering. The supporting information technologies allow a mineral processor to narrow the gap between management business objectives and the process control level. One of the most important contributors is the user friendliness and flexibility of the personal computer in a client/server environment. This synergistic combination when used for real time performance monitoring translates into production cost savings, improved communications and enhanced decision support. Other savings come from reduced time to collect data and perform tedious calculations, act quickly with fresh newmore » data, generate and validate data to be used by others. This paper presents an integrated view of plant management. The selection of the proper tools for continuous quality improvement are described. The process of selecting critical performance monitoring indices for improved plant performance are discussed. The importance of a well balanced technological improvement, personnel empowerment, total quality management and organizational assets are stressed.« less
Measuring the quality of provided services for patients with chronic kidney disease.
Bahadori, Mohammadkarim; Raadabadi, Mehdi; Heidari Jamebozorgi, Majid; Salesi, Mahmood; Ravangard, Ramin
2014-09-01
The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014. This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test. The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001). Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and
Garrido, Terhilda; Kumar, Sudheen; Lekas, John; Lindberg, Mark; Kadiyala, Dhanyaja; Whippy, Alan; Crawford, Barbara; Weissberg, Jed
2014-01-01
Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government. PMID:23831833
Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea
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
National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps
Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael
2013-01-01
OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. PMID:23457148
Giorgi, Fabio; Mattei, Antonella; Notarnicola, Ippolito; Petrucci, Cristina; Lancia, Loreto
2018-03-01
The aim of this study was to investigate any possible relationship between sleep disorders, burnout and job performance in a shift-work population of nurses. Sleep disorders and burnout can affect the job performance of nurses in terms of efficiency, productivity, task execution speed and supervision, which can be compromised when work shifts are organized on a 24-hour schedule and when the shift itself is irregular. A cross-sectional observational study was conducted from August 2014 - January 2015 on a sample of 315 shift-work nurses across 39 wards in seven central Italian hospitals. The Pittsburgh Sleep Quality Index was used to detect the presence of sleep disorders, the Copenhagen Burnout Inventory was used to detect the presence of any possible type of burnout and the Job Performance Scale was used to measure job performance. Data analysis was mainly based on a multivariate logistic regression to identify variables significantly associated with investigated outcomes. On shift-work nurses' sleep quality and burnout correlated positively. The female gender and personal burnout were significantly associated with impaired sleep quality, while working in the psychiatric setting, working a long cycle shift pattern and experiencing daytime dysfunction were significantly associated with burnout. A significant negative association between patient-related burnout and job performance was observed. Specific characteristics of shift-work nurses can directly affect sleep quality and burnout and indirectly job performance. This evidence offers healthcare administrators opportunities to intervene with measures to promote nurse's health, well-being and safety. © 2017 John Wiley & Sons Ltd.
Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.
Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke
2015-12-01
Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.
Nuclear Enterprise Performance Measurement
2011-03-01
xi I. Introduction ...WSA: Weapons Storage Area 1 I. Introduction Overview This paper discusses United States Air Force nuclear enterprise...sustainment systems. Keywords Performance measurement, process measurement, strategy, multicriteria decision- making, aggregation 1. Introduction Nuclear
Physician Perceptions of Performance Feedback in a Quality Improvement Activity.
Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E
Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.
Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M
2018-01-01
Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.
Konetzka, R. Tamara; Skira, Meghan M.; Werner, Rachel M.
2017-01-01
Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement. PMID:29594189
26 CFR 801.2 - Measuring organizational performance.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 26 Internal Revenue 20 2011-04-01 2011-04-01 false Measuring organizational performance. 801.2... REVENUE PRACTICE BALANCED SYSTEM FOR MEASURING ORGANIZATIONAL AND EMPLOYEE PERFORMANCE WITHIN THE INTERNAL REVENUE SERVICE § 801.2 Measuring organizational performance. The performance measures that comprise the...
2011-01-01
Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement
LiDAR for Air Quality Measurements
DOT National Transportation Integrated Search
2017-02-02
The overall goal of this research is to investigate a unique light detection and ranging (LiDAR) technology for ambient air quality measurement of particulate matter. The ODU team has recently received a state-of-the-art elastic LiDAR from NASA Langl...
26 CFR 1.23-4 - Performance and quality standards. [Reserved
Code of Federal Regulations, 2010 CFR
2010-04-01
... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Performance and quality standards. [Reserved] 1.23-4 Section 1.23-4 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Changes in Rates During A Taxable Year § 1.23-4 Performance and quality standards. [Reserved...
Investigation of Malaysian Higher Education Quality Culture and Workforce Performance
ERIC Educational Resources Information Center
Ali, Hairuddin Mohd; Musah, Mohammed Borhandden
2012-01-01
Purpose: The purpose of this study is to examine the relationship between the quality culture and workforce performance in the Malaysian higher education sector. The study also aims to test and validate the psychometric properties of the quality culture and workforce performance instruments used in the study. Design/methodology/approach: A total…
Peabody, John W; DeMaria, Lisa; Smith, Owen; Hoth, Angela; Dragoti, Edmond; Luck, Jeff
2017-09-27
A significant determinant of population health outcomes is the quality of care provided for noncommunicable diseases, obstetric, and pediatric care. We present results on clinical practice quality in these areas as measured among nearly 4,000 providers working at more than 1,000 facilities in 6 Eastern European and Central Asian countries. This study was conducted between March 2011 and April 2013 in Albania, Armenia, Georgia, Kazakhstan, Kirov Province in Russia, and Tajikistan. Using a probability proportional-to-size sampling technique, based on number of hospital beds, we randomly selected within each country 42 hospitals and their associated primary health care clinics. Physicians and midwives within each clinical area of interest were randomly selected from each hospital and clinic and asked how they would care for simulated patients using Clinical Performance and Value (CPV) vignettes. Facility administrators were also asked to complete a facility survey to collect structural measures of quality. CPV vignettes were scored on a scale of 0% to 100% for each provider. We used descriptive statistics and t tests to identify significant differences in CPV scores between hospitals and clinics and rural vs. urban facilities, and ANOVA to identify significant differences in CPV scores across countries. We found that quality of care, as concurrently measured by performance on CPV vignettes, was generally poor and widely variable within and between countries. Providers in Kirov Province, Russia, had the highest overall performance, with an average score of 70.8%, while providers in Albania and Tajikistan had the lowest average score, each at 50.8%. The CPV vignettes with the lowest scores were for multiple noncommunicable disease risk factors and birth asphyxia. A considerable proportion (11%) of providers performed well on the CPV vignettes, regardless of country, facility, or structural resources available to them. Countries of Eastern Europe and Central Asia are
Developing Resident-Sensitive Quality Measures: A Model From Pediatric Emergency Medicine.
Schumacher, Daniel J; Holmboe, Eric S; van der Vleuten, Cees; Busari, Jamiu O; Carraccio, Carol
2017-12-05
To begin closing the gap with respect to quality measures available for use among residents, the authors sought to identify and develop resident-sensitive quality measures (RSQMs) for use in the pediatric emergency department (PED) setting. In May 2016, the authors reviewed National Quality Measures Clearinghouse (NQMC) measures to identify resident-sensitive measures. To create additional measures focused on common, acute illnesses (acute asthma exacerbation, bronchiolitis, closed head injury [CHI]) in the PED, the authors used a nominal group technique (NGT) and Delphi process from September to December 2016. To achieve a local focus for developing these measures, all NGT and Delphi participants were from Cincinnati Children's Hospital Medical Center. Delphi participants rated measures developed through the NGT in two areas: importance of measure to quality care and likelihood that measure represents the work of a resident. The review of NQMC measures identified 28 of 183 as being potentially resident-sensitive. The NGT produced 67 measures for asthma, 46 for bronchiolitis, and 48 for CHI. These were used in the first round of the Delphi process. After two rounds, 18 measures for asthma, 21 for bronchiolitis, and 22 for CHI met automatic inclusion criteria. In round three, participants categorized the potential final measures by their top 10 and next 5. This study describes a template for identifying and developing RSQMs that may promote high-quality care delivery during and following training. Next steps should include implementing and seeking validity evidence for the locally developed measures.
Spaceport Performance Measures
NASA Technical Reports Server (NTRS)
Finger, G. Wayne
2010-01-01
Spaceports have traditionally been characterized by performance measures associated with their site characteristics. Measures such as "Latitude" (proximity to the equator), "Azimuth" (range of available launch azimuths) and "Weather" (days of favorable weather) are commonly used to characterize a particular spaceport. However, other spaceport performance measures may now be of greater value. These measures can provide insight into areas of operational differences between competing spaceports and identify areas for improving the performance of spaceports. This paper suggests Figures of Merit (FOMs) for spaceport "Capacity" (number of potential launch opportunities per year and / or potential mass' to low earth orbit (LEO) per year); "Throughput" (actual mass to orbit per year compared to capacity); "Productivity" (labor effort hours per unit mass to orbit); "Energy Efficiency" (joules expended at spaceport per unit mass to orbit); "Carbon Footprint" tons CO2 per unit mass to orbit). Additional FOMS are investigated with regards to those areas of special interest to commercial launch operators, such as "Assignment Schedule" (days required for a binding assignment of a launch site from the spaceport); "Approval Schedule" (days to complete a range safety assessment leading to an approval or disapproval of a launch vehicle); "Affordability" (cost for a spaceport to assess a new launch vehicle); "Launch Affordability" (fixed range costs per launch); "Reconfigure Time" (hours to reconfigure the range from one vehicle's launch ready configuration to another vehicle's configuration); "Turn,Around Time" (minimum range hours required between launches of an identical type launch vehicle). Available or notional data is analyzed for the KSC/CCAFS area and other spaceports. Observations regarding progress over the past few decades are made. Areas where improvement are needed or indicated are suggested.
ERIC Educational Resources Information Center
Christopher, Minolar T.
2010-01-01
Quality in higher education today is often measured by institutional accountability indicators. The purpose of this study was to examine trends and explore correlational relationships of the performance indicators deemed important to the stakeholders of two postsecondary institutions in the State of Georgia--retention rate, graduation rate, and…
Sorsdahl, Anne Brit; Moe-Nilssen, Rolf; Strand, Liv Inger
2008-02-01
The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2-13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The children's performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC)(1,1) varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding'Alignment'and'Weight shift'in GMPM and'Protective extension'in QUEST highly reliable. The subscores'Dissociated movements'in GMPM and QUEST, and'Grasp'in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.
Image processing system performance prediction and product quality evaluation
NASA Technical Reports Server (NTRS)
Stein, E. K.; Hammill, H. B. (Principal Investigator)
1976-01-01
The author has identified the following significant results. A new technique for image processing system performance prediction and product quality evaluation was developed. It was entirely objective, quantitative, and general, and should prove useful in system design and quality control. The technique and its application to determination of quality control procedures for the Earth Resources Technology Satellite NASA Data Processing Facility are described.
Impacts of pay for performance on the quality of primary care
Allen, T; Mason, T; Whittaker, W
2014-01-01
Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341
Assessing quality outcome measures in children with coeliac disease--experience from two UK centres.
Ross, Alexander; Shelley, Helen; Novell, Kim; Ingham, Elizabeth; Callan, Julia; Heuschkel, Robert; Morris, Mary-Anne; Zilbauer, Matthias
2013-11-19
Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM) in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England paediatric gastroenterology network to 99 patients reviewed at two tertiary hospitals in the Network, to assess the quality of care provided by nurse led and doctor led care models. The average performance across all QOM was 96.2% at Addenbrooke's Hospital (AH), and 98.7% at Norfolk and Norwich Hospital (NNUH), whilst 95% (n = 18) of QOM were met. Patient satisfaction was high at both sites (uptake of questionnaire 53 of 99 patients in the study). The study showed a comparably high level of care delivered by both a nurse and doctor led service. Our quality assessment tools could be applied in the future by other centres to measure standards of care.
Luther, Lauren; Fukui, Sadaaki; Garabrant, Jennifer M; Rollins, Angela L; Morse, Gary; Henry, Nancy; Shimp, Dawn; Gearhart, Timothy; Salyers, Michelle P
2018-04-12
Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.
2012-01-01
Background No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. Methods The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. Results The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. Conclusions It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems. PMID:23171394
DockQ: A Quality Measure for Protein-Protein Docking Models
Basu, Sankar
2016-01-01
The state-of-the-art to assess the structural quality of docking models is currently based on three related yet independent quality measures: Fnat, LRMS, and iRMS as proposed and standardized by CAPRI. These quality measures quantify different aspects of the quality of a particular docking model and need to be viewed together to reveal the true quality, e.g. a model with relatively poor LRMS (>10Å) might still qualify as 'acceptable' with a descent Fnat (>0.50) and iRMS (<3.0Å). This is also the reason why the so called CAPRI criteria for assessing the quality of docking models is defined by applying various ad-hoc cutoffs on these measures to classify a docking model into the four classes: Incorrect, Acceptable, Medium, or High quality. This classification has been useful in CAPRI, but since models are grouped in only four bins it is also rather limiting, making it difficult to rank models, correlate with scoring functions or use it as target function in machine learning algorithms. Here, we present DockQ, a continuous protein-protein docking model quality measure derived by combining Fnat, LRMS, and iRMS to a single score in the range [0, 1] that can be used to assess the quality of protein docking models. By using DockQ on CAPRI models it is possible to almost completely reproduce the original CAPRI classification into Incorrect, Acceptable, Medium and High quality. An average PPV of 94% at 90% Recall demonstrating that there is no need to apply predefined ad-hoc cutoffs to classify docking models. Since DockQ recapitulates the CAPRI classification almost perfectly, it can be viewed as a higher resolution version of the CAPRI classification, making it possible to estimate model quality in a more quantitative way using Z-scores or sum of top ranked models, which has been so valuable for the CASP community. The possibility to directly correlate a quality measure to a scoring function has been crucial for the development of scoring functions for protein structure
[Quality of sleep and academic performance in high school students].
Bugueño, Maithe; Curihual, Carolina; Olivares, Paulina; Wallace, Josefa; López-AlegrÍa, Fanny; Rivera-López, Gonzalo; Oyanedel, Juan Carlos
2017-09-01
Sleeping and studying are the day-to-day activities of a teenager attending school. To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. A bad sleep quality influences academic performance in these students.
The role of quality measurement in a competitive marketplace.
Epstein, A M
1996-01-01
Quality measurement is not a new idea. However, in recent years, several new trends have gained prominence: greater interest in publicly reported information on quality of care, access to care, and patient satisfaction; an increased focus on health plans and integrated systems of care rather than on institutional providers and practitioners as the unit of observation; wide adoption of the techniques of continuous quality improvement within the health care sector; increased use of clinical practice guidelines to improve care for a broad range of medical conditions; incorporation of computer technology into the clinical setting; and greater appreciation for health outcomes as a measure of quality of care. This chapter first reviews the changes in the medical landscape that have seeded these trends and the distinction between quality assurance and quality improvement. It then focuses on public policy concerns, in particular on the emergence of publicly disseminated information about quality of care, now often called "quality report cards." The major prototypes of these reports developed to date, the responses to quality reporting by different members of the delivery system, and the major criticisms of this approach are reviewed. The chapter concludes by predicting probable developments and the strategies most likely to move health care forward in a productive direction.