Systematic monitoring of male circumcision scale-up in Nyanza, Kenya: exploratory factor analysis of service quality instrument and performance ranking.

PubMed

Omondi Aduda, Dickens S; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

2014-01-01

Considerable conceptual and operational complexities related to service quality measurements and variability in delivery contexts of scaled-up medical male circumcision, pose real challenges to monitoring implementation of quality and safety. Clarifying latent factors of the quality instruments can enhance contextual applicability and the likelihood that observed service outcomes are appropriately assessed. To explore factors underlying SYMMACS service quality assessment tool (adopted from the WHO VMMC quality toolkit) and; determine service quality performance using composite quality index derived from the latent factors. Using a comparative process evaluation of Voluntary Medical Male Circumcision Scale-Up in Kenya site level data was collected among health facilities providing VMMC over two years. Systematic Monitoring of the Medical Male Circumcision Scale-Up quality instrument was used to assess availability of guidelines, supplies and equipment, infection control, and continuity of care services. Exploratory factor analysis was performed to clarify quality structure. Fifty four items and 246 responses were analyzed. Based on Eigenvalue >1.00 cut-off, factors 1, 2 & 3 were retained each respectively having eigenvalues of 5.78; 4.29; 2.99. These cumulatively accounted for 29.1% of the total variance (12.9%; 9.5%; 6.7%) with final communality estimates being 13.06. Using a cut-off factor loading value of ≥0.4, fifteen items loading on factor 1, five on factor 2 and one on factor 3 were retained. Factor 1 closely relates to preparedness to deliver safe male circumcisions while factor two depicts skilled task performance and compliance with protocols. Of the 28 facilities, 32% attained between 90th and 95th percentile (excellent); 45% between 50th and 75th percentiles (average) and 14.3% below 25th percentile (poor). the service quality assessment instrument may be simplified to have nearly 20 items that relate more closely to service outcomes. Ranking of facilities and circumcision procedure using a composite index based on these items indicates that majority performed above average.

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

Measurement of Perceived Service Quality in Higher Education Institutions: A Review of HEdPERF Scale Use

ERIC Educational Resources Information Center

Silva, Danilo Soares; de Morales, Gustavo Hermínio Salati Marcondes; Makiya, Ieda Kanashiro; Cesar, Francisco Ignácio Giocondo

2017-01-01

Purpose: This study aims to find evidence of the HEdPERF scale use for measuring the perceived service quality from the perspective of students in higher education institutions (HEIs) worldwide. Design/methodology/approach: A systematic review of the literature was conducted to find evidence of the scale use in articles published between January…

Development and testing of a scale for assessing the quality of home nursing.

PubMed

Chiou, Chii-Jun; Wang, Hsiu-Hung; Chang, Hsing-Yi

2016-03-01

To develop a home nursing quality scale and to evaluate its psychometric properties. This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. The scale is ready to be used to assess the quality of services provided by home care nursing organizations. © 2015 Japan Geriatrics Society.

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)].

PubMed

Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C

2010-01-01

The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

Psychometric Properties of Scores from the Web-based LibQUAL+ Study of Perceptions of Library Service Quality.

ERIC Educational Resources Information Center

Cook, Colleen; Thompson, Bruce

2001-01-01

Investigated the psychometric integrity of scores from the LibQUAL+ evaluation of perceived library service quality conducted by ARL (Association of Research Libraries). Examines score structure, score reliability, score correlation and concurrent validity coefficients, scale means, and scale standardized norms, and considers the potential of the…

Perceptions of Pre-Service Teachers on Student Burnout, Occupational Anxiety and Faculty Life Quality

ERIC Educational Resources Information Center

Türkoglu, Muhammet Emin; Cansoy, Ramazan

2017-01-01

Perceptions of pre-service teachers on burnout, occupational anxiety and faculty life quality were investigated in this research. The research group consisted of 461 pre-service teachers in total studying at Afyon Kocatepe University faculty of education. "Maslach Burnout Inventory-Student Form," "Faculty Life Quality Scale"…

e-GovQual: A Multiple-Item Scale for Assessing e-Government Service Quality

ERIC Educational Resources Information Center

Papadomichelaki, Xenia; Mentzas, Gregoris

2012-01-01

A critical element in the evolution of governmental services through the internet is the development of sites that better serve the citizens' needs. To deliver superior service quality, we must first understand how citizens perceive and evaluate online. Citizen assessment is built on defining quality, identifying underlying dimensions, and…

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.…

[Evaluation of quality of service in Early Intervention: A systematic review].

PubMed

Jemes Campaña, Inmaculada Concepción; Romero-Galisteo, Rita Pilar; Labajos Manzanares, María Teresa; Moreno Morales, Noelia

2018-06-07

Early Intervention (EI), as a paediatric service, has the duty of quantifying the results and the quality of its services provided. The accessibility of valid and reliable tools allows professionals to evaluate the quality of these services. The aim of this study is to review the scientific literature on tools used to measure the methodological and service quality in EI. A search was made in different databases: Medline (from PubMed), Web of Science, PsycINFO, Cochrane, Scopus, ERIC and Scielo. The methodological quality of the studies was tested using the COSMIN scale. A total of 13 manuscripts met the criteria to be included in this review. Ten of them received a "good" or "reasonable" score based on the COSMIN scale. Despite its importance, there is no consensus among authors on the measurement of service quality in EI. It is often the family of the children attended in EI that are considered the target to study, although the opinion of professionals carries more weight and completes the information. Copyright © 2018. Publicado por Elsevier España, S.L.U.

[Validating an instrument for measuring the perceived quality of services received by people using hospitals in Colombia].

PubMed

Cabrera-Arana, Gustavo A; Londoño-Pimienta, Jaime L; Bello-Parías, León D

2008-01-01

Validating an instrument for measuring the perceived quality of services received by people using hospitals forming part of the Colombian Ministry of Social Protection's restructuring, redesigning and modernisation programme for health-service providing networks. Sánchez and Echeverri's guidelines for validating health quality measurement scales were followed due to the lack of a valid instrument for doing this in Colombia. Conceptual synthesis led to identifying a structure of constituent indicators, domains and sub-domains regarding the perception of health service quality. A list of reactions (having a scale for categorising the replies) was analysed according to the validity of appearance, construct, criteria and utility as criteria for sensitivity and usefulness. Successive revisions and three rounds of field-trials led to producing PECASUSS, an acronym given to the instrument for measuring users' perception of health service quality (Percepción de Calidad Según Usuarios de Servicios de Salud). The guidelines effectively orientated the validation of the instrument required for measuring the perceived quality of health services received by people using hospitals forming part of the programme.

Quantifying The Water Quality Services Of Wetlands

EPA Science Inventory

Wetlands are well recognized for their potential for providing a wide range of important ecological services including their ability to provide water quality protection. Watershed-scale water quality trading could create market driven incentives to restore and construct wetlands...

Doctors' service orientation in public, private, and foreign hospitals.

PubMed

Andaleeb, Syed Saad; Siddiqui, Nazlee; Khandakar, Shahjahan

2007-01-01

The purpose of this study is to propose a doctors' service orientation (DSO) scale and uses it to compare the services received in public, private and foreign hospitals in a developing country from the patient's perspective. The scale was derived from the service quality literature and qualitative research. A questionnaire was designed next. Data were collected from patients who had used the services of doctors in a hospital. The scale demonstrated appropriate psychometric properties. Two clear patterns emerge from the study results: on 10 out of 12 measures of doctors' service orientation, there was no significant difference in their perceived behaviors between public and private hospitals and foreign doctors were "always" rated significantly higher. This study focused on one major city because of time and resource constraints. The findings are thus not generalizable to hospitals across the country. Also, because of translation and retranslation issues, the scale ought to be further tested for wider use. The scale may be used periodically in a comprehensive quality assurance program to exhort doctors to become more service oriented and to improve their performance over time.

[Ophthalmological service quality offered to outpatients of the Public Healthcare System].

PubMed

Santos Hercos, Benigno Vicente; Berezovsky, Adriana

2006-01-01

To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective

NASA Astrophysics Data System (ADS)

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective.

PubMed

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Afterschool Quality

ERIC Educational Resources Information Center

Smith, Charles; Akiva, Tom; McGovern, Gina; Peck, Stephen C.

2014-01-01

This chapter discusses efforts to define and improve the quality of afterschool services, highlighting areas of agreement and identifying leading-edge issues. We conclude that the afterschool field is especially well positioned to deliver high-quality services and demonstrate effectiveness at scale because a strong foundation has been built for…

Specific Remedy for Specific Problem: Measuring Service Quality in South African Higher Education

ERIC Educational Resources Information Center

de Jager, Johan; Gbadamosi, Gbolahan

2010-01-01

This study commences a process of developing a scale for the measurement of service quality in higher education in South Africa and also examines the relationship between the measures of service quality on the one hand and some other related variables such as intention to leave the university, trust in management of the university and the overall…

Service Quality and Patient Satisfaction: An Exploratory Study of Pathology Laboratories in Jaipur.

PubMed

Agarwal, Anuradha; Singh, Maithili R P

2016-01-01

One of the most important parts of healthcare system is diagnostics. Nowadays, Indians have become more aware of their health, due to improved and better availability of health related information, increase in medical tourism, and expanding health insurance. The demand for better diagnostic facilities have increased with the increase in lifestyle related diseases, excesses use of chemicals in agriculture practices and change in food habits. It is expected that the Indian diagnostic market will grow from USD $5 billion in the year 2012 to USD $32 billion by the year 2020 with 20% CAGR (India Brand Equity Foundation 2015 ). Today patients have easy access of information regarding the health services and they have become more concerned about it as they look forward to receiving the maximum value for their money. To win the confidence of the patients and to maintain that trust, it is required to deliver the right services to the right person at the right time. The purpose of this study was to develop a scale to measure the service quality at pathology laboratory. A thorough review of literature revealed that there are studies related to healthcare service quality but there is no such established scale to measure service quality of pathology laboratory. Thus, the authors strived to develop a reliable and valid instrument to measure the patients' perception toward pathology laboratory service quality. For this exploratory study was conducted on the sample of 80 patients of the laboratories in Jaipur city. The reliability and factor structures were tested to purify the scale. The findings revealed 13 items, comprising of three dimensions of service quality: responsiveness, tangibility, and reliability.

Service Discovery Oriented Management System Construction Method

NASA Astrophysics Data System (ADS)

Li, Huawei; Ren, Ying

2017-10-01

In order to solve the problem that there is no uniform method for design service quality management system in large-scale complex service environment, this paper proposes a distributed service-oriented discovery management system construction method. Three measurement functions are proposed to compute nearest neighbor user similarity at different levels. At present in view of the low efficiency of service quality management systems, three solutions are proposed to improve the efficiency of the system. Finally, the key technologies of distributed service quality management system based on service discovery are summarized through the factor addition and subtraction of quantitative experiment.

Comparison of corrosion scales in full and partially replaced lead service lines after changes in water quality

EPA Science Inventory

Preliminary results from scales formed 38 weeks following the LSL replacement simulations revealed differences in scale formations amongst varying water qualities and pipe sequence. Rigs fed with dechlorinated tap water show distinct pH gradients between the galvanic and the back...

A Tentative Study on the Evaluation of Community Health Service Quality*

NASA Astrophysics Data System (ADS)

Ma, Zhi-qiang; Zhu, Yong-yue

Community health service is the key point of health reform in China. Based on pertinent studies, this paper constructed an indicator system for the community health service quality evaluation from such five perspectives as visible image, reliability, responsiveness, assurance and sympathy, according to service quality evaluation scale designed by Parasuraman, Zeithaml and Berry. A multilevel fuzzy synthetical evaluation model was constructed to evaluate community health service by fuzzy mathematics theory. The applicability and maneuverability of the evaluation indicator system and evaluation model were verified by empirical analysis.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PubMed

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Influence of land use on water quality in a tropical landscape: a multi-scale analysis

PubMed Central

Yackulic, Charles B.; Lim, Yili; Arce-Nazario, Javier A.

2015-01-01

There is a pressing need to understand the consequences of human activities, such as land transformations, on watershed ecosystem services. This is a challenging task because different indicators of water quality and yield are expected to vary in their responsiveness to large versus local-scale heterogeneity in land use and land cover (LUC). Here we rely on water quality data collected between 1977 and 2000 from dozens of gauge stations in Puerto Rico together with precipitation data and land cover maps to (1) quantify impacts of spatial heterogeneity in LUC on several water quality indicators; (2) determine the spatial scale at which this heterogeneity influences water quality; and (3) examine how antecedent precipitation modulates these impacts. Our models explained 30–58% of observed variance in water quality metrics. Temporal variation in antecedent precipitation and changes in LUC between measurements periods rather than spatial variation in LUC accounted for the majority of variation in water quality. Urbanization and pasture development generally degraded water quality while agriculture and secondary forest re-growth had mixed impacts. The spatial scale over which LUC influenced water quality differed across indicators. Turbidity and dissolved oxygen (DO) responded to LUC in large-scale watersheds, in-stream nitrogen concentrations to LUC in riparian buffers of large watersheds, and fecal matter content and in-stream phosphorus concentration to LUC at the sub-watershed scale. Stream discharge modulated impacts of LUC on water quality for most of the metrics. Our findings highlight the importance of considering multiple spatial scales for understanding the impacts of human activities on watershed ecosystem services. PMID:26146455

Perceived Residential Environment Quality Indicators and neighborhood attachment: A confirmation study on a Chinese sample in Chongqing.

PubMed

Mao, Yanhui; Fornara, Ferdinando; Manca, Sara; Bonnes, Mirilia; Bonaiuto, Marino

2015-09-01

This paper concerns people's assessment of their neighborhood of residence in a Chinese urban context. The aim of the study was to verify the factorial structure and the reliability of two instruments originally developed and validated in Italy (the full versions of the Perceived Residential Environment Quality Indicators [PREQIs] and of the Neighborhood Attachment Scale [NAS]) in a different cultural and linguistic context. The instruments consist of 11 scales measuring the PREQIs and one scale measuring neighborhood attachment (NA). The PREQIs scales include items covering four macroevaluative domains of residential environment quality: architectural and urban planning aspects (three scales: Architectural and Town-planning Space, Organization of Accessibility and Roads, Green Areas), sociorelational aspects (one scale: People and Social Relations), functional aspects (four scales: Welfare Services, Recreational Services, Commercial Services, and Transport Services), and contextual aspects (three scales: Pace of Life, Environmental Health, Upkeep and Care). The PREQIs and NAS were included in a self-report questionnaire, which had been translated and back-translated from English to Chinese, and was then administered to 340 residents in six districts (differing along various features) of a highly urbanized context in China, the city of Chongqing. Results confirmed the factorial structure of the scales and demonstrated good internal consistency of the indicators, thus reaffirming the results of previous studies carried out in Western urban contexts. The indicators tapping the neighborhood's contextual aspects (i.e., pace of life, environmental health, and upkeep) emerged as most correlated to NA. © 2015 The Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.

Women's perception of quality of maternity services: a longitudinal survey in Nepal.

PubMed

Karkee, Rajendra; Lee, Andy H; Pokharel, Paras K

2014-01-24

In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

ERIC Educational Resources Information Center

Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

2005-01-01

Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

Measuring service quality and its relationship to future consumer behavior.

PubMed

Headley, D E; Miller, S J

1993-01-01

The authors adapt the SERVQUAL scale for medical care services and examine it for reliability, dimensionality, and validity in a primary care clinic setting. In addition, they explore the possibility of a link between perceived service quality--and its various dimensions--and a patient's future intent to complain, compliment, repeat purchase, and switch providers. Findings from 159 matched-pair responses indicate that the SERVQUAL scale can be adapted reliably to a clinic setting and that the dimensions of reliability, dependability, and empathy are most predictive of a patient's intent to complain, compliment, repeat purchase, and switch providers.

Managing Vocabulary Mapping Services

PubMed Central

Che, Chengjian; Monson, Kent; Poon, Kasey B.; Shakib, Shaun C.; Lau, Lee Min

2005-01-01

The efficient management and maintenance of large-scale and high-quality vocabulary mapping is an operational challenge. The 3M Health Information Systems (HIS) Healthcare Data Dictionary (HDD) group developed an information management system to provide controlled mapping services, resulting in improved efficiency and quality maintenance. PMID:16779203

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective.

PubMed

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers' expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach's alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions' internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale's dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency.

Accommodation and Health Costs of Deinstitutionalized People with Mental Illness Living in Residential Services in Brazil.

PubMed

Razzouk, Denise

2018-04-30

Health costs are the main hindrances for expanding community mental health services. Exploring patient profiles and cost predictors may be useful for optimising financial resources. However, the deinstitutionalisation process may burden health budgets in terms of supporting multiple community services based on varying levels of need. This study assessed accommodation and health service costs, quality of life and clinical and psychosocial profiles among individuals receiving mental healthcare through residential services. Specific accommodation cost predictors were also verified. Health costs were assessed from the perspective of a public health provider using a microcosting bottom-up approach at 20 residential services in São Paulo, Brazil. Instruments used to assess health costs and patient profiles included the Brazilian version of the Client Socio-demographic and Service Receipt Inventory (CSSRI), the Mini International Neuropsychiatric Interview (MINI), the Clinical Global Impression-Severity Scale (CGI-S), the Independent Living Skills Survey (ILLS), the Social Behaviour Scale (SBS) and the Quality of Life Scale (QLS). One hundred and forty-seven residents, predominantly experiencing psychotic disorders, were interviewed. The geographical region and length of time spent living in residential services or in a psychiatric hospital predicted 66% of the variance in accommodation costs. The CGI-S and ILLS scores and years of education explained 52.7% of the variance in quality of life. Accommodation costs were not driven by patient profile variables, while region and time spent in a hospital or in residential services were the main cost predictors. Semi-staffed homes may be an alternative for resource optimisation among individuals with mild impairment, particularly if strategies for psychosocial rehabilitation and improving quality of life are implemented.

Family Quality of Life: A Key Outcome in Early Childhood Intervention Services--A Scoping Review

ERIC Educational Resources Information Center

Bhopti, Anoo; Brown, Ted; Lentin, Primrose

2016-01-01

A scoping review was conducted to identify factors influencing the quality of life of families of children with disability. The review also explored the scales used to measure family quality of life (FQOL) as an outcome in early childhood intervention services (ECIS). Multiple databases were searched from 2000 to 2013 to include studies pertinent…

The Copernicus Atmosphere Monitoring Service: facilitating the prediction of air quality from global to local scales

NASA Astrophysics Data System (ADS)

Engelen, R. J.; Peuch, V. H.

2017-12-01

The European Copernicus Atmosphere Monitoring Service (CAMS) operationally provides daily forecasts of global atmospheric composition and regional air quality. The global forecasting system is using ECMWF's Integrated Forecasting System (IFS), which is used for numerical weather prediction and which has been extended with modules for atmospheric chemistry, aerosols and greenhouse gases. The regional forecasts are produced by an ensemble of seven operational European air quality models that take their boundary conditions from the global system and provide an ensemble median with ensemble spread as their main output. Both the global and regional forecasting systems are feeding their output into air quality models on a variety of scales in various parts of the world. We will introduce the CAMS service chain and provide illustrations of its use in downstream applications. Both the usage of the daily forecasts and the usage of global and regional reanalyses will be addressed.

The Impact of Large, Multi-Function/Multi-Site Competitions

DTIC Science & Technology

2003-08-01

this approach generates larger savings and improved service quality , and is less expensive to implement. Moreover, it is a way to meet the President s...of the study is to assess the degree to which large-scale competitions completed have resulted in increased savings and service quality and decreased

Level of quality management in the Municipal Sports Services, contrast trough EFQM Excellence Model.

PubMed

Martínez-Moreno, Alfonso; Díaz Suárez, Arturo

2016-01-01

The quality management in the Municipal Sports Services is embedded in the servuction provided to the citizens, which are their internal customers who determine the quality improvement ensuring competitiveness with excellence criteria. The Model of the European Foundation for Quality Management enables the evaluation of organization progress towards achieving quality goals, from a structured, measurable and comparable methodology. The aim is to carry out a diagnosis of the level of implementation of quality in the Municipal Sports Services of the Region of Murcia, Spain. The sample of 287 workers of 30 sports services gets a high level of reliability at all scales, with a coefficient of variation of .985 (range .810-.943). The score in the criteria of Policy and Strategy, People Management, Alliances and Resources, Processes and People Results were significantly higher (p < .05) in the Municipalities with more than 25,000 inhabitants when compared with those less than 10,000 and with those from 10,000 to 25,000 inhabitants obtaining global ratings of 571 points, those less than 10,000, 590 points those from 10,000 to 25,000 and those higher than 25,000 reach 636, having a good level of quality in relation to the scale that determines the model.

[A new scale for the assessment of the quality of hospitality services].

PubMed

Varela Mallou, Jesús; Prat Santaolària, Remei; Voces López, Carmen; Rial Boubeta, Antonio

2006-02-01

In the last 20 years the services sector has experienced a highly significant growth, being currently one of the most important economic sectors in our country. Inside the touristic sector, a strong competence has being experienced among the lodging and restoration establishments. In a scenario characterized by competitiveness, the bet for quality represents a difficult competitive advantage to surpass (García-Buedes, 2001). The objective of this study is to carry out an approach to the evaluation of the perceived quality of the restaurants. As a result of bibliographic revision, and also a first approach of a qualitative nature, we started from a scale of 31 items that included 5 dimensions: access, personal, service, product and installations. The results obtained applying the questionnaire to more than 2400 clients of 180 establishments of Santiago de Compostela and region, by means of structured interviews, confirmed that not all these dimensions had the same importance as predictors of customer satisfaction. Specifically, the product emerges as the most important dimension. Likewise, the elimination of the dimension service and a more exhaustive selection of the items, based on psychometric criteria, has permitted to define a brief scale, consisting of only 15 items, which makes it very attractive as a management tool. The final scale proposed to evaluate the perceived quality in the restaurant sector includes four fundamental and non-independent dimensions. These are, ordered by importance: product, personal, installations and access.

Development and Validation of a Gender Ideology Scale for Family Planning Services in Rural China

PubMed Central

Yang, Xueyan; Li, Shuzhuo; Feldman, Marcus W.

2013-01-01

The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field. PMID:23573222

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective

PubMed Central

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. Objectives: From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers’ expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. Materials and methods: The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach’s alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. Results: The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions’ internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale’s dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Conclusions: Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency. PMID:29796435

Identifying Shortcomings in the Measurement of Service Quality.

ERIC Educational Resources Information Center

Fogarty, Gerard; Catts, R.; Forlin, C.

2000-01-01

Studied the use of SERVPEFR the performance component of the Service Quality Scale (SERVQUAL) in 2 studies involving 113 and 212 customers of businesses in Australia and investigated a revised (extended) version of SERVPEFR with 122 customers. Results suggest that SERVPEFR items are too easy to rate highly, and that the revisions did not overcome…

Using GIS Models to Identify Relative Nitrogen Attenuation by Riparian Buffers in the Coastal Plain of North Carolina

EPA Science Inventory

Riparian areas have demonstrated the ability to attenuate nutrients and provide water quality services at the field scale, but services of riparian buffers for downstream users should be assessed at watershed scales. GIS-based riparian models have been developed to connect ripari...

A survey of the impact of owning a service dog on quality of life for individuals with physical and hearing disability: a pilot study.

PubMed

Hall, Sophie S; MacMichael, Jessica; Turner, Amy; Mills, Daniel S

2017-03-29

Quality of life refers to a person's experienced standard of health, comfort and happiness and is typically measured using subjective self-report scales. Despite increasing scientific interest in the value of dogs to human health and the growing demand for trained service dogs, to date no research has reported how service dogs may affect client perceptions of quality of life. We compared quality of life scores on the 16 item Flanagan quality of life scale from individuals who owned a trained service dog with those who were eligible to receive a dog, but did not yet have one (waiting list control). Data were analysed separately from two groups; those with a service dog trained for individuals with physical disabilities (with physical service dog: n = 72; waiting for a service dog: n = 24; recruited from Dogs for Good database) and those with a hearing service dog (with hearing service dog = 111; waiting for a service dog = 30; recruited from Hearing Dogs for Deaf People database). When controlling for age and gender individuals scored higher on total quality of life scores if they owned a service dog or a hearing service dog, but this was only statistically significant for those with a service dog. Both groups (physical service dog and hearing service dog) scored significantly higher on items relating to health, working, learning and independence if they owned a service dog, in comparison to those on the waiting list. Those with a physical service dog also scored significantly higher on items relating to recreational activities (including items relating to reading/listening to music, socialising, creative expression), and those involving social interactions (including items relating to participating in organisations, socialising, relationship with relatives). Additionally, those with a physical service dog scored higher on understanding yourself and material comforts than those on the waiting list control. In contrast, those with a hearing service dog appeared to receive fewer benefits on items relating to social activities. Owning a service dog can bring significant specific and potentially general benefits to the quality of life of individuals with physical disabilities and hearing impairments. These benefits may have considerable implications for individuals with disabilities, society and the economy by promoting independence, learning and working abilities.

Soil quality and water redistribution influences on plant production over low hillslopes on reclaimed mined land

USDA-ARS?s Scientific Manuscript database

A basic part of soils’ delivery of ecosystem services is the interaction between plant growth response to soil quality (SQ) factors at point scale and water redistribution effects at hillslope scale. To study the influence of SQ-indicator properties and water redistribution, we examined hillslope pr...

Techniques for Developing Health Quality of Life Scales for Point of Service Use

ERIC Educational Resources Information Center

Lee, Young-Sun; Douglas, Jeffrey; Chewning, Betty

2007-01-01

Clinical and health policy research frequently involves health status measurement using generic or disease specific instruments. These instruments are generally developed to arrive at several scales, each measuring a distinct domain of health quality of life (HQOL). Clinical settings are starting to explore how to integrate patient perspectives of…

Understanding relationships among ecosystem services across spatial scales and over time

NASA Astrophysics Data System (ADS)

Qiu, Jiangxiao; Carpenter, Stephen R.; Booth, Eric G.; Motew, Melissa; Zipper, Samuel C.; Kucharik, Christopher J.; Loheide, Steven P., II; Turner, Monica G.

2018-05-01

Sustaining ecosystem services (ES), mitigating their tradeoffs and avoiding unfavorable future trajectories are pressing social-environmental challenges that require enhanced understanding of their relationships across scales. Current knowledge of ES relationships is often constrained to one spatial scale or one snapshot in time. In this research, we integrated biophysical modeling with future scenarios to examine changes in relationships among eight ES indicators from 2001–2070 across three spatial scales—grid cell, subwatershed, and watershed. We focused on the Yahara Watershed (Wisconsin) in the Midwestern United States—an exemplar for many urbanizing agricultural landscapes. Relationships among ES indicators changed over time; some relationships exhibited high interannual variations (e.g. drainage vs. food production, nitrate leaching vs. net ecosystem exchange) and even reversed signs over time (e.g. perennial grass production vs. phosphorus yield). Robust patterns were detected for relationships among some regulating services (e.g. soil retention vs. water quality) across three spatial scales, but other relationships lacked simple scaling rules. This was especially true for relationships of food production vs. water quality, and drainage vs. number of days with runoff >10 mm, which differed substantially across spatial scales. Our results also showed that local tradeoffs between food production and water quality do not necessarily scale up, so reducing local tradeoffs may be insufficient to mitigate such tradeoffs at the watershed scale. We further synthesized these cross-scale patterns into a typology of factors that could drive changes in ES relationships across scales: (1) effects of biophysical connections, (2) effects of dominant drivers, (3) combined effects of biophysical linkages and dominant drivers, and (4) artificial scale effects, and concluded with management implications. Our study highlights the importance of taking a dynamic perspective and accounting for spatial scales in monitoring and management to sustain future ES.

National pilot audit of intermediate care.

PubMed

Hutchinson, Tom; Young, John; Forsyth, Duncan

2011-04-01

The National Service Framework for Older People resulted in the widespread introduction of intermediate care (IC) services. However, although these services have shared common aims, there has been considerable diversity in their staffing, organisation and delivery. Concerns have been raised regarding the clinical governance of IC with a paucity of data to evaluate the effectiveness, quality and safety of these services. This paper presents the results of a national pilot audit of IC services focusing particularly on clinical governance issues. The results confirm these concerns and provide support for a larger scale national audit of IC services to monitor and improve care quality.

The public water supply protection value of forests: A watershed-scale ecosystem services based upon total organic carbon

USDA-ARS?s Scientific Manuscript database

We developed a cost-based methodology to assess the value of forested watersheds to improve water quality in public water supplies. The developed methodology is applicable to other source watersheds to determine ecosystem services for water quality. We assess the value of forest land for source wate...

Developing a Scale for Perceptions of Competency in Teaching Quality

ERIC Educational Resources Information Center

Tasci, Guntay; Atar, Burcu

2016-01-01

The purpose of this study was to develop a measurement instrument for determining pre-service teachers' perceptions of competency in providing quality teaching. The initial phase of the instrument was consisted of 54 items that were composed based on theory and literature. The initial form was applied to 232 pre-service teachers. An exploratory…

Measuring relational security in forensic mental health services

PubMed Central

Chester, Verity; Alexander, Regi T.; Morgan, Wendy

2017-01-01

Aims and method Relational security is an important component of care and risk assessment in mental health services, but the utility of available measures remains under-researched. This study analysed the psychometric properties of two relational security tools, the See Think Act (STA) scale and the Relational Security Explorer (RSE). Results The STA scale had good internal consistency and could highlight differences between occupational groups, whereas the RSE did not perform well as a psychometric measure. Clinical implications The measures provide unique and complimentary perspectives on the quality of relational security within secure services, but have some limitations. Use of the RSE should be restricted to its intended purpose; to guide team discussions about relational security, and services should refrain from collecting and aggregating this data. Until further research validates their use, relational security measurement should be multidimensional and form part of a wider process of service quality assessment. PMID:29234515

Measuring relational security in forensic mental health services.

PubMed

Chester, Verity; Alexander, Regi T; Morgan, Wendy

2017-12-01

Aims and method Relational security is an important component of care and risk assessment in mental health services, but the utility of available measures remains under-researched. This study analysed the psychometric properties of two relational security tools, the See Think Act (STA) scale and the Relational Security Explorer (RSE). Results The STA scale had good internal consistency and could highlight differences between occupational groups, whereas the RSE did not perform well as a psychometric measure. Clinical implications The measures provide unique and complimentary perspectives on the quality of relational security within secure services, but have some limitations. Use of the RSE should be restricted to its intended purpose; to guide team discussions about relational security, and services should refrain from collecting and aggregating this data. Until further research validates their use, relational security measurement should be multidimensional and form part of a wider process of service quality assessment.

Mapping Biodiversity Metrics Representing Ecosystem Services at the Landscape Scale in the American Southwest

EPA Science Inventory

It is widely understood that human condition is intrinsically linked to the quality of the environment and the services it provides. Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conse...

A Framework and Improvements of the Korea Cloud Services Certification System.

PubMed

Jeon, Hangoo; Seo, Kwang-Kyu

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed.

A Framework and Improvements of the Korea Cloud Services Certification System

PubMed Central

Jeon, Hangoo

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed. PMID:26125049

Investment case for improving maternal and child health: results from four countries

PubMed Central

2013-01-01

Background Without addressing the constraints specific to disadvantaged populations, national health policies such as universal health coverage risk increasing equity gaps. Health system constraints often have the greatest impact on disadvantaged populations, resulting in poor access to quality health services among vulnerable groups. Methods The Investment Cases in Indonesia, Nepal, Philippines, and the state of Orissa in India were implemented to support evidence-based sub-national planning and budgeting for equitable scale-up of quality MNCH services. The Investment Case framework combines the basic setup of strategic problem solving with a decision-support model. The analysis and identification of strategies to scale-up priority MNCH interventions is conducted by in-country planners and policymakers with facilitation from local and international research partners. Results Significant variation in scaling-up constraints, strategies, and associated costs were identified between countries and across urban and rural typologies. Community-based strategies have been considered for rural populations served predominantly by public providers, but this analysis suggests that the scaling-up of maternal, newborn, and child health services requires health system interventions focused on 'getting the basics right'. These include upgrading or building facilities, training and redistribution of staff, better supervision, and strengthening the procurement of essential commodities. Some of these strategies involve substantial early capital expenditure in remote and sparsely populated districts. These supply-side strategies are not only the 'best buys', but also the 'required buys' to ensure the quality of health services as coverage increases. By contrast, such public supply strategies may not be the 'best buys' in densely populated urbanised settings, served by a mix of public and private providers. Instead, robust regulatory and supervisory mechanisms are required to improve the accessibility and quality of services delivered by the private sector. They can lead to important maternal mortality reductions at relatively low costs. Conclusions National strategies that do not take into consideration the special circumstances of disadvantaged areas risk disempowering local managers and may lead to a “business-as-usual” acceptance of unreachable goals. To effectively guide health service delivery at a local level, national plans should adopt typologies that reflect the different problems and strategies to scale up key MNCH interventions. PMID:23800035

Assessing Quality of Program Environments for Children and Youth with Autism: Autism Program Environment Rating Scale (APERS)

ERIC Educational Resources Information Center

Odom, Samuel L.; Cox, Ann; Sideris, John; Hume, Kara A.; Hedges, Susan; Kucharczyk, Suzanne; Shaw, Evelyn; Boyd, Brian A.; Reszka, Stephanie; Neitzel, Jennifer

2018-01-01

The purpose of this study was to examine the psychometric properties of the "Autism Program Environment Rating Scale" ("APERS"), an instrument designed to assess quality of program environments for students with autism spectrum disorder. Data sets from two samples of public school programs that provided services to children and…

Evaluation of outpatient service quality in Eastern Saudi Arabia

PubMed Central

Fraihi, Khalid J. Al; FAMCO, Dip; FAMCO, Fellow; Latif, Shahid A.

2016-01-01

Objectives: To investigate perceptions and expectations of patients regarding hospital outpatient services by using a service quality gap model and factors influencing such gaps. Methods: In this cross-sectional descriptive study conducted between October and November 2014 in the outpatient waiting areas of a hospital in the Eastern Province of Saudi Arabia, a sample of 306 patients was selected by convenience sampling technique. The data was collected through an Arabic version of the service quality (SERVQUAL) questionnaire consisting of 2 parts: patients’ demographic characteristics, and 22 items scales of patients’ expectations and perceptions of SERVQUAL. The data was analyzed by confirmatory factor analysis, independent, and paired t samples tests and one way analysis of variance test. Results: The results showed that the proposed model for service quality dimensions had a good fit by satisfying the recommended values. The patients’ expectations exceeded perceptions in all service quality dimensions indicating statistically significant service quality gaps (t=26.3, p<0.000). Findings revealed that the empathy dimension contributed most patients’ expectations (4.7 ± 0.5) and perceptions (3.7 ± 0.8) scores, and responsiveness contributed least to expectations (4.5 ± 0.6) and perceptions (3.2 ± 0.8) scores. Prompt services showed highest service quality gap, while observation of privacy showed the smallest service quality gap in the statements. The study showed a significant association between gender, age, education, multiple visits, and service quality dimensions. Conclusion: The proposed model is valid and reliable and significant service quality gaps of all 5 dimensions need to be prioritized and addressed by focused improvement efforts of hospital management. PMID:27052285

Evaluation of outpatient service quality in Eastern Saudi Arabia. Patient's expectations and perceptions.

PubMed

Al Fraihi, Khalid J; Latif, Shahid A

2016-04-01

To investigate perceptions and expectations of patients regarding hospital outpatient services by using a service quality gap model and factors influencing such gaps. In this cross-sectional descriptive study conducted between October and November 2014 in the outpatient waiting areas of a hospital in the Eastern Province of Saudi Arabia, a sample of 306 patients was selected by convenience sampling technique. The data was collected through an Arabic version of the service quality (SERVQUAL) questionnaire consisting of 2 parts: patients' demographic characteristics, and 22 items scales of patients' expectations and perceptions of SERVQUAL. The data was analyzed by confirmatory factor analysis, independent, and paired t samples tests and one way analysis of variance test The results showed that the proposed model for service quality dimensions had a good fit by satisfying the recommended values. The patients' expectations exceeded perceptions in all service quality dimensions indicating statistically significant service quality gaps (t=26.3, p less than 0.000). Findings revealed that the empathy dimension contributed most patients' expectations (4.7 ± 0.5) and perceptions (3.7 ± 0.8) scores, and responsiveness contributed least to expectations (4.5 ± 0.6) and perceptions (3.2 ± 0.8) scores. Prompt services showed highest service quality gap, while observation of privacy showed the smallest service quality gap in the statements. The study showed a significant association between gender, age, education, multiple visits, and service quality dimensions. The proposed model is valid and reliable and significant service quality gaps of all 5 dimensions need to be prioritized and addressed by focused improvement efforts of hospital management.

The endoscopy Global Rating Scale – Canada: Development and implementation of a quality improvement tool

PubMed Central

MacIntosh, Donald; Dubé, Catherine; Hollingworth, Roger; van Zanten, Sander Veldhuyzen; Daniels, Sandra; Ghattas, George

2013-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer. OBJECTIVE: To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided. METHODS: Based on feedback from 22 sites across Canada that completed the UK endoscopy GRS, and integrating results of the Canadian consensus on safety and quality indicators in endoscopy and other Canadian consensus reports, a working group of endoscopists experienced with the GRS developed the GRS-Canada (GRS-C). RESULTS: The GRS-C mirrors the two dimensions (clinical quality and quality of the patient experience) and 12 patient-centred items of the UK-GRS, but was modified to apply to Canadian health care infrastructure, language and current practice. Each item is assessed by a yes/no response to eight to 12 statements that are divided into levels graded D (basic) through A (advanced). A core team consisting of a booking clerk, charge nurse and the physician responsible for the unit is recommended to complete the GRS-C twice yearly. CONCLUSION: The GRS-C is intended to improve endoscopic services in Canada by providing endoscopy units with a straightforward process to review the quality of the service they provide. PMID:23472242

SEQUenCE: a service user-centred quality of care instrument for mental health services.

PubMed

Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

2015-08-01

To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Confirmatory Factor Analysis of a Family Quality of Life Scale for Taiwanese Families of Children With Intellectual Disability/Developmental Delay.

PubMed

Chiu, Chun-Yu; Seo, Hyojeong; Turnbull, Ann P; Summers, Jean Ann

2017-04-01

The Beach Center Family Quality of Life Scale is an internationally validated instrument for measuring family outcomes. To revise the scale for better alignment with the Family Quality of Life theory, the authors excluded non-outcome items in this revision. In this study, we examined reliability and validity of the revised scale (i.e., the FQoL Scale-21) and its scores for Taiwanese families of children and youth with intellectual disability and developmental delay (age 0-18). Results from 400 Taiwanese respondents suggested that the FQoL Scale-21 has the potential to be used as an indicator of positive outcomes in intervention evaluation, policy making, and service delivery.

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

PubMed

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

2009-09-01

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

Teaching Quality and Student Satisfaction: Nexus or Simulacrum?

ERIC Educational Resources Information Center

Beecham, Rod

2009-01-01

Quality has clear meanings when associated with specific phenomena. The relative nature of quality in commercial contexts, specifically in relation to manufactured goods, has been studied. In service industries there is no satisfactory indicator of quality. The Likert-scale questionnaire does not allow the researcher to distinguish between…

Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International

PubMed Central

Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

2015-01-01

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014—up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI’s 17 and PSI’s 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations’ operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential to contribute to universal health coverage. PMID:26085017

Identifying role of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M

2016-06-24

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.

Modelling End-User of Electronic-Government Service: The Role of Information quality, System Quality and Trust

NASA Astrophysics Data System (ADS)

Witarsyah Jacob, Deden; Fudzee, Mohd Farhan Md; Aizi Salamat, Mohamad; Kasim, Shahreen; Mahdin, Hairulnizam; Azhar Ramli, Azizul

2017-08-01

Many governments around the world increasingly use internet technologies such as electronic government to provide public services. These services range from providing the most basic informational website to deploying sophisticated tools for managing interactions between government agencies and beyond government. Electronic government (e-government) aims to provide a more accurate, easily accessible, cost-effective and time saving for the community. In this study, we develop a new model of e-government adoption service by extending the Unified Theory of Acceptance and Use of Technology (UTAUT) through the incorporation of some variables such as System Quality, Information Quality and Trust. The model is then tested using a large-scale, multi-site survey research of 237 Indonesian citizens. This model will be validated by using Structural Equation Modeling (SEM). The result indicates that System Quality, Information Quality and Trust variables proven to effect user behavior. This study extends the current understanding on the influence of System Quality, Information Quality and Trust factors to researchers, practitioners, and policy makers.

The impact of a quality-improvement package on reproductive health services delivered by private providers in Uganda.

PubMed

Agha, Sohail

2010-09-01

This study assesses the effectiveness of a quality-improvement (QI) package designed to enable small-scale commercial reproductive health (RH) service providers to improve the services they offer. The study was conducted among midwives who are members of the Uganda Private Midwives Association. A pretest-post-test quasi-experimental panel study design was used wherein midwife clinics were allocated to two experimental groups and one control group. Baseline and follow-up measurements of structural and process attributes of quality were taken at the clinics by means of a facility inventory, interviews with midwives, and observations of client-provider interactions. Nearly 70 percent of the midwives who were trained to use the package reported that it was easy to use. Among clinics in which midwives received training in the use of the self-assessment tool and in developing action plans, structural and process attributes of quality improved only among those clinics in which the midwives' supervisors received training in finding solutions to the problems identified through self-assessments. The QI package may be implemented with small-scale private providers of RH services who are part of a professional association, network, or franchise that supervises their performance.

Urban Air Quality Modelling with AURORA: Prague and Bratislava

NASA Astrophysics Data System (ADS)

Veldeman, N.; Viaene, P.; De Ridder, K.; Peelaerts, W.; Lauwaet, D.; Muhammad, N.; Blyth, L.

2012-04-01

The European Commission, in its strategy to protect the health of the European citizens, states that in order to assess the impact of air pollution on public health, information on long-term exposure to air pollution should be available. Currently, indicators of air quality are often being generated using measured pollutant concentrations. While air quality monitoring stations data provide accurate time series information at specific locations, air quality models have the advantage of being able to assess the spatial variability of air quality (for different resolutions) and predict air quality in the future based on different scenarios. When running such air quality models at a high spatial and temporal resolution, one can simulate the actual situation as closely as possible, allowing for a detailed assessment of the risk of exposure to citizens from different pollutants. AURORA (Air quality modelling in Urban Regions using an Optimal Resolution Approach), a prognostic 3-dimensional Eulerian chemistry-transport model, is designed to simulate urban- to regional-scale atmospheric pollutant concentration and exposure fields. The AURORA model also allows to calculate the impact of changes in land use (e.g. planting of trees) or of emission reduction scenario's on air quality. AURORA is currently being applied within the ESA atmospheric GMES service, PASODOBLE (http://www.myair-eu.org), that delivers information on air quality, greenhouse gases, stratospheric ozone, … At present there are two operational AURORA services within PASODOBLE. Within the "Air quality forecast service" VITO delivers daily air quality forecasts for Belgium at a resolution of 5 km and for the major Belgian cities: Brussels, Ghent, Antwerp, Liege and Charleroi. Furthermore forecast services are provided for Prague, Czech Republic and Bratislava, Slovakia, both at a resolution of 1 km. The "Urban/regional air quality assessment service" provides urban- and regional-scale maps (hourly resolution) for air pollution and human exposure statistics for an entire year. So far we concentrated on Brussels, Belgium and the Rotterdam harbour area, The Netherlands. In this contribution we focus on the operational forecast services. Reference Lefebvre W. et al. (2011) Validation of the MIMOSA-AURORA-IFDM model chain for policy support: Modeling concentrations of elemental carbon in Flanders, Atmospheric Environment 45, 6705-6713

Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients.

PubMed

Duffy, Sonia A; Terrell, Jeffrey E; Valenstein, Marcia; Ronis, David L; Copeland, Laurel A; Connors, Mary

2002-01-01

This pilot study examined the relationship between smoking, alcohol intake, depressive symptoms and quality of life (QoL) in head and neck cancer patients. A questionnaire on smoking, alcohol, depressive symptoms and QoL was distributed to head and neck cancer patients (N=81). Over one-third (35%) of the respondents had smoked within the last 6 months, 46% had drunk alcohol within the last 6 months and 44% screened positive for significant depressive symptoms. About one-third (32%) of smokers were interested in smoking cessation services and 37% of patients with depressive symptoms were interested in depression services. However, only 9% of those who drank alcohol expressed interest in alcohol services. Smoking was negatively associated with five scales of the SF-36V including Physical Functioning, General Health, Vitality, Social Functioning, and Role-Emotional Health. Depressive symptoms were negatively associated with all eight scales on the SF-36V and all four scales of the Head and Neck Quality of Life instrument. Surprisingly, alcohol was not found to be associated with any of the QoL scales. While smoking, alcohol intake and depression may be episodically treated, standardized protocols and aggressive intervention strategies for systematically addressing these highly prevalent disorders are needed in this population.

Valuing the non-market benefits of estuarine ecosystem services in a river basin context: Testing sensitivity to scope and scale

NASA Astrophysics Data System (ADS)

Pinto, R.; Brouwer, R.; Patrício, J.; Abreu, P.; Marta-Pedroso, C.; Baeta, A.; Franco, J. N.; Domingos, T.; Marques, J. C.

2016-02-01

A large scale contingent valuation survey is conducted among residents in one of the largest river basins in Portugal to estimate the non-market benefits of the ecosystem services associated with implementation of the European Water Framework Directive (WFD). Statistical tests of public willingness to pay's sensitivity to scope and scale are carried out. Decreasing marginal willingness to pay (WTP) is found when asking respondents to value two water quality improvement scenarios (within sample comparison), from current moderate water quality conditions to good and subsequently excellent ecological status. However, insensitivity to scale is found when asking half of the respondents to value water quality improvements in the estuary only and the other half in the whole basin (between sample comparison). Although respondents living outside the river basin value water quality improvements significantly less than respondents inside the basin, no spatial heterogeneity can be detected within the basin between upstream and downstream residents. This finding has important implications for spatial aggregation procedures across the population of beneficiaries living in the river basin to estimate its total economic value based on public WTP for the implementation of the WFD.

Creating an Excellent Patient Experience Through Service Education: Content and Methods for Engaging and Motivating Front-Line Staff.

PubMed

Kennedy, Denise M

2017-12-01

Service quality and patient satisfaction affect an organization's value-based payments. This new value paradigm calls for a new approach to service education and training for front-line staff. Thoughtfully conceived, department-specific content, infused with patient feedback, value creation, and science of service quality principles, was developed to give front-line staff a deeper understanding of the impact of their performance on patient experience, value creation, and value-based revenue. Feedback from nearly 1500 trainees in 60 educational sessions delivered over 7 years indicates good understanding of the content and appreciation of the targeted approach. On a 5-point scale ranging from 1 (least effective) to 5 (most effective), trainees' ratings of their understanding of service quality concepts and impact on value ranged from 4.7 to 4.9. Verbatim comments showed a positive impact on staff. Employee feedback suggests that value-based service education may be useful in motivating front-line staff, improving service quality, and creating value.

Creating an Excellent Patient Experience Through Service Education

PubMed Central

2017-01-01

Service quality and patient satisfaction affect an organization’s value-based payments. This new value paradigm calls for a new approach to service education and training for front-line staff. Thoughtfully conceived, department-specific content, infused with patient feedback, value creation, and science of service quality principles, was developed to give front-line staff a deeper understanding of the impact of their performance on patient experience, value creation, and value-based revenue. Feedback from nearly 1500 trainees in 60 educational sessions delivered over 7 years indicates good understanding of the content and appreciation of the targeted approach. On a 5-point scale ranging from 1 (least effective) to 5 (most effective), trainees’ ratings of their understanding of service quality concepts and impact on value ranged from 4.7 to 4.9. Verbatim comments showed a positive impact on staff. Employee feedback suggests that value-based service education may be useful in motivating front-line staff, improving service quality, and creating value. PMID:29276761

Preliminary investigation of the STBBI Stigma Scale: Description and pilot results.

PubMed

Wagner, Anne C; MacLean, Rachel

2017-11-09

Sexually transmitted and blood-borne infections (STBBIs) are associated with stigmatizing attitudes and beliefs, which can affect the quality of and access to health care, as well as mental health and quality of life. The current study describes the adaptation from an HIV-related stigma scale and pilot testing of a new STBBI Stigma Scale, assessing the stigmatizing attitudes and beliefs of health and social service providers in Canada. 144 health and social service providers from across Canada completed the newly adapted scale assessing stigma associated with HIV, hepatitis C, other viral STBBIs and bacterial STBBIs, as well as demographic information, a scale of social desirability and measures of convergent and divergent validity. Participants were recruited through listservs and completed the scale online. The new scale, consisting of 21 items for each category, demonstrated excellent internal consistency, reliability, and convergent and divergent validity. The factor structure of the scale supports a tripartite model of stigma consisting of stereotyping, prejudice and discrimination. Stereotyping had the highest relative scores on the subscales, and attitudes regarding other viral STBBIs differed significantly from the other STBBI categories. The new scale provides a contextually relevant and applicable psychometrically valid tool to assess STBBI-related stigma among health and social service providers in Canada. The tool can be used to assess attitudes and beliefs, as well as guide self-assessment and possible trainings for providers.

Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, R M; Abdullah, M S; Rahman, A M; Alam, A M

2015-04-01

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic Service Satisfaction (CCSS) scale (chronbach's α = 0.97), were constructed and validated for measuring perceived service quality and satisfaction in Bangladesh context. This study showed mothers with preprimary education [(χ2 = 4.20, p = 0.04), AOR with 95% CI = 1.89 (1.03, 3.53)] utilized the limited curative care services more than educated mothers. On the contrary, higher income families [for income group 5000-10,000 BDT χ2 = 8.83, p = 0.003 and AOR with 95% CI = 0.37(0.19, 0.71)] and [for income group above 10,000 BDT χ2 = 5.02, p = 0.025 and AOR with 95% CI = 0.40 (0.18, 0.89)] and families having cultivable lands [for 5-10 decimal group χ2 = 5.51, p = 0.19, and AOR with 95% CI = 0.56 (0.35, 0.91)] and [for > 10 decimal group χ2 = 6.70, p = 0.010, and AOR with 95% CI = 0.50 (0.29, 0.84)] utilized the limited curative care services less than their poorer and landless counterpart. The same relationship was observed in case of health education and Antenatal Care (ANC) and Postnatal Care (PNC) services. Women who lived in their own residence used health education services more frequently than those who lived in a rental house [χ2 = 24.00, p = 0.000 and AOR with 95% CI = 1.21, (1.12, 1.30)] and they also increasingly used maternal and child health services χ2 = 27.49, p = 0.000 and AOR with 95% CI 1.61, (1.35, 1.93)]. Perceptions concerning skill and competence of the health care provider [χ2 = 16.90, p = 0.000 and AOR with 95% CI = 1.14, (1.07, 1.22)] and satisfaction indicating interpersonal communication and attitude of the care provider [χ2 = 7.07, p = 0.008 AOR with 95% CI = 1.08, (1.02, 1.15)] were found significant predictors for limited curative care service utilization of CC. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues also played significant role on CC's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in CC service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers .to improve quality of primary health care services, realizing providers' and patients' ideas of CC service quality.

Association between the perspective of adult inpatients with digestive cancer regarding the nursing service and their quality of recovery on postoperative day 3.

PubMed

Sasaki, Kumiko; Tamakoshi, Koji

2018-02-01

Although qualitative research that focuses on inpatients' experience immediately after surgery has continued to elucidate the efficacy of the nursing service for postoperative recovery, there has been little quantitative research. Our aim was to quantitatively clarify the association between inpatients' perception of the nursing service and the quality of postoperative recovery. Seventy-one digestive cancer patients who underwent surgery were recruited. Participants completed two self-administered questionnaires, including the Japanese version of the 40-item postoperative Quality of Recovery scale (QoR-40J) and the Nursing Service Quality Scale for Japan (NURSERV-J) which has 22 items and five dimensions (tangibles, reliability, responsiveness, assurance, and empathy) on postoperative day 3. There were significant positive associations between the global scores of the NURSERV-J and the QoR-40J. The global score of the QoR-40J was compared between patients who gave full marks for each dimension of the NURSERV-J (the entirely satisfied group) and those who did not (the not entirely satisfied group). The entirely satisfied groups regarding tangibles, reliability and responsiveness had a significantly higher global score for the QoR-40J than the respective not entirely satisfied groups. Adjusted for age, gender, operative procedure, and duration of surgery, the entirely satisfied groups regarding tangibles and responsiveness had a significant higher global score for the QoR-40J than the respective not entirely satisfied groups. Patients who perceived that they had received a nursing service of high quality were likely to attain a high quality of postoperative recovery. Nursing services related to tangibles, reliability, and responsiveness especially contributed to postoperative recovery.

From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services.

PubMed

Daleiden, Eric L; Chorpita, Bruce F

2005-04-01

The Hawaii Department of Health Child and Adolescent Mental Health Division has explored various strategies to promote widespread use of empirical evidence to improve the quality of services and outcomes for youth. This article describes a core set of clinical decisions and how several general and local evidence bases may inform those decisions. Multiple quality improvement strategies are illustrated in the context of a model that outlines four phases of evidence: data, information, knowledge, and wisdom.

Free-standing health care facilities: financial arrangements, quality assurance and a pilot study

PubMed Central

Lavis, J N; Lomas, J; Anderson, G M; Donner, A; Iscoe, N A; Gold, G; Craighead, J

1998-01-01

Free-standing health care facilities now deliver many diagnostic and therapeutic services formerly provided only in hospitals. The financial arrangements available to these facilities differ according to whether the services are uninsured or insured. For an uninsured service, such as cosmetic surgery, the patient pays a fee directly to the service provider. For an insured service, such as cataract surgery, the provincial government uses tax revenues to fund the facility by paying it a facility fee and remunerates the physician who provided the service with a professional fee. No comprehensive, proactive quality assurance efforts have been implemented for either these facilities or the clinical practice provided within them. A pilot study involving therapeutic facilities in Ontario has suggested that a large-scale quality improvement effort could be undertaken in these facilities and rigorously evaluated. PMID:9484263

Free-standing health care facilities: financial arrangements, quality assurance and a pilot study.

PubMed

Lavis, J N; Lomas, J; Anderson, G M; Donner, A; Iscoe, N A; Gold, G; Craighead, J

1998-02-10

Free-standing health care facilities now deliver many diagnostic and therapeutic services formerly provided only in hospitals. The financial arrangements available to these facilities differ according to whether the services are uninsured or insured. For an uninsured service, such as cosmetic surgery, the patient pays a fee directly to the service provider. For an insured service, such as cataract surgery, the provincial government uses tax revenues to fund the facility by paying it a facility fee and remunerates the physician who provided the service with a professional fee. No comprehensive, proactive quality assurance efforts have been implemented for either these facilities or the clinical practice provided within them. A pilot study involving therapeutic facilities in Ontario has suggested that a large-scale quality improvement effort could be undertaken in these facilities and rigorously evaluated.

How services for children with disabilities in Serbia affect the quality of life of their families.

PubMed

Ignjatovic, Tamara Dzamonja; Milanovic, Marko; Zegarac, Nevenka

2017-09-01

Families that have children with disabilities face numerous difficulties related to the lack of services support, social isolation and poverty in Serbia. Mostly due to the prolonged effect of social and economic crisis, there are insufficient adequate and diverse community-based services for those families. The aim of the study was to examine the effect of newly introduced services on the quality of families' life. A pretest/posttest study was conducted at the beginning of service and one year later to evaluate the effect of services measured by Family Quality of Life Scale (Hoffman et al., 2006). The sample consists of 153 families of children with disabilities from 35 different places in Serbia. The results show that the services generally improved the families' quality of life, particularly in the aspects targeted by services, but also had significant positive effect on family interaction and parenting. The services had the highest impact on the families that perceived the lowest life quality before using them. The life quality was improved, regardless of the type of services, but the effectiveness is affected by the severity of child disability. The results might be useful for further steps in developing and evaluating individually and flexible tailored service that support families' needs and suits them the best. Copyright © 2017 Elsevier Ltd. All rights reserved.

Leveraging the private health sector to enhance HIV service delivery in lower-income countries.

PubMed

Rao, Pamela; Gabre-Kidan, Tesfai; Mubangizi, Deus Bazira; Sulzbach, Sara

2011-08-01

Evidence that the private health sector is a key player in delivering health services and impacting health outcomes, including those related to HIV/AIDS, underscores the need to optimize the role of the private health sector to scale up national HIV responses in lower-income countries. This article reviews findings on the types of HIV/AIDS services provided by the private health sector in developing countries and elaborates on the role of private providers of HIV services in Ethiopia. Drawing on data from the nation's innovative Private Health Sector Project, a pilot project that has demonstrated the feasibility of public-private partnerships in this area, the article highlights the potential for national governments to scale up HIV/AIDS services by leveraging private health sector resources, innovations, and expertise while working to regulate quality and cost of services. Although concerns about uneven quality and affordability of private sector health services must be addressed through regulation, policy, or other innovative approaches, we argue that the benefits of leveraging the private sector outweigh these challenges, particularly in light of finite donor and public domestic resources.

Quality Indicators of Cervical Cytopathology Tests in the Public Service in Minas Gerais, Brazil.

PubMed

Tobias, Alessandra Hermógenes Gomes; Amaral, Rita Goreti; Diniz, Elói Martins; Carneiro, Cláudia Martins

2016-02-01

The objective of this study is to assess the performance of cytopathology laboratories providing services to the Brazilian Unified Health System (Sistema Único de Saúde - SUS) in the State of Minas Gerais, Brazil. This descriptive study uses data obtained from the Cervical Cancer Information System from January to December 2012. Three quality indicators were analyzed to assess the quality of cervical cytopathology tests: positivity index, percentage of atypical squamous cells (ASCs) in abnormal tests, and percentage of tests compatible with high-grade squamous intraepithelial lesions (HSILs). Laboratories were classified according to their production scale in tests per year ≤ 5,000; from 5,001 to 10,000; from 10,001 to 15,000; and ≥ 15,001. Based on the collection of variables and the classification of laboratories according to production scale, we created and analyzed a database using Microsoft Office Excel 97-2003. In the Brazilian state of Minas Gerais, 146 laboratories provided services to the SUS in 2012 by performing a total of 1,277,018 cervical cytopathology tests. Half of these laboratories had production scales ≤ 5,000 tests/year and accounted for 13.1% of all tests performed in the entire state; in turn, 13.7% of these laboratories presented production scales of > 15,001 tests/year and accounted for 49.2% of the total of tests performed in the entire state. The positivity indexes of most laboratories providing services to the SUS in 2012, regardless of production scale, were below or well below recommended limits. Of the 20 laboratories that performed more than 15,001 tests per year, only three presented percentages of tests compatible with HSILs above the lower limit recommended by the Brazilian Ministry of Health. The majority of laboratories providing services to the SUS in Minas Gerais presented quality indicators outside the range recommended by the Brazilian Ministry of Health. Thieme Publicações Ltda Rio de Janeiro, Brazil.

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...

Clinical Utility and Psychometric Properties of the Traumatic Brain Injury Quality of Life Scale (TBI-QOL) in US Military Service Members.

PubMed

Lange, Rael T; Brickell, Tracey A; Bailie, Jason M; Tulsky, David S; French, Louis M

2016-01-01

To examine the clinical utility and psychometric properties of the Traumatic Brain Injury Quality of Life (TBI-QOL) scale in a US military population. One hundred fifty-two US military service members (age: M = 34.3, SD = 9.4; 89.5% men) prospectively enrolled from the Walter Reed National Military Medical Center and other nationwide community outreach initiatives. Participants included 99 service members who had sustained a mild traumatic brain injury (TBI) and 53 injured or noninjured controls without TBI (n = 29 and n = 24, respectively). Participants completed the TBI-QOL scale and 5 other behavioral measures, on average, 33.8 months postinjury (SD = 37.9). Fourteen TBI-QOL subscales; Neurobehavioral Symptom Inventory; Posttraumatic Stress Disorder Checklist-Civilian version; Alcohol Use Disorders Identification Test; Combat Exposure Scale. The internal consistency reliability of the TBI-QOL scales ranged from α = .91 to α = .98. The convergent and discriminant validity of the 14 TBI-QOL subscales was high. The mild TBI group had significantly worse scores on 10 of the 14 TBI-QOL subscales than the control group (range, P < .001 to P = .043). Effect sizes ranged from medium to very large (d = 0.35 to d = 1.13). The largest differences were found on the Cognition-General Concerns (d = 1.13), Executive Function (d = 0.94), Grief-Loss (d = 0.88), Pain Interference (d = 0.83), and Headache Pain (d = 0.83) subscales. These results support the use of the TBI-QOL scale as a measure of health-related quality of life in a mild TBI military sample. Additional research is recommended to further evaluate the clinical utility of the TBI-QOL scale in both military and civilian settings.

Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study.

PubMed

Mayston, Rosie; Habtamu, Kassahun; Medhin, Girmay; Alem, Atalay; Fekadu, Abebaw; Habtamu, Alehegn; Prince, Martin; Hanlon, Charlotte

2017-03-09

Service satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient's responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up. We used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new 'Mental health service satisfaction scale' (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers). Factors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct. Our findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement.

Identifying shortcomings in the measurement of service quality.

PubMed

Fogarty, G; Catts, R; Forlin, C

2000-01-01

SERVPEFR, the performance component of the Service Quality Scale (SERVQUAL), has been shown to measure five underlying dimensions corresponding to Tangibles, Reliability, Responsiveness, Assurance, and Empathy (Parasuraman, Zeithaml, & Berry, 1988). This paper describes three separate studies employing SERVPERF in an Australian context. In the first of these studies (N = 113), a shortened 15-item version of the SERVPERF scale (SERVPERF-R) was found to be suitable for use in an Australian small business setting. A five-factor structure was identifiable but the factors were highly correlated, suggesting that they were not clearly distinct. The tendency for marked negative skewness observed by other researchers was also noted here. A follow-up study involving three other small businesses (N = 212) used Rasch analysis to test assumptions about the spread of items on the underlying continuum. These analyses indicated that there is an even, though narrow, spread of items across the continuum. The Rasch analysis suggested that the items in both SERVPERF and SERVPERF-R are too easy to rate highly and that more "difficult" items need to be added to the scale. The third study (N = 122) was conducted using a version of SERVPERF-R that included seven new items intended to extend the range of the scale. The new items, however, did not achieve this desirable outcome. The implications for service quality assessment are discussed.

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation

PubMed Central

Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Mumba, Grace Tembo; Gill, Michelle M.; Strasser, Susan; Peeling, Rosanna W.; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider’s perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up. PMID:25970443

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

PubMed

Shelley, Katharine D; Ansbro, Éimhín M; Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Tembo Mumba, Grace; Gill, Michelle M; Strasser, Susan; Peeling, Rosanna W; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider's perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up.

Pro-Bono Service Through Student-Run Clinics: How Does Physical Therapy Measure Up?

PubMed

Stickler, Kellie; Sabus, Carla; Gustafson, Hedi; Kueser, Molly; Lavaveshkul, Bridget; Denney, Linda

2016-01-01

The objectives of this paper were to evaluate pre- to post-treatment outcomes of patients attending a student-run free physical therapy clinic in order to provide new evidence concerning patient response to student care. We hypothesize improved functional and quality of life scores as measured by outcome scales. Twenty-eight patients were included in this retrospective chart review. Data were analyzed through SPSS Statistical software (ver. 13) using paired t-tests to compare baseline and follow-up data for the following measures: blood pressure, numeric pain rating scale (NPRS), quality of life visual analog scale, SF-8 quality of life scale, and population demographics. Most of the patient population was between the ages of 30 and 59 yrs (78.4%) with an unemployment rate of 75%. Significant changes (p<0.05) were exhibited in both the physical health portion of the SF-8 survey and the NPRS. Although not statistically significant, the mental health portion of the SF-8 survey showed notable improvement. Service learning provides opportunities for students to serve the community while expanding clinical experience. The results demonstrated the effectiveness of student-run pro-bono physical therapy clinics in improving the quality of life for both physical and pain measures.

A quality tool for health insurers. A new scale measures "quality orientation" from the customer's point of view.

PubMed

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.

Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service.

PubMed

Raspollini, E; Pappalettera, M; Riccardi, D; Parravicini, A; Sestili, S; Rebulla, P; Sirchia, G

1997-01-01

Limited information is available on the level of satisfaction of clinicians with services delivered by blood banks. The purpose of this study was to evaluate the satisfaction of clinicians with our blood transfusion service. We prepared a questionnaire based on SERVQUAL, a method used to measure customers' appreciation of quality of service, by assessing the gap between perceived and expected quality. The questionnaire consisted of 14 items grouped according to five dimensions of quality of service: assurance, empathy, responsiveness, reliability, tangibles. Clinicians were asked to give two scores on a scale from 1 to 7 for each item, score (e) representing what they expected from an 'excellent' service, score (r) how they graded the service received. We considered wide differences in scores of service expectation and receipt for a question to be indicative of either service above expected levels (r > e) or service below expectation (r < e); similar scores for both expected and received service (within 1 point on the grading scale) were taken to indicate that the service received was that which was expected. A total of 184 questionnaires (49%) were returned. For the 14 items considered, the proportion of clinicians expressing levels of satisfaction similar to or above expectation ranged from 67 to 96%. Three critical areas, which clinicians considered important (expectation scores 6-7) were associated with satisfaction below expectation in more than 20% of responders. They were: clarity of procedures, clarity of blood request forms, and convenience of blood request and issuing times, which were rated as important by 77, 80 and 72% of clinicians, respectively. SERVQUAL was useful to gather information on the level of clinicians' satisfaction with our transfusion service.

Analysis of Student Satisfaction in The Process of Teaching and Learning Using Importance Performance Analysis

NASA Astrophysics Data System (ADS)

Sembiring, P.; Sembiring, S.; Tarigan, G.; Sembiring, OD

2017-12-01

This study aims to determine the level of student satisfaction in the learning process at the University of Sumatra Utara, Indonesia. The sample size of the study consisted 1204 students. Students’ response measured through questionnaires an adapted on a 5-point likert scale and interviews directly to the respondent. SERVQUAL method used to measure the quality of service with five dimensions of service characteristics, namely, physical evidence, reliability, responsiveness, assurance and concern. The result of Importance Performance Analysis reveals that six services attributes must be corrected by policy maker of University Sumatera Utara. The quality of service is still considered low by students.

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

PubMed

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[General background and practical implementation of the health management service institution in Korea].

PubMed

Okahara, Shintaro; Lee, Byeong-Woo; Ogasawara, Takayuki; Mori, Koji

2014-09-01

The Korean Occupational Safety and Health Act requires an employer with more than 50 employees to assign a health manager or an occupational physician. However, there are many cases where it is difficult for medium-scale enterprises to perform occupational health practices autonomously because their financial base is weaker than that of large-scale enterprises. The Korean Occupational Safety and Health Act was amended in 1990 so that medium-scale enterprises could entrust a health management service institution with their health management tasks. This system is similar to the outsourcing of medical examinations, occupational physicians, or the measurement of the working environment in Japan, but its legal background and actual activities are korea-specific, and it has some different points. In particular, the quality control of health management service institutions by legal and administrative regulations, and the multidisciplinary provision of services contribute to the development of occupational health in medium-scale enterprises. This will be a good reference for occupational health services in small- and medium-scale enterprises in the future in Japan.

Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

PubMed

Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

2017-01-01

Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). The study suggests that service quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients' point of view as most aspects of service quality in public hospitals of Pakistan, require improvements. In this manner patient's satisfaction regarding use of services in public hospitals can be made better.

Approaches to Mapping Nitrogen Removal: Examples at a Landscape Scale

EPA Science Inventory

Wetlands can provide the ecosystem service of improved water quality via nitrogen removal, providing clean drinking water and reducing the eutrophication of aquatic resources. Within the ESRP, mapping nitrogen removal by wetlands is a service that incorporates the goals of the ni...

Measuring conditions and trends in ecosystem services at multiple scales: the Southern African Millennium Ecosystem Assessment (SAfMA) experience

PubMed Central

van Jaarsveld, A.S; Biggs, R; Scholes, R.J; Bohensky, E; Reyers, B; Lynam, T; Musvoto, C; Fabricius, C

2005-01-01

The Southern African Millennium Ecosystem Assessment (SAfMA) evaluated the relationships between ecosystem services and human well-being at multiple scales, ranging from local through to sub-continental. Trends in ecosystem services (fresh water, food, fuel-wood, cultural and biodiversity) over the period 1990–2000 were mixed across scales. Freshwater resources appear strained across the continent with large numbers of people not securing adequate supplies, especially of good quality water. This translates to high infant mortality patterns across the region. In some areas, the use of water resources for irrigated agriculture and urban–industrial expansion is taking place at considerable cost to the quality and quantity of freshwater available to ecosystems and for domestic use. Staple cereal production across the region has increased but was outstripped by population growth while protein malnutrition is on the rise. The much-anticipated wood-fuel crisis on the subcontinent has not materialized but some areas are experiencing shortages while numerous others remain vulnerable. Cultural benefits of biodiversity are considerable, though hard to quantify or track over time. Biodiversity resources remain at reasonable levels, but are declining faster than reflected in species extinction rates and appear highly sensitive to land-use decisions. The SAfMA sub-global assessment provided an opportunity to experiment with innovative ways to assess ecosystem services including the use of supply–demand surfaces, service sources and sink areas, priority areas for service provision, service ‘hotspots’ and trade-off assessments. PMID:15814355

Measuring conditions and trends in ecosystem services at multiple scales: the Southern African Millennium Ecosystem Assessment (SAfMA) experience.

PubMed

van Jaarsveld, A S; Biggs, R; Scholes, R J; Bohensky, E; Reyers, B; Lynam, T; Musvoto, C; Fabricius, C

2005-02-28

The Southern African Millennium Ecosystem Assessment (SAfMA) evaluated the relationships between ecosystem services and human well-being at multiple scales, ranging from local through to sub-continental. Trends in ecosystem services (fresh water, food, fuel-wood, cultural and biodiversity) over the period 1990-2000 were mixed across scales. Freshwater resources appear strained across the continent with large numbers of people not securing adequate supplies, especially of good quality water. This translates to high infant mortality patterns across the region. In some areas, the use of water resources for irrigated agriculture and urban-industrial expansion is taking place at considerable cost to the quality and quantity of freshwater available to ecosystems and for domestic use. Staple cereal production across the region has increased but was outstripped by population growth while protein malnutrition is on the rise. The much-anticipated wood-fuel crisis on the subcontinent has not materialized but some areas are experiencing shortages while numerous others remain vulnerable. Cultural benefits of biodiversity are considerable, though hard to quantify or track over time. Biodiversity resources remain at reasonable levels, but are declining faster than reflected in species extinction rates and appear highly sensitive to land-use decisions. The SAfMA sub-global assessment provided an opportunity to experiment with innovative ways to assess ecosystem services including the use of supply-demand surfaces, service sources and sink areas, priority areas for service provision, service 'hotspots' and trade-off assessments.

Home-Based Care and Perceived Quality of Life Among People Living with HIV in Ho Chi Minh City, Viet Nam.

PubMed

Bui, Quyen Thi Tu; Brickley, Deborah Bain; Tieu, Van Thi Thu; Hills, Nancy K

2018-03-31

We conducted a cross-sectional study to examine the perceptions of quality of life among people living with HIV who received home-based care services administered through outpatient clinics in Ho Chi Minh City, Viet Nam. Data were collected from a sample of 180 consecutively selected participants (86 cases, 94 controls) at four outpatient clinics, all of whom were on antiretroviral therapy. Quality of life was evaluated using the WHOQOL-BREF instrument. In adjusted analysis, those who received home-based care services had a quality of life score 4.08 points higher (on a scale of 100) than those who did not receive home-based care services (CI 95%, 2.32-5.85; p < 0.001). The findings suggest that home-based care is associated with higher self-perceptions of quality of life among people living with HIV.

Quality of Life, Integrative Community Therapy, Family Support, and Satisfaction with Health Services Among Elderly Adults with and without Symptoms of Depression.

PubMed

de Lima Silva, Vanessa; de Medeiros, Caroline Addison Carvalho Xavier; Guerra, Gerlane Coelho Bernardo; Ferreira, Priscila Helena Antunes; de Araújo Júnior, Raimundo Fernandes; de Araújo Barbosa, Stphannie Jamyla; de Araújo, Aurigena Antunes

2017-06-01

The aim of this cross-sectional study was to analyse quality of life, socio-demographic characteristics, family support, satisfaction with health services, and effect of integrative community therapy among non-institutionalised elderly adults with and without symptoms of depression in the state of Rio Grande do Norte, Brazil. Data from elderly adults with (n = 59) and without (n = 61) depressive symptoms were compared. The instruments used were the Mini-Mental State Examination, the short version of the Geriatric Depression Scale, a clinical socio-demographic questionnaire, the abbreviated version of the World Health Organisation Quality of Life questionnaire, the Family Assessment Device, and the Patient Satisfaction with Mental Health Services Rating Scale. Elderly adults with depressive symptoms had lower quality of life in the social relations domain than did those without depressive symptoms (p = 0.003). In addition, compared with those without depression, fewer elderly adults with depressive symptoms attended integrative community therapy (p = 0.04); they also reported a low degree of family involvement in problem solving (p = 0.04) and showed apathy regarding their satisfaction with health services (p = 0.007). These results have important implications in the decision-making process with regard to strategies for improving the health status of elderly adults with depressive symptoms.

A Social Network Approach to the Estimation of Perceived Quality of Health Care

PubMed Central

Carletti, Giulia; Soriani, Nicola; Mattiazzi, Martina; Gregori, Dario

2017-01-01

Background: Measuring service quality aids health care providers to recognize specific and unmet needs of patients. Nevertheless, perceived quality of health care services (PQC) is often investigated with inadequate techniques which may lead to biased results. Objective: The aim of the present study is to develop a proof-of-concept for estimating the PQC using the scale-up estimator, with reference to a concrete assessment in patients of a major Oncology Hospital in Veneto (IOV). Results have then been compared with those collected by the Customer Relations Office (CRO) after the annual survey conducted with traditional questionnaire based techniques. Material and Methods: Seven hundred and eighty-three sets consisting of two questionnaires were handed out to IOV patients between 26 and 28 November 2012. The first questionnaire was the CRO annual one composed by 15 direct questions about the perception of quality satisfaction rate using a Likert scale. The second questionnaire was the scale-up (NSUM) one, composed by 20 indirect questions, 5 of which were reproducing the main target of CRO for estimating PQC. Results: The comparisons made over 299 sets of questionnaires showed differences between the two techniques. Network Scale-Up Method (NSUM) questionnaire seems to be able to produce lower estimates of PQC with respect to the CRO annual questionnaire. In some cases, the NSUM showed dissatisfaction rates which are 20-fold higher respect to CRO. Conclusion: NSUM could be a promising method for assessing the perceived quality of care. PMID:29238425

The Turkish adaptation of scale to measure patient perceptions of the quality of nursing care and related hospital services: A validity and reliability study

PubMed Central

Oren, Besey; Zengin, Neriman; Yildiz, Nebahat

2016-01-01

OBJECTIVE: This study aimed to test the validity and reliability of a version of the tool developed in Sri Lanka in 2011 to assess patient perceptions of the quality of nursing care and related hospital services created for use with Turkish patients. METHODS: This methodological study was conducted between November 2013 and November 2014 after obtaining ethical approval and organizational permission. Data was collected during discharge from 180 adult patients who were hospitalized for at least 3 days at a medical school hospital located in Istanbul. After language validation, validity and reliability analyses of the scale were conducted. Content validity, content validity index (CVI), construct validity, and exploratory factor analysis were assessed and examined, and reliability was tested using the Cronbach’s alpha coefficient and item-total correlations. RESULTS: Mean CVI was found to be 0.95, which is above expected value. Exploratory factor analysis revealed 4 factors with eigenvalues above 1, which explained 82.4% of total variance in the Turkish version of the tool to measure patient perceptions of nursing care and other hospital services. Factor loading for each item was ≥.40. Cronbach’s alpha coefficient of sub-dimensions and total scale were found to be 0.84-0.98 and 0.98, respectively. Item-total correlations ranged from 0.56 to 0.83 for the entire group, which was above expected values. CONCLUSION: The Turkish version of the scale to assess patient perceptions of the quality of nursing care and related hospital services, which comprised 4 sub-dimensions and 36 items, was found to be valid and reliable for use with the Turkish population. PMID:28275750

The Turkish adaptation of scale to measure patient perceptions of the quality of nursing care and related hospital services: A validity and reliability study.

PubMed

Oren, Besey; Zengin, Neriman; Yildiz, Nebahat

2016-01-01

This study aimed to test the validity and reliability of a version of the tool developed in Sri Lanka in 2011 to assess patient perceptions of the quality of nursing care and related hospital services created for use with Turkish patients. This methodological study was conducted between November 2013 and November 2014 after obtaining ethical approval and organizational permission. Data was collected during discharge from 180 adult patients who were hospitalized for at least 3 days at a medical school hospital located in Istanbul. After language validation, validity and reliability analyses of the scale were conducted. Content validity, content validity index (CVI), construct validity, and exploratory factor analysis were assessed and examined, and reliability was tested using the Cronbach's alpha coefficient and item-total correlations. Mean CVI was found to be 0.95, which is above expected value. Exploratory factor analysis revealed 4 factors with eigenvalues above 1, which explained 82.4% of total variance in the Turkish version of the tool to measure patient perceptions of nursing care and other hospital services. Factor loading for each item was ≥.40. Cronbach's alpha coefficient of sub-dimensions and total scale were found to be 0.84-0.98 and 0.98, respectively. Item-total correlations ranged from 0.56 to 0.83 for the entire group, which was above expected values. The Turkish version of the scale to assess patient perceptions of the quality of nursing care and related hospital services, which comprised 4 sub-dimensions and 36 items, was found to be valid and reliable for use with the Turkish population.

Effect of home care service on the quality of life in patients with gynecological cancer.

PubMed

Aktas, Demet; Terzioglu, Fusun

2015-01-01

The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (p<0.05). This study found home care services to be efficient in improving the quality of life in patients with gynecological cancer.

Towards Integrating Soil Quality Monitoring Targets as Measures of Soil Natural Capital Stocks with the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Taylor, M. D.; Mackay, A. D.; Dominati, E.; Hill, R. B.

2012-04-01

This paper presents the process used to review soil quality monitoring in New Zealand to better align indicators and indicator target ranges with critical values of change in soil function. Since its inception in New Zealand 15 year ago, soil quality monitoring has become an important state of the environment reporting tool for Regional Councils. This tool assists councils to track the condition of soils resources, assess the impact of different land management practices, and provide timely warning of emerging issues to allow early intervention and avoid irreversible loss of natural capital stocks. Critical to the effectiveness of soil quality monitoring is setting relevant, validated thresholds or target ranges. Provisional Target Ranges were set in 2003 using expert knowledge available and data on production responses. Little information was available at that time for setting targets for soil natural capital stocks other than those for food production. The intention was to revise these provisional ranges as further information became available and extend target ranges to cover the regulating and cultural services provided by soils. A recently developed ecosystems service framework was used to explore the feasibility of linking soil natural capital stocks measured by the current suite of soil quality indicators to the provision of ecosystem services by soils. Importantly the new approach builds on and utilises the time series data sets collected by current suite of soil quality indicators, adding value to the current effort, and has the potential to set targets ranges based on the economic and environmental outcomes required for a given farm, catchment or region. It is now timely to develop a further group of environmental indicators for measuring specific soil issues. As with the soil quality indicators, these environmental indicators would be aligned with the provision of ecosystem services. The toolbox envisaged is a set of indicators for specific soil issues with appropriate targets tied to ecosystem services and changes in critical soil function. Such indicators would be used for specific purposes for limited periods, rather than long-term, continuous monitoring. Some examples will be presented. An important step needed to successfully initiate and complete the review was assigning national oversight. Reigniting scientific interest (which had declined with the cessation of funding in 2003) and documentation of the process were other important steps. We had to extend the recently developed ecosystem service approach to accommodate the catchment scale. This required additional attributes in the framework and recognition that some of the proxies will change with scale as will the techniques to value the services. The framework was originally developed for use at the farm scale. Macroporosity, one of the two indicators used to monitor the physical condition of the soil, was used to illustrate how the ecosystem service framework could be used to link a change in the physical condition of the soil with the provision of services. The sum of the dollar values of selected soil ecosystem services were used to inform the state of soil natural capital stocks. This estimate provides a new insight into the value of the soil quality indicators and existing target ranges. Doing so will enable targets to be more closely aligned and integrated with the provision of a range of ecosystem services, going far beyond food production.

Reproductive health services in Malawi: an evaluation of a quality improvement intervention.

PubMed

Rawlins, Barbara J; Kim, Young-Mi; Rozario, Aleisha M; Bazant, Eva; Rashidi, Tambudzai; Bandazi, Sheila N; Kachale, Fannie; Sanghvi, Harshad; Noh, Jin Won

2013-01-01

this study was to evaluate the impact of a quality improvement initiative in Malawi on reproductive health service quality and related outcomes. (1) post-only quasi-experimental design comparing observed service quality at intervention and comparison health facilities, and (2) a time-series analysis of service statistics. sixteen of Malawi's 23 district hospitals, half of which had implemented the Performance and Quality Improvement (PQI) intervention for reproductive health at the time of the study. a total of 98 reproductive health-care providers (mostly nurse-midwives) and 139 patients seeking family planning (FP), antenatal care (ANC), labour and delivery (L&D), or postnatal care (PNC) services. health facility teams implemented a performance and quality improvement (PQI) intervention over a 3-year period. Following an external observational assessment of service quality at baseline, facility teams analysed performance gaps, designed and implemented interventions to address weaknesses, and conducted quarterly internal assessments to assess progress. Facilities qualified for national recognition by complying with at least 80% of reproductive health clinical standards during an external verification assessment. key measures include facility readiness to provide quality care, observed health-care provider adherence to clinical performance standards during service delivery, and trends in service utilisation. intervention facilities were more likely than comparison facilities to have the needed infrastructure, equipment, supplies, and systems in place to offer reproductive health services. Observed quality of care was significantly higher at intervention than comparison facilities for PNC and FP. Compared with other providers, those at intervention facilities scored significantly higher on client assessment and diagnosis in three service areas, on clinical management and procedures in two service areas, and on counselling in one service area. Service statistics suggest that the PQI intervention increased the number of Caesarean sections, but showed no impact on other indicators of service utilisation and skilled care. the PQI intervention showed a positive impact on the quality of reproductive health services. The effects of the intervention on service utilisation had likely not yet been fully realized, since none of the facilities had achieved national recognition before the evaluation. Staff turnover needs to be reduced to maximise the effectiveness of the intervention. the PQI intervention evaluated here offers an effective way to improve the quality of health services in low-resource settings and should continue to be scaled up in Malawi. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Multi-scale Method of Mapping Urban Influence

EPA Science Inventory

Urban development can impact environmental quality and ecosystem services well beyond urban extent. Many methods to map urban areas have been developed and used in the past, but most have simply tried to map existing extent of urban development, and all have been single-scale t...

Contribution of ecosystem services to air quality and climate change mitigation policies: the case of urban forests in Barcelona, Spain.

PubMed

Baró, Francesc; Chaparro, Lydia; Gómez-Baggethun, Erik; Langemeyer, Johannes; Nowak, David J; Terradas, Jaume

2014-05-01

Mounting research highlights the contribution of ecosystem services provided by urban forests to quality of life in cities, yet these services are rarely explicitly considered in environmental policy targets. We quantify regulating services provided by urban forests and evaluate their contribution to comply with policy targets of air quality and climate change mitigation in the municipality of Barcelona, Spain. We apply the i-Tree Eco model to quantify in biophysical and monetary terms the ecosystem services "air purification," "global climate regulation," and the ecosystem disservice "air pollution" associated with biogenic emissions. Our results show that the contribution of urban forests regulating services to abate pollution is substantial in absolute terms, yet modest when compared to overall city levels of air pollution and GHG emissions. We conclude that in order to be effective, green infrastructure-based efforts to offset urban pollution at the municipal level have to be coordinated with territorial policies at broader spatial scales.

[Psychometric properties of scales of professional competence and treatment by health personnel in outpatient hospital surgeries].

PubMed

Bermejo Alegría, Rosa M; Hidalgo Montesinos, M Dolores; Parra Hidalgo, Pedro; Más Castillo, Adelia; Gomis Cebrián, Rafael

2011-04-01

The aim of this study was to analyze the psychometric properties of two scales that assess the perceived quality and patient satisfaction with outpatient surgery in the Health Service of Murcia. These scales assess the degree of Professional Competence (PC) and Personnel Treatment (PT). The scales were administered to a sample of 2017 users of outpatient surgery in the Health Service of Murcia during the years 2008 and 2009. Exploratory factor analysis indicates a unidimensional structure for each scale. Internal consistency was adequate: .68 for PC and .75 for PT. The correlation between the PC scale and patients' global satisfaction was positive and statistically significant. The correlation between the PT scale and patients' global satisfaction was also statistically significant. The scales have shown their utility to detect areas of improvement and to plan intervention strategies.

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

PubMed

Yildiz, M Said; Khan, M Mahmud

2016-08-12

The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

The climate-wildfire-air quality system: interactions and feedbacks across spatial and temporal scales

Treesearch

E. Natasha Stavros; Donald McKenzie; Narasimhan Larkin

2014-01-01

Future climate change and its effects on social and ecological systems present challenges for preserving valued ecosystem services, including local and regional air quality. Wildfire is a major source of air-quality impact in some locations, and a substantial contributor to pollutants of concern, including nitrogen oxides and particulate matter, which are regulated to...

Patients' satisfaction of service quality in Saudi hospitals: a SERVQUAL analysis.

PubMed

Al-Borie, Hussein M; Damanhouri, Amal M Sheikh

2013-01-01

Saudi Arabian hospital performance, vis-á-vis patient satisfaction with service provision, has emerged as a key policy and planning concern. Keeping in view public and private hospital service quality, this article seeks to provide guidelines to the on-going Saudi Arabian health service reorganization, which emphasizes decentralization, bed-capacity expansion, research-based policymaking and initiatives in the health insurance sector. The article outlines an empirical study that compares patient satisfaction with service quality in Saudi Arabian public and private sector hospitals. The authors employ a stratified random sample (1,000 inpatients) from five Saudi Arabian public and five private hospitals. Data were collected through questionnaire using the SERVQUAL scale. For reducing the language bias the questionnaire was translated into Arabic. The response rate was 74.9 percent. Data were analyzed using SPSS and appropriate descriptive and inferential statistical techniques. Cronbach's alpha for five service-quality dimensions (tangibles, reliability, responsiveness, safety and empathy) were high and the SERVQUAL instrument proved to be reliable, valid and appropriate. The results showed that sex, education, income and occupation were statistically significant in influencing inpatients' satisfaction, and all the null hypotheses were rejected. Only inpatient age was not significant. The study highlights service quality influence in the design of broader healthcare strategies for Saudi Arabian public and private hospitals. It demands that management researchers and analysts must identify regional service quality consistencies and related inpatient demographic indicators. The study offers some insights into, and guidance for, hospital quality assurance in Saudi Arabia in general and the urban hospital setting in the Middle-East in particular.

Development and psychometric properties of the client's assessment of treatment scale for supported accommodation (CAT-SA).

PubMed

Sandhu, Sima; Killaspy, Helen; Krotofil, Joanna; McPherson, Peter; Harrison, Isobel; Dowling, Sarah; Arbuthnott, Maurice; Curtis, Sarah; King, Michael; Leavey, Gerard; Shepherd, Geoff; Priebe, Stefan

2016-02-25

Patient-Reported Outcome Measures (PROMs) are important for evaluating mental health services. Yet, no specific PROM exists for the large and diverse mental health supported accommodation sector. We aimed to produce and validate a PROM specifically for supported accommodation services, by adapting the Client's Assessment of Treatment Scale (CAT) and assessing its psychometric properties in a large sample. Focus groups with service users in the three main types of mental health supported accommodation services in the United Kingdom (residential care, supported housing and floating outreach) were conducted to adapt the contents of the original CAT items and assess the acceptability of the modified scale (CAT-SA). The CAT-SA was then administered in a survey to service users across England. Internal consistency was assessed using Cronbach's alpha. Convergent validity was tested through correlations with subjective quality of life and satisfaction with accommodation, as measured by the Manchester Short Assessment of Quality of Life (MANSA). All seven original items of the CAT were regarded as relevant to appraisals of mental health supported accommodation services, with only slight modifications to the wording required. In the survey, data were obtained from 618 clients. The internal consistency of the CAT-SA items was 0.89. Mean CAT-SA scores were correlated with the specific accommodation item on the MANSA (r s  = 0.37, p ˂ .001). The content of the CAT-SA has relevance to service users living in mental health supported accommodation. The findings from our large survey show that the CAT-SA is acceptable across different types of supported accommodation and suggest good psychometric properties. The CAT-SA appears a valid and easy to use PROM for service users in mental health supported accommodation services.

Cultural competency assessment tool for hospitals: evaluating hospitals' adherence to the culturally and linguistically appropriate services standards.

PubMed

Weech-Maldonado, Robert; Dreachslin, Janice L; Brown, Julie; Pradhan, Rohit; Rubin, Kelly L; Schiller, Cameron; Hays, Ron D

2012-01-01

The U.S. national standards for culturally and linguistically appropriate services (CLAS) in health care provide guidelines on policies and practices aimed at developing culturally competent systems of care. The Cultural Competency Assessment Tool for Hospitals (CCATH) was developed as an organizational tool to assess adherence to the CLAS standards. First, we describe the development of the CCATH and estimate the reliability and validity of the CCATH measures. Second, we discuss the managerial implications of the CCATH as an organizational tool to assess cultural competency. We pilot tested an initial draft of the CCATH, revised it based on a focus group and cognitive interviews, and then administered it in a field test with a sample of California hospitals. The reliability and validity of the CCATH were evaluated using factor analysis, analysis of variance, and Cronbach's alphas. Exploratory and confirmatory factor analyses identified 12 CCATH composites: leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and quality improvement, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices. All the CCATH scales had internal consistency reliability of .65 or above, and the reliability was .70 or above for 9 of the 12 scales. Analysis of variance results showed that not-for-profit hospitals have higher CCATH scores than for-profit hospitals in five CCATH scales and higher CCATH scores than government hospitals in two CCATH scales. The CCATH showed adequate psychometric properties. Managers and policy makers can use the CCATH as a tool to evaluate hospital performance in cultural competency and identify and target improvements in hospital policies and practices that undergird the provision of CLAS.

LISTENing to healthcare students: the impact of new library facilities on the quality of services.

PubMed

Haldane, Graham C

2003-06-01

Following a low assessment of 'Learning resources' provision by the Quality Assurance Agency, the librarian of Homerton College, School of Health Studies commenced the LISTEN Project, a long-term study to monitor the effects of planned interventions on the quality of library provision. Surveys of entry-to-register student nurses & midwives were conducted in 1999 and 2001 by extensive questionnaires, inviting Likert-scaled and free text responses. Following a college relocation, students made greater than expected use of a new health studies library in Cambridge, and significantly less use of the local teaching hospital library. Using both a satisfaction index and a non-parametric test of mean scores, student evaluation of library services in Cambridge significantly improved following relocation. The physical accommodation and location of library services remain important to healthcare students. Identifiable improvements to the quality of services, however, will overcome initial resistance to change. Education providers must ensure the best mix of physical and electronic services for students who spend much of their time on clinical placement.

Locating Continuing Education Programs.

ERIC Educational Resources Information Center

Mason, Robert C.

1986-01-01

Emphasizes program location as an important component of the marketing plan for continuing education. Also discusses relations among program location and quality, costs, supportive services, and economies of scale. (CH)

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

PubMed

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

2015-11-14

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

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Diagnosing Contributions of Sensory and Cognitive Deficits to Hearing Dysfunction in Blast-Exposed/TBI Service Members

DTIC Science & Technology

2017-10-01

The speech, spatial and qualities of hearing scale (SSQ). International Journal of Audiology, 43(2), 85–99. 11 Quad Chart Diagnosing contributions... Service Members” PRINCIPAL INVESTIGATOR: Dr. Barbara Shinn-Cunningham CONTRACTING ORGANIZATION: Boston University Boston, MA 02215-1703 REPORT DATE...information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services , Directorate for Information Operations

Neighborhood scale quantification of ecosystem goods and ...

EPA Pesticide Factsheets

Ecosystem goods and services are those ecological structures and functions that humans can directly relate to their state of well-being. Ecosystem goods and services include, but are not limited to, a sufficient fresh water supply, fertile lands to produce agricultural products, shading, air and water of sufficient quality for designated uses, flood water retention, and places to recreate. The US Environmental Protection Agency (USEPA) Office of Research and Development’s Tampa Bay Ecosystem Services Demonstration Project (TBESDP) modeling efforts organized existing literature values for biophysical attributes and processes related to EGS. The goal was to develop a database for informing mapped-based EGS assessments for current and future land cover/use scenarios at multiple scales. This report serves as a demonstration of applying an EGS assessment approach at the large neighborhood scale (~1,000 acres of residential parcels plus common areas). Here, we present mapped inventories of ecosystem goods and services production at a neighborhood scale within the Tampa Bay, FL region. Comparisons of the inventory between two alternative neighborhood designs are presented as an example of how one might apply EGS concepts at this scale.

Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International.

PubMed

Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

2015-06-17

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014-up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI's 17 and PSI's 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations' operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential to contribute to universal health coverage. © Thurston et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis.

PubMed

Teshnizi, Saeed Hosseini; Aghamolaei, Teamur; Kahnouji, Kobra; Teshnizi, Seyyed Mehrdad Hosseini; Ghani, Jalil

2018-03-01

The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool. A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database. All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services. Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist. Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps. All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

Ecosystem processes at the watershed scale: mapping and modeling ecohydrological controls

Treesearch

Lawrence E. Band; T. Hwang; T.C. Hales; James Vose; Chelcy Ford

2012-01-01

Mountain watersheds are sources of a set of valuable ecosystem services as well as potential hazards. The former include high quality freshwater, carbon sequestration, nutrient retention, and biodiversity, whereas the latter include flash floods, landslides and forest fires. Each of these ecosystem services and hazards represents different elements of the integrated...

Quality and Utility of the Multi-Tiered Instruction Self-Efficacy Scale

ERIC Educational Resources Information Center

Barnes, Susan K.; Burchard, Melinda S.

2011-01-01

Response to Intervention (RTI) is an educational approach that integrates ongoing assessment of individual student progress with targeted instruction. Administrators and teachers in P-12 schools expressed a need for colleagues in higher education to provide training to general education pre-service and in-service teachers in selecting appropriate…

Report Card on College Services.

ERIC Educational Resources Information Center

Clements, William H.

This study of the Wisconsin State University, Stevens Point was conducted to assess the quality and quantity of the institution's facilities and its services to and procedures used with students. The Likert technique was used to obtain responses to 97 questions on a 5-point scale from former students of the university. The sampling comprised…

The Disabled Student Experience: Does the SERVQUAL Scale Measure Up?

ERIC Educational Resources Information Center

Vaughan, Elizabeth; Woodruffe-Burton, Helen

2011-01-01

Purpose: The purpose of this paper is to empirically test a new disabled service user-specific service quality model ARCHSECRET against a modified SERVQUAL model in the context of disabled students within higher education. Design/methodology/approach: The application of SERVQUAL in the voluntary sector had raised serious issues on its portability…

Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia.

PubMed

Dansereau, Emily; Masiye, Felix; Gakidou, Emmanuela; Masters, Samuel H; Burstein, Roy; Kumar, Santosh

2015-12-30

To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia. Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts. 2789 exiting patients. Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care). Respondent, visit-related, and facility characteristics. Patient satisfaction measured on a 1-10 scale. Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics. Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care--healthcare delivery and accessibility of care--were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64). Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia. 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/

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being.

PubMed

Martinussen, Monica; Kaiser, Sabine; Adolfsen, Frode; Patras, Joshua; Richardsen, Astrid M

2017-07-01

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T 1 ) and after (T 2 , T 3 ) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T 1 to T 2 . No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T 3 ) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

The use of data from national and other large-scale user experience surveys in local quality work: a systematic review.

PubMed

Haugum, Mona; Danielsen, Kirsten; Iversen, Hilde Hestad; Bjertnaes, Oyvind

2014-12-01

An important goal for national and large-scale surveys of user experiences is quality improvement. However, large-scale surveys are normally conducted by a professional external surveyor, creating an institutionalized division between the measurement of user experiences and the quality work that is performed locally. The aim of this study was to identify and describe scientific studies related to the use of national and large-scale surveys of user experiences in local quality work. Ovid EMBASE, Ovid MEDLINE, Ovid PsycINFO and the Cochrane Database of Systematic Reviews. Scientific publications about user experiences and satisfaction about the extent to which data from national and other large-scale user experience surveys are used for local quality work in the health services. Themes of interest were identified and a narrative analysis was undertaken. Thirteen publications were included, all differed substantially in several characteristics. The results show that large-scale surveys of user experiences are used in local quality work. The types of follow-up activity varied considerably from conducting a follow-up analysis of user experience survey data to information sharing and more-systematic efforts to use the data as a basis for improving the quality of care. This review shows that large-scale surveys of user experiences are used in local quality work. However, there is a need for more, better and standardized research in this field. The considerable variation in follow-up activities points to the need for systematic guidance on how to use data in local quality work. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

[Personalizing the reference level: gold standard to evaluate the quality of service perceived].

PubMed

Rodrigo-Rincón, I; Reyes-Pérez, M; Martínez-Lozano, M E

2014-01-01

To know the cutoff point at which in-house Nuclear Medicine Department (MND) customers consider that the quality of service is good (personalized cutoff). We conducted a survey of the professionals who had requested at least 5 tests to the Nuclear Medicine Department. A total of 71 doctors responded (response rate: 30%). A question was added to the questionnaire for the user to establish a cutoff point for which they would consider the quality of service as good. The quality non-conformities, areas of improvement and strong points of the six questions measuring the quality of service (Likert scale 0 to 10) were compared with two different thresholds: personalized cutoff and one proposed by the service itself a priori. Test statistics: binomial and Student's t-test for paired data. A cutoff value of 7 was proposed by the service as a reference while 68.1% of respondents suggested a cutoff above 7 points (mean 7.9 points). The 6 elements of perceived quality were considered strong points with the cutoff proposed by the MND, while there were 3 detected with the personalized threshold. Thirteen percent of the answers were nonconformities with the service cutoff versus 19.2% with the personalized one, the differences being statistically significant (difference 95% CI 6.44%:0,83-12.06). The final image of the perceived quality of an in-house customer is different when using the cutoff established by the Department versus the personalized cutoff given by the respondent. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Linking quality and performance. Quality orientation can be a competitive strategy for health care providers.

PubMed

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.

The Quantitative Measurement of Family Quality of Life: A Review of Available Instruments

ERIC Educational Resources Information Center

Hu, X.; Summers, J. A.; Turnbull, A.; Zuna, N.

2011-01-01

Background: Family quality of life (FQOL) has emerged as an important outcome of service delivery for individuals with disabilities and their families. The purpose of this review was to explore the disparity of scale development approaches between families with children with disabilities and families from other populations and identify strengths…

The Working Alliance in Online Therapy with Young People: Preliminary Findings

ERIC Educational Resources Information Center

Hanley, Terry

2009-01-01

This paper examines the quality of the working alliance in online counseling relationships with young people. A mixed method approach has been adopted which combines the completion of a self-report quantitative measure (the "Therapeutic Alliance Quality Scale") and qualitative interviews with service users of a UK-based service…

Quality differentials and reproductive health service utilisation determinants in India.

PubMed

Anand, Sandip; Sinha, R K

2010-01-01

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

[Satisfaction according to health care insurance systems in an emergency department].

PubMed

Dávila, F A; Herrera, J S; Yasnó, D A; Forero, L C; Alvarado, M V

Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Students' perception of quality of medical education in a medical college in west Bengal, India.

PubMed

Mukhopadhyay, Dipta Kanti

2016-01-01

Students' perceived quality of educational service is an important field of educational research. To identify the gaps in the quality of educational services as perceived by students in a medical college in West Bengal, India. In a cross-sectional study, educational quality was measured using validated SERVQUAL instrument between two randomly selected groups of undergraduate medical students (n = 179). This five-point Likert scale questionnaire measured the expectation and perception of students on 26 items under five dimensions of quality of educational services, viz., tangible (physical facilities, equipment, and appearance of personnel), reliability (accuracy and consistency of a department in providing educational services), responsiveness (eagerness to help and commitment), assurance (ability of teaching departments to earn students' confidence), and empathy (ability to communicate care and understanding). Dimension-wise difference in the mean scores for expectation and perception was calculated and was considered as quality gaps in educational services. Significant negative quality gaps were noted in all five dimensions. The highest gap was found in tangible (-1.67) followed by empathy (-1.64) although the mean score of perceived quality in the dimension of empathy was the lowest (2.53). This indicates the need for improvement in physical facilities as well as behavior of teachers and staff toward students. The smallest gap was noted in the dimension of assurance (-1.29), which indicates the students' overall confidence in teaching departments regarding their management or content expertise. These findings underscore students' aspiration for the overall improvement of educational services that can be taken into consideration during development planning.

An overview of service quality of continuous positive airway pressure services in Australian pharmacies.

PubMed

Hanes, Carissa A; Wong, Keith K H; Saini, Bandana

2014-01-01

Little is known about CPAP services offered in the Australian primary care pharmacy setting, despite the potential influence of service quality on patient adherence. The objective of this study was to provide an overview on a nationwide scale of the range and quality of CPAP and sleep apnoea-related services in Australian pharmacies. A paper-based questionnaire was developed and mailed to all pharmacies in Australia that currently provide CPAP services (as identified by manufacturer's distributor lists or Internet search). A point system was devised to score participants on the quality of their CPAP service. Pharmacies were rated against a list of 23 criteria that were determined by consensus, with one point allocated for each criterion met, allowing for a maximum score of 23. The study response rate was 55% (110/199), and representation was obtained from all eight Australian states and territories. The mean number of criteria met (total score) for pharmacies was 15.7 ± 3.4 (15.7/23 = 68.3%; score range 2-22). Variability was evident in the range of services offered. Eighty-seven per cent of respondents believed that pharmacies supplying CPAP should adhere to a formalized set of professional guidelines. The accessibility of pharmacies may make them a valuable venue for CPAP service provision. However, models of care to guide practice and standardize the variability in services are required. Implementation of such models could improve patient access to quality treatment in the primary care setting. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2013-01-16

Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers' demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions.

Developing Quality Improvement capacity and capability across the Children in Fife partnership.

PubMed

Morris, Craig; Alexander, Ingrid

2016-01-01

A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families. Essentially growing the confidence and capability of practitioners to deliver sustainable QI. 27 respective improvement projects were delivered, some leading to service redesign, reduced waiting times, increased uptake of health entitlements, and improved accessibility to front-line health services. 13 improvement projects spread or scaled beyond the initial site and informal QI mentoring took place with peers in respective agencies. Multiple PDSA cycles were conducted testing the most efficient and effective support mechanisms during and post training, maintaining regular contact, and utilising social media to share progress and achievements.

Assessing the physical service setting: a look at emergency departments.

PubMed

Steinke, Claudia

2015-01-01

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

Quality or financing: what drives design of the health care system?

PubMed Central

McLoughlin, V; Leatherman, S

2003-01-01



 The scope and scale of problems in the quality of health service provision have been increasingly recognised in recent years. Policy and planning for financing are usually concerned with how funding is made available and allocated, rather than with what is being achieved, including the quality of health services delivered. A fundamental challenge is how to improve the delivery of health services to achieve improved patient outcomes and to optimize financial outcomes. To accomplish this it is essential that the debates on quality of care and financing are aligned. Approaches to improving the quality of care are drawn from Australia, the US, and the UK. Financing arrangments for care at a national level have a bearing on how payment incentives can be used to promote or impede quality. The level of overall expenditure is obviously important, as are the mechanisms for payment. Long term programs to build knowledge, standardise processes, provide credible performance data and foster accountability are required to ensure that further investments lead to improvement in care. PMID:12679511

Identifying profiles of service users in housing services and exploring their quality of life and care needs.

PubMed

Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

2016-11-23

Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services. ISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.

Managing a Statewide Virtual Reference Service: How Q and A NJ Works.

ERIC Educational Resources Information Center

Bromberg, Peter

2003-01-01

Describes the live virtual reference service, Q and A NJ (Question and Answer New Jersey), strategies used to meet the challenges of day-to-day management, scaled growth and quality control. Describes how it began; how long it took; how to manage a large project (constant communication; training and practice; transcript analysis and privacy;…

Results of the 2002 QUEST Survey. Annual Staff Survey. Research Report.

ERIC Educational Resources Information Center

Howard Community Coll., Columbia, MD. Office of Planning and Evaluation.

This document is the results of the 2002 employee survey (Quality Evaluation of Service Trends) for all Howard Community College Employees. The response rate was 64%. Ratings for various topics and services were made on a five-point scale ranging from poor to excellent. Employees were also given an "unfamiliar with" category, which did…

The 2001 QUEST Survey Results. Annual Staff Survey. Research Report.

ERIC Educational Resources Information Center

Howard Community Coll., Columbia, MD. Office of Planning and Evaluation.

This document is the results of the 2001 employee survey (Quality Evaluation of Service Trends) for all Howard Community College Employees. The response rate was 63%. Ratings for various topics and services were made on a five-point scale ranging from poor to excellent. Employees were also given an "unfamiliar with" category, which did…

The Millennium QUEST: Results of the Survey. Annual Staff Survey. Research Report.

ERIC Educational Resources Information Center

Howard Community Coll., Columbia, MD. Office of Planning and Evaluation.

This document is the results of the 2000 employee survey (Quality Evaluation of Service Trends) for all Howard Community College Employees. The response rate was 57% and respondents replied both by paper and electronically. Ratings for various topics and services were made on a five-point scale ranging from poor to excellent. Employees were also…

The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital.

PubMed

Wang, Hsiu-Ling; Huang, Jun-Ying; Howng, Shen-Long

2011-02-01

The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician-patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.

The PQRS-Montreal: a measure of patients' perceptions of the quality of rehabilitation services for persons with a traumatic brain injury.

PubMed

Swaine, Bonnie; Dassa, Clément; Koné, Anna; Dutil, Élisabeth; Demers, Louise; Trempe, Claire

2017-01-01

Purpose To determine the factorial validity, internal consistency, criterion-related and concurrent validity of the Perception of Quality of Rehabilitation Services - Montreal (PQRS-Montreal) questionnaire for persons receiving traumatic brain injury (TBI) rehabilitation services. Design Cross-sectional study. Setting Seventeen facilities providing acute care and intensive inpatient and outpatient TBI adult rehabilitation. Participants Five-hundred thirty adults (GCS  =  3-15; mean age  =  41.5 ± 16.9 years) who received rehabilitation were administered the questionnaire during an interview near time of discharge. Subjects responded to the 61 PQRS-Montreal items (five-point scale of agreement) and to the Client Satisfaction Question (CSQ8). Results Exploratory and confirmatory factor analyses identified three potential subscales (one- and two-factor solutions) explaining 26.1-41% of the variance (ecological approach, quality of team, service organization). The subscales' internal structures were interpretable and their internal consistency varied from 0.51 to 0.90 (Cronbach's α). Rehabilitation phase significantly and positively impacted factor scores and all factor scores were significantly and moderately correlated with CSQ8 scores. Conclusions The PQRS-Montreal possesses adequate psychometric properties supporting its use as a valid tool to measure patients' perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery. Implications for Rehabilitation The importance of measuring and monitoring quality of care is increasingly important in rehabilitation. Using the experiences and perceptions of care of service users is a valid way of assessing the quality of rehabilitation services. The PQRS-Montreal has adequate psychometric properties supporting its use as a valid tool to measure patients' perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery.

Patient-perceived hospital service quality: an empirical assessment.

PubMed

Pai, Yogesh P; Chary, Satyanarayana T; Pai, Rashmi Yogesh

2018-02-12

Purpose The purpose of this paper is to appraise Pai and Chary's (2016) conceptual framework for measuring patient-perceived hospital service quality (HSQ). Design/methodology/approach A structured questionnaire was used to obtain data from teaching, public and corporate hospital patients. Several tests were conducted to assess the instrument's reliability and validity. Pai and Chary's (2016) nine dimensions for measuring HSQ were examined in this paper. Findings The tests confirm that Pai and Chary's (2016) conceptual framework is reliable and valid. The study also establishes that the nine dimensions measure HSQ. Practical implications The framework empowers managers to assess service quality in any hospital settings, corporate, public and teaching, using an approach that is superior to the existing HSQ scales. Originality/value This paper helps researchers and practitioners to assess HSQ from patient perspectives in any hospital setting.

Maternity-care: measuring women's perceptions.

PubMed

Clark, Kim; Beatty, Shelley; Reibel, Tracy

2016-01-01

Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

Development of a questionnaire to measure consumers' perceptions of service quality in Australian community pharmacies.

PubMed

Mirzaei, Ardalan; Carter, Stephen R; Chen, Jenny Yimin; Rittsteuer, Claudia; Schneider, Carl R

2018-06-11

Recent changes within community pharmacy have seen a shift towards some pharmacies providing "value-added" services. However, providing high levels of service is resource intensive yet revenues from dispensing are declining. Of significance therefore, is how consumers perceive service quality (SQ). However, at present there are no validated and reliable instruments to measure consumers' perceptions of SQ in Australian community pharmacies. The aim of this study was to build a theory-grounded model of service quality (SQ) in community pharmacies and to create a valid survey instrument to measure consumers' perceptions of service quality. Stage 1 dealt with item generation using theory, prior research and qualitative interviews with pharmacy consumers. Selected items were then subjected to content validity and face validity. Stages 2 and 3 included psychometric testing among English-speaking adult consumers of Australian pharmacies. Exploratory factor analysis was used for item reduction and to explain the domains of SQ. In stage 1, item generation for SQ initially generated 113 items which were then refined, through content and face validity, down to 61 items. In stage 2, after subjecting the questionnaire to psychometric testing on the data from the first pharmacy (n = 374), the use of the primary dimensions of SQ was abandoned leaving 32 items representing 5 domains of SQ. In stage 3, the questionnaire was subject to further testing and item reduction in 3 other pharmacies (n = 320). SQ was best described using 23 items representing 6 domains: 'health and medicines advice', 'relationship quality', 'technical quality', 'environmental quality', 'non-prescription service', and 'health outcomes'. This research presents a theoretically-grounded and robust measurement scale developed for consumer perceptions of SQ in a community pharmacy. Copyright © 2018. Published by Elsevier Inc.

Validation of the Beliefs against Volunteering Scale among Chinese Adolescents in Hong Kong

ERIC Educational Resources Information Center

Law, Ben M. F.; Shek, Daniel T. L.

2011-01-01

Participation in volunteer service is an indicator of quality of life. This study attempts to validate the Beliefs Against Volunteering Scale (BAV), an assessment of the negative beliefs about volunteerism among Chinese adolescents in Hong Kong. The BAV was administered to 5,946 Chinese adolescents. The BAV and its subscales were found to be…

Longitudinal Invariance of the Satisfaction with Life Scale for Individuals with Schizophrenia

ERIC Educational Resources Information Center

Lee, Karen Kyeunghae; Brekke, John S.; Yamada, Ann-Marie; Chou, Chih-Ping

2010-01-01

Objectives: This study examined the longitudinal structural stability of a subjective quality of life measure in an ethnically diverse sample of 331 adults with schizophrenia. Methods: Participants completed the Satisfaction With Life (SWL) scale at entry to community-based mental health services and again at 6 and 12 months. Five types of…

A multi-scale method of mapping urban influence

Treesearch

Timothy G. Wade; James D. Wickham; Nicola Zacarelli; Kurt H. Riitters

2009-01-01

Urban development can impact environmental quality and ecosystem services well beyond urban extent. Many methods to map urban areas have been developed and used in the past, but most have simply tried to map existing extent of urban development, and all have been single-scale techniques. The method presented here uses a clustering approach to look beyond the extant...

Patient satisfaction with a hospital-based neuropsychology service.

PubMed

Foran, Amie; Millar, Elisa; Dorstyn, Diana

2016-09-01

Objective The aim of the present study was to develop and pilot a measure of patient satisfaction that encompasses themes, activities, settings and interactions specific to the neuropsychological assessment process. Methods A focus group of out-patients (n=15) was surveyed to identify the factors commonly associated with a satisfactory neuropsychological experience. Responses informed a purposely designed 14-item patient satisfaction scale (α=0.88) that was completed by 66 hospital out-patients with mild to moderate cognitive impairment. Results Satisfaction with the neuropsychological assessment process was generally reported, with the testing phase (85%) rated significantly more favourably than the pre-assessment (79%) and feedback (70%) phases. Commentaries provided by 32 respondents identified interpersonal facilitators to a satisfactory neuropsychological assessment experience, but also dissatisfaction with physical aspects of the testing environment in addition to service availability. Conclusions The patient satisfaction scale can be used as a quality assurance tool to evaluate neuropsychological service delivery. Large-scale research is needed to confirm the scale's psychometric properties. Further research may also include a broader perspective on the consumers' experience of neuropsychological services.

Social franchising primary healthcare clinics--a model for South African National Health Insurance?

PubMed

Robinson, Andrew Ken Lacey

2015-09-21

This article describes the first government social franchise initiative in the world to deliver a 'brand' of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable 'brand' of quality universal coverage of healthcare services.

Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

PubMed Central

Morris, Mary B; Chapula, Bushimbwa Tambatamba; Chi, Benjamin H; Mwango, Albert; Chi, Harmony F; Mwanza, Joyce; Manda, Handson; Bolton, Carolyn; Pankratz, Debra S; Stringer, Jeffrey SA; Reid, Stewart E

2009-01-01

The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region. PMID:19134202

Perceived Quality of In-Service Communication and Counseling Among Adolescents Undergoing Voluntary Medical Male Circumcision.

PubMed

Van Lith, Lynn M; Mallalieu, Elizabeth C; Patel, Eshan U; Dam, Kim H; Kaufman, Michelle R; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-04-03

Experience with providers shapes the quality of adolescent health services, including voluntary medical male circumcision (VMMC). This study examined the perceived quality of in-service communication and counseling during adolescent VMMC services. A postprocedure quantitative survey measuring overall satisfaction, comfort, perceived quality of in-service communication and counseling, and perceived quality of facility-level factors was administered across 14 VMMC sites in South Africa, Tanzania, and Zimbabwe. Participants were adolescent male clients aged 10-14 years (n = 836) and 15-19 years (n = 457) and completed the survey 7 to 10 days following VMMC. Adjusted prevalence ratios (aPRs) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust variance estimation to account for site-level clustering. Of 10- to 14-year-olds and 15- to 19-year-olds, 97.7% and 98.7%, respectively, reported they were either satisfied or very satisfied with their VMMC counseling experience. Most were also very likely or somewhat likely (93.6% of 10- to 14-year olds and 94.7% of 15- to 19-year olds) to recommend VMMC to their peers. On a 9-point scale, the median perceived quality of in-service (counselor) communication was 9 (interquartile range [IQR], 8-9) among 15- to 19-year-olds and 8 (IQR, 7-9) among 10- to 14-year-olds. The 10- to 14-year-olds were more likely than 15- to 19-year-olds to perceive a lower quality of in-service (counselor) communication (score <7; 21.5% vs. 8.2%; aPR, 1.61 [95% confidence interval, 1.33-1.95]). Most adolescents were more comfortable with a male rather than female counselor and provider. Adolescents of all ages wanted more discussion about pain, wound care, and healing time. Adolescents perceive the quality of in-service communication as high and recommend VMMC to their peers; however, many adolescents desire more discussion about key topics outlined in World Health Organization guidance.

Assessing care-givers' satisfaction with child immunisation services in Zambia: Evidence from a national survey.

PubMed

Chama-Chiliba, Chitalu Miriam; Masiye, Felix; Mphuka, Chrispin

2017-10-09

The main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants. This study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction. Findings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services. These findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Local Geographic Variation of Public Services Inequality: Does the Neighborhood Scale Matter?

PubMed Central

Wei, Chunzhu; Cabrera-Barona, Pablo; Blaschke, Thomas

2016-01-01

This study aims to explore the effect of the neighborhood scale when estimating public services inequality based on the aggregation of social, environmental, and health-related indicators. Inequality analyses were carried out at three neighborhood scales: the original census blocks and two aggregated neighborhood units generated by the spatial “k”luster analysis by the tree edge removal (SKATER) algorithm and the self-organizing map (SOM) algorithm. Then, we combined a set of health-related public services indicators with the geographically weighted principal components analyses (GWPCA) and the principal components analyses (PCA) to measure the public services inequality across all multi-scale neighborhood units. Finally, a statistical test was applied to evaluate the scale effects in inequality measurements by combining all available field survey data. We chose Quito as the case study area. All of the aggregated neighborhood units performed better than the original census blocks in terms of the social indicators extracted from a field survey. The SKATER and SOM algorithms can help to define the neighborhoods in inequality analyses. Moreover, GWPCA performs better than PCA in multivariate spatial inequality estimation. Understanding the scale effects is essential to sustain a social neighborhood organization, which, in turn, positively affects social determinants of public health and public quality of life. PMID:27706072

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

Turkey Creek—a case study of ecohydrology and integrated watershed management in the low-gradient Atlantic Coastal Plain, USA

Treesearch

Devendra Amatya; Timothy Callahan; William Hansen; Carl Trettin; Artur Radecki-Pawlik; Patrick Meire

2015-01-01

Water yield, water supply and quality, wildlife habitat, and ecosystem productivity and services are important societal concerns for natural resource management in the 21st century. Watershed-scale ecohydrologic studies can provide needed context for addressing complex spatial and temporal dynamics of these functions and services. This study was...

Exceeding Parents' Expectations in Ear-Nose-Throat Outpatient Facilities: The Development and Analysis of a Questionnaire

ERIC Educational Resources Information Center

Margaritis, Eleftherios; Katharaki, Maria; Katharakis, George

2012-01-01

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in…

Improving service quality in primary care.

PubMed

Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

2015-01-01

A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. © 2014 by the American College of Medical Quality.

Cultural competency assessment tool for hospitals: Evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards

PubMed Central

Weech-Maldonado, Robert; Dreachslin, Janice L.; Brown, Julie; Pradhan, Rohit; Rubin, Kelly L.; Schiller, Cameron; Hays, Ron D.

2016-01-01

Background The U.S. national standards for culturally and linguistically appropriate services (CLAS) in health care provide guidelines on policies and practices aimed at developing culturally competent systems of care. The Cultural Competency Assessment Tool for Hospitals (CCATH) was developed as an organizational tool to assess adherence to the CLAS standards. Purposes First, we describe the development of the CCATH and estimate the reliability and validity of the CCATH measures. Second, we discuss the managerial implications of the CCATH as an organizational tool to assess cultural competency. Methodology/Approach We pilot tested an initial draft of the CCATH, revised it based on a focus group and cognitive interviews, and then administered it in a field test with a sample of California hospitals. The reliability and validity of the CCATH were evaluated using factor analysis, analysis of variance, and Cronbach’s alphas. Findings Exploratory and confirmatory factor analyses identified 12 CCATH composites: leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and quality improvement, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices. All the CCATH scales had internal consistency reliability of .65 or above, and the reliability was .70 or above for 9 of the 12 scales. Analysis of variance results showed that not-for-profit hospitals have higher CCATH scores than for-profit hospitals in five CCATH scales and higher CCATH scores than government hospitals in two CCATH scales. Practice Implications The CCATH showed adequate psychometric properties. Managers and policy makers can use the CCATH as a tool to evaluate hospital performance in cultural competency and identify and target improvements in hospital policies and practices that undergird the provision of CLAS. PMID:21934511

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study

PubMed Central

2010-01-01

Background The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. Methods A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Results Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%). Conclusion Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies. PMID:20144212

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study.

PubMed

Mushtaq, Muhammad Umair; Majrooh, Muhammad Ashraf; Ullah, Mohsin Zia Sana; Akram, Javed; Siddiqui, Arif Mahmood; Shad, Mushtaq Ahmad; Waqas, Muhammad; Abdullah, Hussain Muhammad; Ahmad, Waqar; Shahid, Ubeera; Khurshid, Usman

2010-02-09

The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 +/- 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 +/- 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 +/- 2.1 [scale 0-16]; compliance percentage = 72.8%). Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.

Symptoms, functioning and quality of life after treatment in a residential sub-acute mental health service in Australia.

PubMed

Thomas, Kerry A; Rickwood, Debra J; Brown, Patricia M

2017-01-01

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery-focused, sub-acute service, in Australia. Clients were either step-up clients, entering the service directly from the community, or step-down clients who were transitioning from an inpatient unit to home. During the 30-month period of data collection (August 2011 to January 2014) all clients (N = 102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis-32) and service providers completed the Life Skills Profile-16 and Health of the Nations Outcome Scales. Follow-up data 3 months after exit were available for 12 clients, including the Basis-32 and a self-report measure of quality of life (Assessment of Quality of Life 8-dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self-care, level of symptoms and presence of social problems. At 3 months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub-acute service, step-up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step-down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub-acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital. © 2015 John Wiley & Sons Ltd.

Ecosystem services and agriculture: tradeoffs and synergies

PubMed Central

Power, Alison G.

2010-01-01

Agricultural ecosystems provide humans with food, forage, bioenergy and pharmaceuticals and are essential to human wellbeing. These systems rely on ecosystem services provided by natural ecosystems, including pollination, biological pest control, maintenance of soil structure and fertility, nutrient cycling and hydrological services. Preliminary assessments indicate that the value of these ecosystem services to agriculture is enormous and often underappreciated. Agroecosystems also produce a variety of ecosystem services, such as regulation of soil and water quality, carbon sequestration, support for biodiversity and cultural services. Depending on management practices, agriculture can also be the source of numerous disservices, including loss of wildlife habitat, nutrient runoff, sedimentation of waterways, greenhouse gas emissions, and pesticide poisoning of humans and non-target species. The tradeoffs that may occur between provisioning services and other ecosystem services and disservices should be evaluated in terms of spatial scale, temporal scale and reversibility. As more effective methods for valuing ecosystem services become available, the potential for ‘win–win’ scenarios increases. Under all scenarios, appropriate agricultural management practices are critical to realizing the benefits of ecosystem services and reducing disservices from agricultural activities. PMID:20713396

Positioning patient-perceived medical services to develop a marketing strategy.

PubMed

Jung, Minsoo; Hong, Myung-Sun

2012-01-01

In today's medical market, marketing philosophy is being rapidly transformed from customer searching to patient satisfaction and service improvement. The principal objective of this study was to contribute to the establishment of a desirable medical marketing strategy, through the factors of customer satisfaction and the positioning of patients' perceptions by marketing institutions. The data were collected from 282 students of the College of Public Health and Medicine in Seoul. The survey tools were developed using the SERVQUAL scale. Analysis in this study involved both statistical and network analysis. The former was used to verify the determinants of service satisfaction as perceived by respondents, via factor analysis and multiple regression analysis. The latter was obtained using a positioning map and 2-mode network analysis with the matrix data converted from raw data. The determining factors for patient satisfaction were identified as facilities, accessibility, process, physicians, and medical staff. The regression equation was significant (R = 0.606), and the most influential variable was the service quality of physicians (β = .569). According to multidimensional scaling, the positioning of medical institutions indicated that patients' perceptions were affected by hospital size and specialization. By recognizing and managing patient satisfaction, medical institutions are able to foster customer loyalty and, in turn, to enhance service quality. It is necessary to develop an adequate marketing mix to provide better medical services and to overcome medical competition among institutions.

Evaluating Commercial and Private Cloud Services for Facility-Scale Geodetic Data Access, Analysis, and Services

NASA Astrophysics Data System (ADS)

Meertens, C. M.; Boler, F. M.; Ertz, D. J.; Mencin, D.; Phillips, D.; Baker, S.

2017-12-01

UNAVCO, in its role as a NSF facility for geodetic infrastructure and data, has succeeded for over two decades using on-premises infrastructure, and while the promise of cloud-based infrastructure is well-established, significant questions about suitability of such infrastructure for facility-scale services remain. Primarily through the GeoSciCloud award from NSF EarthCube, UNAVCO is investigating the costs, advantages, and disadvantages of providing its geodetic data and services in the cloud versus using UNAVCO's on-premises infrastructure. (IRIS is a collaborator on the project and is performing its own suite of investigations). In contrast to the 2-3 year time scale for the research cycle, the time scale of operation and planning for NSF facilities is for a minimum of five years and for some services extends to a decade or more. Planning for on-premises infrastructure is deliberate, and migrations typically take months to years to fully implement. Migrations to a cloud environment can only go forward with similar deliberate planning and understanding of all costs and benefits. The EarthCube GeoSciCloud project is intended to address the uncertainties of facility-level operations in the cloud. Investigations are being performed in a commercial cloud environment (Amazon AWS) during the first year of the project and in a private cloud environment (NSF XSEDE resource at the Texas Advanced Computing Center) during the second year. These investigations are expected to illuminate the potential as well as the limitations of running facility scale production services in the cloud. The work includes running parallel equivalent cloud-based services to on premises services and includes: data serving via ftp from a large data store, operation of a metadata database, production scale processing of multiple months of geodetic data, web services delivery of quality checked data and products, large-scale compute services for event post-processing, and serving real time data from a network of 700-plus GPS stations. The evaluation is based on a suite of metrics that we have developed to elucidate the effectiveness of cloud-based services in price, performance, and management. Services are currently running in AWS and evaluation is underway.

Going to Scale with High-Quality Early Education

ERIC Educational Resources Information Center

Christina, Rachel; Nicholson-Goodman, JoVictoria

2005-01-01

This report is an initial effort to describe efforts of a number of states that are seeking to create statewide systems of high-quality pre-kindergarten services, as well as some of the progress they have made in doing so. Focusing on the efforts of a sample of eight U.S. states, it examines the policy choices that states have made when…

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

PubMed Central

2013-01-01

Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers’ demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions. PMID:23320786

Life satisfaction and quality in Korean War veterans five decades after the war.

PubMed

Ikin, J F; Sim, M R; McKenzie, D P; Horsley, K W A; Wilson, E J; Harrex, W K; Moore, M R; Jelfs, P L; Henderson, S

2009-05-01

Military service is considered to be a hidden variable underlying current knowledge about well-being in the elderly. This study aimed to examine life satisfaction and quality of life in Australia's surviving male Korean War veterans and a community comparison group, and to investigate any association with war deployment-related factors. Participants completed a postal questionnaire which included the Life Satisfaction Scale, the brief World Health Organization Quality of Life (WHOQOL-Bref) questionnaire and the Combat Exposure Scale. Korean War veterans reported significantly lower Percentage Life Satisfaction (PLS) and quality of life scores on four WHOQOL-Bref domains, compared with similarly aged Australian men (each p value <0.001). These outcomes were most strongly associated with severity of combat exposure and low rank. Mean PLS was approximately 15% lower in veterans who reported heavy combat compared with those reporting no combat, and approximately 12% lower in enlisted ranked veterans compared with officers. Fifty years after the Korean War, life satisfaction and quality in Australian veterans is poor relative to other Australian men, and is associated with deployment-related factors including combat severity and low rank. In order to respond effectively to current and projected population health needs, nations with large veteran populations may need to consider the impact of military service on well-being in later life.

Measurement repeatability of a large-scale inventory of forest fuels

Treesearch

J.A. Westfall; C.W. Woodall

2007-01-01

An efficient and accurate inventory of forest fuels at large scales is critical for assessment of forest fire hazards across landscapes. The Forest Inventory and Analysis (FIA) program of the USDA Forest Service conducts a national inventory of fuels along with blind remeasurement of a portion of inventory plots to monitor and improve data quality. The goal of this...

[Reorganizing the management of specialist uro-andrologic ultrasound health-care service: impact on professional quality].

PubMed

Dell'Atti, Lucio; Russo, Gian Rosario

2011-01-01

The process of organizing a ultrasound service nowadays can be improved by properly managing the user's request, the speed of response and safety, the standardization of methods and skills. The outpatients at our uro-andrologic ultrasound clinic (O.U. of Urology in Ferrara) received a questionnaire each; we administered a total of 640 questionnaires. The number of questionnaires collected was 532. Patients were asked to give an assessment of services using a qualitative method according to a 4-parameter response scale: very satisfied, satisfied, dissatisfied, very dissatisfied. The identification of indicators to be monitored by the user's perceived quality was accomplished by establishing the correlation coefficient between different parameters of analysis and an overall rating of the sample. Some of these parameters were: the relationship with the practitioner, the availability of doctors, the ability of doctors for reassurance, the completeness of information and facilities hygiene conditions. When these parameters vary, positively or negatively, also the citizen's overall opinion changes. The customer satisfaction is an important component of the quality of care, it represents both an indicator of the effectiveness of health intervention and the ability to meet quality requirements of the health service organization. The objective of an ultrasound service should be to provide, within a reasonable timeframe, the supply of high quality with qualified personnel, with adequate tools and procedures.

Supporting Collaborative Model and Data Service Development and Deployment with DevOps

NASA Astrophysics Data System (ADS)

David, O.

2016-12-01

Adopting DevOps practices for model service development and deployment enables a community to engage in service-oriented modeling and data management. The Cloud Services Integration Platform (CSIP) developed the last 5 years at Colorado State University provides for collaborative integration of environmental models into scalable model and data services as a micro-services platform with API and deployment infrastructure. Originally developed to support USDA natural resource applications, it proved suitable for a wider range of applications in the environmental modeling domain. While extending its scope and visibility it became apparent community integration and adequate work flow support through the full model development and application cycle drove successful outcomes.DevOps provide best practices, tools, and organizational structures to optimize the transition from model service development to deployment by minimizing the (i) operational burden and (ii) turnaround time for modelers. We have developed and implemented a methodology to fully automate a suite of applications for application lifecycle management, version control, continuous integration, container management, and container scaling to enable model and data service developers in various institutions to collaboratively build, run, deploy, test, and scale services within minutes.To date more than 160 model and data services are available for applications in hydrology (PRMS, Hydrotools, CFA, ESP), water and wind erosion prediction (WEPP, WEPS, RUSLE2), soil quality trends (SCI, STIR), water quality analysis (SWAT-CP, WQM, CFA, AgES-W), stream degradation assessment (SWAT-DEG), hydraulics (cross-section), and grazing management (GRAS). In addition, supporting data services include soil (SSURGO), ecological site (ESIS), climate (CLIGEN, WINDGEN), land management and crop rotations (LMOD), and pesticides (WQM), developed using this workflow automation and decentralized governance.

Trans-National Scale-Up of Services in Global Health

PubMed Central

Shahin, Ilan; Sohal, Raman; Ginther, John; Hayden, Leigh; MacDonald, John A.; Mossman, Kathryn; Parikh, Himanshu; McGahan, Anita; Mitchell, Will; Bhattacharyya, Onil

2014-01-01

Background Scaling up innovative healthcare programs offers a means to improve access, quality, and health equity across multiple health areas. Despite large numbers of promising projects, little is known about successful efforts to scale up. This study examines trans-national scale, whereby a program operates in two or more countries. Trans-national scale is a distinct measure that reflects opportunities to replicate healthcare programs in multiple countries, thereby providing services to broader populations. Methods Based on the Center for Health Market Innovations (CHMI) database of nearly 1200 health programs, the study contrasts 116 programs that have achieved trans-national scale with 1,068 single-country programs. Data was collected on the programs' health focus, service activity, legal status, and funding sources, as well as the programs' locations (rural v. urban emphasis), and founding year; differences are reported with statistical significance. Findings This analysis examines 116 programs that have achieved trans-national scale (TNS) across multiple disease areas and activity types. Compared to 1,068 single-country programs, we find that trans-nationally scaled programs are more donor-reliant; more likely to focus on targeted health needs such as HIV/AIDS, TB, malaria, or family planning rather than provide more comprehensive general care; and more likely to engage in activities that support healthcare services rather than provide direct clinical care. Conclusion This work, based on a large data set of health programs, reports on trans-national scale with comparison to single-country programs. The work is a step towards understanding when programs are able to replicate their services as they attempt to expand health services for the poor across countries and health areas. A subset of these programs should be the subject of case studies to understand factors that affect the scaling process, particularly seeking to identify mechanisms that lead to improved health outcomes. PMID:25375328

Implementation of a large-scale hospital information infrastructure for multi-unit health-care services.

PubMed

Yoo, Sun K; Kim, Dong Keun; Kim, Jung C; Park, Youn Jung; Chang, Byung Chul

2008-01-01

With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.

Landscape Simplification Constrains Adult Size in a Native Ground-Nesting Bee

PubMed Central

Renauld, Miles; Hutchinson, Alena; Loeb, Gregory; Poveda, Katja; Connelly, Heather

2016-01-01

Bees provide critical pollination services to 87% of angiosperm plants; however, the reliability of these services may become threatened as bee populations decline. Agricultural intensification, resulting in the simplification of environments at the landscape scale, greatly changes the quality and quantity of resources available for female bees to provision their offspring. These changes may alter or constrain the tradeoffs in maternal investment allocation between offspring size, number and sex required to maximize fitness. Here we investigate the relationship between landscape scale agricultural intensification and the size and number of individuals within a wild ground nesting bee species, Andrena nasonii. We show that agricultural intensification at the landscape scale was associated with a reduction in the average size of field collected A. nasonii adults in highly agricultural landscapes but not with the number of individuals collected. Small females carried significantly smaller (40%) pollen loads than large females, which is likely to have consequences for subsequent offspring production and fitness. Thus, landscape simplification is likely to constrain allocation of resources to offspring through a reduction in the overall quantity, quality and distribution of resources. PMID:26943127

Landscape Simplification Constrains Adult Size in a Native Ground-Nesting Bee.

PubMed

Renauld, Miles; Hutchinson, Alena; Loeb, Gregory; Poveda, Katja; Connelly, Heather

2016-01-01

Bees provide critical pollination services to 87% of angiosperm plants; however, the reliability of these services may become threatened as bee populations decline. Agricultural intensification, resulting in the simplification of environments at the landscape scale, greatly changes the quality and quantity of resources available for female bees to provision their offspring. These changes may alter or constrain the tradeoffs in maternal investment allocation between offspring size, number and sex required to maximize fitness. Here we investigate the relationship between landscape scale agricultural intensification and the size and number of individuals within a wild ground nesting bee species, Andrena nasonii. We show that agricultural intensification at the landscape scale was associated with a reduction in the average size of field collected A. nasonii adults in highly agricultural landscapes but not with the number of individuals collected. Small females carried significantly smaller (40%) pollen loads than large females, which is likely to have consequences for subsequent offspring production and fitness. Thus, landscape simplification is likely to constrain allocation of resources to offspring through a reduction in the overall quantity, quality and distribution of resources.

Assessing the relationship between pharmacists' job satisfaction and over-the-counter counselling at community pharmacies.

PubMed

Urbonas, Gvidas; Kubilienė, Loreta

2016-04-01

Community pharmacies have an increasing role in self-medication and community health is dependent on the quality of counselling services provided to patients. Some studies show that pharmacists' job satisfaction affects their work quality; other studies found that higher involvement in clinical services increases pharmacists' job satisfaction. To test the relationship between job satisfaction and over-the-counter counselling practice at community pharmacies. Community pharmacies in Lithuania. A convenience sample (n = 305) of community pharmacists participated in the cross-sectional survey where they expressed satisfaction with job and reported on their over-the-counter counselling behaviour on self-report scales. The Partial Least Squares Structural Equation Modelling approach was employed for data analysis. The strength of the relationship between job satisfaction and over-the-counter counselling service. A bidirectional relationship between job satisfaction and over-the-counter counselling service was found. In addition, job satisfaction and over-the-counter counselling quality depended on pharmacists' age. Organizations were recommended to create a counselling friendly environment that would increase pharmacists' job satisfaction and, in return, counselling quality. Also, additional motivation of the retired pharmacists, as well as development of counselling skills of the younger pharmacy workforce, were seen as a means to improve both organizational climate and counselling quality over the counter.

Associated and mediating variables related to quality of life among service users with mental disorders.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie

2018-02-01

This study aimed to identify variables associated with quality of life (QoL) and mediating variables among 338 service users with mental disorders in Quebec (Canada). Data were collected using nine standardized questionnaires and participant medical records. Quality of life was assessed with the Satisfaction with Life Domains Scale. Independent variables were organized into a six-block conceptual framework. Using structural equation modeling, associated and mediating variables related to QoL were identified. Lower seriousness of needs was the strongest variable associated with QoL, followed by recovery, greater service continuity, gender (male), adequacy of help received, not living alone, absence of substance use or mood disorders, and higher functional status, in that order. Recovery was the single mediating variable linking lower seriousness of needs, higher service continuity, and reduced alcohol use with QoL. Findings suggest that greater service continuity creates favorable conditions for recovery, reducing seriousness of needs and increasing QoL among service users. Lack of recovery-oriented services may affect QoL among alcohol users, as substance use disorders were associated directly and negatively with QoL. Decision makers and mental health professionals should promote service continuity, and closer collaboration between primary care and specialized services, while supporting recovery-oriented services that encourage service user involvement in their treatment and follow-up. Community-based organizations should aim to reduce the seriousness of needs particularly for female service users and those living alone.

Users' demographic profile and quality attributes of bus services: The perspectives of users, operators and local authorities

NASA Astrophysics Data System (ADS)

Noh, Nur'Amirah Mhd.; Hamid, Ahmad Hilmy Abd

2017-10-01

Bus services that can help meet almost every bus user's needs are the goals of bus operators. Despite such an idealistic view, the operators themselves, users and even the local authorities have been found to hold different views about the quality of service that the bus should deliver. As the users i.e., customers are considered as important stakeholders, understanding their characteristics, profile and pattern is very crucial. To this end, the present study has attempted to gauge the perspectives of all the above-mentioned stakeholders. For the users, a customer satisfaction survey was employed to look into the relative influence of service attributes. In addition, surveys were also administered to bus operators and local authorities to study their perspectives in relation to this matter. 450 randomly selected respondents were surveyed. Identification of the service level was analyzed through the Likert scale whereas the perspectives of the operators and authorities were dealt with through mean value Analysis. Specifically, this study aims to identify the crucial attributes in determining the quality of the bus services. Findings of the study indicated that different attributes were selected by users, operators and authorities, which clearly enlightened the variations of the important attributes in determining the level of bus service quality. In its attempt to compare the service level attributes from three perspectives, this study has helped advance better improvement and strategies for the urban public bus operators and planners, in addition to the authorities in delivering user-friendly bus services by taking into account the local context, user profile and demographic characteristics.

Library and information services: impact on patient care quality.

PubMed

Marshall, Joanne Gard; Morgan, Jennifer Craft; Thompson, Cheryl A; Wells, Amber L

2014-01-01

The purpose of this paper is to explore library and information service impact on patient care quality. A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the USA and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. Of 4,520 respondents, 75 percent said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: first, time saved; second, patient care changes; and third, adverse events avoided. The outcomes were examined in relation to four information access methods: first, asking librarian for assistance; second, performing search in a physical library; third, searching library's web site; or fourth, searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. Electronic collections and services provided by the library and the librarian contribute to patient care quality.

Are consumer-directed home care beneficiaries satisfied? Evidence from Washington state.

PubMed

Wiener, Joshua M; Anderson, Wayne L; Khatutsky, Galina

2007-12-01

This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study, we developed an 8-item Satisfaction With Paid Personal Assistance Scale as the measure of satisfaction. In predicting satisfaction with personal assistance services, we estimated an ordinary least squares regression model that was right-censored to account for the large percentage of respondents who were highly satisfied with their care. Among the older population, but not younger people with disabilities, beneficiaries receiving consumer-directed services were more satisfied than individuals receiving agency-directed care. There was no evidence that quality of care was less with consumer-directed services. In addition, overall satisfaction levels with paid home care were very high. This study supports the premise that consumer satisfaction, an important measure of quality, in consumer-directed home care is not inferior to that in agency-directed care. The positive effect of consumer direction for older people underlines the fact that this service option is relevant for this population. In addition, this research provides evidence that home- and community-based services are of high quality, at least on one dimension.

Level of Service Program for INDOT Operations : APPENDIX F Asset Deficiency Weight Scale

DOT National Transportation Integrated Search

2012-01-01

INDOT has used an inspection program named Maintenance Quality Survey (MQS) to perform a statewide inspection of their roadway assets, rightofway to rightofway. This inspection requires two twoperson teams approximately 18 months to...

[Evaluation of social demographic aspect of life quality of coal extraction workers in Kouzbass enterprises].

PubMed

Ivoĭlov, V M; Semenikhin, V A; Odintseva, O V; Shternis, T A

2014-01-01

For assessing influence of social factors on life quality of workers in coal extraction enterpirses of Kemerovo region, the authors used questionnaire SF-36. Life quality parameters of workers engaged into coal extraction in Kemerovo region appeared to lower with age from 20 to 64 years. Life quality parameters on scales of pain, physical functioning and general health are invertedly correlated with age and length of service in hazardous work conditions for coal extraction workers. Life quality of the miners is influenced by the following factors: marital status, educational level and income level of the workers.

Significant components of service brand equity in healthcare sector.

PubMed

Chahal, Hardeep; Bala, Madhu

2012-01-01

The purpose of the study is to examine three significant components of service brand equity--i.e. perceived service quality, brand loyalty, and brand image--and analyze relationships among the components of brand equity and also their relationship with brand equity, which is still to be theorized and developed in the healthcare literature. Effective responses were received from 206 respondents, selected conveniently from the localities of Jammu city. After scale item analysis, the data were analyzed using factor analysis, correlations, t-tests, multiple regression analysis and path modeling using SEM. The findings of the study support that service brand equity in the healthcare sector is greatly influenced by brand loyalty and perceived quality. However, brand image has an indirect effect on service brand equity through brand loyalty (mediating variable). The research can be criticized on the ground that data were selected conveniently from respondents residing in the city of Jammu, India. But at the same time the respondents were appropriate for the study as they have adequate knowledge about the hospitals, and were associated with the selected hospital for more than four years. Furthermore, the validity and reliability of the data are strong enough to take care of the limitations of the convenience sampling selection method. The study has unique value addition to the service marketing vis-à-vis healthcare literature, from both theoretical and managerial perspectives. The study establishes a direct and significant relationship between service brand equity and its two components, i.e. perceived service quality and brand loyalty in the healthcare sector. It also provides directions to healthcare service providers in creating, enhancing, and maintaining service brand equity through service quality and brand loyalty, to sustain competitive advantage.

Quality Assurance Framework for Mini-Grids

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

Baring-Gould, Ian; Burman, Kari; Singh, Mohit

Providing clean and affordable energy services to the more than 1 billion people globally who lack access to electricity is a critical driver for poverty reduction, economic development, improved health, and social outcomes. More than 84% of populations without electricity are located in rural areas where traditional grid extension may not be cost-effective; therefore, distributed energy solutions such as mini-grids are critical. To address some of the root challenges of providing safe, quality, and financially viable mini-grid power systems to remote customers, the U.S. Department of Energy (DOE) teamed with the National Renewable Energy Laboratory (NREL) to develop a Qualitymore » Assurance Framework (QAF) for isolated mini-grids. The QAF for mini-grids aims to address some root challenges of providing safe, quality, and affordable power to remote customers via financially viable mini-grids through two key components: (1) Levels of service: Defines a standard set of tiers of end-user service and links them to technical parameters of power quality, power availability, and power reliability. These levels of service span the entire energy ladder, from basic energy service to high-quality, high-reliability, and high-availability service (often considered 'grid parity'); (2) Accountability and performance reporting framework: Provides a clear process of validating power delivery by providing trusted information to customers, funders, and/or regulators. The performance reporting protocol can also serve as a robust monitoring and evaluation tool for mini-grid operators and funding organizations. The QAF will provide a flexible alternative to rigid top-down standards for mini-grids in energy access contexts, outlining tiers of end-user service and linking them to relevant technical parameters. In addition, data generated through implementation of the QAF will provide the foundation for comparisons across projects, assessment of impacts, and greater confidence that will drive investment and scale-up in this sector. The QAF implementation process also defines a set of implementation guidelines that help the deployment of mini-grids on a regional or national scale, helping to insure successful rapid deployment of these relatively new remote energy options. Note that the QAF is technology agnostic, addressing both alternating current (AC) and direct current (DC) mini-grids, and is also applicable to renewable, fossil-fuel, and hybrid systems.« less

Psychometric Properties of the Beach Center Family Quality of Life in French-Speaking Families with a Preschool-Aged Child Diagnosed with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Rivard, Mélina; Mercier, Céline; Mestari, Zakaria; Terroux, Amélie; Mello, Catherine; Bégin, Jean

2017-01-01

The Beach Center Family Quality of Life Scale (Beach Center FQOL) is used to evaluate and develop family-centered intervention services. However, its use with families of children with autism spectrum disorder (ASD) and in non-English speaking populations requires further investigation. The present study sought to assess the psychometric…

The impact of medical tourism on Thai private hospital management: informing hospital policy.

PubMed

James, Paul T J

2012-01-01

The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

The Impact of Medical Tourism on Thai Private Hospital Management: Informing Hospital Policy

PubMed Central

James, Paul TJ

2012-01-01

Background: The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. Methods: The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualise the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Results: Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. Conclusions: As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand’s health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology. PMID:22980119

Field_ac: a research project on ocean modelling in coastal areas. The experience in the Catalan Sea.

NASA Astrophysics Data System (ADS)

Grifoll, Manel; Pallarès, Elena; Tolosana-Delgado, Raimon; Fernandez, Juan; Lopez, Jaime; Mosso, Cesar; Hermosilla, Fernando; Espino, Manuel; Sanchez-Arcilla, Agustín

2013-04-01

The EU founded Field_ac project has investigated during the last three years methods and strategies for improving operational services in coastal areas. The objective has been to generate added value for shelf and regional scale predictions from GMES Marine Core Services. In this sense the experience in the Catalan Sea site has allowed to combine high-resolution numerical modeling tools nested into regional GMES services, data from intensive field campaigns or local observational networks and remote sensing products. Multi-scale coupled models have been implemented to evaluate different temporal and spatial scales of the dominant physical processes related with waves, currents, continental/river discharges or sediment transport. In this sense the experience of the Field_ac project in the Catalan Sea has permit to "connect" GMES marine core service results to the coastal (local) anthropogenic forcing (e.g. causes of morphodynamic evolution and ecosystem degradation) and will support a knowledge-based assessment of decisions in the coastal zone. This will contribute to the implementation of EU directives (e.g., the Water Framework Directive for water quality at beaches near harbour entrances or the Risk or Flood Directives for waves and sea-level at beach/river-mouth scales).

A family-specific use of the Measure of Processes of Care for Service Providers (MPOC-SP).

PubMed

Siebes, R C; Nijhuis, B J G; Boonstra, A M; Ketelaar, M; Wijnroks, L; Reinders-Messelink, H A; Postema, K; Vermeer, A

2008-03-01

To examine the validity and utility of the Dutch Measure of Processes of Care for Service Providers (MPOC-SP) as a family-specific measure. A validation study. Five paediatric rehabilitation settings in the Netherlands. The MPOC-SP was utilized in a general (reflecting on services provided for all clients and clients' families) and family-specific way (filled out in reference to a particular child and his or her family). Professionals providing rehabilitation and educational services to children with cerebral palsy. For construct validity, Pearson's product-moment correlation coefficients (r ) between the scales were calculated. The ability of service providers to discriminate between general and family-specific ratings was examined by exploration of absolute difference scores. One hundred and sixteen service professionals filled out 240 family-specific MPOC-SPs. In addition, a subgroup of 81 professionals filled out a general MPOC-SP. For each professional, family-specific and general scores were paired, resulting in 151 general-family-specific MPOC-SP pairs. The construct validity analyses confirmed the scale structure: 21 items (77.8%) loaded highest in the original MPOC-SP factors, and all items correlated best and significantly with their own scale score (r 0.565 to 0.897; P<0.001). Intercorrelations between the scales ranged from r = 0.159 to r = 0.522. In total, 94.4% of the mean absolute difference scores between general and family-specific scale scores were larger than the expected difference. Service providers were able to discriminate between general and family-specific MPOC-SP item ratings. The family-specific MPOC-SP is a valid measure that can be used for individual evaluation of family-centred services and can be the impetus for family-related quality improvement.

Uncertainties in ecosystem service maps: a comparison on the European scale.

PubMed

Schulp, Catharina J E; Burkhard, Benjamin; Maes, Joachim; Van Vliet, Jasper; Verburg, Peter H

2014-01-01

Safeguarding the benefits that ecosystems provide to society is increasingly included as a target in international policies. To support such policies, ecosystem service maps are made. However, there is little attention for the accuracy of these maps. We made a systematic review and quantitative comparison of ecosystem service maps on the European scale to generate insights in the uncertainty of ecosystem service maps and discuss the possibilities for quantitative validation. Maps of climate regulation and recreation were reasonably similar while large uncertainties among maps of erosion protection and flood regulation were observed. Pollination maps had a moderate similarity. Differences among the maps were caused by differences in indicator definition, level of process understanding, mapping aim, data sources and methodology. Absence of suitable observed data on ecosystem services provisioning hampers independent validation of the maps. Consequently, there are, so far, no accurate measures for ecosystem service map quality. Policy makers and other users need to be cautious when applying ecosystem service maps for decision-making. The results illustrate the need for better process understanding and data acquisition to advance ecosystem service mapping, modelling and validation.

Essential tips for measuring levels of consumer satisfaction with rural health service quality.

PubMed

Smith, Karly B; Humphreys, John S; Jones, Judith A

2006-01-01

Quality of health services is a matter of increasing importance to health authorities. Monitoring consumer satisfaction of health care is an important input to improving the quality of health services. This article highlights a number of important considerations learned from rural consumer studies relevant to ensuring the valid measurement of consumer satisfaction with rural health services, as a means of contributing to quality improvements. This article compares two methods of analysing rural consumers' satisfaction with healthcare services. In one study of three rural communities in western New South Wales (NSW) and eight communities in north-west Victoria, residents were asked to rate their satisfaction with five key aspects of local health services (availability, geographical accessibility, choice, continuity, economic accessibility as measured by affordability) using a 5 point Likert scale from: one = very satisfied to five = very dissatisfied. An alternative method of assessing levels of consumer satisfaction was undertaken in the survey of eight rural communities in north-west Victoria by investigating consumers' experiences with actual and potential complaints in relation to health services. Both the NSW and Victorian respondents reported generally high levels of satisfaction with the five indicators of quality of health care. At the same time, 11% of Victorian study respondents reported having made a complaint about a health service in the previous 12 months, and one-third of the Victorian respondents reported experiences with their health services about which they wanted to complain but did not, over the same period. Interpretation of apparent consumer satisfaction with their health services must take particular account of the measures and research methods used. In assessing consumer satisfaction with health services in rural areas, specific attention should be given to maximising the engagement of rural consumers in order to ensure representativeness of findings, and to minimise possible biases in satisfaction ratings associated with the use of particular tools.

Psychometric Properties of the Beach Center Family Quality of Life in French-Speaking Families With a Preschool-Aged Child Diagnosed With Autism Spectrum Disorder.

PubMed

Rivard, Mélina; Mercier, Céline; Mestari, Zakaria; Terroux, Amélie; Mello, Catherine; Bégin, Jean

2017-09-01

The Beach Center Family Quality of Life Scale (Beach Center FQOL) is used to evaluate and develop family-centered intervention services. However, its use with families of children with autism spectrum disorder (ASD) and in non-English speaking populations requires further investigation. The present study sought to assess the psychometric properties of a French translation of this scale on 452 parents of children aged 5 and under who were recently diagnosed with ASD. The resulting Satisfaction and Importance scales presented excellent internal consistency at the scale level and acceptable internal consistency at the subscale level. Theoretical model positing 5 dimensions of FQOL generally fit the data acceptably. Satisfaction ratings were found to be sensitive to changes and were negatively correlated with parenting stress.

Projecting supply and demand of hydrologic ecosystem services under future climate conditions

NASA Astrophysics Data System (ADS)

Chiang, Li-Chi; Huang, Tao; Lee, Tsung-Yu

2014-05-01

Ecosystems provide essential goods and services, such as food, clean water, water purification, soil conservation and cultural services for human being. In a watershed, these water-related ecosystem goods and services can directly or indirectly benefit both local people and downstream beneficiaries through a reservoir. Water quality and quantity in a reservoir are of importance for agricultural, industrial and domestic uses. Under the impacts of climate and land use changes, both ecosystem service supply and demand will be affected by changes in precipitation patterns, temperature, urbanization and agricultural activities. However, the linkage between ecosystem service provisioning (ESP) and ecosystem service beneficiary (ESB), and scales of supply and demand of ecosystem services are not clear yet. Therefore, to investigate water-related ecosystem service supply under climate and land use change, we took the Xindian river watershed (303 km2) as a case study, where the Feitsui Reservoir provides hydro-power and daily domestic water use of 3,450,000 m3 for 3.46 million people in Taipei, Taiwan. We integrated a hydrological model (Soil and Water Assessment Tool, SWAT) and a land use change model (Conversion of Land Use and its Effects, CLUE-s) with future climate change scenarios derived from General Circulation Models (GCMs), to assess the changes in ecosystem service supply and demand at different hydrologic scales. The results will provide useful information for decision-making on future land use management and climate change adaptation strategies in the watersheds. Keywords: climate change, land use change, ecosystem service, watershed, scale

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective.

PubMed

Wainberg, Milton L; Scorza, Pamela; Shultz, James M; Helpman, Liat; Mootz, Jennifer J; Johnson, Karen A; Neria, Yuval; Bradford, Jean-Marie E; Oquendo, Maria A; Arbuckle, Melissa R

2017-05-01

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

Integrating ecosystem services trade-offs with paddy land-to-dry land decisions: A scenario approach in Erhai Lake Basin, southwest China.

PubMed

Hu, Yi'na; Peng, Jian; Liu, Yanxu; Tian, Lu

2018-06-01

Ecosystem services are the benefits people obtain from ecosystems, and ecosystem services trade-offs have been widely applied to the development of land-use policy. Although previous studies have focused on trade-offs of ecosystem services, a scenario approach has been seldom used. The scenario approach can reveal the changes of ecosystem services for different land-use patterns in the future, and is of great significance for land-use decisions and ecosystem management. Based on the actual situation of deteriorating water quality and dwindling water supply in the Erhai Lake Basin of southwest China, this study put forward to convert paddy land to dry land (PLDL) in the basin, and simulated its potential impact on ecosystem services. Taking environmental pollution, social impact, economic benefit and residential participation into consideration, four scenarios of PLDL were designed. Then, four ecosystem services (water purification, water yield, soil conservation and rice production) were calculated for each scenario. The optimal scenario of PLDL in the Erhai Lake Basin was identified by trade-offs of the four ecosystem services. The results showed that the total nitrogen export could be reduced by 42.07% and water yield can be increased by 5.61% after converting 100% of paddy lands to dry land, thereby greatly improving the water quality and increasing the water yield of Erhai Lake. However, PLDL involving 100% of paddy lands also increased the sediment export by 17.22%, and eliminated rice production in the region. By comparing the four PLDL scenarios for converting just 50% of paddy lands, the residential participation scenario was identified to be the best choice for PLDL implementation because it achieved the best level of water purification and had the smallest negative effect on other ecosystem services. The optimal scenario for each township showed spatial differentiation, and there were conflicts between the optimal scenarios at basin scale and township scale, suggesting that the object and the spatial-temporal scale should be taken into consideration in land-use decisions using ecosystem services trade-offs. Copyright © 2018 Elsevier B.V. All rights reserved.

Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria.

PubMed

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J

2012-01-01

In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug. This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.

Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria

PubMed Central

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J.

2012-01-01

Background In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. Methods NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. Findings LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child’s vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children’s illness, and only 19.9% could accurately describe how to administer the prescribed drug. Conclusion This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services. PMID:23028519

Impacts of biodiversity loss on ocean ecosystem services.

PubMed

Worm, Boris; Barbier, Edward B; Beaumont, Nicola; Duffy, J Emmett; Folke, Carl; Halpern, Benjamin S; Jackson, Jeremy B C; Lotze, Heike K; Micheli, Fiorenza; Palumbi, Stephen R; Sala, Enric; Selkoe, Kimberley A; Stachowicz, John J; Watson, Reg

2006-11-03

Human-dominated marine ecosystems are experiencing accelerating loss of populations and species, with largely unknown consequences. We analyzed local experiments, long-term regional time series, and global fisheries data to test how biodiversity loss affects marine ecosystem services across temporal and spatial scales. Overall, rates of resource collapse increased and recovery potential, stability, and water quality decreased exponentially with declining diversity. Restoration of biodiversity, in contrast, increased productivity fourfold and decreased variability by 21%, on average. We conclude that marine biodiversity loss is increasingly impairing the ocean's capacity to provide food, maintain water quality, and recover from perturbations. Yet available data suggest that at this point, these trends are still reversible.

Quantifying beliefs regarding telehealth: Development of the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire.

PubMed

Hirani, Shashivadan P; Rixon, Lorna; Beynon, Michelle; Cartwright, Martin; Cleanthous, Sophie; Selva, Abi; Sanders, Caroline; Newman, Stanton P

2017-05-01

Introduction Telehealth (TH) is a potential solution to the increased incidence of chronic illness in an ageing population. The extent to which older people and users with chronic conditions accept and adhere to using assistive technologies is a potential barrier to mainstreaming the service. This study reports the development and validation of the Whole Systems Demonstrator (WSD) Service User Technology Acceptability Questionnaire (SUTAQ). Methods Questionnaires measuring the acceptability of TH, quality of life, well-being and psychological processes were completed by 478 users of TH. The 22 acceptability items were subject to principal components analysis (PCA) to determine sub-scales. Scale scores, relationships between scales and other patient-reported outcome measures (PROMs), and group differences on scales were utilised to check the reliability and validity of the measure. Results PCAs of SUTAQ items produced six TH acceptability scales: enhanced care, increased accessibility, privacy and discomfort, care personnel concerns, kit as substitution and satisfaction. Significant correlations within these beliefs and between these scales and additional PROMs were coherent, and the SUTAQ sub-scales were able to predict those more likely to refuse TH. Discussion The SUTAQ is an instrument that can be used to measure user beliefs about the acceptability of TH, and has the ability to discriminate between groups and predict individual differences in beliefs and behaviour. Measuring acceptability beliefs of TH users can provide valuable information to direct and target provision of services to increase uptake and maintain use of TH.

Linking research to practice: the organisation and implementation of The Netherlands health and social care improvement programmes.

PubMed

Ovretveit, John; Klazinga, Niek

2013-02-01

Both public and private health and social care services are facing increased and changing demands to improve quality and reduce costs. To enable local services to respond to these demands, governments and other organisations have established large scale improvement programmes. These usually seek to enable many services to make changes to apply proven improvements and to make use of quality improvement methods. The purpose of this paper is to provide an empirical description of how one organisation coordinated ten national improvement programmes between 2004 and 2010. It provides details which may be useful to others seeking to plan and implement such programmes, and also contributes to the understanding of knowledge translation and of network governance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Performance Evaluation of Resource Management in Cloud Computing Environments.

PubMed

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price.

Performance Evaluation of Resource Management in Cloud Computing Environments

PubMed Central

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price. PMID:26555730

Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

PubMed

Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

2015-06-01

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

Pursuing scale and quality in STI interventions with sex workers: initial results from Avahan India AIDS Initiative

PubMed Central

Steen, R; Mogasale, V; Wi, T; Singh, A K; Das, A; Daly, C; George, B; Neilsen, G; Loo, V; Dallabetta, G

2006-01-01

Background Migration, population mobility, and sex work continue to drive sexually transmitted epidemics in India. Yet interventions targeting high incidence networks are rarely implemented at sufficient scale to have impact. India AIDS Initiative (Avahan), funded by the Bill and Melinda Gates Foundation, is scaling up interventions with sex workers (SWs) and other high risk populations in India's six highest HIV prevalence states. Methods Avahan resources are channelled through state level partners (SLPs) to local level non‐governmental organisations (NGOs) who organise outreach, community mobilisation, and dedicated clinics for SWs. These clinics provide services for sexually transmitted infections (STIs) including Condom Promotion, syndromic case management, regular check‐ups, and treatment of asymptomatic infections. SWs take an active role in service delivery. STI capacity building support functions on three levels. A central capacity building team developed guidelines and standards, trains state level STI coordinators, monitors outcomes, and conducts operations research. Standards are documented in an Avahan‐wide manual. State level STI coordinators train NGO clinic staff and conduct supervision of clinics based on these standards and related quality monitoring tools. Clinic and outreach staff report on indicators that guide additional capacity building inputs. Results In 2 years, clinics with community outreach for SWs have been established in 274 settings covering 77 districts. Mapping and size estimation have identified 187 000 SWs. In a subset of four large states covered by six SLPs (183 000 estimated SWs, 65 districts), 128 326 (70%) of the SWs have been contacted through peer outreach and 74 265 (41%) have attended the clinic at least once. A total of 127 630 clinic visits have been reported, an increasing proportion for recommended routine check ups. Supervision and monitoring facilitate standardisation of services across sites. Conclusion Targeted HIV/STI interventions can be brought to scale and standardised given adequate capacity building support. Intervention coverage, service utilisation, and quality are key parameters that should be monitored and progressively improved with active involvement of SWs themselves. PMID:17012513

Fishing for ecosystem services.

PubMed

Pope, Kevin L; Pegg, Mark A; Cole, Nicholas W; Siddons, Stephen F; Fedele, Alexis D; Harmon, Brian S; Ruskamp, Ryan L; Turner, Dylan R; Uerling, Caleb C

2016-12-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships. Published by Elsevier Ltd.

Fishing for ecosystem services

USGS Publications Warehouse

Pope, Kevin L.; Pegg, Mark A.; Cole, Nicholas W.; Siddons, Stephen F.; Fedele, Alexis D.; Harmon, Brian S.; Ruskamp, Ryan L.; Turner, Dylan R.; Uerling, Caleb C.

2016-01-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships.

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

The relationship between advertising, price, and nursing home quality.

PubMed

Kash, Bita A; Miller, Thomas R

2009-01-01

Theoretically, nursing homes should engage in advertising for the following two reasons: (a) to improve awareness of the services offered in a particular market and (b) to signal high-quality services. In this study, we build upon results from prior studies of nursing home advertising activity, market competition, and quality. The purpose of this study was to examine the association between advertising expenses, price, and quality. We focused on answering the question: Do nursing homes use advertising and price to signal superior quality? The Texas Nursing Facilities Medicaid Cost Report, the Texas Quality Reporting System, and the Area Resource File were merged for the year 2003. We used three alternative measures of quality to improve the robustness of this exploratory analysis. Quality measures were examined using Bonferroni correlation coefficient analysis. Associations between advertising expenses and quality were evaluated using three regression models predicting quality. We also examined the association of the price of a private bed per day with quality. Advertising expenses were not associated with better nursing home quality as measured by three quality scales. The average price customers pay for one private bed per day was associated with better quality only in one of the three quality regression models. The price of nursing home care might be a better indicator of quality and necessary to increase as quality of care is improved in the nursing homes sector. Because more advertising expenditures are not necessarily associated with better quality, consumers could be mislead by advertisements and choose poor quality nursing homes. Nursing home administrators should focus on customer relationship management tools instead of expensive advertising. Relationship management tools are proven marketing techniques for the health services sector, usually less expensive than advertising, and help with staff retention and quality outcomes.

A Regional Multi-permit Market for Ecosystem Services

NASA Astrophysics Data System (ADS)

Bernknopf, R.; Amos, P.; Zhang, E.

2014-12-01

Regional cap and trade programs have been in operation since the 1970's to reduce environmental externalities (NOx and SOx emissions) and have been shown to be beneficial. Air quality and water quality limits are enforced through numerous Federal and State laws and regulations while local communities are seeking ways to protect regional green infrastructure and their ecosystems services. Why not combine them in a market approach to reduce many environmental externalities simultaneously? In a multi-permit market program reforestation (land offsets) as part of a nutrient or carbon sequestration trading program would provide a means to reduce agrochemical discharges into streams, rivers, and groundwater. Land conversions also improve the quality and quantity of other environmental externalities such as air pollution. Collocated nonmarket ecosystem services have societal benefits that can expand the crediting system into a multi-permit trading program. At a regional scale it is possible to combine regulation of water quality, air emissions and quality, and habitat conservation and restoration into one program. This research is about the economic feasibility of a Philadelphia regional multi-permit (cap and trade) program for ecosystem services. Instead of establishing individual markets for ecosystem services, the assumption of the spatial portfolio approach is that it is based on the interdependence of ecosystem functions so that market credits encompasses a range of ecosystem services. Using an existing example the components of the approach are described in terms of scenarios of land portfolios and the calculation of expected return on investment and risk. An experiment in the Schuylkill Watershed will be described for ecosystem services such as nutrients in water and populations of bird species along with Green House Gases. The Philadelphia regional market includes the urban - nonurban economic and environmental interactions and impacts.

Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes.

PubMed

Shrimpton, Roger; du Plessis, Lisanne M; Delisle, Hélène; Blaney, Sonia; Atwood, Stephen J; Sanders, David; Margetts, Barrie; Hughes, Roger

2016-08-01

To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC). Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training. The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes. The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions. Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition. Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.

An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa.

PubMed

Magasana, Vuyolwethu; Zembe, Wanga; Tabana, Hanani; Naik, Reshma; Jackson, Debra; Swanevelder, Sonja; Doherty, Tanya

2016-12-01

HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training.

Comparative Effectiveness Research and Children With Cerebral Palsy: Identifying a Conceptual Framework and Specifying Measures.

PubMed

Gannotti, Mary E; Law, Mary; Bailes, Amy F; OʼNeil, Margaret E; Williams, Uzma; DiRezze, Briano

2016-01-01

A step toward advancing research about rehabilitation service associated with positive outcomes for children with cerebral palsy is consensus about a conceptual framework and measures. A Delphi process was used to establish consensus among clinicians and researchers in North America. Directors of large pediatric rehabilitation centers, clinicians from large hospitals, and researchers with expertise in outcomes participated (N = 18). Andersen's model of health care utilization framed outcomes: consumer satisfaction, activity, participation, quality of life, and pain. Measures agreed upon included Participation and Environment Measure for Children and Youth, Measure of Processes of Care, PEDI-CAT, KIDSCREEN-10, PROMIS Pediatric Pain Interference Scale, Visual Analog Scale for pain intensity, PROMIS Global Health Short Form, Family Environment Scale, Family Support Scale, and functional classification levels for gross motor, manual ability, and communication. Universal forms for documenting service use are needed. Findings inform clinicians and researchers concerned with outcome assessment.

SMALL SCALE ECOSYSTEM ENGINEERING: DEVELOPMENT OF HOUSEHOLD LEVEL GREYWATER TREATMENT SYSTEMS

EPA Science Inventory

The project will increase quality of life through the protection of ecosystem services and drinking water supplies through pollution reduction. Additionally, through water reuse our project has the potential to decrease overall water consumption. Decreasing overall water co...

Customer orientation among employees in public administration: a transnational, longitudinal study.

PubMed

Korunka, Christian; Scharitzer, Dieter; Carayon, Pascale; Hoonakker, Peter; Sonnek, Angelika; Sainfort, Francois

2007-05-01

The relation between ergonomic principles and quality management initiatives, both, in the private and public sector, has received increasing attention in the recent years. Customer orientation among employees is not only an important quality principle, but also an essential prerequisite for customer satisfaction, especially in service organizations. In this context, the objective of introducing new public management (NPM) in public-service organizations is to increase customer orientation among employees who are at the forefront of service providing. In this study, we developed a short scale to measure perceived customer orientation. In two separate longitudinal studies carried out in Austria and the US, we analyzed changes in customer orientation resulting from the introduction of NPM. In both organizations, we observed a significant increase in customer orientation. Perceived customer orientation was related to job characteristics, organizational characteristics and employee quality of working life. Creating positive influences on these characteristics within the framework of an organizational change process has positive effects on employee customer orientation.

Cost and impact of a quality improvement programme in mental health services.

PubMed

Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

2010-04-01

To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: a 5-year experience.

PubMed

Janssen, Willy; Ngirabega, Jean de Dieu; Matungwa, Michel; Van Bastelaere, Stefaan

2015-01-01

Since 2000 performance-based financing (PBF) made its way to sub-Saharan health systems in an attempt to improve service delivery. In Rwanda initial experiences in 2001 and 2002 led to a scaling up of the initiative to all health centres (HC) and district hospitals (DH). In 2008 PBF became national strategy. PBF was introduced in Rwanda in 2006 at the DH level. Evaluation on their service delivery was carried out quarterly in the following areas: hospital management, support to the health centres and clinical activities. We studied four DHs. After 5 years, an improvement in the quantity of clinical activities was observed, as well as quality in hospital management, in HC support and in clinical activities. PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Modeling the impact of watershed management policies on marine ecosystem services with application to Hood Canal, WA, USA

NASA Astrophysics Data System (ADS)

Sutherland, D. A.; Kim, C.; Marsik, M.; Spiridonov, G.; Toft, J.; Ruckelshaus, M.; Guerry, A.; Plummer, M.

2011-12-01

Humans obtain numerous benefits from marine ecosystems, including fish to eat; mitigation of storm damage; nutrient and water cycling and primary production; and cultural, aesthetic and recreational values. However, managing these benefits, or ecosystem services, in the marine world relies on an integrated approach that accounts for both marine and watershed activities. Here we present the results of a set of simple, physically-based, and spatially-explicit models that quantify the effects of terrestrial activities on marine ecosystem services. Specifically, we model the circulation and water quality of Hood Canal, WA, USA, a fjord system in Puget Sound where multiple human uses of the nearshore ecosystem (e.g., shellfish aquaculture, recreational Dungeness crab and shellfish harvest) can be compromised when water quality is poor (e.g., hypoxia, excessive non-point source pollution). Linked to the estuarine water quality model is a terrestrial hydrology model that simulates streamflow and nutrient loading, so land cover and climate changes in watersheds can be reflected in the marine environment. In addition, a shellfish aquaculture model is linked to the water quality model to test the sensitivity of the ecosystem service and its value to both terrestrial and marine activities. The modeling framework is general and will be publicly available, allowing easy comparisons of watershed impacts on marine ecosystem services across multiple scales and regions.

Fundholders' referral patterns and perceptions of service quality in hospital provision of elective general surgery.

PubMed Central

Whynes, D K; Reed, G

1994-01-01

BACKGROUND. The introduction of fundholding established an internal market in public sector health care, involving purchasers and providers contracting for the supply of health care. AIM. This study set out to examine fundholders' hospital referral patterns, and to evaluate the quality of the service provided to patients undergoing elective general surgery, as perceived by fundholding general practitioners. METHOD. A questionnaire was posted to the senior partners of all fundholding practices in the Trent Regional Health Authority area. This questionnaire requested assessments of the importance of 13 specified aspects of service quality and the quality of provision by general practitioners' most frequently-used hospitals. Five-point scales were employed in each case. Respondents were asked to provide additional details about their practice. RESULTS. A 67% response rate was achieved. Confidence in the consultant's ability, short waiting times and informative feedback from the providers emerged as the most important elements in referral decisions, while the cost of treatment and patient convenience received lower importance ratings. In terms of how well their providers were seen to perform, fundholders ranked confidence in the consultant and patient convenience highest, and style of hospital management lowest. The majority of referrals seemed to be local. CONCLUSION. Judged in terms of fundholders' perceptions, sizeable variations in service quality between hospital providers of general surgery are evident. PMID:7748666

Lean management systems: creating a culture of continuous quality improvement.

PubMed

Clark, David M; Silvester, Kate; Knowles, Simon

2013-08-01

This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

The impact of service and hearing dogs on health-related quality of life and activity level: a Swedish longitudinal intervention study.

PubMed

Lundqvist, Martina; Levin, Lars-Åke; Roback, Kerstin; Alwin, Jenny

2018-06-27

Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are trained to assist specific individuals and can be specialized to meet individual needs. The aim of this study was to describe and explore potential consequences for health-related quality of life, well-being and activity level, of having a certified service or hearing dog. A longitudinal interventional study with a pre-post design was conducted. At inclusion, all participants in the study had a regular (untrained) companion dog. Data were collected before training of the dog started and three months after certification of the dog. Health-related quality of life was assessed with EQ-5D-3L, EQ-VAS and RAND-36. Well-being was measured with WHO-5 and self-esteem with the Rosenberg Self-Esteem Scale. In addition, questions were asked about physical activity and time spent away from home and on social activities. Subgroups were analyzed for physical service and diabetes alert dogs. Fifty-five owner-and-dog pairs completed the study (30 physical service dogs, 20 diabetes alert dogs, 2 epilepsy alert dogs, and 3 hearing dogs). Initially, study participants reported low health-related quality of life compared with the general population. At follow-up, health-related quality of life measured with the EQ-VAS, well-being and level of physical activity had improved significantly. In the subgroup analysis, physical service dog owners had lower health-related quality of life than diabetes alert dog owners. The improvement from baseline to follow-up measured with EQ-5D statistically differed between the subgroups. The target population for service and hearing dogs has an overall low health-related quality of life. Our study indicates that having a certified service or hearing dog may have positive impact on health-related quality of life, well-being and activity level. Service and hearing dogs are a potentially important "wagging tail aid" for this vulnerable population, able to alleviate strain, increase independence, and decrease the risk of social isolation. The trial was retrospectively registered in http://clinicaltrial.gov , NCT03270592. September, 2017.

The patient satisfaction questionnaire of EUprimecare project: measurement properties.

PubMed

Cimas, Marta; Ayala, Alba; García-Pérez, Sonia; Sarria-Santamera, Antonio; Forjaz, Maria João

2016-06-01

The measurement of patient satisfaction is considered an essential outcome indicator to evaluate health care quality. Patient satisfaction is considered a multi-dimensional construct, which would include a variety of domains. Although a large number of studies have proposed scales to measure patient satisfaction, there is a lack of psychometric information on them. This study aims to describe the psychometric properties of the Primary Care Satisfaction Scale (PCSS) of the EUprimecare project. A cross-sectional survey of patient satisfaction with primary care was carried out by telephone interview. Primary care services of Estonia, Finland, Germany, Hungary, Lithuania, Italy and Spain. A total of 3020 adult patients aged 18-65 years old attending primary care services. Classic psychometric properties were analysed and Rasch analysis was used to assess the following measurement properties: fit to the Rasch model; uni-dimensionality; reliability; differential item functioning (DIF) by gender, age, civil status, area of residency and country; local independency; adequacy of response scale; and scale targeting. To achieve good fit to the Rasch model, the original response scales of three items (1, 2 and 6) were rescored and Item 3 (waiting time in the room) was removed. The scale was uni-dimensional and Person Separation Index was 0.79, indicating a good reliability. All items were free from bias. PCSS linear measure displayed satisfactory convergent validity with overall satisfaction with primary care. PCSS, as a reliable and valid scale, could be used to measure patient satisfaction in primary care in Europe. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Describing Ecosystem Complexity through Integrated Catchment Modeling

NASA Astrophysics Data System (ADS)

Shope, C. L.; Tenhunen, J. D.; Peiffer, S.

2011-12-01

Land use and climate change have been implicated in reduced ecosystem services (ie: high quality water yield, biodiversity, and agricultural yield. The prediction of ecosystem services expected under future land use decisions and changing climate conditions has become increasingly important. Complex policy and management decisions require the integration of physical, economic, and social data over several scales to assess effects on water resources and ecology. Field-based meteorology, hydrology, soil physics, plant production, solute and sediment transport, economic, and social behavior data were measured in a South Korean catchment. A variety of models are being used to simulate plot and field scale experiments within the catchment. Results from each of the local-scale models provide identification of sensitive, local-scale parameters which are then used as inputs into a large-scale watershed model. We used the spatially distributed SWAT model to synthesize the experimental field data throughout the catchment. The approach of our study was that the range in local-scale model parameter results can be used to define the sensitivity and uncertainty in the large-scale watershed model. Further, this example shows how research can be structured for scientific results describing complex ecosystems and landscapes where cross-disciplinary linkages benefit the end result. The field-based and modeling framework described is being used to develop scenarios to examine spatial and temporal changes in land use practices and climatic effects on water quantity, water quality, and sediment transport. Development of accurate modeling scenarios requires understanding the social relationship between individual and policy driven land management practices and the value of sustainable resources to all shareholders.

The role of environmental variables on the efficiency of water and sewerage companies: a case study of Chile.

PubMed

Molinos-Senante, María; Sala-Garrido, Ramón; Lafuente, Matilde

2015-07-01

This paper evaluates the efficiency of water and sewerage companies (WaSCs) by introducing the lack of service quality as undesirable outputs. It also investigates whether the production frontier of WaSCs is overall constant returns to scale (CRS) or variable returns to scale (VRS) by using two different data envelopment analysis models. In a second-stage analysis, we study the influence of exogenous and endogenous variables on WaSC performance by applying non-parametric hypothesis tests. In a pioneering approach, the analysis covers 18 WaSCs from Chile, representing about 90% of the Chilean urban population. The results evidence that the technology of the sample studied is characterized overall by CRS. Peak water demand, the percentage of external workers, and the percentage of unbilled water are the factors affecting the efficiency of WaSCs. From a policy perspective, the integration of undesirable outputs into the assessment of WaSC performance is crucial not to penalize companies that provide high service quality to customers.

Scaling Up Integrated Community Case Management of Childhood Illness: Update from Malawi

PubMed Central

Nsona, Humphreys; Mtimuni, Angella; Daelmans, Bernadette; Callaghan-Koru, Jennifer A.; Gilroy, Kate; Mgalula, Leslie; Kachule, Timothy; Zamasiya, Texas

2012-01-01

The Government of Malawi (GoM) initiated activities to deliver treatment of common childhood illnesses (suspected pneumonia, fever/suspected malaria, and diarrhea) in the community in 2008. The service providers are Health Surveillance Assistants (HSAs), and they are posted nationwide to serve communities at a ratio of 1 to 1,000 population. The GoM targeted the establishment of 3,452 village health clinics (VHCs) in hard-to-reach areas by 2011. By September of 2011, 3,296 HSAs had received training in integrated case management of childhood illness, and 2,709 VHCs were functional. An assessment has shown that HSAs are able to treat sick children with quality similar to the quality provided in fixed facilities. Monitoring data also suggest that communities are using the sick child services. We summarize factors that have facilitated the scale up of integrated community case management of children in Malawi and address challenges, such as ensuring a steady supply of medicines and supportive supervision. PMID:23136278

Integrating child health services into malaria control services of village malaria workers in remote Cambodia: service utilization and knowledge of malaria management of caregivers.

PubMed

Hasegawa, Aya; Yasuoka, Junko; Ly, Po; Nguon, Chea; Jimba, Masamine

2013-08-23

Malaria and other communicable diseases remain major threats in developing countries. In Cambodia, village malaria workers (VMWs) have been providing malaria control services in remote villages to cope with the disease threats. In 2009, the VMW project integrated child health services into the original malaria control services. However, little has been studied about the utilization of VMWs' child health services. This study aimed to identify determinants of caregivers' VMW service utilization for childhood illness and caregivers' knowledge of malaria management. A cross-sectional study was conducted in 36 VMW villages of Kampot and Kampong Thom provinces in July-September 2012. An equal number of VMW villages with malaria control services only (M) and those with malaria control plus child health services (M+C) were selected from each province. Using structured questionnaires, 800 caregivers of children under five and 36 VMWs, one of the two VMWs who was providing VMW services in each study village were interviewed. Among the caregivers, 23% in M villages and 52% in M+C villages utilized VMW services for childhood illnesses. Determinants of caregivers' utilization of VMWs in M villages included their VMWs' length of experience (AOR = 11.80, 95% confidence interval [CI] = 4.46-31.19) and VMWs' service quality (AOR = 2.04, CI = 1.01-4.11). In M+C villages, VMWs' length of experience (AOR = 2.44, CI = 1.52-3.94) and caregivers' wealth index (AOR = 0.35, CI = 0.18-0.68) were associated with VMW service utilization. Meanwhile, better service quality of VMWs (AOR = 3.21, CI = 1.34-7.66) and caregivers' literacy (AOR = 9.91, CI = 4.66-21.05) were positively associated with caregivers' knowledge of malaria management. VMWs' service quality and length of experience are important determinants of caregivers' utilization of VMWs' child health services and their knowledge of malaria management. Caregivers are seeking VMWs' support for childhood illnesses even if they are providing only malaria control services. This underlines the importance of scaling-up VMWs' capacity by adding child health services of good quality, which will result in improving child health status in remote Cambodia.

Context matters: Successes and challenges of intrapartum care scale-up in four districts of Afghanistan.

PubMed

Tappis, Hannah; Koblinsky, Marge; Winch, Peter J; Turkmani, Sabera; Bartlett, Linda

2016-01-01

Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.

Service quality in public health clinics: perceptions of users and health professionals.

PubMed

Campos, Domingos Fernandes; Negromonte Filho, Rinaldo Bezerra; Castro, Felipe Nalon

2017-10-09

Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the rational allocation of available resources and improvement of the quality of the service delivered to patients. Besides, it offers a focus to prioritize specific actions. Originality/value It is important to compare the perceptions of service quality between patients and the healthcare service providers who work in direct contact with them. The managers can smooth out these differences and ensure, over time, customer satisfaction. In this study, providers were asked to express what they think about the expectations of patients and about their own service performance delivered. Thus, not only the traditional gap 5 was measured, but it was also possible to evaluate the distance between what providers think that patients need and their actual needs.

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

PubMed Central

Clarke, Andrew; Murray, Emily; Groce, Nora

2017-01-01

Background Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. Methods A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. Results All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05). Conclusions Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities. PMID:29261691

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women.

PubMed

Devkota, Hridaya Raj; Clarke, Andrew; Murray, Emily; Groce, Nora

2017-01-01

Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women's socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15-49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: 'Health Facility', 'Healthcare Delivery', 'Inter-personal' and 'Access to Care' was used to measure women's perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the 'Health Facility' dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to 'Cleanliness and Facilities', 'Open and Friendliness' and 'Compassion and Kindness' were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the 'Availability of cash Incentives' more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to 'Cleanliness and facilities', which Dalit women rated lower than non-Dalits (p<0.05). Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services 'low.' Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities.

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Toward of a highly integrated probe for improving wireless network quality

NASA Astrophysics Data System (ADS)

Ding, Fei; Song, Aiguo; Wu, Zhenyang; Pan, Zhiwen; You, Xiaohu

2016-10-01

Quality of service and customer perception is the focus of the telecommunications industry. This paper proposes a low-cost approach to the acquisition of terminal data, collected from LTE networks with the application of a soft probe, based on the Java language. The soft probe includes support for fast call in the form of a referenced library, and can be integrated into various Android-based applications to automatically monitor any exception event in the network. Soft probe-based acquisition of terminal data has the advantages of low cost and can be applied on large scale. Experiment shows that a soft probe can efficiently obtain terminal network data. With this method, the quality of service of LTE networks can be determined from acquired wireless data. This work contributes to efficient network optimization, and the analysis of abnormal network events.

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

PubMed Central

Wainberg, Milton L.; Scorza, Pamela; Shultz, James M.; Helpman, Liat; Mootz, Jennifer J.; Johnson, Karen A.; Neria, Yuval; Bradford, Jean-Marie E.; Oquendo, Maria A.; Arbuckle, Melissa R.

2017-01-01

Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions. PMID:28425023

Ethical sensitivity, burnout, and job satisfaction in emergency nurses.

PubMed

Palazoğlu, Cansu Atmaca; Koç, Zeliha

2017-01-01

Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. This research employed a descriptive and cross-sectional design. Participants and research context: This study was conducted with a sample of 236 nurses, all of whom worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale. Ethical considerations: This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University. There was a weak and negative correlation (r = -0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = -0.335, p < 0.001) between the Maslach Burnout Inventory and Minnesota Job Satisfaction Scale scores. Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized.

Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities.

PubMed

Ballard, Clive; Powell, Ian; James, Ian; Reichelt, Katharina; Myint, Pat; Potkins, Dawn; Bannister, Carol; Lana, Marisa; Howard, Robert; O'Brien, John; Swann, Alan; Robinson, Damian; Shrimanker, Jay; Barber, Robert

2002-02-01

The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia. The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design. There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing. A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care. Copyright 2002 John Wiley & Sons, Ltd.

Assessment of patient satisfaction of the quality of health care provided by outpatient services of an oncology hospital.

PubMed

Pini, Anastasia; Sarafis, Pavlos; Malliarou, Maria; Tsounis, Andreas; Igoumenidis, Michael; Bamidis, Panagiotis; Niakas, Dimitris

2014-06-12

The purpose of this research is to investigate the patient's satisfaction (patient's satisfaction) with medical services provided in Outpatients' Departments of a Greek Anti-Cancer Hospital in morning and afternoon clinics. The assessment of patients and identification of factors that contribute to their satisfaction will highlight the organizational and operational problems of outpatient department and assist in finding solutions to upgrade the quality of services provided. For the collection of data, a questionnaire with closed answers in a five-point scale 'Likert' scale was used. The questions were related to demographics, social data users, and the overall service process in the outpatient Hospital. The sample consisted of 100 patients (RR: 76%) who visited the outpatient clinic in the morning or afternoon over a month long period of time. The results of our research showed that cancer patients reported a high satisfaction rate with the health services provided in outpatient department of Anti-Cancer Hospital. The highest reported levels of satisfaction were related to working with medical staff because of the special relationship of trust that patients develop with their physician. Some problems were noted during the morning shift by patients. Patients reported frustration over long waiting times to get an appointment, last minute appointments, lack of flexibility when making appointments and long waiting times before being examined by a doctor. No statistically significant relationship was found between overall satisfaction with demographics' and other factors, although the grading services seem to be affected by the health status of patients, education and sex.

Identifying Riparian Buffer Effects on Stream 1 Nitrogen in Southeastern Coastal Plain Watersheds

EPA Science Inventory

Riparian areas have long demonstrated their ability to attenuate nutrients and sediments from agricultural runoff at the field scale; however, to inform effective nutrient management choices, the impact of riparian buffers on water quality services must be assessed at watershed s...

Measurement-Driven Characterization of the Mobile Environment

ERIC Educational Resources Information Center

Soroush, Hamed

2013-01-01

The concurrent deployment of high-quality wireless networks and large-scale cloud services offers the promise of secure ubiquitous access to seemingly limitless amount of content. However, as users' expectations have grown more demanding, the performance and connectivity failures endemic to the existing networking infrastructure have become more…

Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication

PubMed Central

Ghahramanian, Akram; Rezaei, Tayyebeh; Abdullahzadeh, Farahnaz; Sheikhalipour, Zahra; Dianat, Iman

2017-01-01

Background: This study investigated quality of healthcare services from patients’ perspectives and its relationship with patient safety culture and nurse-physician professional communication. Methods: A cross-sectional study was conducted among 300 surgery patients and 101 nurses caring them in a public hospital in Tabriz–Iran. Data were collected using the service quality measurement scale (SERVQUAL), hospital survey on patient safety culture (HSOPSC) and nurse physician professional communication questionnaire. Results: The highest and lowest mean (±SD) scores of the patients’ perception on the healthcare services quality belonged to the assurance 13.92 (±3.55) and empathy 6.78 (±1.88) domains,respectively. With regard to the patient safety culture, the mean percentage of positive answers ranged from 45.87% for "non-punitive response to errors" to 68.21% for "organizational continuous learning" domains. The highest and lowest mean (±SD) scores for the nurse physician professional communication were obtained for "cooperation" 3.44 (±0.35) and "non-participative decision-making" 2.84 (±0.34) domains, respectively. The "frequency of reported errors by healthcare professionals" (B=-4.20, 95% CI = -7.14 to -1.27, P<0.01) and "respect and sharing of information" (B=7.69, 95% CI=4.01 to 11.36, P<0.001) predicted the patients’perceptions of the quality of healthcare services. Conclusion: Organizational culture in dealing with medical error should be changed to non-punitive response. Change in safety culture towards reporting of errors, effective communication and teamwork between healthcare professionals are recommended. PMID:28695106

DataFed: A Federated Data System for Visualization and Analysis of Spatio-Temporal Air Quality Data

NASA Astrophysics Data System (ADS)

Husar, R. B.; Hoijarvi, K.

2017-12-01

DataFed is a distributed web-services-based computing environment for accessing, processing, and visualizing atmospheric data in support of air quality science and management. The flexible, adaptive environment facilitates the access and flow of atmospheric data from provider to users by enabling the creation of user-driven data processing/visualization applications. DataFed `wrapper' components, non-intrusively wrap heterogeneous, distributed datasets for access by standards-based GIS web services. The mediator components (also web services) map the heterogeneous data into a spatio-temporal data model. Chained web services provide homogeneous data views (e.g., geospatial, time views) using a global multi-dimensional data model. In addition to data access and rendering, the data processing component services can be programmed for filtering, aggregation, and fusion of multidimensional data. A complete application software is written in a custom made data flow language. Currently, the federated data pool consists of over 50 datasets originating from globally distributed data providers delivering surface-based air quality measurements, satellite observations, emissions data as well as regional and global-scale air quality models. The web browser-based user interface allows point and click navigation and browsing the XYZT multi-dimensional data space. The key applications of DataFed are for exploring spatial pattern of pollutants, seasonal, weekly, diurnal cycles and frequency distributions for exploratory air quality research. Since 2008, DataFed has been used to support EPA in the implementation of the Exceptional Event Rule. The data system is also used at universities in the US, Europe and Asia.

Resilience and Professional Quality of Life in Staff Working with People with Intellectual Disabilities and Offending Behavior in Community Based and Institutional Settings.

PubMed

Søndenaa, Erik; Lauvrud, Christian; Sandvik, Marita; Nonstad, Kåre; Whittington, Richard

2013-01-02

Staff in forensic services for people with intellectual disabilities (ID) are expected to deal with a wide range of emotional challenges when providing care. The potential impact of this demanding work has not been systematically explored previously. This article explores the professional quality of life (QoL) and the resilience (hardiness) of the staff in this setting. The Professional QoL questionnaire and the Disposional Resilience Scale were completed by staff (n=85, 80% response rate) in the Norwegian forensic service for ID offenders. Responses from staff working in institutional settings were compared to those from staff in local community services. Staff in the local community services had higher resilience scores compared to the staff in the institutional setting, (t=2.19; P<0.05). However in the other QoL and resilience domains there were no differences between the staff in the two settings. The greater sense of resilient control among community staff may be a function of both the number of service users they work with and the institutional demands they face. Even though these participants worked with relatively high risk clients, they did not report significantly impaired quality of life compared to other occupations.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases.

PubMed

Kurpas, D; Bujnowska-Fedak, M M; Athanasiadou, A; Mroczek, B

2015-01-01

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

Resilience and Professional Quality of Life in Staff Working with People with Intellectual Disabilities and Offending Behavior in Community Based and Institutional Settings

PubMed Central

Søndenaa, Erik; Lauvrud, Christian; Sandvik, Marita; Nonstad, Kåre; Whittington, Richard

2013-01-01

Staff in forensic services for people with intellectual disabilities (ID) are expected to deal with a wide range of emotional challenges when providing care. The potential impact of this demanding work has not been systematically explored previously. This article explores the professional quality of life (QoL) and the resilience (hardiness) of the staff in this setting. The Professional QoL questionnaire and the Disposional Resilience Scale were completed by staff (n=85, 80% response rate) in the Norwegian forensic service for ID offenders. Responses from staff working in institutional settings were compared to those from staff in local community services. Staff in the local community services had higher resilience scores compared to the staff in the institutional setting, (t=2.19; P<0.05). However in the other QoL and resilience domains there were no differences between the staff in the two settings. The greater sense of resilient control among community staff may be a function of both the number of service users they work with and the institutional demands they face. Even though these participants worked with relatively high risk clients, they did not report significantly impaired quality of life compared to other occupations. PMID:26973892

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: the development and analysis of a questionnaire.

PubMed

Margaritis, Eleftherios; Katharaki, Maria; Katharakis, George

2012-05-01

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents' overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors' attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents' satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

PubMed

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

1996-12-01

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

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department.

PubMed

Rodrigo-Rincon, I; Goñi-Girones, E; Serra-Arbeloa, P; Martinez-Lozano, M E; Reyes-Pérez, M

2015-01-01

To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as "conformity" or "non-conformity." The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen's Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

[Creation and validation of the scale for measuring quality of life in patients with cancer: Puerto Rican version (ECVCA-PR). ].

PubMed

Sanoguet, Janelly Muriel; Gómez, José Rodríguez

2013-01-01

The aim of this pioneer study is to begin to create and validate a scale to measure Quality of Life in cancer patients in Puerto Rico (ECVCA-PR) in order to provide local health professionals with a reliable instrument that help to measure attitudes that could affect different patient's quality of life aspects and allows knowing the needs of those cancer patients. Sample consisted of 32 patients (9 men, 23 women), between ages of 30 to 83 years that were receiving services (i.e., hospitalization, treatment, and follow up) at Dr. Isaac González Martínez Oncological Hospital in San Juan, Puerto Rico. The psychometric properties of the instrument indicate a reliability index (Cronbach's Alpha) of 0.927 with 164 items, an excellent index according to the literature.

Impact of body image on depression and quality of life among women with breast cancer.

PubMed

Begovic-Juhant, Ana; Chmielewski, Amy; Iwuagwu, Stella; Chapman, Lauren A

2012-01-01

The purpose of this study was to explore body image, physical attractiveness, and femininity among survivors of breast cancer and to examine the effects of the aforementioned variables on depression and quality of life. The participants comprised 70 female survivors of breast cancer, ages between 23 and 79 years. They completed a questionnaire that includes Center for Epidemiological Studies Depression Scale, Functional Assessment of Cancer Therapy, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire--Breast Cancer, measuring depression, quality of life, and body image, respectively. On the depression scale, 56% of the participants had scores higher than 16; a score of 16 and above identifies participants with potential depression. Majority of women felt less attractive and less feminine. Low body image, attractiveness, and femininity positively correlated with depression and negatively with overall quality of life. The authors conclude that multidisciplinary health care services relevant to physical attractiveness and femininity of survivors of breast cancer may foster positive body image perceptions, reduced depression, and increased quality of life.

Can patient experience with service quality predict survival in colorectal cancer?

PubMed

Gupta, Digant; Lis, Christopher G; Rodeghier, Mark

2013-01-01

Despite the recognized relevance of symptom burden in colorectal cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality-of-care received might influence outcome. We evaluated the relationship between patient-reported experience with service quality and survival in 702 returning colorectal cancer patients treated at our institution between July 2007 and December 2010. Overall patient experience "considering everything, how satisfied are you with your overall experience?" was measured on a 7-point Likert scale ranging from completely dissatisfied to completely satisfied. It was dichotomized into two categories: top box response (7) versus all others (1-6). Cox regression was used to evaluate the association between patient experience and survival. Of 702 patients, 506 were "completely satisfied" while 196 were not. On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality compared to those "not completely satisfied" (hazard ratio [HR] = 0.78; 95% confidence interval [CI]: 0.61-0.98; p = .04). Similarly, on multivariate analysis controlling for stage at diagnosis, treatment history, age, and gender, "completely satisfied" patients demonstrated significantly lower mortality (HR = 0.74; 95% CI: 0.58-0.95; p = .02). Patient experience with service quality was an independent predictor of survival in colorectal cancer, a novel finding in the literature. © 2012 National Association for Healthcare Quality.

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

PubMed Central

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

2016-01-01

Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout sub-Saharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia. PMID:26976883

The Role of Nonphysician Clinicians in the Rapid Expansion of HIV Care in Mozambique

PubMed Central

Sherr, Kenneth; Pfeiffer, James; Mussa, Antonio; Vio, Ferruccio; Gimbel, Sarah; Micek, Mark; Gloyd, Stephen

2017-01-01

The shortage of health workers impedes universal coverage of quality HIV services, especially in those countries hardest hit by the epidemic. The dramatic increase in international aid to scale-up HIV services, including antiretroviral therapy (ART), has highlighted workforce deficiencies and provided an opportunity to strengthen health systems capacity. In Mozambique, a country with a high HIV burden and a staggering workforce deficit, the Ministry of Health looked to past experience in workforce expansion to rapidly build ART delivery capacity, including reliance on existing non-physician clinicians (NPC) to prescribe ART and dramatically increasing the output of NPC training. As a result of responsible task shifting, the number of facilities providing ART tripled during a 6-month period, and patients from disadvantaged areas have access to quality ART services. Because the NPC-driven ART approach is integrated into primary health care, the addition of new clinical staff also promises to improve general health services. PMID:19858931

Family support for stroke: a randomised controlled trial.

PubMed

Mant, J; Carter, J; Wade, D T; Winner, S

2000-09-02

Attention is currently focused on family care of stroke survivors, but the effectiveness of support services is unclear. We did a single-blind, randomised, controlled trial to assess the impact of family support on stroke patients and their carers. Patients with acute stroke admitted to hospitals in Oxford, UK, were assigned family support or normal care within 6 weeks of stroke. After 6 months, we assessed, for carers, knowledge about stroke, Frenchay activities index, general health questionnaire-28 scores, caregiver strain index, Dartmouth co-op charts, short form 36 (SF-36), and satisfaction scores, and, for patients, knowledge about stroke and use of services, Barthel index, Rivermead mobility index, Frenchay activities index, London handicap scale, hospital anxiety and depression scales, Dartmouth co-op charts, and satisfaction. 323 patients and 267 carers were followed up. Carers in the intervention group had significantly better Frenchay activities indices (p=0.03), SF-36 scores (energy p=0.02, mental health p=0.004, pain p=0.03, physical function p=0.025, and general health perception p=0.02), quality of life on the Dartmouth co-op chart (p=0.01), and satisfaction with understanding of stroke (82 vs 71%, p=0.04) than those in the control group. Patients' knowledge about stroke, disability, handicap, quality of life, and satisfaction with services and understanding of stroke did not differ between groups. Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge (44 vs 56%, p=0.04), but use of other services was similar. Family support significantly increased social activities and improved quality of life for carers, with no significant effects on patients.

Resilience of Professional Counselors Following Hurricanes Katrina and Rita

ERIC Educational Resources Information Center

Lambert, Simone F.; Lawson, Gerard

2013-01-01

Professional counselors who provided services to those affected by Hurricanes Katrina and Rita completed the K6+ (screen for severe mental illness), the Posttraumatic Growth Inventory, and the Professional Quality of Life Scale. Results indicated that participants who survived the hurricanes had higher levels of posttraumatic growth than…

Life Satisfaction in Persons with Intellectual Disabilities

ERIC Educational Resources Information Center

Lucas-Carrasco, Ramona; Salvador-Carulla, Luis

2012-01-01

We appraised life satisfaction using the Satisfaction with Life Scale (SWLS), and analysed its psychometric properties in persons with intellectual disability (ID). Ninety-nine persons with ID from four services in Spain participated. A battery of subjective assessments was used, including the SWLS, a Quality of Life measure (WHOQOL-BREF), and…

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

Chaubey, Indrajeet; Cibin, Raj; Bowling, Laura

The overall goal of this project was to conduct a watershed-scale sustainability assessment of multiple species of energy crops and removal of crop residues within two watersheds (Wildcat Creek, and St. Joseph River) representative of conditions in the Upper Midwest. The sustainability assessment included bioenergy feedstock production impacts on environmental quality, economic costs of production, and ecosystem services.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

PubMed

Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

2017-01-08

Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

PubMed Central

Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

2017-01-01

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International

PubMed Central

Munroe, Erik; Hayes, Brendan; Taft, Julia

2015-01-01

Background: To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. Methods: We analyzed MSI’s social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008–2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011–2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI “Impact 2” model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Results: Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44.0), with 46.1% (95% CI = 40.9, 51.2) of them reporting having never previously used family planning at all. Analysis of age and poverty levels of clients indicate mixed results in bridging equity gaps: 57.4% of clients lived on under US$2.50/day in 2013 (95% CI = 54.9, 60.0) and 26.1% were 15–24 years old (95% CI = 23.8, 28.4), but only 15.1% lived on less than $1.25/day (95% CI = 13.8, 16.4) and 5.0% were 15–19 years old (95% CI = 3.9, 6.1). The services provided via social franchising are estimated to avert 4,958,000 unintended pregnancies and 7,150 maternal deaths. Conclusion: Social franchising through the existing private sector has the ability to rapidly scale-up access to high-quality family planning services, including LARCs, for the general population as well as young women and the poor, providing a promising model to help achieve the global FP2020 goal. PMID:26085018

A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya.

PubMed

Abuya, Timothy; Njuki, Rebecca; Warren, Charlotte E; Okal, Jerry; Obare, Francis; Kanya, Lucy; Askew, Ian; Bellows, Ben

2012-07-23

Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

Managing adaptively for multifunctionality in agricultural systems

USGS Publications Warehouse

Hodbod, Jennifer; Barreteau, Olivier; Allen, Craig R.; Magda, Danièle

2016-01-01

The critical importance of agricultural systems for food security and as a dominant global landcover requires management that considers the full dimensions of system functions at appropriate scales, i.e. multifunctionality. We propose that adaptive management is the most suitable management approach for such goals, given its ability to reduce uncertainty over time and support multiple objectives within a system, for multiple actors. As such, adaptive management may be the most appropriate method for sustainably intensifying production whilst increasing the quantity and quality of ecosystem services. However, the current assessment of performance of agricultural systems doesn’t reward ecosystem service provision. Therefore, we present an overview of the ecosystem functions agricultural systems should and could provide, coupled with a revised definition for assessing the performance of agricultural systems from a multifunctional perspective that, when all satisfied, would create adaptive agricultural systems that can increase production whilst ensuring food security and the quantity and quality of ecosystem services. The outcome of this high level of performance is the capacity to respond to multiple shocks without collapse, equity and triple bottom line sustainability. Through the assessment of case studies, we find that alternatives to industrialized agricultural systems incorporate more functional goals, but that there are mixed findings as to whether these goals translate into positive measurable outcomes. We suggest that an adaptive management perspective would support the implementation of a systematic analysis of the social, ecological and economic trade-offs occurring within such systems, particularly between ecosystem services and functions, in order to provide suitable and comparable assessments. We also identify indicators to monitor performance at multiple scales in agricultural systems which can be used within an adaptive management framework to increase resilience at multiple scales.

Managing adaptively for multifunctionality in agricultural systems.

PubMed

Hodbod, Jennifer; Barreteau, Olivier; Allen, Craig; Magda, Danièle

2016-12-01

The critical importance of agricultural systems for food security and as a dominant global landcover requires management that considers the full dimensions of system functions at appropriate scales, i.e. multifunctionality. We propose that adaptive management is the most suitable management approach for such goals, given its ability to reduce uncertainty over time and support multiple objectives within a system, for multiple actors. As such, adaptive management may be the most appropriate method for sustainably intensifying production whilst increasing the quantity and quality of ecosystem services. However, the current assessment of performance of agricultural systems doesn't reward ecosystem service provision. Therefore, we present an overview of the ecosystem functions agricultural systems should and could provide, coupled with a revised definition for assessing the performance of agricultural systems from a multifunctional perspective that, when all satisfied, would create adaptive agricultural systems that can increase production whilst ensuring food security and the quantity and quality of ecosystem services. The outcome of this high level of performance is the capacity to respond to multiple shocks without collapse, equity and triple bottom line sustainability. Through the assessment of case studies, we find that alternatives to industrialized agricultural systems incorporate more functional goals, but that there are mixed findings as to whether these goals translate into positive measurable outcomes. We suggest that an adaptive management perspective would support the implementation of a systematic analysis of the social, ecological and economic trade-offs occurring within such systems, particularly between ecosystem services and functions, in order to provide suitable and comparable assessments. We also identify indicators to monitor performance at multiple scales in agricultural systems which can be used within an adaptive management framework to increase resilience at multiple scales. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

PubMed Central

2012-01-01

Background Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies. PMID:22823923

MUSTANG: A Community-Facing Web Service to Improve Seismic Data Quality Awareness Through Metrics

NASA Astrophysics Data System (ADS)

Templeton, M. E.; Ahern, T. K.; Casey, R. E.; Sharer, G.; Weertman, B.; Ashmore, S.

2014-12-01

IRIS DMC is engaged in a new effort to provide broad and deep visibility into the quality of data and metadata found in its terabyte-scale geophysical data archive. Taking advantage of large and fast disk capacity, modern advances in open database technologies, and nimble provisioning of virtual machine resources, we are creating an openly accessible treasure trove of data measurements for scientists and the general public to utilize in providing new insights into the quality of this data. We have branded this statistical gathering system MUSTANG, and have constructed it as a component of the web services suite that IRIS DMC offers. MUSTANG measures over forty data metrics addressing issues with archive status, data statistics and continuity, signal anomalies, noise analysis, metadata checks, and station state of health. These metrics could potentially be used both by network operators to diagnose station problems and by data users to sort suitable data from unreliable or unusable data. Our poster details what MUSTANG is, how users can access it, what measurements they can find, and how MUSTANG fits into the IRIS DMC's data access ecosystem. Progress in data processing, approaches to data visualization, and case studies of MUSTANG's use for quality assurance will be presented. We want to illustrate what is possible with data quality assurance, the need for data quality assurance, and how the seismic community will benefit from this freely available analytics service.

Informatics Resources to Support Health Care Quality Improvement in the Veterans Health Administration

PubMed Central

Hynes, Denise M.; Perrin, Ruth A.; Rappaport, Steven; Stevens, Joanne M.; Demakis, John G.

2004-01-01

Information systems are increasingly important for measuring and improving health care quality. A number of integrated health care delivery systems use advanced information systems and integrated decision support to carry out quality assurance activities, but none as large as the Veterans Health Administration (VHA). The VHA's Quality Enhancement Research Initiative (QUERI) is a large-scale, multidisciplinary quality improvement initiative designed to ensure excellence in all areas where VHA provides health care services, including inpatient, outpatient, and long-term care settings. In this paper, we describe the role of information systems in the VHA QUERI process, highlight the major information systems critical to this quality improvement process, and discuss issues associated with the use of these systems. PMID:15187063

Towards quality indicators for assertive outreach programmes for severely impaired substance abusers: concept mapping with Dutch experts.

PubMed

Roeg, Diana; van de Goor, Ien; Garretsen, Henk

2005-06-01

We investigated the concept of 'quality of assertive outreach programmes for severely impaired substance abusers' with the aim of developing a conceptual framework as the basis for an assessment instrument. We held a concept-mapping session with 13 experts in 2003. Fifty measurable elements of quality were mentioned and rated in terms of relative importance on a Likert-type response scale. Subsequently, the experts grouped the statements that were similar in content. The resulting concept map and additional interpretation made up the final quality framework. SETTING/STUDY PARTICIPANTS: Theoretical sampling was used to select Dutch managers, team leaders, and service providers from different assertive outreach delivery systems for substance abusers. Variation in both perspective and region was reflected in the sample. Nine aspects of quality were formulated: preconditions for care, preconditions for service providers' work, relationship to regular care, service providers' activities and goals, service providers' skills, the role of repression, optimal care for the client, goals of assertive outreach, and nuisance reduction to society. Each aspect was presented using a selection of measurable elements. According to the experts, optimal assertive outreach depends on a broad range of aspects that were later classified in three regions: structure, process, and outcomes. Saturation of the elements has not been proved so far. Nevertheless, it is promising that the framework's regions are supported by theory and that it is largely in accordance with clients' perspectives on assertive community treatment.

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention

PubMed Central

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson–customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research. PMID:26903927

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention.

PubMed

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson-customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research.

Involving mental health service users in quality assurance

PubMed Central

Weinstein, Jenny

2006-01-01

Abstract Objective  This study compares the process and outcomes of two approaches to engaging mental health (MH) service users in the quality assurance (QA) process. Background  QA plays a significant role in health and care services, including those delivered in the voluntary sector. The importance of actively, rather than passively, involving service users in evaluation and service development has been increasingly recognized during the last decade. Design  This retrospective small‐scale study uses document analysis to compare two QA reviews of a MH Day Centre, one that took place in 1998 as a traditional inspection‐type event and one that took place in 2000 as a collaborative process with a user‐led QA agenda. Setting and participants  The project was undertaken with staff, volunteers and service users in a voluntary sector MH Day Centre. Intervention  The study compares the management, style, evaluation tools and service user responses for the two reviews; it considers staff perspectives and discusses the implications of a collaborative, user‐led QA process for service development. Results  The first traditional top–down inspection‐type QA event had less ownership from service users and staff and served the main purpose of demonstrating that services met organizational standards. The second review, undertaken collaboratively with a user‐led agenda focused on different priorities, evolving a new approach to seeking users’ views and achieving a higher response rate. Conclusions  Because both users and staff had participated in most aspects of the second review they were more willing to work together and action plan to improve the service. It is suggested that the process contributed to an evolving ethos of more effective quality improvement and user involvement within the organization. PMID:16677189

The effects of catchment and riparian forest quality on stream environmental conditions across a tropical rainforest and oil palm landscape in Malaysian Borneo.

PubMed

Luke, Sarah H; Barclay, Holly; Bidin, Kawi; Chey, Vun Khen; Ewers, Robert M; Foster, William A; Nainar, Anand; Pfeifer, Marion; Reynolds, Glen; Turner, Edgar C; Walsh, Rory P D; Aldridge, David C

2017-06-01

Freshwaters provide valuable habitat and important ecosystem services but are threatened worldwide by habitat loss and degradation. In Southeast Asia, rainforest streams are particularly threatened by logging and conversion to oil palm, but we lack information on the impacts of this on freshwater environmental conditions, and the relative importance of catchment versus riparian-scale disturbance. We studied 16 streams in Sabah, Borneo, including old-growth forest, logged forest, and oil palm sites. We assessed forest quality in riparian zones and across the whole catchment and compared it with stream environmental conditions including water quality, structural complexity, and organic inputs. We found that streams with the highest riparian forest quality were nearly 4 °C cooler, over 20 cm deeper, had over 40% less sand, greater canopy cover, more stored leaf litter, and wider channels than oil palm streams with the lowest riparian forest quality. Other variables were significantly related to catchment-scale forest quality, with streams in the highest quality forest catchments having 40% more bedrock and 20 times more dead wood, along with higher phosphorus, and lower nitrate-N levels compared to streams with the lowest catchment-scale forest quality. Although riparian buffer strips went some way to protecting waterways, they did not maintain fully forest-like stream conditions. In addition, logged forest streams still showed signs of disturbance 10-15 years after selective logging. Our results suggest that maintenance and restoration of buffer strips can help to protect healthy freshwater ecosystems but logging practices and catchment-scale forest management also need to be considered.

The effects of catchment and riparian forest quality on stream environmental conditions across a tropical rainforest and oil palm landscape in Malaysian Borneo

PubMed Central

Barclay, Holly; Bidin, Kawi; Chey, Vun Khen; Ewers, Robert M.; Foster, William A.; Nainar, Anand; Pfeifer, Marion; Reynolds, Glen; Turner, Edgar C.; Walsh, Rory P. D.; Aldridge, David C.

2017-01-01

Abstract Freshwaters provide valuable habitat and important ecosystem services but are threatened worldwide by habitat loss and degradation. In Southeast Asia, rainforest streams are particularly threatened by logging and conversion to oil palm, but we lack information on the impacts of this on freshwater environmental conditions, and the relative importance of catchment versus riparian‐scale disturbance. We studied 16 streams in Sabah, Borneo, including old‐growth forest, logged forest, and oil palm sites. We assessed forest quality in riparian zones and across the whole catchment and compared it with stream environmental conditions including water quality, structural complexity, and organic inputs. We found that streams with the highest riparian forest quality were nearly 4 °C cooler, over 20 cm deeper, had over 40% less sand, greater canopy cover, more stored leaf litter, and wider channels than oil palm streams with the lowest riparian forest quality. Other variables were significantly related to catchment‐scale forest quality, with streams in the highest quality forest catchments having 40% more bedrock and 20 times more dead wood, along with higher phosphorus, and lower nitrate‐N levels compared to streams with the lowest catchment‐scale forest quality. Although riparian buffer strips went some way to protecting waterways, they did not maintain fully forest‐like stream conditions. In addition, logged forest streams still showed signs of disturbance 10–15 years after selective logging. Our results suggest that maintenance and restoration of buffer strips can help to protect healthy freshwater ecosystems but logging practices and catchment‐scale forest management also need to be considered. PMID:28706573

Correlation Between Stress and Quality of Life Experienced by Caregivers: Perception of a Group of Healthcare Professionals.

PubMed

Silva, Bhárbara Karolline Rodrigues; Quaresma, Fernando Rodrigues Peixoto; Maciel, Erika da Silva; Figueiredo, Francisco Winter Dos Santos; Sarraf, Jonathan Souza; Adami, Fernando

2017-01-01

This study aims to evaluate the relationship between perceived level of stress and quality of life of professionals working in Prompt Service Units in the city of Palmas, Tocantins. A cross-sectional study was performed among 164 professionals from Prompt Service Units. Stress levels were evaluated using the Perceived Stress Scale. The WHOQOL-bref was used to evaluate the perception of quality of life. Quantitative variables distribution was evaluated using Shapiro-Wilk's test. For the analyses of correlations among perceived level of stress, total quality of life score, and the physical health domain of the WHOQOL-bref, Pearson's correlation test was applied. The significance level adopted for this trial was 95%. The study was approved by the Committee of Ethics in Research with Human Beings. When assessing the perceived level of stress with the total quality of life score, there was no significant correlation between those variables. However, there was an association between the perceived level of stress and the physical health domain of quality of life. Perceived quality of life was correlated with the physical health domain, and this result reinforces the importance of the facets that make up this area.

Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International

PubMed Central

Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

2014-01-01

Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels—mobile outreach, social franchising, and clinics—to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users. PMID:25276564

Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International.

PubMed

Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

2014-02-01

Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels-mobile outreach, social franchising, and clinics-to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users.

Creating a new class of pharmaceutical services provider for underserved areas: the Tanzania accredited drug dispensing outlet experience.

PubMed

Rutta, Edmund; Senauer, Katie; Johnson, Keith; Adeya, Grace; Mbwasi, Romuald; Liana, Jafary; Kimatta, Suleiman; Sigonda, Margareth; Alphonce, Emmanuel

2009-01-01

In developing countries, the most accessible source of treatment for common conditions is often an informal drug shop, where drug sellers are untrained and operations are unmonitored. We sought to describe a public-private initiative in Tanzania that created a new class of provider in government-accredited drug outlets, which improved the quality of medicines and pharmaceutical services in previously underserved areas. The accredited drug-dispensing outlet program combines changing behavior and expectations of community members who use, own, regulate, and work in drug shops. Success resulted from including community stakeholders from the beginning of the process. Addressing shortages in qualified health care providers by training and accrediting private sector drug dispensers to recognize common conditions and provide quality pharmaceutical products and services is feasible in a developing country, when supported by an appropriate policy and regulatory environment. Scaling up and sustaining the program will be a challenge.

Multimedia telehomecare system using standard TV set.

PubMed

Guillén, S; Arredondo, M T; Traver, V; García, J M; Fernández, C

2002-12-01

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting.

PubMed

Palmer, Victoria J; Chondros, Patty; Piper, Donella; Callander, Rosemary; Weavell, Wayne; Godbee, Kali; Potiriadis, Maria; Richard, Lauralie; Densely, Konstancja; Herrman, Helen; Furler, John; Pierce, David; Schuster, Tibor; Iedema, Rick; Gunn, Jane

2015-03-24

User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. Australian and New Zealand Clinical Trials Registry ACTRN12614000457640. 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.

The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting

PubMed Central

Palmer, Victoria J; Chondros, Patty; Piper, Donella; Callander, Rosemary; Weavell, Wayne; Godbee, Kali; Potiriadis, Maria; Richard, Lauralie; Densely, Konstancja; Herrman, Helen; Furler, John; Pierce, David; Schuster, Tibor; Iedema, Rick; Gunn, Jane

2015-01-01

Introduction User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. Methods An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. Ethics and dissemination The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. Trial registration number Australian and New Zealand Clinical Trials Registry ACTRN12614000457640. PMID:25805530

Factors influencing health care and service providers' and their respective "at risk" populations' adoption of the Air Quality Health Index (AQHI): a qualitative study.

PubMed

Radisic, Sally; Newbold, K Bruce

2016-03-31

The Air Quality Health Index (AQHI) provides air quality and health information such that the public can implement health protective behaviours (reducing and/or rescheduling outdoor activity) and decrease exposure to outdoor air pollution. The AQHI's health messages account for increased risk associated with "at risk" populations (i.e. young children, elderly and those with pre-existing respiratory and/or cardiovascular conditions) who rely on health care and service providers for guidance. Using Rogers' Diffusion of Innovations theory, our objective with respect to health care and service providers and their respective "at risk" populations was to explore: 1) level of AQHI knowledge; 2) factors influencing AQHI adoption and; 3) strategies that may increase uptake of AQHI, according to city divisions and socioeconomic status (SES). Semi-structured face-to-face interviews with health care (Registered Nurses and Certified Respiratory Educators) and service providers (Registered Early Childhood Educators) and focus groups with their respective "at risk" populations explored barriers and facilitators to AQHI adoption. Participants were selected using purposive sampling. Each transcript was analyzed using an Interpretive Description approach to identify themes. Analyses were informed by Rogers' Diffusion of Innovations theory. Fifty participants (6 health care and service providers, 16 parents, 13 elderly, 15 people with existing respiratory conditions) contributed to this study. AQHI knowledge, AQHI characteristics and perceptions of air quality and health influenced AQHI adoption. AQHI knowledge centred on numerical reliance and health protective intent but varied with SES. More emphasis on AQHI relevance with respect to health benefits was required to stress relative advantage over other indices and reduce index confusion. AQHI reporting at a neighbourhood scale was recognized as addressing geographic variability and uncertainty in perceived versus measured air quality impacting health. Participants predominantly expressed that they relied on sensory cues (i.e. feel, sight, taste) to determine when to implement health protective behaviours. Time constraints were identified as barriers; whereas local media reporting and wearable devices were identified as facilitators to AQHI adoption. Increasing knowledge, emphasizing relevance, and reporting AQHI information at a neighbourhood scale via local media sources and wearable devices may facilitate AQHI adoption while accounting for SES differences.

Development and implementation of a comprehensive quality assurance program at a community endoscopy facility.

PubMed

Hilsden, Robert Jay; Rostom, Alaa; Dubé, Catherine; Pontifex, Darlene; McGregor, S Elizabeth; Bridges, Ronald J

2011-10-01

Quality assurance (QA) is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta) - a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors' experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom's National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.

HEALTH WORKERS' PERCEPTIONON THE QUALITY OF SERVICE AND CORPORATE CULTURE OF A TEACHING HOSPITAL IN NIGERIA.

PubMed

Akpan, Etukumana Etiobong; Bassey, Orie Jacob

2015-01-01

Quality of service delivery remains the most important issue in hospitals since patients expect higher standard care and services. This quality service is rooted in the culture of the health care organization. Therefore,this study seeks to determine health workers' perception on the quality of service and corporate culture at University of Uyo Teaching hospital, Uyo, Nigeria. A cross-sectional descriptive study was carried out. Using structured questionnaire and convenient sampling technique, data were collected from 250 hospital workers.The responses on questions to elicit the hospital's quality of service and corporate culture were rated on a five-point Likert Scale as follows; Strongly Agree (SA), Agree (A), Neutral(N), Disagree (D) and Strongly Disagree (SD). Data entry and analysis were performed using Epi Info 3.2.2 (CDC, Atlanta, Georgia, USA). The minimum and maximum ages of the respondents were 21 years and 60 years respectively. The mean, median and mode ages in the respondents were 34.6 (± 7.88) years, 33 years, and 30 years respectively. Majority of the study respondents were in the age group of 31-40 years (30%), female (56.8%) and Doctors (36%). The respondents' positive perception on quality of service offered by the hospital was 69.2% (OR 5.05, 95% CI 3.39-7.52, P < 0.00001). The subjects' positive perception on the organization values for the individual worker was 54.4% (OR 1.42, 95% CI 0.99- 2.06, P = 0.049). However, only 43.2% of the subjects accepted that the management of the hospital was flexible and understands the important of balancing their work/personal life (OR 0.58, 95%CI 0.40-0.84), P = 0.002).Thirty-eight percentages (38%) accepted that top management of the hospital communicates changes in decisions that affect employees (OR 0.38, 95% CI 0.26-0.55), P < 0.00001). Majority of the workers in the various professions accepted that the hospital offer quality services as obtained in other hospitals. Majority of the workers in all the professions except Medical Doctors accepted that the hospital values the individual workers. Majority of the Pharmacists and Non-clinical staff accepted that the hospital management was flexible and understands the importance of balancing their work and personal life. Majority of the Doctors, Pharmacists and laboratory/image scientists did not accept that top management communicates changes in decisions that affect employees. The perception of health workers on the quality of service rendered by the University of Uyo Teaching Hospital was satisfactory. However, the hospital needs to improve on its corporate culture to achieve a higher quality of service.

Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study.

PubMed

Maas, Marjo J M; Nijhuis-van der Sanden, Maria W G; Driehuis, Femke; Heerkens, Yvonne F; van der Vleuten, Cees P M; van der Wees, Philip J

2017-02-10

To evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement. Mixed methods study. 64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands. The programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2. We identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication. This study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study. 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/.

Voice of the customer---a roadmap for service improvement.

PubMed

Uberoi, Ravinder S; Nayak, Yogamaya; Sachdeva, Pritindira; Sibal, Anupam

2013-01-01

Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.

A Lane-Level LBS System for Vehicle Network with High-Precision BDS/GPS Positioning

PubMed Central

Guo, Chi; Guo, Wenfei; Cao, Guangyi; Dong, Hongbo

2015-01-01

In recent years, research on vehicle network location service has begun to focus on its intelligence and precision. The accuracy of space-time information has become a core factor for vehicle network systems in a mobile environment. However, difficulties persist in vehicle satellite positioning since deficiencies in the provision of high-quality space-time references greatly limit the development and application of vehicle networks. In this paper, we propose a high-precision-based vehicle network location service to solve this problem. The major components of this study include the following: (1) application of wide-area precise positioning technology to the vehicle network system. An adaptive correction message broadcast protocol is designed to satisfy the requirements for large-scale target precise positioning in the mobile Internet environment; (2) development of a concurrence service system with a flexible virtual expansion architecture to guarantee reliable data interaction between vehicles and the background; (3) verification of the positioning precision and service quality in the urban environment. Based on this high-precision positioning service platform, a lane-level location service is designed to solve a typical traffic safety problem. PMID:25755665

A profile of women at the highest risk of maternal death in Pakistan.

PubMed

Agha, Sohail

2015-09-01

Traditionally, health interventions implemented in Pakistan have been designed to increase the supply of maternal health services, but have not focused on reaching the poorest women or on providing high-quality services. Demand-side barriers to the utilization of health services are substantial in Pakistan, as are supply-side constraints to the provision of quality health care. This study uses data from the Pakistan Demographic and Health Survey 2006-07 to develop a profile of the poorest women in Pakistan in order to understand demand-side barriers to accessing maternal health care. The study shows stark differences in human capital, material and demographic resources between the poorest women and other women. It illustrates how these differences translate into low levels of service utilization among the poorest women. The purpose of the study is to stimulate a discussion of both the difficulty and the importance of reaching the poorest women with high-quality maternal health interventions. The findings from several pilot projects in Pakistan suggest that the poorest women can be reached at disproportionately higher rates than non-poor women through targeted, community-based, interventions. There is little demonstrable evidence, however, that high-quality care has been provided through these interventions. Evidence-based approaches, which have the potential to overcome financial and sociocultural barriers to service utilization, should be scaled up as soon as possible. However, measures should be taken to ensure that the quality of care provided through these interventions is adequate and able to lead to significant reductions in mortality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Factor structure of the Essen Climate Evaluation Schema measure of social climate in a UK medium-security setting.

PubMed

Milsom, Sophia A; Freestone, Mark; Duller, Rachel; Bouman, Marisa; Taylor, Celia

2014-04-01

Social climate has an influence on a number of treatment-related factors, including service users' behaviour, staff morale and treatment outcomes. Reliable assessment of social climate is, therefore, beneficial within forensic mental health settings. The Essen Climate Evaluation Schema (EssenCES) has been validated in forensic mental health services in the UK and Germany. Preliminary normative data have been produced for UK high-security national health services and German medium-security and high-security services. We aim to validate the use of the EssenCES scale (English version) and provide preliminary normative data in UK medium-security hospital settings. The EssenCES scale was completed in a medium-security mental health service as part of a service-wide audit. A total of 89 patients and 112 staff completed the EssenCES. The three-factor structure of the EssenCES and its internal construct validity were maintained within the sample. Scores from this medium-security hospital sample were significantly higher than those from earlier high-security hospital data, with three exceptions--'patient cohesion' according to the patients and 'therapeutic hold' according to staff and patients. Our data support the use of the EssenCES scale as a valid measure for assessing social climate within medium-security hospital settings. Significant differences between the means of high-security and medium-security service samples imply that degree of security is a relevant factor affecting the ward climate and that in monitoring quality of secure services, it is likely to be important to apply different scores to reflect standards. Copyright © 2013 John Wiley & Sons, Ltd.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

PubMed

Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J

2018-02-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

PubMed Central

Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

2018-01-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

Gaining and maintaining commitment to large-scale change in healthcare organizations.

PubMed

Narine, L; Persaud, D D

2003-08-01

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organization's culture.

The Cluster-Randomized BRIGHT Trial: Proactive Case Finding for Community-Dwelling Older Adults

PubMed Central

Kerse, Ngaire; McLean, Chris; Moyes, Simon A.; Peri, Kathy; Ng, Terence; Wilkinson-Meyers, Laura; Brown, Paul; Latham, Nancy; Connolly, Martin

2014-01-01

PURPOSE People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients. METHODS We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF). RESULTS All 8,308 community-dwelling patients aged 75 years and older were approached; 3,893 (47%) participated, of whom 3,010 (77%) completed the trial. Their mean age was 80.3 (SD 4.5) years, and 55% were women. Overall, 88% of the intervention group returned a BRIGHT tool; 549 patients were referred. After 36 months, patients in the intervention group were more likely than those in the control group to have been placed in residential care: 8.4% vs 6.2% (hazard ratio = 1.32; 95% CI, 1.04–1.68; P = .02). Intervention patients had smaller declines in mean scores for physical health-related quality of life (1.6 vs 2.9 points, P = .007) and psychological health-related quality of life (1.1 vs 2.4 points, P = .005). Hospitalization, disability, and use of services did not differ between groups, however. CONCLUSIONS Our case-finding strategy was effective in increasing identification of older adults with disability, but there was little evidence of improved outcomes. Further research could trial stronger primary care integration strategies. PMID:25384813

[Evaluation of the cost of treating pressure ulcers in hospitalized patients using industrialized dressings].

PubMed

Lima, Angela Cristina Beck; Guerra, Diana Mendonça

2011-01-01

This work evaluated wound dresses used in the Neurosurgery Department of Restauração Hospital: polyurethane, hydrogel and activated carbon wound dresses and hydrogel with alginate used for pressure ulcer care. This work aimed to identify a critical factor that increases demand and cost of wound dresses. The evaluation conducted at the Neurosurgery Department identified individuals at risk of pressure ulcer development. Sixty-two patients were evaluated and the prevalence of pressure ulcer was 22.6% according to the Braden scale. Comparative evaluation between patients that didn't receive preventive measures and others that received, showed that the average daily cost of hospitalization for the first group was 45% higher than the mean for the second group. The Wilcoxon-Mann-Withiney test compared the population at risk to develop pressure ulcer and population at low risk showing that the evaluation of Braden Scale scores between the groups presents statistically significant differences and confidence limits of 95%. Pressure ulcer is a key quality indicator in health services.It is possible to reduce costs and offer higher quality public health services by implementing a training program of nursing staff using a preventive measure protocol based on a test to evaluate risk as Braden Scale.

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

PubMed Central

Saha, Kuntal Kumar; Chowdhury, Ashfaqul Haq; Garnett, Sarah P.; Arifeen, Shams El; Menon, Purnima

2017-01-01

Background In 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years. Methods Service delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children. Results Structural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average. Conclusions Strengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up. PMID:28542530

Evaluation of factors to convert absorbed dose calibrations from graphite to water for the NPL high-energy photon calibration service.

PubMed

Nutbrown, R F; Duane, S; Shipley, D R; Thomas, R A S

2002-02-07

The National Physical Laboratory (NPL) provides a high-energy photon calibration service using 4-19 MV x-rays and 60Co gamma-radiation for secondary standard dosemeters in terms of absorbed dose to water. The primary standard used for this service is a graphite calorimeter and so absorbed dose calibrations must be converted from graphite to water. The conversion factors currently in use were determined prior to the launch of this service in 1988. Since then, it has been found that the differences in inherent filtration between the NPL LINAC and typical clinical machines are large enough to affect absorbed dose calibrations and, since 1992, calibrations have been performed in heavily filtered qualities. The conversion factors for heavily filtered qualities were determined by interpolation and extrapolation of lightly filtered results as a function of tissue phantom ratio 20,10 (TPR20,10). This paper aims to evaluate these factors for all mega-voltage photon energies provided by the NPL LINAC for both lightly and heavily filtered qualities and for 60Co y-radiation in two ways. The first method involves the use of the photon fluence-scaling theorem. This states that if two blocks of different material are irradiated by the same photon beam, and if all dimensions are scaled in the inverse ratio of the electron densities of the two media, then, assuming that all photon interactions occur by Compton scatter the photon attenuation and scatter factors at corresponding scaled points of measurement in the phantom will be identical. The second method involves making in-phantom measurements of chamber response at a constant target-chamber distance. Monte Carlo techniques are then used to determine the corresponding dose to the medium in order to determine the chamber calibration factor directly. Values of the ratio of absorbed dose calibration factors in water and in graphite determined in these two ways agree with each other to within 0.2% (1sigma uncertainty). The best fit to both sets of results agrees with values determined in previous work to within 0.3% (1sigma uncertainty). It is found that the conversion factor is not sensitive to beam filtration.

On the Quality Assessment of Advanced E-Learning Services

ERIC Educational Resources Information Center

Stefani, Antonia; Vassiliadis, Bill; Xenos, Michalis

2006-01-01

Distance learning has been widely researched the past few years, nevertheless the focus has been more on its technological dimension. Designing, developing and supporting a large scale e-learning application for Higher Education is still a challenging task in many ways. E-learning is data-intensive, user-driven, and has increasing needs for…

Exploring the Use of Participatory Information to Improve Monitoring, Mapping and Assessment of Aquatic Ecosystem Services at Landascape Scales

EPA Science Inventory

Traditionally, the EPA has monitored aquatic ecosystems using statistically rigorous sample designs and intensive field efforts which provide high quality datasets. But by their nature they leave many aquatic systems unsampled, follow a top down approach, have a long lag between ...

The challenge of documenting water quality benefits of conservation practices: a review of USDA-ARS's conservation effects assessment project watershed studies.

PubMed

Tomer, M D; Locke, M A

2011-01-01

The Conservation Effects Assessment Project was established to quantify water quality benefits of conservation practices supported by the U.S. Department of Agriculture (USDA). In 2004, watershed assessment studies were begun in fourteen agricultural watersheds with varying cropping systems, landscapes, climate, and water quality concerns. This paper reviews USDA Agricultural Research Service 'Benchmark' watershed studies and the challenge of identifying water quality benefits in watersheds. Study goals included modeling and field research to assess practices, and evaluation of practice placement in watersheds. Not all goals were met within five years but important lessons were learned. While practices improved water quality, problems persisted in larger watersheds. This dissociation between practice-focused and watershed-scale assessments occurred because: (1) Conservation practices were not targeted at critical sources/pathways of contaminants; (2) Sediment in streams originated more from channel and bank erosion than from soil erosion; (3) Timing lags, historical legacies, and shifting climate combined to mask effects of practice implementation; and (4) Water quality management strategies addressed single contaminants with little regard for trade-offs among contaminants. These lessons could help improve conservation strategies and set water quality goals with realistic timelines. Continued research on agricultural water quality could better integrate modeling and monitoring capabilities, and address ecosystem services.

Exploring nursing e-learning systems success based on information system success model.

PubMed

Chang, Hui-Chuan; Liu, Chung-Feng; Hwang, Hsin-Ginn

2011-12-01

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs)

PubMed Central

Weldring, Theresa; Smith, Sheree M.S.

2013-01-01

In recent years, there has been an increased focus on placing patients at the center of health care research and evaluating clinical care in order to improve their experience and ensure that research is both robust and of maximum value for the use of medicinal products, therapy, or health services. This paper provides an overview of patients’ involvement in clinical research and service evaluation along with its benefits and limitations. We describe and discuss patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs), including the trends in current research. Both the patient-reported experiences measures (PREMs) and patient and public involvement (PPI) initiative for including patients in the research processes are also outlined. PROs provide reports from patients about their own health, quality of life, or functional status associated with the health care or treatment they have received. PROMs are tools and/or instruments used to report PROs. Patient report experiences through the use of PREMs, such as satisfaction scales, providing insight into the patients’ experience with their care or a health service. There is increasing international attention regarding the use of PREMS as a quality indicator of patient care and safety. This reflects the ongoing health service commitment of involving patients and the public within the wider context of the development and evaluation of health care service delivery and quality improvement. PMID:25114561

Physician satisfaction with clinical laboratory services: a College of American Pathologists Q-probes study of 138 institutions.

PubMed

Jones, Bruce A; Bekeris, Leonas G; Nakhleh, Raouf E; Walsh, Molly K; Valenstein, Paul N

2009-01-01

Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. To survey the level of physician satisfaction with hospital clinical laboratory services. Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

Applying ethnography to the study of context in healthcare quality and safety.

PubMed

Leslie, Myles; Paradis, Elise; Gropper, Michael A; Reeves, Scott; Kitto, Simon

2014-02-01

Translating and scaling healthcare quality improvement (QI) and patient safety interventions remains a significant challenge. Context has been identified as a major factor in this. QI and patient safety research have begun to focus on context, with ethnography seen as a promising methodology for understanding the professional, organisational and cultural aspects of context. While ethnography is used to investigate the context of a variety of QI and safety interventions, the challenges inherent in effectively importing a qualitative methodology and its social science practitioners into this work have been largely unexamined. We explain ethnography as a research practice grounded in theory and dependent on observations gathered and interpreted in particular ways. We then review the approach of health services literature to evaluating this sort of qualitative research. Although the study of context is an interest shared by both social scientists and healthcare QI and safety researchers, we identify three key points at which those 'exporting' ethnography as a methodology and those 'importing' it to deal with QI and safety challenges may diverge. We describe perspectival divergences on the methodology's mission, form and scale. At the level of mission we demonstrate how ethnography has been adapted to a 'describe and feed back' role in the service of QI. At the level of form, we show how the long-term embedded observation at the heart of ethnography can be adapted only so far to accommodate QI interests if both data quality and ethical standards are to be upheld. Finally, at the level of scale, we demonstrate one ethnographic study design that balances breadth of exposure with depth of experience in its observations and so generates a particular type of scalable findings. The effective export of ethnography into QI and safety research requires discussion and negotiation between social scientific and health services research perspectives, as well as creative approaches to producing self-reflexive data that will allow clinicians to understand their own context and so improve their own processes.

JTS and its Application in Environmental Protection Applications

NASA Astrophysics Data System (ADS)

Atanassov, Emanouil; Gurov, Todor; Slavov, Dimitar; Ivanovska, Sofiya; Karaivanova, Aneta

2010-05-01

The environmental protection was identified as a domain of high interest for South East Europe, addressing practical problems related to security and quality of life. The gridification of the Bulgarian applications MCSAES (Monte Carlo Sensitivity Analysis for Environmental Studies) which aims to develop an efficient Grid implementation of a sensitivity analysis of the Danish Eulerian Model), MSACM (Multi-Scale Atmospheric Composition Modeling) which aims to produce an integrated, multi-scale Balkan region oriented modelling system, able to interface the scales of the problem from emissions on the urban scale to their transport and transformation on the local and regional scales), MSERRHSA (Modeling System for Emergency Response to the Release of Harmful Substances in the Atmosphere) which aims to develop and deploy a modeling system for emergency response to the release of harmful substances in the atmosphere, targeted at the SEE and more specifically Balkan region) faces several challenges: These applications are resource intensive, in terms of both CPU utilization and data transfers and storage. The use of applications for operational purposes poses requirements for availability of resources, which are difficult to be met on a dynamically changing Grid environment. The validation of applications is resource intensive and time consuming. The successful resolution of these problems requires collaborative work and support from part of the infrastructure operators. However, the infrastructure operators are interested to avoid underutilization of resources. That is why we developed the Job Track Service and tested it during the development of the grid implementations of MCSAES, MSACM and MSERRHSA. The Job Track Service (JTS) is a grid middleware component which facilitates the provision of Quality of Service in grid infrastructures using gLite middleware like EGEE and SEEGRID. The service is based on messaging middleware and uses standart protocols like AMQP (Advanced Message Queuing Protocol) and XMPP (eXtensible Messaging and Presence Protocol) for real-time communication, while its security model is based on GSI authentication. It enables resource owners to provide the most popular types of QoS of execution to some of their users, using a standardized model. The first version of the service offered services to individual users. In this work we describe a new version of the Job Track service offering application specific functionality, geared towards the specific needs of the Environmental Modelling and Protection applications and oriented towards collaborative usage by groups and subgroups of users. We used the modular design of the JTS in order to implement plugins enabling smoother interaction of the users with the Grid environment. Our experience shows improved response times and decreased failure rate from the executions of the application. In this work we present such observations from the use of the South East European Grid infrastructure.

Private sector, for-profit health providers in low and middle income countries: can they reach the poor at scale?

PubMed

Tung, Elizabeth; Bennett, Sara

2014-06-24

The bottom of the pyramid concept suggests that profit can be made in providing goods and services to poor people, when high volume is combined with low margins. To-date there has been very limited empirical evidence from the health sector concerning the scope and potential for such bottom of the pyramid models. This paper analyzes private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. We searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, we searched for additional information on location, target market, business model and performance, including quality of care. Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialized services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts (such as Bhattacharya 2010). They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. There is very limited evidence to support the notion that large scale bottom of the pyramid models in health offer good prospects for extending services to the poor in the future. In order to be successful PFP providers often require partnerships with government or support from social health insurance schemes. Nonetheless, more reliable and independent data on such schemes is needed.

Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar.

PubMed

Marek, T; Diallo, I; Ndiaye, B; Rakotosalama, J

1999-12-01

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

Private sector, for-profit health providers in low and middle income countries: can they reach the poor at scale?

PubMed Central

2014-01-01

Background The bottom of the pyramid concept suggests that profit can be made in providing goods and services to poor people, when high volume is combined with low margins. To-date there has been very limited empirical evidence from the health sector concerning the scope and potential for such bottom of the pyramid models. This paper analyzes private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. Methods We searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, we searched for additional information on location, target market, business model and performance, including quality of care. Results Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialized services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts (such as Bhattacharya 2010). They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. Conclusions There is very limited evidence to support the notion that large scale bottom of the pyramid models in health offer good prospects for extending services to the poor in the future. In order to be successful PFP providers often require partnerships with government or support from social health insurance schemes. Nonetheless, more reliable and independent data on such schemes is needed. PMID:24961496

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents.

PubMed

Lin, Jesun; Hsiao, Chih-Tung; Glen, Robert; Pai, Jar-Yuan; Zeng, Sin-Huei

2014-06-01

To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions. The five-point Likert scale questionnaire administered through facetoface interviews. Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population. One hundred and eighty long-term institutional care residents. Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction. The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. © 2012 John Wiley & Sons Ltd.

Validation of Toolkit After-Death Bereaved Family Member Interview.

PubMed

Teno, J M; Clarridge, B; Casey, V; Edgman-Levitan, S; Fowler, J

2001-09-01

The purpose of this study was to examine the reliability and validity of the Toolkit After-Death Bereaved Family Member Interview to measure quality of care at the end of life from the unique perspective of family members. The survey included proposed problem scores (a count of the opportunity to improve the quality of care) and scales. Data were collected through a retrospective telephone survey with a family member who was interviewed between 3 and 6 months after the death of the patient. The setting was an outpatient hospice service, a consortium of nursing homes, and a hospital in New England. One hundred fifty-six family members from across these settings participated. The 8 proposed domains of care, as represented by problem scores or scales, were based on a conceptual model of patient-focused, family-centered medical care. The survey design emphasized face validity in order to provide actionable information to health care providers. A correlational and factor analysis was undertaken of the 8 proposed problem scores or scales. Cronbach's alpha scores varied from 0.58 to 0.87, with two problem scores (each of which had only 3 survey items) having a low alpha of 0.58. The mean item-to-total correlations for the other problem scores varied from 0.36 to 0.69, and the mean item-to-item correlations were between 0.32 and 0.70. The proposed problem scores or scales, with the exception of closure and advance care planning, demonstrated a moderate correlation (i.e., from 0.44 to 0.52) with the overall rating of satisfaction (as measured by a five-point, "excellent" to "poor" scale). Family members of persons who died with hospice service reported fewer problems in each of the six domains of medical care, gave a higher rating of the quality of care, and reported higher self-efficacy in caring for their loved ones. These results indicate that 7 of the 8 proposed problem scores or scales demonstrated psychometric properties that warrant further testing. The domain of closure demonstrated a poor correlation with overall satisfaction and requires further work. This survey could provide information to help guide quality improvement efforts to enhance the care of the dying.

The relationship between depressive symptoms among female workers and job stress and sleep quality.

PubMed

Cho, Ho-Sung; Kim, Young-Wook; Park, Hyoung-Wook; Lee, Kang-Ho; Jeong, Baek-Geun; Kang, Yune-Sik; Park, Ki-Soo

2013-07-22

Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers. From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted. Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively. This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace.

An interdisciplinary swat ecohydrological model to define catchment-scale hydrologic partitioning

NASA Astrophysics Data System (ADS)

Shope, C. L.; Maharjan, G. R.; Tenhunen, J.; Seo, B.; Kim, K.; Riley, J.; Arnhold, S.; Koellner, T.; Ok, Y. S.; Peiffer, S.; Kim, B.; Park, J.-H.; Huwe, B.

2013-06-01

Land use and climate change have long been implicated in modifying ecosystem services, such as water quality and water yield, biodiversity, and agricultural production. To account for future effects on ecosystem services, the integration of physical, biological, economic, and social data over several scales must be implemented to assess the effects on natural resource availability and use. Our objective is to assess the capability of the SWAT model to capture short-duration monsoonal rainfall-runoff processes in complex mountainous terrain under rapid, event-driven processes in a monsoonal environment. To accomplish this, we developed a unique quality-control gap-filling algorithm for interpolation of high frequency meteorological data. We used a novel multi-location, multi-optimization calibration technique to improve estimations of catchment-wide hydrologic partitioning. We calibrated the interdisciplinary model to a combination of statistical, hydrologic, and plant growth metrics. In addition, we used multiple locations of different drainage area, aspect, elevation, and geologic substrata distributed throughout the catchment. Results indicate scale-dependent sensitivity of hydrologic partitioning and substantial influence of engineered features. While our model accurately reproduced observed discharge variability, the addition of hydrologic and plant growth objective functions identified the importance of culverts in catchment-wide flow distribution. The results of this study provide a valuable resource to describe landscape controls and their implication on discharge, sediment transport, and nutrient loading. This study also shows the challenges of applying the SWAT model to complex terrain and extreme environments. By incorporating anthropogenic features into modeling scenarios, we can greatly enhance our understanding of the hydroecological impacts on ecosystem services.

The Birth Satisfaction Scale-Revised Indicator (BSS-RI).

PubMed

Martin, Colin R; Hollins Martin, Caroline; Redshaw, Maggie

2017-08-29

The current study sought to develop a short birth satisfaction indicator utilising items from the Birth Satisfaction Scale-Revised (BSS-R) for use as a brief measure of birth satisfaction and as a possible key performance indicator for perinatal service delivery evaluation. Building on the recently developed BSS-R, the study aimed to develop a simplified version of the instrument to assess birth satisfaction easily that could work as a short evaluative measure of clinical service delivery for labour and birth that is consistent with policy documents, placing women at the centre of the birth experience. The six item Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. A random selection of mothers who had given birth in a two week period in England were surveyed three months after the birth. Using a two-stage design and split-half dataset, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation were conducted in a secondary analysis of the survey data. Using this large population based survey of recent mothers the short revised measure was found to comprise two distinct domains of birth satisfaction, 'stress and emotional response to labour and birth' and 'quality of care'. The psychometric qualities of the tool were robust as were the indices of validity and reliability evaluated. The BSS-RI represents a short easily administered and scored measure of women's satisfaction with care and the experience of labour and birth. The instrument is potentially useful for researchers, service evaluation and policy makers.

Methodology for Air Quality Forecast Downscaling from Regional- to Street-Scale

NASA Astrophysics Data System (ADS)

Baklanov, Alexander; Nuterman, Roman; Mahura, Alexander; Amstrup, Bjarne; Hansen Saas, Bent; Havskov Sørensen, Jens; Lorenzen, Thomas; Weismann, Jakob

2010-05-01

The most serious air pollution events occur in cities where there is a combination of high population density and air pollution, e.g. from vehicles. The pollutants can lead to serious human health problems, including asthma, irritation of the lungs, bronchitis, pneumonia, decreased resistance to respiratory infections, and premature death. In particular air pollution is associated with increase in cardiovascular disease and lung cancer. In 2000 WHO estimated that between 2.5 % and 11 % of total annual deaths are caused by exposure to air pollution. However, European-scale air quality models are not suited for local forecasts, as their grid-cell is typically of the order of 5 to 10km and they generally lack detailed representation of urban effects. Two suites are used in the framework of the EC FP7 project MACC (Monitoring of Atmosphere Composition and Climate) to demonstrate how downscaling from the European MACC ensemble to local-scale air quality forecast will be carried out: one will illustrate capabilities for the city of Copenhagen (Denmark); the second will focus on the city of Bucharest (Romania). This work is devoted to the first suite, where methodological aspects of downscaling from regional (European/ Denmark) to urban scale (Copenhagen), and from the urban down to street scale. The first results of downscaling according to the proposed methodology are presented. The potential for downscaling of European air quality forecasts by operating urban and street-level forecast models is evaluated. This will bring a strong support for continuous improvement of the regional forecast modelling systems for air quality in Europe, and underline clear perspectives for the future regional air quality core and downstream services for end-users. At the end of the MACC project, requirements on "how-to-do" downscaling of European air-quality forecasts to the city and street levels with different approaches will be formulated.

Patient satisfaction with service quality as a predictor of survival outcomes in breast cancer.

PubMed

Gupta, Digant; Rodeghier, Mark; Lis, Christopher G

2014-01-01

Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer. A random sample of 1,521 breast cancer patients treated at Cancer Treatment Centers of America. A questionnaire which covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from "completely dissatisfied" to "completely satisfied". Univariate and multivariate Cox regression was used to evaluate the association between patient satisfaction and survival. Of 1,521 patients, 836 were newly diagnosed, and 685 had previously been treated. A number of 409, 611, 323, and 178 patients had stage I, II, III, and IV disease, respectively. A total of 1,106 (72.7 %) patients were completely satisfied with the overall service quality, while 415 (27.3 %) were not. On univariate analysis, completely satisfied patients had a significantly lower risk of mortality compared to those not completely satisfied (HR = 0.62; 95 % CI 0.50-0.76; p < 0.001). On multivariate analysis, completely satisfied patients demonstrated significantly lower mortality (HR = 0.71; 95 % CI 0.57-0.87; p = 0.001) compared to those not completely satisfied. Patient satisfaction with service quality was an independent predictor of survival in breast cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they receive and outcomes in breast cancer is indicated.

Service quality from the perspective of myocardial infarction patients.

PubMed

Gholipour, Kamal; Tabrizi, Jafar Sadegh; Azimzadeh, Solmaz; Ghafari, Samad; Iezadi, Shabnam

2018-04-01

Service quality (SQ) generally refers to the nonclinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients' perspective. A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach's alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10- (importance × performance), based on the importance and performance of non-health-related aspects from the customers' perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1. Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers' perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score. The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

A Pragmatic Randomised, Controlled Trial of Intensive Care follow up programmes in improving Longer-term outcomes from critical illness. The PRACTICAL study

PubMed Central

Cuthbertson, Brian H; Rattray, Janice; Johnston, Marie; Wildsmith, J Anthony; Wilson, Edward; Hernendez, Rodolfo; Ramsey, Craig; Hull, Alastair M; Norrie, John; Campbell, Marion

2007-01-01

Background A number of intensive care (ICU) patients experience significant problems with physical, psychological, and social functioning for some time after discharge from ICU. These problems have implications not just for patients, but impose a continuing financial burden for the National Health Service. To support recovery, a number of hospitals across the UK have developed Intensive Care follow-up clinics. However, there is a lack of evidence base to support these, and this study aims to test the hypothesis that intensive care follow up programmes are effective and cost-effective at improving physical and psychological quality of life in the year after intensive care discharge. Methods/Design This is a multi-centre, pragmatic, randomised controlled trial. Patients (n = 270) will be recruited prior to hospital discharge from three intensive care units in the UK, and randomised to one of two groups. The control group will receive standard in-hospital follow-up and the intervention group will participate in an ICU follow-up programme with clinic appointments 2–3 and 9 months after ICU discharge. The primary outcome measure is Health-related Quality of Life (HRQoL) 12 months after ICU discharge as measured by the Short Form-36. Secondary measures include: HRQoL at six months; Quality-adjusted life years using EQ-5D; posttraumatic psychopathology as measured by Davidson Trauma Scale; and anxiety and depression using the Hospital Anxiety and Depression Scale at both six and twelve months after ICU discharge. Contacts with health services in the twelve months after ICU discharge will be measured as part of the economic analysis. Discussion The provision of intensive care follow-up clinics within the UK has developed in an ad hoc manner, is inconsistent in both the number of hospitals offering such a service or in the type of service offered. This study provides the opportunity to evaluate such services both in terms of patient benefit and cost-effectiveness. The results of this study therefore will inform clinical practice and policy with regard to the appropriate development of such services aimed at improving outcomes after intensive care. Trial Registration ISRCTN24294750. PMID:17645791

Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International.

PubMed

Munroe, Erik; Hayes, Brendan; Taft, Julia

2015-06-17

To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. We analyzed MSI's social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008-2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011-2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI "Impact 2" model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44.0), with 46.1% (95% CI = 40.9, 51.2) of them reporting having never previously used family planning at all. Analysis of age and poverty levels of clients indicate mixed results in bridging equity gaps: 57.4% of clients lived on under US$2.50/day in 2013 (95% CI = 54.9, 60.0) and 26.1% were 15-24 years old (95% CI = 23.8, 28.4), but only 15.1% lived on less than $1.25/day (95% CI = 13.8, 16.4) and 5.0% were 15-19 years old (95% CI = 3.9, 6.1). The services provided via social franchising are estimated to avert 4,958,000 unintended pregnancies and 7,150 maternal deaths. Social franchising through the existing private sector has the ability to rapidly scale-up access to high-quality family planning services, including LARCs, for the general population as well as young women and the poor, providing a promising model to help achieve the global FP2020 goal. © Munroe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception

PubMed Central

Mugore, Stembile; Kassouta, Ntapi Tchiguiri K; Sebikali, Boniface; Lundstrom, Laurel; Saad, Abdulmumin

2016-01-01

ABSTRACT High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for abortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions. We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach—IntraHealth International’s Optimizing Performance and Quality (OPQ) approach—was applied at 5 health care facilities in Togo starting in November 2014. A baseline assessment identified the following needs: reorganizing services to ensure that contraceptives are provided at point of treatment for abortion complications, before PAC clients are discharged; improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices; ensuring that contraceptive methods are available to all PAC clients free of charge; standardizing PAC registers and enhancing data collection and reporting systems; enhancing internal supervision systems at facilities and teamwork among PAC providers; and engaging PAC providers in community talks. Solutions devised and applied at the facilities during OPQ resulted in significant increases in contraceptive counseling and uptake among PAC clients: During the 5-month baseline period, 31% of PAC clients were counseled, while during the 13-month intervention period, 91% were counseled. Of all PAC clients counseled during the baseline period, 37% accepted a contraceptive, compared with 60% of those counseled during the intervention period. Oral contraceptive pills remained the most popular method during both periods, yet uptake of implants increased significantly during the intervention period—from 4% to 27% of those accepting contraceptives. This result demonstrates that the solutions applied maintained method choice while expanding access to underused long-acting reversible contraceptives. OPQ shows great potential for sustainability and scale in Togo and for application in similar contexts where the health system struggles to offer safe, high-quality, accessible PAC services. PMID:27688719

The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis.

PubMed

Topp, Stephanie M; Black, Jim; Morrow, Martha; Chipukuma, Julien M; Van Damme, Wim

2015-02-18

Questions about the impact of large donor-funded HIV interventions on low- and middle-income countries' health systems have been the subject of a number of expert commentaries, but comparatively few empirical research studies. Aimed at addressing a particular evidence gap vis-à-vis the influence of HIV service scale-up on micro-level health systems, this article examines the impact of HIV scale-up on mechanisms of accountability in Zambian primary health facilities. Guided by the Mechanisms of Effect framework and Brinkerhoff's work on accountability, we conducted an in-depth multi-case study to examine how HIV services influenced mechanisms of administrative and social accountability in four Zambian primary health centres. Sites were selected for established (over 3 yrs) antiretroviral therapy (ART) services and urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (2 wks/centre) and key informant interviews (14). Resource-intensive investment in HIV services contributed to some early gains in administrative answerability within the four ART departments, helping to establish the material capabilities necessary to deliver and monitor service delivery. Simultaneous investment in external supervision and professional development helped to promote transparency around individual and team performance and also strengthened positive work norms in the ART departments. In the wider health centres, however, mechanisms of administrative accountability remained weak, hindered by poor data collection and under capacitated leadership. Substantive gains in social accountability were also elusive as HIV scale-up did little to address deeply rooted information and power asymmetries in the wider facilities. Short terms gains in primary-level service accountability may arise from investment in health system hardware. However, sustained improvements in service quality and responsiveness arising from genuine improvements in social and administrative accountability require greater understanding of, and investment in changing, the power relations, work norms, leadership and disciplinary mechanisms that shape these micro-level health systems.

Identifying key hospital service quality factors in online health communities.

PubMed

Jung, Yuchul; Hur, Cinyoung; Jung, Dain; Kim, Minki

2015-04-07

The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. We defined social media-based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea's two biggest online portals were used to test the effectiveness of detection of social media-based key quality factors for hospitals. To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and classification performance still has room for improvement, but the extraction results are applicable to more detailed analysis. Further analysis of the extracted information reveals that there are differences in the details of social media-based key quality factors for hospitals according to the regions in Korea, and the patterns of change seem to accurately reflect social events (eg, influenza epidemics). These findings could be used to provide timely information to caregivers, hospital officials, and medical officials for health care policies.

[Neighborhood environment quality, individual-level social capital, and depressive symptoms among adolescents].

PubMed

Asakura, Takashi

2011-09-01

We aimed to develop measures to assess features of neighborhood quality and individual social capital, as well as their associations with depressive symptoms among early adolescents. To determine whether relations of depressive symptoms with neighborhood quality might be contingent upon the level of individual cognitive social capital, neighborhood-by-cognitive social capital interaction terms were examined. A qualitative study was conducted to elicit the perceptions of early adolescents about their neighborhood environment. Subsequently, we recruited 2,002 eighth graders and asked for responses to a self-administered questionnaire. The variables analyzed in this study were the Center for Epidemiologic Studies-Depression scale (10 items), features of neighborhood quality, cognitive and structural individual social capital, and demographics. We adopted a generalized estimating equation regression model for the multivariate analysis. The analytic sample was 1,786 with no missing variable in the models. Seven subscales were devised to assess quality features of neighborhood environments with an examination of validity and reliability: "availability of services," "good neighborhood relations," "spaces for recreation," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," "civic communities," and "aesthetic look." We also developed a scale of individual cognitive social capital, which consisted of three constructs: "social trust," "reciprocity," and "social norms." Additionally, the number of social activities in which subjects participated was counted as an indicator of the structural aspect of individual social capital. On examination with the generalized estimating equation regression model, "availability of services," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," and cognitive social capital were significantly associated with the CES-D scores controlling for demographics. We also found a significant interplay between "dirty-looking, squalid, unclean" and the cognitive social capital for estimating scores of depressive symptoms. Improvement in features of neighborhood quality such as availability of services, cleanliness, and security and social order in terms of public policy as well as civic activities could contribute to promotion of mental health in adolescents. Individual cognitive social capital accumulated through experiencs of good social relationshisp in a community could also play important roles in maximizing mental health.

Pollutant Transport and Fate: Relations Between Flow-paths and Downstream Impacts of Human Activities

NASA Astrophysics Data System (ADS)

Thorslund, J.; Jarsjo, J.; Destouni, G.

2017-12-01

The quality of freshwater resources is increasingly impacted by human activities. Humans also extensively change the structure of landscapes, which may alter natural hydrological processes. To manage and maintain freshwater of good water quality, it is critical to understand how pollutants are released into, transported and transformed within the hydrological system. Some key scientific questions include: What are net downstream impacts of pollutants across different hydroclimatic and human disturbance conditions, and on different scales? What are the functions within and between components of the landscape, such as wetlands, on mitigating pollutant load delivery to downstream recipients? We explore these questions by synthesizing results from several relevant case study examples of intensely human-impacted hydrological systems. These case study sites have been specifically evaluated in terms of net impact of human activities on pollutant input to the aquatic system, as well as flow-path distributions trough wetlands as a potential ecosystem service of pollutant mitigation. Results shows that although individual wetlands have high retention capacity, efficient net retention effects were not always achieved at a larger landscape scale. Evidence suggests that the function of wetlands as mitigation solutions to pollutant loads is largely controlled by large-scale parallel and circular flow-paths, through which multiple wetlands are interconnected in the landscape. To achieve net mitigation effects at large scale, a large fraction of the polluted large-scale flows must be transported through multiple connected wetlands. Although such large-scale flow interactions are critical for assessing water pollution spreading and fate through the landscape, our synthesis shows a frequent lack of knowledge at such scales. We suggest ways forward for addressing the mismatch between the large scales at which key pollutant pressures and water quality changes take place and the relatively scale at which most studies and implementations are currently made. These suggestions can help bridge critical knowledge gaps, as needed for improving water quality predictions and mitigation solutions under human and environmental changes.

Performance of HIV care decentralization from the patient's perspective: health-related quality of life and perceived quality of services in Cameroon.

PubMed

Boyer, Sylvie; Protopopescu, Camelia; Marcellin, Fabienne; Carrieri, Maria Patrizia; Koulla-Shiro, Sinata; Moatti, Jean-Paul; Spire, Bruno

2012-07-01

(i) To assess HIV care decentralization in Cameroon from the patients' point of view, in terms of health-related quality of life (HRQL) and perceived quality of services; (ii) to identify patient- and hospital-related factors undermining HRQL. Perceived quality of services was compared among 1985 HIV-infected patients treated with antiretroviral therapy (ART) for at least 6 months in 27 treatment centres at different levels of health care delivery (central, provincial and district) (EVAL-ANRS 12-116 survey, 2007) using chi-square and non-parametric tests. Correlates of the SF-12 physical (PCS) and mental (MCS) HRQL scores were identified using two-level linear models. Patients followed-up at central and district levels had similar physical HRQL, while those followed-up at the more decentralized district level reported significantly better mental HRQL. Patients at district level also expressed better relationships with caregivers, easier access to consultations and more reliable drug supply. Financial barriers to access to HIV care and self-reported side-effects were independently associated with both lower PCS and lower MCS. Caregivers' heavy workload tended to impair both PCS and MCS, while availability of counselling by social workers in the hospital was independently associated with higher MCS. Despite limited resources, the decentralization of ART delivery can improve quality of care, providing a positive impact on HIV-infected patients' well-being. The development of psychosocial support interventions is necessary but not sufficient for improving quality of care in ART scaling-up programmes, and should be related to global strengthening of health human resources.

Evaluating an extended rehabilitation service for stroke patients (EXTRAS): study protocol for a randomised controlled trial.

PubMed

Rodgers, Helen; Shaw, Lisa; Cant, Robin; Drummond, Avril; Ford, Gary A; Forster, Anne; Hills, Katie; Howel, Denise; Laverty, Anne-Marie; McKevitt, Christopher; McMeekin, Peter; Price, Christopher

2015-05-05

Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models. We describe the protocol for a multicentre randomised controlled trial which is evaluating an extended stroke rehabilitation service. The extended service commences when routine 'organised stroke care' (stroke unit and early supported discharge (ESD)) ends. This study is a multicentre randomised controlled trial with health economic and process evaluations. It is set within NHS stroke services which provide ESD. Participants are adults who have experienced a new stroke (and carer if appropriate), discharged from hospital under the care of an ESD team. The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD. The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation. Contact is usually by telephone. The control group receives usual stroke care post-ESD. Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice. Randomisation is via a central independent web-based service. The primary outcome is extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post-randomisation. Secondary outcomes (at 12 and 24 months post-randomisation) are health status, quality of life, mood and experience of services for patients, and quality of life, experience of services and carer stress for carers. Resource use and adverse events are also collected. Outcomes are undertaken by a blinded assessor. Implementation and delivery of the extended stroke rehabilitation service will also be described. Semi-structured interviews will be conducted with a subsample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received. Allowing for 25% attrition, 510 participants are needed to provide 90% power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5% significance level. The provision of longer term support for stroke survivors is currently limited. The results from this trial will inform future stroke service planning and configuration. This trial was registered with ISRCTN (identifier: ISRCTN45203373 ) on 9 August 2012.

Paediatric Palliative Care in Resource-Poor Countries

PubMed Central

Boucher, Sue; Daniels, Alex; Nkosi, Busi

2018-01-01

There is a great need for paediatric palliative care (PPC) services globally, but access to services is lacking in many parts of the world, particularly in resource-poor settings. Globally it is estimated that 21.6 million children need access to palliative care, with 8.2 needing specialist services. PC has been identified as important within the global health agenda e.g., within universal health coverage, and a recent Lancet commission report recognised the need for PPC. However, a variety of challenges have been identified to PPC development globally such as: access to treatment, access to medications such as oral morphine, opiophobia, a lack of trained health and social care professionals, a lack of PPC policies and a lack of awareness about PPC. These challenges can be overcome utilising a variety of strategies including advocacy and public awareness, education, access to medications, implementation and research. Examples will be discussed impacting on the provision of PPC in resource-poor settings. High-quality PPC service provision can be provided with resource-poor settings, and there is an urgent need to scale up affordable, accessible, and quality PPC services globally to ensure that all children needing palliative care can access it. PMID:29463065

Assimilation of Satellite Data in Regional Air Quality Models

NASA Technical Reports Server (NTRS)

Mcnider, Richard T.; Norris, William B.; Casey, Daniel; Pleim, Jonathan E.; Roselle, Shawn J.; Lapenta, William M.

1997-01-01

In terms of important uncertainty in regional-scale air-pollution models, probably no other aspect ranks any higher than the current ability to specify clouds and soil moisture on the regional scale. Because clouds in models are highly parameterized, the ability of models to predict the correct spatial and radiative characteristics is highly suspect and subject to large error. The poor representation of cloud fields from point measurements at National Weather Services stations and the almost total absence of surface moisture availability observations has made assimilation of these variables difficult to impossible. Yet, the correct inclusion of clouds and surface moisture are of first-order importance in regional-scale photochemistry.

Exploration of the Factorial Structure of the Revised Personal Functions of the Volunteerism Scale for Chinese Adolescents

ERIC Educational Resources Information Center

Law, Ben M F.; Shek, Daniel T. L.; Ma, Cecilia M. S.

2011-01-01

Participation in volunteer services can be regarded as an indicator of quality of life among adolescents. The Volunteer Functions Inventory (VFI) has long been used to assess the underlying motives of volunteers. Owing to conceptual, methodological and empirical limitations, the VFI could not be fully endorsed to understand Chinese adolescent…

Development of USPS Laboratory and pilot-scale testing protocols

Treesearch

Carl Houtman; Nancy Ross Sutherland; David Bormett; Donald Donermeyer

2000-01-01

The ultimate goal of the US Postal Service (USPS) Environmentally Benign Stamp Program is to develop stamp adhesives that can be removed by unit operations found in recycling mills. The maintenance of final product quality specifications for a recycling mill while loading the feedstock with a significant quantity of adhesive is the criterion for success of this program...

The Mid-Atlantic Regional Wetland Conservation Effects Assessment Project

Treesearch

Megan Lang; Greg McCarty; Mark Walbridge; Patrick Hunt; Tom Ducey; Clinton Church; Jarrod Miller; Laurel Kluber; Ali Sadeghi; Martin Rabenhorst; Amir Sharifi; In-Young Yeo; Andrew Baldwin; Margaret Palmer; Tom Fisher; Dan Fenstermaher; Sanchul Lee; Owen McDonough; Metthea Yepsen; Liza McFarland; Anne Gustafson; Rebecca Fox; Chris Palardy; William Effland; Mari-Vaughn Johnson; Judy Denver; Scott Ator; Joseph Mitchell; Dennis Whigham

2016-01-01

Wetlands impart many important ecosystem services, including maintenance of water quality, regulation of the climate and hydrological flows, and enhancement of biodiversity through the provision of food and habitat. The conversion of natural lands to agriculture has led to broad scale historic wetland loss, but current US Department of Agriculture conservation programs...

The Department of Defense Very High Speed Integrated Circuit (VHSIC) Technology Availability Program Plan for the Committees on Armed Services United States Congress.

DTIC Science & Technology

1986-06-30

features of computer aided design systems and statistical quality control procedures that are generic to chip sets and processes. RADIATION HARDNESS -The...System PSP Programmable Signal Processor SSI Small Scale Integration ." TOW Tube Launched, Optically Tracked, Wire Guided TTL Transistor Transitor Logic

Health services utilization of women following a traumatic birth.

PubMed

Turkstra, E; Creedy, D K; Fenwick, J; Buist, A; Scuffham, P A; Gamble, J

2015-12-01

This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.

Normative data on the diurnal pattern of the Karolinska Sleepiness Scale ratings and its relation to age, sex, work, stress, sleep quality and sickness absence/illness in a large sample of daytime workers.

PubMed

Åkerstedt, Torbjorn; Hallvig, David; Kecklund, Göran

2017-10-01

Self-rated sleepiness responds to sleep loss, time of day and work schedules. There is, however, a lack of a normative reference showing the diurnal pattern during a normal working day, compared with a day off, as well as differences depending on stress, sleep quality, sex, age and being sick listed. The present study sought to provide such data for the Karolinska Sleepiness Scale. Participants were 431 individuals working in medium-sized public service units. Sleepiness (Karolinska Sleepiness Scale, scale 1-9) was rated at six times a day for a working week and 2 days off (>90.000 ratings). The results show a clear circadian pattern, with high values during the morning (4.5 at 07:00 hours) and evening (6.0 at 22:00 hours), and with low values (3-4) during the 10:00-16:00 hours span. Women had significantly higher (0.5 units) Karolinska Sleepiness Scale values than men, as did younger individuals (0.3 units), those with stress (1.3 units above the low-stress group) and those with poor sleep quality (1.0 units above those with qood sleep quality). Days off showed reduced sleepiness (0.7 units), while being sick listed was associated with an increased sleepiness (0.8 units). Multiple regression analysis of mean sleepiness during the working week yielded mean daytime stress, mean sleep quality, age, and sex as predictors (not sleep duration). Improved sleep quality accounted for the reduced sleepiness during days off, but reduced stress was a second factor. Similar results were obtained in a longitudinal mixed-model regression analysis across the 7 days of the week. The percentage of ratings at Karolinska Sleepiness Scale risk levels (8 + 9) was 6.6%, but most of these were obtained at 22:00 hours. It was concluded that sleepiness ratings are strongly associated with time of day, sleep quality, stress, work day/day off, being ill, age, and sex. © 2017 European Sleep Research Society.

Management-focused approach to investigating coastal water-quality drivers and impacts in the Baltic Sea

NASA Astrophysics Data System (ADS)

Vigouroux, G.; Destouni, G.; Chen, Y.; Bring, A.; Jönsson, A.; Cvetkovic, V.

2017-12-01

Coastal areas link human-driven conditions on land with open sea conditions, and include crucial and vulnerable ecosystems that provide a variety of ecosystem services. Eutrophication is a common problem that is not least observed in the Baltic Sea, where coastal water quality is influenced both by land-based nutrient loading and by partly eutrophic open sea conditions. Robust and adaptive management of coastal systems is essential and necessitates integration of large scale catchment-coastal-marine systems as well as consideration of anthropogenic drivers and impacts, and climate change. To address this coastal challenge, relevant methodological approaches are required for characterization of coupled land, local coastal, and open sea conditions under an adaptive management framework for water quality. In this paper we present a new general and scalable dynamic characterization approach, developed for and applied to the Baltic Sea and its coastal areas. A simple carbon-based water quality model is implemented, dividing the Baltic Sea into main management basins that are linked to corresponding hydrological catchments on land, as well as to each other though aggregated three-dimensional marine hydrodynamics. Relevant hydrodynamic variables and associated water quality results have been validated on the Baltic Sea scale and show good accordance with available observation data and other modelling approaches. Based on its scalability, this methodology is further used on coastal zone scale to investigate the effects of hydrodynamic, hydro-climatic and nutrient load drivers on water quality and management implications for coastal areas in the Baltic Sea.

[Current status of occupational health activities and the way that occupational health services should be offered to small- and medium-scale enterprises].

PubMed

Kayashima, Kotaro

2013-10-01

Activating occupational safety and health activities among Small- and Medium-scale Enterprises (SMEs) is a major issue because more than 80% of Japanese workers belong to these enterprises, in which the number of workers are less than 300 people. However, as the size of the enterprise decreases, the occurrence of problems of safety and health management systems and safety and health activities increases. Reasons for this include both the limitations of investments shortages of human resources. Occupational health services in SMEs has been provided by the cooperation of the following institutions: public associations (such as Regional Occupational Health Centers, Occupational Health Promotion Centers, Japan Industrial Safety and Health Association (JISHA)), occupational health agencies which provide checkup services, health insurance associations, and regional medical services. In contrast to the low coverage of occupational health services among SMEs in Japan, there are some countries in Europe in which this coverage is almost 100%. This is because of the development of occupational health services outside the company. To show the benefits of the safety and health activities to managers of SMEs, and to motivate them to take advantage of the services, it is important to consider measurements. Also, establishing systems that provide those services, improving the quality of specialists such as occupational physicians, and educating human resources, are all necessary.

A Norwegian prospective study of preterm mother-infant interactions at 6 and 18 months and the impact of maternal mental health problems, pregnancy and birth complications.

PubMed

Misund, Aud R; Bråten, Stein; Nerdrum, Per; Pripp, Are Hugo; Diseth, Trond H

2016-05-04

Pregnancy, birth and health complications, maternal mental health problems following preterm birth and their possible impact on early mother-infant interaction at 6 and 18 months corrected age (CA) were explored. Predictors of mother-infant interaction at 18 months CA were identified. This prospective longitudinal and observational study included 33 preterm mother-infant (<33 gestational age (GA)) interactions at 6 and 18 months CA from a socioeconomic low-risk, middle-class sample. The Parent-Child Early Relational Assessment (PCERA) scale was used to assess the mother-infant interaction. 'Bleeding in pregnancy' predicted lower quality in preterm mother-infant interaction in 6 PCERA scales, while high 'maternal trait anxiety' predicted higher interactional quality in 2 PCERA scales and 'family size' predicted lower interactional quality in 1 PCERA scale at 18 months CA. Mothers with symptoms of post-traumatic stress reactions, general psychological distress and anxiety at 2 weeks postpartum (PP) showed significantly better outcome than mothers without symptoms in 6 PCERA subscales at 6 months CA and 2 PCERA subscales at 18 months CA. Our study detected a correspondence between early pregnancy complications and lower quality of preterm mother-infant interaction, and an association between high levels of maternal mental health problems and better quality in preterm mother-infant interaction. 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/

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

PubMed Central

2014-01-01

Background Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. Methods A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. Results Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. Conclusion The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems. PMID:25001366

Patient perception of nursing service quality; an applied model of Donabedian's structure-process-outcome approach theory.

PubMed

Kobayashi, Hideyuki; Takemura, Yukie; Kanda, Katsuya

2011-09-01

Nursing is a labour-intensive field, and an extensive amount of latent information exists to aid in evaluating the quality of nursing service, with patients' experiences, the primary focus of such evaluations. To effect further improvement in nursing as well as medical care, Donabedian's structure-process-outcome approach has been applied. To classify and confirm patients' specific experiences with regard to nursing service based on Donabedian's structure-process-outcomes model for improving the quality of nursing care. Items were compiled from existing scales and assigned to structure, process or outcomes in Donabedian's model through discussion among expert nurses and pilot data collection. With regard to comfort, surroundings were classified as structure (e.g. accessibility to nurses, disturbance); with regard to patient-practitioner interaction, patient participation was classified as a process (e.g. expertise and skill, patient decision-making); and with regard to changes in patients, satisfaction was classified as an outcome (e.g. information support, overall satisfaction). Patient inquiry was carried out using the finalized questionnaire at general wards in Japanese hospitals in 2005-2006. Reliability and validity were tested using psychometric methods. Data from 1,810 patients (mean age: 59.7 years; mean length of stay: 23.7 days) were analysed. Internal consistency reliability was supported (α = 0.69-0.96), with factor analysis items of structure aggregated to one factor and overall satisfaction under outcome aggregated to one. The remaining items of outcome and process were distributed together in two factors. Inter-scale correlation (r = 0.442-0.807) supported the construct validity of each structure-process-outcome approach. All structure items were represented as negative-worded examples, as they dealt with basic conditions under Japanese universal health care system, and were regarded as representative related to concepts of dissatisfaction and no dissatisfaction. Patients' experiences with nursing service were confirmed using Donabedian's approach and can therefore be applied to improve quality of nursing practice by practitioners, managers and policy makers. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

Mitigation for one & all: An integrated framework for mitigation of development impacts on biodiversity and ecosystem services

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

Tallis, Heather, E-mail: htallis@tnc.org; Kennedy, Christina M., E-mail: ckennedy@tnc.org; Ruckelshaus, Mary

Emerging development policies and lending standards call for consideration of ecosystem services when mitigating impacts from development, yet little guidance exists to inform this process. Here we propose a comprehensive framework for advancing both biodiversity and ecosystem service mitigation. We have clarified a means for choosing representative ecosystem service targets alongside biodiversity targets, identified servicesheds as a useful spatial unit for assessing ecosystem service avoidance, impact, and offset options, and discuss methods for consistent calculation of biodiversity and ecosystem service mitigation ratios. We emphasize the need to move away from area- and habitat-based assessment methods for both biodiversity and ecosystemmore » services towards functional assessments at landscape or seascape scales. Such comprehensive assessments more accurately reflect cumulative impacts and variation in environmental quality, social needs and value preferences. The integrated framework builds on the experience of biodiversity mitigation while addressing the unique opportunities and challenges presented by ecosystem service mitigation. These advances contribute to growing potential for economic development planning and execution that will minimize impacts on nature and maximize human wellbeing. - Highlights: • This is the first framework for biodiversity and ecosystem service mitigation. • Functional, landscape scale assessments are ideal for avoidance and offsets. • Servicesheds define the appropriate spatial extent for ecosystem service mitigation. • Mitigation ratios should be calculated consistently and based on standard factors. • Our framework meets the needs of integrated mitigation assessment requirements.« less

Development and Evaluation of the Telephone Crisis Support Skills Scale.

PubMed

Kitchingman, Taneile A; Wilson, Coralie J; Caputi, Peter; Woodward, Alan; Hunt, Tara

2015-01-01

Although telephone services continue to play an important role in the delivery of front-line crisis support, published evidence of the standardized assessment of such services does not exist to date. To describe the development of the Telephone Crisis Support Skills Scale (TCSSS), an instrument to assess workers' intentions to use recommended skills with callers, and to evaluate its factor structure and reliability. TCSSS items were mapped to a national telephone crisis support practice model. A national sample of workers (n = 210) completed the TCSSS as part of a larger online survey. Principal axis factoring was used to evaluate the structure of the instrument. Internal consistency was assessed by Cronbach's α values. A single factor accounted for more than 40% of the variance within TCSSS ratings, indicating unidimensional structure. Cronbach's α coefficients suggested adequate internal consistency. Results indicate that the TCSSS is an internally consistent, unidimensional scale, sufficiently sensitive to detect workers' skill priorities for different caller problem types. Further study is required to confirm the factor structure and reliability of the TCSSS using workers from different organizations. Following further evaluation, the TCSSS may be applied to assessing readiness for and quality of service delivery.

Designing a valid and reliable Likert attitude scale on the generation of electricity from nuclear power plants

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

Calhoun, L.D.

A 15-step flowchart model was applied to the construction of a 20-item long form and a 6-item short form of the scale. Both scales were field-tested on 829 respondents representing a diverse range of subjects: high school juniors and seniors, nuclear engineering students, pre-service teachers, and members of a citizens action group. Both scales are available for immediate use. The 20-item scale appears to be reliable, content valid, and construct valid. Content validity was examined through factor analysis and the use of two separate juries of nuclear experts. Construct validity was examined by application of the known-groups approach. Scale reliabilitymore » and homogeneity were evidenced by a 0.93 coefficient alpha, a range of positive interim correlations of 0.15 to 0.73, and a range of adjusted item-total correlations of 0.46 to 0.80. The 20-item scale also has evaluative quality; means ranged from 2.80 to 3.70. Content validity for the 6-item scale was examined by a jury of nuclear experts. An obtained coefficient alpha of 0.82, a range of interim correlations of 0.51 to 0.72 suggest the scale is reliable and homogeneous. The 6-item short form also appears to have evaluative quality; means ranged from 2.37 to 3.18.« less

Global Health Diplomacy, Monitoring & Evaluation, and the Importance of Quality Assurance & Control: Findings from NIMH Project Accept (HPTN 043): A Phase III Randomized Controlled Trial of Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand.

PubMed

Kevany, Sebastian; Khumalo-Sakutukwa, Gertrude; Singh, Basant; Chingono, Alfred; Morin, Stephen

2016-01-01

Provision and scale-up of high quality, evidence-based services is essential for successful international HIV prevention interventions in order to generate and maintain intervention uptake, study integrity and participant trust, from both health service delivery and diplomatic perspectives. We developed quality assurance (QAC) procedures to evaluate staff fidelity to a cluster-randomized trial of the NIMH Project Accept (HPTN 043) assessing the effectiveness of a community-based voluntary counseling and testing strategy. The intervention was comprised of three components-Mobile Voluntary Counseling and Testing (MVCT), Community Mobilization (CM) and Post-Test Support Services (PTSS). QAC procedures were based on standardized criteria, and were designed to assess both provider skills and adherence to the intervention protocol. Supervisors observed a random sample of 5% to 10% of sessions each month and evaluated staff against multiple criteria on scales of 1-5. A score of 5 indicated 100% adherence, 4 indicated 95% adherence, and 3 indicated 90% adherence. Scores below 3 were considered unsatisfactory, and protocol deviations were discussed with the respective staff. During the first year of the intervention, the mean scores of MVCT and CM staff across the 5 study sites were 4 (95% adherence) or greater and continued to improve over time. Mean QAC scores for the PTSS component were lower and displayed greater fluctuations. Challenges to PTSS staff were identified as coping with the wide range of activities in the PTSS component and the novelty of the PTSS process. QAC fluctuations for PTSS were also associated with new staff hires or changes in staff responsibilities. Through constant staff monitoring and support, by Year 2, QAC scores for PTSS activities had reached those of MVCT and CM. The implementation of a large-sale, evidence based HIV intervention requires extensive QAC to ensure implementation effectiveness. Ongoing appraisal of study staff across sites ensures consistent and high quality delivery of all intervention components, in keeping with the goals of the study protocol, while also providing a forum for corrective feedback, additional supervision and retraining of staff. QAC ensures staff fidelity to study procedures and is critical to the successful delivery of multi-site HIV prevention interventions, as well as the delivery of services scaled up in programmatic situations.

Factoring quality laboratory diagnosis into the malaria control agenda for sub-Saharan Africa.

PubMed

Aidoo, Michael

2013-09-01

Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

Voluntary medical male circumcision scale-up in Nyanza, Kenya: evaluating technical efficiency and productivity of service delivery.

PubMed

Omondi Aduda, Dickens S; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

2015-01-01

Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya's context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350-5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959-4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning.

Stroke survivors' levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area.

PubMed

Kusambiza-Kiingi, Adrian; Maleka, Douglas; Ntsiea, Veronica

2017-01-01

Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. To determine stroke survivors' levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% ( n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services ( r = 0.27, p < 0.0001) and QOL ( r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain ( r = -0.37, p < 0.0001). Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services.

Stroke survivors’ levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area

PubMed Central

Kusambiza-Kiingi, Adrian; Maleka, Douglas

2017-01-01

Background Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. Aim To determine stroke survivors’ levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Method This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. Results A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). Conclusion Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services. PMID:28730068

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long‐term care institution residents

PubMed Central

Lin, Jesun; Hsiao, Chih‐Tung; Glen, Robert; Pai, Jar‐Yuan; Zeng, Sin‐Huei

2012-01-01

Abstract Objective  To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long‐term care institutions. Design  The five‐point Likert scale questionnaire administered through facetoface interviews. Setting  Fourteen long‐term care institutions located in central and southern Taiwan stratified according to services and accommodation population. Participants  One hundred and eighty long‐term institutional care residents. Main outcome measures  Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Results  Student’s t‐test on institutional location shows a significant difference between overall satisfaction for central and southern institution long‐term care recipients. The correlation test revealed that the higher a resident’s level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index‐of‐model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long‐term care institutions, is also an important factor in residents’ overall satisfaction. Conclusion  The primary goal of long‐term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost‐effective but high‐quality care. On the basis of the results of in‐depth interviews with long‐term institutional care residents, this study suggests long‐term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. PMID:22429448

Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study

PubMed Central

Nijhuis-van der Sanden, Maria W G; Driehuis, Femke; Heerkens, Yvonne F; van der Vleuten, Cees P M; van der Wees, Philip J

2017-01-01

Objectives To evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement. Design Mixed methods study. Participants and setting 64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands. Methods The programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2. Results We identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication. Conclusions This study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study. PMID:28188156

Consequences of land use cover change and precipitation regimes on water quality in a tropical landscape: the case of São Paulo, Brazil

NASA Astrophysics Data System (ADS)

Ribeiro Piffer, P.; Reverberi Tambosi, L.; Uriarte, M.

2017-12-01

One of the most pressing challenges faced by modern societies is ensuring a sufficient supply of water considering the ever-growing conflict between environmental conservation and expansion of agricultural and urban frontiers worldwide. Land use cover change have marked effects on natural landscapes, putting key watershed ecosystem services in jeopardy. We investigated the consequences of land use cover change and precipitation regimes on water quality in the state of São Paulo, Brazil, a landscape that underwent major changes in past century. Water quality data collected bi-monthly between 2000 and 2014 from 229 water monitoring stations was analyzed together with 2011 land use cover maps. We focused on six water quality metrics (dissolved oxygen, total nitrogen, total phosphorus, turbidity, total dissolved solids and fecal coliforms) and used generalized linear mixed models to analyze the data. Models were built at two scales, the entire watershed and a 60 meters riparian buffer along the river network. Models accounted for 46-67% of the variance in water quality metrics and, apart from dissolved oxygen, which reflected land cover composition in riparian buffers, all metrics responded to land use at the watershed scale. Highly urbanized areas had low dissolved oxygen and high fecal coliforms, dissolved solids, phosphorus and nitrogen levels in streams. Pasture was associated with increases in turbidity, while sugarcane plantations significantly increased nitrogen concentrations. Watersheds with high forest cover had greater dissolved oxygen and lower turbidity. Silviculture plantations had little impact on water quality. Precipitation decreased dissolved oxygen and was associated with higher levels of turbidity, fecal coliforms and phosphorus. Results indicate that conversion of forest cover to other land uses had negative impacts on water quality in the study area, highlighting the need for landscape restoration to improve watersheds ecosystem services.

Bobath or motor relearning programme? A follow-up one and four years post stroke.

PubMed

Langhammer, Birgitta; Stanghelle, Johan K

2003-11-01

The purpose of this follow-up one and four years post stroke was to find out whether the initial physiotherapy approach had had any long-term effects on mortality, motor function, postural control, activities of daily living, life quality, follow-up from community services and living conditions. A randomized controlled trial of first time ever stroke patients. Group 1 (n = 33) and group 2 (n = 28) had initial physiotherapy according to the Motor Relearning Programme and Bobath, respectively. The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index, the Nottingham Health Profile (NHP) and Berg Balance Scale were used. The following parameters were also registered: incidence of new strokes, other diseases, use of assistive devices, the patient's accommodation and use of services from the community. The mortality rates were similar in the two groups. In both groups the motor function, postural control and ADL had decreased rapidly, leaving many of the patients dependent and with a high risk of falling. Life quality had increased compared to the acute stage, but was still low in comparison with healthy persons. Patients in both groups lived at home, but were dependent on help from relatives and community services. Physiotherapy as follow-up service was seldom used. The initial physiotherapy approach did not seem to have a major influence on the patients' ability to cope in the long-term. This follow-up at one and four years post stroke showed no major influence of two different initial physiotherapy regimens on long-term function. The study confirmed a rapid deterioration of ADL and motor function and an increased dependence on relatives. The study reveals a gap between the intense treatment in the acute phase and little or no follow-up of physiotherapy treatment or other rehabilitation activities later.

Potential for using regional and global datasets for national scale ecosystem service modelling

NASA Astrophysics Data System (ADS)

Maxwell, Deborah; Jackson, Bethanna

2016-04-01

Ecosystem service models are increasingly being used by planners and policy makers to inform policy development and decisions about national-level resource management. Such models allow ecosystem services to be mapped and quantified, and subsequent changes to these services to be identified and monitored. In some cases, the impact of small scale changes can be modelled at a national scale, providing more detailed information to decision makers about where to best focus investment and management interventions that could address these issues, while moving toward national goals and/or targets. National scale modelling often uses national (or local) data (for example, soils, landcover and topographical information) as input. However, there are some places where fine resolution and/or high quality national datasets cannot be easily obtained, or do not even exist. In the absence of such detailed information, regional or global datasets could be used as input to such models. There are questions, however, about the usefulness of these coarser resolution datasets and the extent to which inaccuracies in this data may degrade predictions of existing and potential ecosystem service provision and subsequent decision making. Using LUCI (the Land Utilisation and Capability Indicator) as an example predictive model, we examine how the reliability of predictions change when national datasets of soil, landcover and topography are substituted with coarser scale regional and global datasets. We specifically look at how LUCI's predictions of where water services, such as flood risk, flood mitigation, erosion and water quality, change when national data inputs are replaced by regional and global datasets. Using the Conwy catchment, Wales, as a case study, the land cover products compared are the UK's Land Cover Map (2007), the European CORINE land cover map and the ESA global land cover map. Soils products include the National Soil Map of England and Wales (NatMap) and the European Soils Database. NEXTmap elevation data, which covers the UK and parts of continental Europe, are compared to global AsterDEM and SRTM30 topographical products. While the regional and global datasets can be used to fill gaps in data requirements, the coarser resolution of these datasets means that there is greater aggregation of information over larger areas. This loss of detail impacts on the reliability of model output, particularly where significant discrepancies between datasets exist. The implications of this loss of detail in terms of spatial planning and decision making is discussed. Finally, in the context of broader development the need for better nationally and globally available data to allow LUCI and other ecosystem models to become more globally applicable is highlighted.

Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care.

PubMed

Park, Young Joo; Martin, Erika G

2017-11-12

We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. A cross-sectional study design of nursing homes within U.S. metropolitan areas. Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. © Health Research and Educational Trust.

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

PubMed Central

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

2012-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy. PMID:22308578

Long-term assessment at field scale of Floating Treatment Wetlands for improvement of water quality and provision of ecosystem services in a eutrophic urban pond.

PubMed

Olguín, Eugenia J; Sánchez-Galván, Gloria; Melo, Francisco J; Hernández, Víctor J; González-Portela, Ricardo E

2017-04-15

Pollution of urban water bodies requires stringent control measures and the development of low-cost and highly efficient alternative technologies. In contrast to Constructed Wetlands, Floating Treatment Wetlands (FTWs) have the advantage of not requiring large surface of land since they operate in situ. However, there is limited information about their long-term evaluation while operating at field scale. The aim of this work was to assess the performance of FTWs using a combination of Pontederia sagittata and Cyperus papyrus for the improvement of the water quality and provision of ecosystem services of a eutrophic urban pond. The FTWs were built with low-cost material easy to acquire and to ensemble. Two FTWs (17.5m 2 and 33m 2 ) located in Pond 1 within a complex of 4 urban artificial ponds were evaluated for two years. They promoted an increase in the dissolved oxygen (D.O.) within a range of 15 to 67%, a removal of fecal coliforms in the range of 9 to 86% and a nitrate removal in the range of 9 to 76%. The plant productivity reached a maximum of 363g dm m -2 d -1 in the FTW1 and 536g dm m -2 d -1 in the FTW2 during the period March-June 2016. The TKN and the TP content in the plant were in the range of 18.3 to 28.1 and of 0.05 to 0.196gkg -1 dry matter, respectively. In conclusion, the tested FTWs have proved to be a very beneficial low-cost technology for the improvement of water quality and provision of ecosystem services. Copyright © 2017 Elsevier B.V. All rights reserved.

Soil indicators to assess the effectiveness of restoration strategies in dryland ecosystems

NASA Astrophysics Data System (ADS)

Costantini, E. A. C.; Branquinho, C.; Nunes, A.; Schwilch, G.; Stavi, I.; Valdecantos, A.; Zucca, C.

2015-12-01

Soil indicators may be used for assessing both land suitability for restoration and the effectiveness of restoration strategies in restoring ecosystem functioning and services. In this review paper, several soil indicators, which can be used to assess the effectiveness of restoration strategies in dryland ecosystems at different spatial and temporal scales, are discussed. The selected indicators represent the different viewpoints of pedology, ecology, hydrology, and land management. The recovery of soil capacity to provide ecosystem services is primarily obtained by increasing soil rooting depth and volume, and augmenting water accessibility for vegetation. Soil characteristics can be used either as indicators of suitability, that is, inherently slow-changing soil qualities, or as indicators for modifications, namely dynamic, thus "manageable" soil qualities. Soil organic matter forms, as well as biochemistry, micro- and meso-biology, are among the most utilized dynamic indicators. On broader territorial scales, the Landscape Function Analysis uses a functional approach, where the effectiveness of restoration strategies is assessed by combining the analysis of spatial pattern of vegetation with qualitative soil indicators. For more holistic and comprehensive projects, effective strategies to combat desertification should integrate soil indicators with biophysical and socio-economic evaluation and include participatory approaches. The integrated assessment protocol of Sustainable Land Management developed by the World Overview of Conservation Approaches and Technologies network is thoroughly discussed. Two overall outcomes stem from the review: (i) the success of restoration projects relies on a proper understanding of their ecology, namely the relationships between soil, plants, hydrology, climate, and land management at different scales, which is particularly complex due to the heterogeneous pattern of ecosystems functioning in drylands, and (ii) the selection of the most suitable soil indicators follows a clear identification of the different and sometimes competing ecosystem services that the project is aimed at restoring.

Effects of land use and seasonality on stream water quality in a small tropical catchment: The headwater of Córrego Água Limpa, São Paulo (Brazil).

PubMed

Rodrigues, Valdemir; Estrany, Joan; Ranzini, Mauricio; de Cicco, Valdir; Martín-Benito, José Mª Tarjuelo; Hedo, Javier; Lucas-Borja, Manuel E

2018-05-01

Stream water quality is controlled by the interaction of natural and anthropogenic factors over a range of temporal and spatial scales. Among these anthropogenic factors, land cover changes at catchment scale can affect stream water quality. This work aims to evaluate the influence of land use and seasonality on stream water quality in a representative tropical headwater catchment named as Córrego Água Limpa (Sao Paulo, Brasil), which is highly influenced by intensive agricultural activities and urban areas. Two systematic sampling approach campaigns were implemented with six sampling points along the stream of the headwater catchment to evaluate water quality during the rainy and dry seasons. Three replicates were collected at each sampling point in 2011. Electrical conductivity, nitrates, nitrites, sodium superoxide, Chemical Oxygen Demand (DQO), colour, turbidity, suspended solids, soluble solids and total solids were measured. Water quality parameters differed among sampling points, being lower at the headwater sampling point (0m above sea level), and then progressively higher until the last downstream sampling point (2500m above sea level). For the dry season, the mean discharge was 39.5ls -1 (from April to September) whereas 113.0ls -1 were averaged during the rainy season (from October to March). In addition, significant temporal and spatial differences were observed (P<0.05) for the fourteen parameters during the rainy and dry period. The study enhance significant relationships among land use and water quality and its temporal effect, showing seasonal differences between the land use and water quality connection, highlighting the importance of multiple spatial and temporal scales for understanding the impacts of human activities on catchment ecosystem services. Copyright © 2017 Elsevier B.V. All rights reserved.

Buddy programs for people infected with HIV.

PubMed

Burrage, Joe; Demi, Alice

2003-01-01

The purposes of this correlational study were to describe and compare clients' and volunteers' perceptions of a buddy program for people infected with HIV and to identify relationships between social support and clients' quality of life. Clients' social support was assessed with the Interpersonal Support Evaluation List(ISEL), and their quality of life was assessed with the Medical Outcomes Study-HIV (MOS-HIV) Scale. Clients' and volunteers' perceptions of satisfaction and assistance with activities were assessed with researcher-developed instruments. A convenience sample of 46 client-volunteer dyads was recruited from five AIDS service organizations. Clients perceived adequate levels of social support, moderate amounts of assistance, high levels of satisfaction with client-volunteer relationships, and moderate to low quality of life. A positive relationship was found between clients' and volunteers' perceptions of satisfaction. Relationships were found between ISEL subscales and the Health Transition and Mental Health subscales of the MOS-HIV and the MOS-HIV total scale scores. The findings of the study provide support for the continuation of buddy programs.

Service quality in health care setting.

PubMed

Rashid, Wan Edura Wan; Jusoff, Hj Kamaruzaman

2009-01-01

This paper attempts to explore the concept of service quality in a health care setting. This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in the health care sector. The paper also discusses several service quality dimensions and service quality problems in order to provide a more holistic conception of hospital service quality. The paper finds that service quality in health care is very complex as compared to other services because this sector highly involves risk. The paper adds a new perspective towards understanding how the concept of service quality is adopted in a health care setting.

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.

PubMed

Ko, Michelle; Murphy, Julia; Bindman, Andrew B

2015-11-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.

Evaluating a measure of social health derived from two mental health recovery measures: the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program Consumer Survey (MHSIP).

PubMed

Carlson, Jordan A; Sarkin, Andrew J; Levack, Ashley E; Sklar, Marisa; Tally, Steven R; Gilmer, Todd P; Groessl, Erik J

2011-08-01

Social health is important to measure when assessing outcomes in community mental health. Our objective was to validate social health scales using items from two broader commonly used measures that assess mental health outcomes. Participants were 609 adults receiving psychological treatment services. Items were identified from the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program (MHSIP) outcome measures by their conceptual correspondence with social health and compared to the Social Functioning Questionnaire (SFQ) using correlational analyses. Pearson correlations for the identified CA-QOL and MSHIP items with the SFQ ranged from .42 to .62, and the identified scale scores produced Pearson correlation coefficients of .56, .70, and, .70 with the SFQ. Concurrent validity with social health was supported for the identified scales. The current inclusion of these assessment tools allows community mental health programs to include social health in their assessments.

Interim hardwood tree grades for factory lumber

Treesearch

Leland F. Hanks; Leland F. Hanks

1971-01-01

Hardwood trees have for many years been measured in such a way that tree volume could be estimated; and in recent years the prediction of tree quality by using tree grades has become of interest to owners, sellers, and buyers of timber. Several tree-grading systems have been developed, but none has been publicized and used on a widespread scale. The Forest Service...

Chapter 6 - Links between land cover and lichen species richness at large scales in forested ecosystems across the United States.

Treesearch

Susan Will-Wolf; Randall S. Morin; Mark J. Ambrose; Kurt Riitters; Sarah Jovan

2014-01-01

Lichen community composition is well known for exhibiting response to air pollution, and to macroenvironmental and microenvironmental variables. Lichens are useful indicators of air quality impact, forest health, and forest ecosystem integrity across the United States (McCune 2000, reviews in Nimis and others 2002, USDA Forest Service 2007).

Role of oaks in fisher habitat quality in the Sierra Nevada mountains at multiple spatial scales

Treesearch

Craig M. Thompson; Kathryn Purcell; Rebecca Green; Richard. Sweitzer

2015-01-01

Fishers (Pekania pennanti) occur in ponderosa pine, mixed conifer, and mixed hardwood conifer habitats in the southern Sierra Nevada at elevations from approximately 1400 to 2300 m. They are a candidate species for listing under both the Federal and California Endangered Species Acts. Since 2007, the U.S. Department of Agriculture, Forest Service (...

Scaling Users' Perceptions of Library Service Quality Using Item Response Theory: A LibQUAL+ [TM] Study

ERIC Educational Resources Information Center

Wei, Youhua; Thompson, Bruce; Cook, C. Colleen

2005-01-01

LibQUAL+[TM] data to date have not been subjected to the modern measurement theory called polytomous item response theory (IRT). The data interpreted here were collected from 42,090 participants who completed the "American English" version of the 22 core LibQUAL+[TM] items, and 12,552 participants from Australia and Europe who…

The Tanzania experience: clinical laboratory testing harmonization and equipment standardization at different levels of a tiered health laboratory system.

PubMed

Massambu, Charles; Mwangi, Christina

2009-06-01

The rapid scale-up of the care and treatment programs in Tanzania during the preceding 4 years has greatly increased the demand for quality laboratory services for diagnosis of HIV and monitoring patients during antiretroviral therapy. Laboratory services were not in a position to cope with this demand owing to poor infrastructure, lack of human resources, erratic and/or lack of reagent supply and commodities, and slow manual technologies. With the limited human resources in the laboratory and the need for scaling up the care and treatment program, it became necessary to install automated equipment and train personnel for the increased volume of testing and new tests across all laboratory levels. With the numerous partners procuring equipment, the possibility of a multitude of equipment platforms with attendant challenges for procurement of reagents, maintenance of equipment, and quality assurance arose. Tanzania, therefore, had to harmonize laboratory tests and standardize laboratory equipment at different levels of the laboratory network. The process of harmonization of tests and standardization of equipment included assessment of laboratories, review of guidelines, development of a national laboratory operational plan, and stakeholder advocacy. This document outlines this process.

Adverse psychosocial working conditions and poor quality of life among financial service employees in Brazil.

PubMed

Silva, Luiz Sergio; Barreto, Sandhi Maria

2012-01-01

Workers in the financial services sector are exposed to great stress at work. This study investigates whether exposure to adverse psychosocial work conditions is independently associated with poor health-related physical and mental quality of life among financial services workers. We studied a nationwide representative sample of 2,054 workers of a large Brazilian state bank in 2008. Adverse psychosocial work conditions were investigated by the Effort-reward imbalance (ERI) scale and the Job content questionnaire (JCQ). Health-related quality of life (HRQL) was assessed using the Medical Outcomes Study Short-Form General Health Survey (SF-12). Poor mental and physical HRQL was defined by the lowest quartiles of the SF-12 final score distributions. Associations were investigated using multiple logistic regression analysis. In the multivariate analysis, exposures to low control and lack of social support at work (JCQ) were associated with poor HRQL in the physical domain. Increasing effort-reward imbalance and overcommitment (ERI), on the other hand, were associated with poor HRQL in the mental domain, with a significant statistical trend. Overcommitment was also associated with poor physical HRQL. The results suggest that exposure to adverse psychosocial work conditions has a negative impact on both domains of HRQL among financial service workers. They also indicate that ERI and DC models capture different aspects of job strain.

The complexity of earth observation valuation: Modeling the patterns and processes of agricultural production and groundwater quality to construct a production possibilities frontier

NASA Astrophysics Data System (ADS)

Forney, W.; Raunikar, R. P.; Bernknopf, R.; Mishra, S.

2012-12-01

A production possibilities frontier (PPF) is a graph comparing the production interdependencies for two commodities. In this case, the commodities are defined as the ecosystem services of agricultural production and groundwater quality. This presentation focuses on the refinement of techniques used in an application to estimate the value of remote sensing information. Value of information focuses on the use of uncertain and varying qualities of information within a specific decision-making context for a certain application, which in this case included land use, biogeochemical, hydrogeologic, economic and geospatial data and models. The refined techniques include deriving alternate patterns and processes of ecosystem functions, new estimates of ecosystem service values to construct a PPF, and the extension of this work into decision support systems. We have coupled earth observations of agricultural production with groundwater quality measurements to estimate the value of remote sensing information in northeastern Iowa to be 857M ± 198M (at the 2010 price level) per year. We will present an improved method for modeling crop rotation patterns to include multiple years of rotation, reduction in the assumptions associated with optimal land use allocations, and prioritized improvement of the resolution of input data (for example, soil resources and topography). The prioritization focuses on watersheds that were identified at a coarse-scale of analysis to have higher intensities of agricultural production and lower probabilities of groundwater survivability (in other words, remaining below a regulatory threshold for nitrate pollution) over time, and thus require finer-scaled modeling and analysis. These improved techniques and the simulation of certain scale-dependent policy and management actions, which trade-off the objectives of optimizing crop value versus maintaining potable groundwater, and provide new estimates for the empirical values of the PPF. The calculation of a PPF in this way provides a decision maker with a tool to consider the ramifications of different policies, management practices and regional objectives.

The feasibility of a randomised controlled trial to compare the cost-effectiveness of palliative cardiology or usual care in people with advanced heart failure: Two exploratory prospective cohorts.

PubMed

Johnson, Miriam J; McSkimming, Paula; McConnachie, Alex; Geue, Claudia; Millerick, Yvonne; Briggs, Andrew; Hogg, Karen

2018-06-01

The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. Non-randomised feasibility. Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group). Outcomes/safety: Symptoms (Edmonton Symptom Assessment Scale), Kansas City Cardiomyopathy Questionnaire, performance, understanding of disease, anticipatory care planning, cost-effectiveness, survival and carer burden. A total of 77 participants (caring together group = 43; usual care group = 34) were enrolled (53% men; mean age 77 years (33-100)). The caring together group scored worse in Edmonton Symptom Assessment Scale (43.5 vs 35.2) and Kansas City Cardiomyopathy Questionnaire (35.4 vs 39.9). The caring together group had a lower consent/screen ratio (1:1.7 vs 1: 2.8) and few died before approach (0.08% vs 16%) or declined invitation (17% vs 37%). Data quality: At 4 months, 74% in the caring together group and 71% in the usual care group provided data. Most attrition was due to death or deterioration. Data quality in self-report measures was otherwise good. There was no difference in survival. Symptoms and quality of life improved in both groups. A future trial requires 141 (202 allowing 30% attrition) to detect a minimal clinical difference (1 point) in Edmonton Symptom Assessment Scale score for breathlessness (80% power). More participants (176; 252 allowing 30% attrition) are needed to detect a 10.5 change in Kansas City Cardiomyopathy Questionnaire score (80% power; minimum clinical difference = 5). A trial to test the clinical effectiveness (improvement in breathlessness) of cardiology-led palliative care is feasible.

The feasibility of a randomised controlled trial to compare the cost-effectiveness of palliative cardiology or usual care in people with advanced heart failure: Two exploratory prospective cohorts

PubMed Central

McSkimming, Paula; McConnachie, Alex; Geue, Claudia; Millerick, Yvonne; Briggs, Andrew; Hogg, Karen

2018-01-01

Background: The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. Aim: To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. Design: Non-randomised feasibility. Setting/participants: Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group). Outcomes/safety: Symptoms (Edmonton Symptom Assessment Scale), Kansas City Cardiomyopathy Questionnaire, performance, understanding of disease, anticipatory care planning, cost-effectiveness, survival and carer burden. Results: A total of 77 participants (caring together group = 43; usual care group = 34) were enrolled (53% men; mean age 77 years (33–100)). The caring together group scored worse in Edmonton Symptom Assessment Scale (43.5 vs 35.2) and Kansas City Cardiomyopathy Questionnaire (35.4 vs 39.9). The caring together group had a lower consent/screen ratio (1:1.7 vs 1: 2.8) and few died before approach (0.08% vs 16%) or declined invitation (17% vs 37%). Data quality: At 4 months, 74% in the caring together group and 71% in the usual care group provided data. Most attrition was due to death or deterioration. Data quality in self-report measures was otherwise good. Safety: There was no difference in survival. Symptoms and quality of life improved in both groups. A future trial requires 141 (202 allowing 30% attrition) to detect a minimal clinical difference (1 point) in Edmonton Symptom Assessment Scale score for breathlessness (80% power). More participants (176; 252 allowing 30% attrition) are needed to detect a 10.5 change in Kansas City Cardiomyopathy Questionnaire score (80% power; minimum clinical difference = 5). Conclusion: A trial to test the clinical effectiveness (improvement in breathlessness) of cardiology-led palliative care is feasible. PMID:29688127

Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework

PubMed Central

Helfrich, Christian D; Li, Yu-Fang; Sharp, Nancy D; Sales, Anne E

2009-01-01

Background The Promoting Action on Research Implementation in Health Services, or PARIHS, framework is a theoretical framework widely promoted as a guide to implement evidence-based clinical practices. However, it has as yet no pool of validated measurement instruments that operationalize the constructs defined in the framework. The present article introduces an Organizational Readiness to Change Assessment instrument (ORCA), organized according to the core elements and sub-elements of the PARIHS framework, and reports on initial validation. Methods We conducted scale reliability and factor analyses on cross-sectional, secondary data from three quality improvement projects (n = 80) conducted in the Veterans Health Administration. In each project, identical 77-item ORCA instruments were administered to one or more staff from each facility involved in quality improvement projects. Items were organized into 19 subscales and three primary scales corresponding to the core elements of the PARIHS framework: (1) Strength and extent of evidence for the clinical practice changes represented by the QI program, assessed with four subscales, (2) Quality of the organizational context for the QI program, assessed with six subscales, and (3) Capacity for internal facilitation of the QI program, assessed with nine subscales. Results Cronbach's alpha for scale reliability were 0.74, 0.85 and 0.95 for the evidence, context and facilitation scales, respectively. The evidence scale and its three constituent subscales failed to meet the conventional threshold of 0.80 for reliability, and three individual items were eliminated from evidence subscales following reliability testing. In exploratory factor analysis, three factors were retained. Seven of the nine facilitation subscales loaded onto the first factor; five of the six context subscales loaded onto the second factor; and the three evidence subscales loaded on the third factor. Two subscales failed to load significantly on any factor. One measured resources in general (from the context scale), and one clinical champion role (from the facilitation scale). Conclusion We find general support for the reliability and factor structure of the ORCA. However, there was poor reliability among measures of evidence, and factor analysis results for measures of general resources and clinical champion role did not conform to the PARIHS framework. Additional validation is needed, including criterion validation. PMID:19594942

Organizational readiness to change assessment (ORCA): development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework.

PubMed

Helfrich, Christian D; Li, Yu-Fang; Sharp, Nancy D; Sales, Anne E

2009-07-14

The Promoting Action on Research Implementation in Health Services, or PARIHS, framework is a theoretical framework widely promoted as a guide to implement evidence-based clinical practices. However, it has as yet no pool of validated measurement instruments that operationalize the constructs defined in the framework. The present article introduces an Organizational Readiness to Change Assessment instrument (ORCA), organized according to the core elements and sub-elements of the PARIHS framework, and reports on initial validation. We conducted scale reliability and factor analyses on cross-sectional, secondary data from three quality improvement projects (n = 80) conducted in the Veterans Health Administration. In each project, identical 77-item ORCA instruments were administered to one or more staff from each facility involved in quality improvement projects. Items were organized into 19 subscales and three primary scales corresponding to the core elements of the PARIHS framework: (1) Strength and extent of evidence for the clinical practice changes represented by the QI program, assessed with four subscales, (2) Quality of the organizational context for the QI program, assessed with six subscales, and (3) Capacity for internal facilitation of the QI program, assessed with nine subscales. Cronbach's alpha for scale reliability were 0.74, 0.85 and 0.95 for the evidence, context and facilitation scales, respectively. The evidence scale and its three constituent subscales failed to meet the conventional threshold of 0.80 for reliability, and three individual items were eliminated from evidence subscales following reliability testing. In exploratory factor analysis, three factors were retained. Seven of the nine facilitation subscales loaded onto the first factor; five of the six context subscales loaded onto the second factor; and the three evidence subscales loaded on the third factor. Two subscales failed to load significantly on any factor. One measured resources in general (from the context scale), and one clinical champion role (from the facilitation scale). We find general support for the reliability and factor structure of the ORCA. However, there was poor reliability among measures of evidence, and factor analysis results for measures of general resources and clinical champion role did not conform to the PARIHS framework. Additional validation is needed, including criterion validation.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

PubMed

Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

2013-01-01

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

[The impact of compulsory health service on physicians and burnout in a province in Eastern Anatolia].

PubMed

Taycan, Okan; Erdoğan Taycan, Serap; Çelik, Cihat

2013-01-01

The Compulsory Health Service (CHS) for physicians has been in place since 2005. The aim of this study was to investigate the impact of the CHS on physicians and the factors associated with burnout. The sample group consisted of all physicians working within the province of Muş in this cross-sectional, descriptive, epidemiological study. All participants were assessed using the Maslach Burnout Inventory (MBI), the Beck Depression Inventory, the Job Satisfaction Scale (JSS), the Satisfaction with Life Scale, the Professional Quality of Life Scale (ProQOL) and the General Health Questiannaire-12, along with a detailed sociodemographic and professional data form. A total of 139 physicians participated in this study, and 100 of them (71%) were fulfilling the CHS. Physicians who fulfilled the CHS were found to have lower levels of job satisfaction and professional quality of life. They also had higher levels of depression, general psychiatric symptoms, and psychological stress. The relationships between the level of burnout in physicians fulfilling the CHS and the scores from the scales used in the study were statistically significant except those between MBI-Personal Accomplishment, JSS, and ProQOL-Compassion Fatigue subscales. The extent of depressive symptoms and the daily number of patients were predictors of all three subscales of burnout. Job satisfaction was a predictor of both emotional exhaustion and depersonalization, while life satisfaction was a predictor of emotional exhaustion, and gender was a predictor of personal accomplishment. The level of burnout among physicians who had fulfilled the CHS was high. The factors and predictors associated with burnout were discussed.

Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

PubMed Central

de Dieu Iragena, Jean; Kao, Kekeletso; Erni, Donatelle; Mekonen, Teferi

2017-01-01

Background Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. Objectives The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. Method An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit. PMID:28879161

The relationship between depressive symptoms among female workers and job stress and sleep quality

PubMed Central

2013-01-01

Objective Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers. Methods From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted. Results Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively. Conclusion This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace. PMID:24472381

Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. Results Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. Conclusions Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery. PMID:26390886

Patient-reported symptom questionnaires in laryngeal cancer: voice, speech and swallowing.

PubMed

Rinkel, R N P M; Verdonck-de Leeuw, I M; van den Brakel, N; de Bree, R; Eerenstein, S E J; Aaronson, N; Leemans, C R

2014-08-01

To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Laryngeal cancer patients at least three months post-treatment completed the VHI (voice), SHI (speech), SWAL-QOL (swallowing), EORTC QLQ-C30, QLQ-HN35, HADS, and study-specific questions on rehabilitation. Eighty-eight patients and 110 healthy controls participated. Cut off scores of 15, 6, and 14 were defined for the VHI, SHI, and SWAL-QOL (sensitivity > 90%; specificity > 80%). Based on these scores, 56% of the patients reported voice, 63% speech, and 54% swallowing problems. VHI, SHI, and SWAL-QOL scores were associated significantly with quality of life (EORTC QLQ-C30 global quality of life scale) (r = .43 (VHI and SHI) and r = .46 (SWAL-QOL)) and distress (r = .50 (VHI and SHI) and r = .58 (SWAL-QOL)). In retrospect, 32% of the patients indicated the need for rehabilitation at time of treatment, and 81% of these patients availed themselves of such services. Post-treatment, 8% of the patients expressed a need for rehabilitation, and 20% of these patients actually made use of such services. Psychometric characteristics of the VHI, SHI, and SWAL-QOL in laryngeal cancer patients are good. The prevalence of voice, speech, and swallowing problems is high, and clearly related to quality of life and distress. Although higher during than after treatment, the perceived need for and use of rehabilitation services is limited. Copyright © 2014 Elsevier Ltd. All rights reserved.

Prostate cancer: how assessment of QoL can improve delivery of care.

PubMed

Brown, Michelle

Prostate cancer treatments often affect quality of life and problems may present at any point during treatment. Measuring and identifying issues of quality of life (QoL) may create an opportunity for the patient to discuss problems and induce information transfer from health professional to patient and vice versa. Many practitioners already assess QoL in patients with prostate cancer because treatment for the disease can have a dramatic impact on lifestyle. QoL may facilitate a more holistic approach to patient care. Using a QoL assessment tool may promote and enhance the current service provision and aid identification of bothersome side-effects, for example loss of libido, gynaecomastia (i.e. abnormal over-development of the breasts in a man), and hot flushes. The Functional Assessment of Cancer Therapy-Prostate scale (FACT-P) (Cella et al, 1993) is a prostate-specific QoL assessment tool, which can be self-administered and takes little time to complete. This may be a useful tool in the ongoing management of patients with advanced prostate cancer. With the emphasis on quality of service for cancer patients (Department of Health (DH), 2000; DH, 2007a; National Health Service Improvement, 2009), it is paramount that health professionals continually examine practice and the quality of the service delivered. Addressing QoL issues for the patient with cancer should be a priority. This article will outline the significant side-effects that a patient with advanced prostate cancer may sustain and attempts to indicate how QoL assessment tools may contribute to care management and delivery.

Quality effort decision in service supply chain with quality preference based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng; Wang, Jianwei

2015-04-01

Service quality preference behaviors of both members are considered in service supply chain (SSC) including a service integrator and a service provider with stochastic demand. Through analysis of service quality cost and revenue, the utility functions are established on service quality effort degree and service quality preference level in integrated and decentralized SSC. Nash equilibrium and quantum game are used to optimize the models. By comparing the different solutions, the optimal strategies are obtained in SSC with quality preference. Then some numerical examples are studied and the changing trend of service quality effort is further analyzed by the influence of the entanglement operator and quality preferences.

Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial.

PubMed

King, Anna I I; Parsons, Matthew; Robinson, Elizabeth; Jörgensen, Diane

2012-07-01

Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face-to-face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health-related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well-being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI -0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P < 0.001). In conclusion, a restorative home care service may be of benefit to older people, and improves home care service efficacy. © 2011 Blackwell Publishing Ltd.

E-Services quality assessment framework for collaborative networks

NASA Astrophysics Data System (ADS)

Stegaru, Georgiana; Danila, Cristian; Sacala, Ioan Stefan; Moisescu, Mihnea; Mihai Stanescu, Aurelian

2015-08-01

In a globalised networked economy, collaborative networks (CNs) are formed to take advantage of new business opportunities. Collaboration involves shared resources and capabilities, such as e-Services that can be dynamically composed to automate CN participants' business processes. Quality is essential for the success of business process automation. Current approaches mostly focus on quality of service (QoS)-based service selection and ranking algorithms, overlooking the process of service composition which requires interoperable, adaptable and secure e-Services to ensure seamless collaboration, data confidentiality and integrity. Lack of assessment of these quality attributes can result in e-Service composition failure. The quality of e-Service composition relies on the quality of each e-Service and on the quality of the composition process. Therefore, there is the need for a framework that addresses quality from both views: product and process. We propose a quality of e-Service composition (QoESC) framework for quality assessment of e-Service composition for CNs which comprises of a quality model for e-Service evaluation and guidelines for quality of e-Service composition process. We implemented a prototype considering a simplified telemedicine use case which involves a CN in e-Healthcare domain. To validate the proposed quality-driven framework, we analysed service composition reliability with and without using the proposed framework.

The key technique study of a kind of personal navigation oriented LBS system

NASA Astrophysics Data System (ADS)

Yan, Lei; Zheng, Jianghua; Zhang, Xin; Peng, Chunhua; He, Lina

2005-11-01

With the integration of GIS, IT technology and wireless communication techniques, LBS is fast developing and caused wide concern. Personal navigation is the critical application of LBS. It has higher requirement of data quality, positioning accuracy and multi-model services. The study discusses the key techniques of a personal navigation oriented LBS system. As an example for service platform of China Unicom, NAVISTAR especially emphasizes the importance of spatial data organization. Based-on CDMA1X network, it adopts gpsOne\\MS-Assisted dynamic positioning technique, and puts forward a data organization solution to realize multi-scale representation.

The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa.

PubMed

Kabore, Inoussa; Bloem, Jeanette; Etheredge, Gina; Obiero, Walter; Wanless, Sebastian; Doykos, Patricia; Ntsekhe, Pearl; Mtshali, Nomantshali; Afrikaner, Eric; Sayed, Rauf; Bostwelelo, John; Hani, Andiswa; Moshabesha, Tiisetso; Kalaka, Agnes; Mameja, Jerry; Zwane, Nompumelelo; Shongwe, Nomvuyo; Mtshali, Phangisile; Mohr, Beryl; Smuts, Archie; Tiam, Appolinaire

2010-09-01

Antiretroviral therapy (ART) for HIV/AIDS in developing countries has been rapidly scaled up through directed public and private resources. Data on the efficacy of ART in developing countries are limited, as are operational research studies to determine the effect of selected nonmedical supportive care services on health outcomes in patients receiving ART. We report here on an investigation of the delivery of medical care combined with community-based supportive services for patients with HIV/AIDS in four resource-limited settings in sub-Saharan Africa, carried out between 2005 and 2007. The clinical and health-related quality of life (HRQOL) efficacy of ART combined with community support services was studied in a cohort of 377 HIV-infected patients followed for 18 months, in community-based clinics through patient interviews, clinical evaluations, and questionnaires. Patients exposed to community-based supportive services experienced a more rapid and greater overall increase in CD4 cell counts than unexposed patients. They also had higher levels of adherence, attributed primarily to exposure to home-based care services. In addition, patients receiving home-based care and/or food support services showed greater improvements in selected health-related QOL indicators. This report discusses the feasibility of effective ART in a large number of patients in resource-limited settings and the added value of concomitant community-based supportive care services.

Scenarios reveal pathways to sustain future ecosystem services in an agricultural landscape.

PubMed

Qiu, Jiangxiao; Carpenter, Stephen R; Booth, Eric G; Motew, Melissa; Zipper, Samuel C; Kucharik, Christopher J; Chen, Xi; Loheide, Steven P; Seifert, Jenny; Turner, Monica G

2018-01-01

Sustaining food production, water quality, soil retention, flood, and climate regulation in agricultural landscapes is a pressing global challenge given accelerating environmental changes. Scenarios are stories about plausible futures, and scenarios can be integrated with biophysical simulation models to explore quantitatively how the future might unfold. However, few studies have incorporated a wide range of drivers (e.g., climate, land-use, management, population, human diet) in spatially explicit, process-based models to investigate spatial-temporal dynamics and relationships of a portfolio of ecosystem services. Here, we simulated nine ecosystem services (three provisioning and six regulating services) at 220 × 220 m from 2010 to 2070 under four contrasting scenarios in the 1,345-km 2 Yahara Watershed (Wisconsin, USA) using Agro-IBIS, a dynamic model of terrestrial ecosystem processes, biogeochemistry, water, and energy balance. We asked (1) How does ecosystem service supply vary among alternative future scenarios? (2) Where on the landscape is the provision of ecosystem services most susceptible to future social-ecological changes? (3) Among alternative future scenarios, are relationships (i.e., trade-offs, synergies) among food production, water, and biogeochemical services consistent over time? Our results showed that food production varied substantially with future land-use choices and management, and its trade-offs with water quality and soil retention persisted under most scenarios. However, pathways to mitigate or even reverse such trade-offs through technological advances and sustainable agricultural practices were apparent. Consistent relationships among regulating services were identified across scenarios (e.g., trade-offs of freshwater supply vs. flood and climate regulation, and synergies among water quality, soil retention, and climate regulation), suggesting opportunities and challenges to sustaining these services. In particular, proactive land-use changes and management may buffer water quality against undesirable future climate changes, but changing climate may overwhelm management efforts to sustain freshwater supply and flood regulation. Spatially, changes in ecosystem services were heterogeneous across the landscape, underscoring the power of local actions and fine-scale management. Our research highlights the value of embracing spatial and temporal perspectives in managing ecosystem services and their complex interactions, and provides a system-level understanding for achieving sustainability of the food-water-climate nexus in agricultural landscapes. © 2017 by the Ecological Society of America.

Symptoms and health-related quality of life in patients with advanced cancer - A population-based study in Greenland.

PubMed

Augustussen, Mikaela; Sjøgren, Per; Timm, Helle; Hounsgaard, Lise; Pedersen, Michael Lynge

2017-06-01

The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. A Greenlandic version of the EORTC QLQ-C30 v.3.0 was developed. The translation process included independent forward translation, reconciliation and independent back translation by native Greenlandic-speaking translators who were fluent in English. After pilot testing, a population-based cross-sectional study of patients with advanced cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbach's alpha coefficients for five function scales and three symptom scales. Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbach's alpha coefficients (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale. Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Experience from the 1st Year running a Massive High Quality Videoconferencing Service for the LHC

NASA Astrophysics Data System (ADS)

Fernandes, Joao; Baron, Thomas; Bompastor, Bruno

2014-06-01

In the last few years, we have witnessed an explosion of visual collaboration initiatives in the industry. Several advances in video services and also in their underlying infrastructure are currently improving the way people collaborate globally. These advances are creating new usage paradigms: any device in any network can be used to collaborate, in most cases with an overall high quality. To keep apace with this technology progression, the CERN IT Department launched a service based on the Vidyo product. This new service architecture introduces Adaptive Video Layering, which dynamically optimizes the video for each endpoint by leveraging the H.264 Scalable Video Coding (SVC)-based compression technology. It combines intelligent AV routing techniques with the flexibility of H.264 SVC video compression, in order to achieve resilient video collaboration over the Internet, 3G and WiFi. We present an overview of the results that have been achieved after this major change. In particular, the first year of operation of the CERN Vidyo service will be described in terms of performance and scale: The service became part of the daily activity of the LHC collaborations, reaching a monthly usage of more than 3200 meetings with a peak of 750 simultaneous connections. We also present some key features such as the integration with CERN Indico. LHC users can now join a Vidyo meeting either from their personal computer or a CERN videoconference room simply from an Indico event page, with the ease of a single click. The roadmap for future improvements, service extensions and core infrastructure tendencies such as cloud based services and virtualization of system components will also be discussed. Vidyo's strengths allowed us to build a universal service (it is accessible from PCs, but also videoconference rooms, traditional phones, tablets and smartphones), developed with 3 key ideas in mind: ease of use, full integration and high quality.

Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.

PubMed

Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

2017-04-12

The Standards Based Management and Recognition (SBM-R © ) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother. The SBM-R quality improvement intervention made a significant positive impact on MNH providers' performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government's five-year (2015-2020) health sector transformation plan and health care quality strategies needed to meet the country's MNH goals.

Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives.

PubMed

Wagner, Adam P; Croudace, Tim J; Bateman, Naomi; Pennington, Mark W; Prince, Elizabeth; Redley, Marcus; White, Simon R; Ring, Howard

2017-01-01

Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area. We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.

Family Quality of Life of South African Families Raising Children with Autism Spectrum Disorder.

PubMed

Schlebusch, Liezl; Dada, Shakila; Samuels, Alecia E

2017-07-01

This article describes the family quality of life among families who are raising a young child with autism spectrum disorder. Survey research was conducted with 180 families of children with autism spectrum disorder who were receiving disability-related services in the Gauteng province of South Africa. The principle measure used was the Beach Center Family Quality of Life Scale to assess five subdomains: family interaction, parenting, emotional well-being, material/physical well-being, and disability-related support. Results indicated that families felt the most satisfied with disability-related support and the least satisfied with the family's emotional well-being. Family income, family type, and the severity level of autism were significantly associated with how satisfied families felt about their quality of life.

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost.

PubMed

Humphries, Debbie L; Hyde, Justeen; Hahn, Ethan; Atherly, Adam; O'Keefe, Elaine; Wilkinson, Geoffrey; Eckhouse, Seth; Huleatt, Steve; Wong, Samuel; Kertanis, Jennifer

2018-01-01

Forty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use. To characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA). We interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews. The findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models - independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population. There are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations.

PubMed

Meacock, Rachel

2018-04-20

There is a requirement for economic evaluation of health technologies seeking public funding across Europe. Changes to the organisation and delivery of health services, including changes to health policy, are not covered by such appraisals. These changes also have consequences for National Health Service (NHS) funds, yet undergo no mandatory cost-effectiveness assessment. The focus on health technologies may have occurred because larger-scale service changes pose more complex challenges to evaluators. This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them. The five principal challenges identified are as follows: undertaking ex-ante evaluation; evaluating impacts in terms of quality-adjusted life years; assessing costs and opportunity costs; accounting for spillover effects; and generalisability. Of these challenges, methods for estimating the impact on costs and quality-adjusted life years are those most in need of development. Methods are available for ex-ante evaluation, assessing opportunity costs and examining generalisability. However, these are rarely applied in practice. The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that involving health technologies. Advancements in this area have the potential to improve the allocation of scarce NHS resources.

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

PubMed

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

2017-02-13

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

Identifying Key Hospital Service Quality Factors in Online Health Communities

PubMed Central

Jung, Yuchul; Hur, Cinyoung; Jung, Dain

2015-01-01

Background The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. Objective As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. Methods We defined social media–based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea’s two biggest online portals were used to test the effectiveness of detection of social media–based key quality factors for hospitals. Results To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and classification performance still has room for improvement, but the extraction results are applicable to more detailed analysis. Further analysis of the extracted information reveals that there are differences in the details of social media–based key quality factors for hospitals according to the regions in Korea, and the patterns of change seem to accurately reflect social events (eg, influenza epidemics). Conclusions These findings could be used to provide timely information to caregivers, hospital officials, and medical officials for health care policies. PMID:25855612

Urban forests and pollution mitigation: analyzing ecosystem services and disservices.

PubMed

Escobedo, Francisco J; Kroeger, Timm; Wagner, John E

2011-01-01

The purpose of this paper is to integrate the concepts of ecosystem services and disservices when assessing the efficacy of using urban forests for mitigating pollution. A brief review of the literature identifies some pollution mitigation ecosystem services provided by urban forests. Existing ecosystem services definitions and typologies from the economics and ecological literature are adapted and applied to urban forest management and the concepts of ecosystem disservices from natural and semi-natural systems are discussed. Examples of the urban forest ecosystem services of air quality and carbon dioxide sequestration are used to illustrate issues associated with assessing their efficacy in mitigating urban pollution. Development of urban forest management alternatives that mitigate pollution should consider scale, contexts, heterogeneity, management intensities and other social and economic co-benefits, tradeoffs, and costs affecting stakeholders and urban sustainability goals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada.

PubMed

Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea

2015-01-01

Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.

Quality of services and quality of life from service providers' perspectives: analysis with focus groups.

PubMed

Jenaro, C; Vega, V; Flores, N; Cruz, M

2013-06-01

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

Service employees give as they get: internal service as a moderator of the service climate-service outcomes link.

PubMed

Ehrhart, Karen Holcombe; Witt, L A; Schneider, Benjamin; Perry, Sara Jansen

2011-03-01

We lend theoretical insight to the service climate literature by exploring the joint effects of branch service climate and the internal service provided to the branch (the service received from corporate units to support external service delivery) on customer-rated service quality. We hypothesized that service climate is related to service quality most strongly when the internal service quality received is high, providing front-line employees with the capability to deliver what the service climate motivates them to do. We studied 619 employees and 1,973 customers in 36 retail branches of a bank. We aggregated employee perceptions of the internal service quality received from corporate units and the local service climate and external customer perceptions of service quality to the branch level of analysis. Findings were consistent with the hypothesis that high-quality internal service is necessary for branch service climate to yield superior external customer service quality. PsycINFO Database Record (c) 2011 APA, all rights reserved.

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova.

PubMed

Kempers, Jari; Ketting, Evert; Lesco, Galina

2014-07-21

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies.

Habitat Suitability Index Models: Black-shouldered kite

USGS Publications Warehouse

Faanes, Craig A.; Howard, Rebecca J.

1987-01-01

A review and synthesis of existing information were used to develop a model for evaluating black-shouldered kite habitat quality. The model is scaled to produce an index between 0 (unsuitable habitat) to 1.0 (optimal habitat). Habitat suitability index models are designed for use with the Habitat Evaluation Procedures previously developed by the U.S. Fish and Wildlife Service. Guidelines for model application are provided.

Privatisation in reproductive health services in Pakistan: three case studies.

PubMed

Ravindran, T K Sundari

2010-11-01

Privatisation in Pakistan's health sector was part of the Structural Adjustment Programme that started in 1998 following the country's acute foreign exchange crisis. This paper examines three examples of privatisation which have taken place in service delivery, management and capacity-building functions in the health sector: 1) large-scale contracting out of publicly-funded health services to private, not-for-profit organisations; 2) social marketing/franchising networks providing reproductive health services; and 3) a public-private partnership involving a consortium of private players and the government of Pakistan. It assesses the extent to which these initiatives have contributed to promoting equitable access to good quality, comprehensive reproductive health services. The paper concludes that these forms of privatisation in Pakistan's health sector have at best made available a limited range of fragmented reproductive health services, often of sub-optimal quality, to a fraction of the population, with poor returns in terms of health and survival, especially for women. This analysis has exposed a deep-rooted malaise within the health system as an important contributor to this situation. Sustained investment in health system strengthening is called for, where resources from both public and private sectors are channelled towards achieving health equity, under the stewardship of the state and with active participation by and accountability to members of civil society. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Ecosystem services of human-dominated watersheds and land use influences: a case study from the Dianchi Lake watershed in China.

PubMed

Hou, Ying; Li, Bo; Müller, Felix; Chen, Weiping

2016-11-01

Watersheds provide multiple ecosystem services. Ecosystem service assessment is a promising approach to investigate human-environment interaction at the watershed scale. The spatial characteristics of ecosystem services are closely related to land use statuses in human-dominated watersheds. This study aims to investigate the effects of land use on the spatial variations of ecosystem services at the Dianchi Lake watershed in Southwest China. We investigated the spatial variations of six ecosystem services-food supply, net primary productivity (NPP), habitat quality, evapotranspiration, water yield, and nitrogen retention. These services were selected based on their significance at the Dianchi Lake watershed and the availability of their data. The quantification of these services was based on modeling, value transference, and spatial analysis in combination with biophysical and socioeconomic data. Furthermore, we calculated the values of ecosystem services provided by different land use types and quantified the correlations between ecosystem service values and land use area proportions. The results show considerable spatial variations in the six ecosystem services associated with land use influences in the Dianchi Lake watershed. The cropland and forest land use types had predominantly positive influences on food productivity and NPP, respectively. The rural residential area and forest land use types reduced and enhanced habitat quality, respectively; these influences were identical to those of evapotranspiration. Urban area and rural residential area exerted significantly positive influences on water yield. In contrast, water yield was negatively correlated with forest area proportion. Finally, cropland and forest had significantly positive and negative influences, respectively, on nitrogen retention. Our study emphasizes the importance of consideration of the influences from land use composition and distribution on ecosystem services for managing the ecosystems of human-dominated watersheds.

The Self-Perception and Relationships Tool (S-PRT): A novel approach to the measurement of subjective health-related quality of life

PubMed Central

Atkinson, Mark J; Wishart, Paul M; Wasil, Bushra I; Robinson, John W

2004-01-01

Background The Self-Perception and Relationships Tool (S-PRT) is intended to be a clinically responsive and holistic assessment of patients' experience of illness and subjective Health Related Quality of Life (HRQL). Methods A diversity of patients were involved in two phases of this study. Patient samples included individuals involved with renal, cardiology, psychiatric, cancer, chronic pelvic pain, and sleep services. In Phase I, five patient focus groups generated 128 perceptual rating scales. These scales described important characteristics of illness-related experience within six life domains (i.e., Physical, Mental-Emotional, Interpersonal Receptiveness, Interpersonal Contribution, Transpersonal Receptiveness and Transpersonal Orientation). Item reduction was accomplished using Importance Q-sort and Importance Checklist methodologies with 150 patients across the participating services. In Phase II, a refined item pool (88 items) was administered along with measures of health status (SF-36) and spiritual beliefs (Spiritual Involvements and Beliefs Scale – SIBS) to 160 patients, of these 136 patients returned complete response sets. Results Factor analysis of S-PRT results produced a surprisingly clean five-factor solution (Eigen values> 2.0 explaining 73.5% of the pooled variance). Items with weaker or split loadings were removed leaving 36 items to form the final S-PRT rating scales; Intrapersonal Well-being (physical, mental & emotional items), Interpersonal Receptivity, Interpersonal Contribution, Transpersonal Receptivity and Transpersonal Orientation (Eigen values> 5.4 explaining 83.5% of the pooled variance). The internal consistency (Cronbach's Alpha) of these scales was very high (0.82–0.97). Good convergent correlations (0.40 to 0.67) were observed between the S-PRT scales and the Mental Health scales of the SF-36. Correlations between the S-PRT Intrapersonal Well-being scale and three of SF-36 Physical Health scales were moderate (0.30 to 0.46). The criterion-related validity of the S-PRT spiritual scales was supported by moderate convergence (0.40–0.49) with three SIBS scales. Conclusion Evidence supports the validity of the S-PRT as a generally applicable measure of perceived health status and HRQL. The test-retest reliability was found to be adequate for most scales, and there is some preliminary evidence that the S-PRT is responsive to patient-reported changes in determinants of their HRQL. Clinical uses and directions for future research are discussed. PMID:15257754

Evaluation of a Community Reintegration Outpatient Program Service for Community-Dwelling Persons with Spinal Cord Injury

PubMed Central

Bain, Patricia; Hébert, Debbie; Hitzig, Sander L.

2014-01-01

Objective. To evaluate the effectiveness of a community reintegration outpatient (CROP) service for promoting well-being and community participation following spinal cord injury (SCI). Participants. Community-dwelling adults (N = 14) with traumatic and nontraumatic SCI. Interventions. The CROP service is a 12-week (1 × week; 120 minutes) interprofessional closed therapeutic education service. Main Outcome Measure(s). Moorong Self-Efficacy Scale (MSES); Impact on Participation and Autonomy (IPA); Positive Affect and Negative Affect Scale (PANAS); Coping Inventory of Stressful Situations (CISS); World Health Organization Quality of Life (WHOQOL-BREF); semistructured qualitative interviews. Methods. Twenty-one participants were recruited from two subsequent CROP services, with only 14 persons completing all data assessments. Data were collected at baseline (week 0), at exit (week 12), and at a three-month follow-up. Semistructured interviews were conducted at exit. Results. Self-efficacy (MSES) and positive affect (PANAS) improved from baseline to exit (P < .05), but the changes were not maintained at follow-up. Qualitative analysis identified four major themes related to therapeutic benefits: (1) role of self; (2) knowledge acquisition; (3) skill application; and (4) group processes. Conclusions. Participation in a therapeutic education service has the potential to improve well-being in persons with SCI, but there is a need to identify strategies to maintain long-term gains. PMID:25574397

Stormwater management and ecosystem services: a review

NASA Astrophysics Data System (ADS)

Prudencio, Liana; Null, Sarah E.

2018-03-01

Researchers and water managers have turned to green stormwater infrastructure, such as bioswales, retention basins, wetlands, rain gardens, and urban green spaces to reduce flooding, augment surface water supplies, recharge groundwater, and improve water quality. It is increasingly clear that green stormwater infrastructure not only controls stormwater volume and timing, but also promotes ecosystem services, which are the benefits that ecosystems provide to humans. Yet there has been little synthesis focused on understanding how green stormwater management affects ecosystem services. The objectives of this paper are to review and synthesize published literature on ecosystem services and green stormwater infrastructure and identify gaps in research and understanding, establishing a foundation for research at the intersection of ecosystems services and green stormwater management. We reviewed 170 publications on stormwater management and ecosystem services, and summarized the state-of-the-science categorized by the four types of ecosystem services. Major findings show that: (1) most research was conducted at the parcel-scale and should expand to larger scales to more closely understand green stormwater infrastructure impacts, (2) nearly a third of papers developed frameworks for implementing green stormwater infrastructure and highlighted barriers, (3) papers discussed ecosystem services, but less than 40% quantified ecosystem services, (4) no geographic trends emerged, indicating interest in applying green stormwater infrastructure across different contexts, (5) studies increasingly integrate engineering, physical science, and social science approaches for holistic understanding, and (6) standardizing green stormwater infrastructure terminology would provide a more cohesive field of study than the diverse and often redundant terminology currently in use. We recommend that future research provide metrics and quantify ecosystem services, integrate disciplines to measure ecosystem services from green stormwater infrastructure, and better incorporate stormwater management into environmental policy. Our conclusions outline promising future research directions at the intersection of stormwater management and ecosystem services.

Factors influencing the perceived quality of clinical supervision of occupational therapists in a large Australian state.

PubMed

Martin, Priya; Kumar, Saravana; Lizarondo, Lucylynn; Tyack, Zephanie

2016-10-01

Clinical supervision is important for effective health service delivery, professional development and practice. Despite its importance there is a lack of evidence regarding the factors that improve its quality. This study aimed to investigate the factors that influence the quality of clinical supervision of occupational therapists employed in a large public sector health service covering mental health, paediatrics, adult physical and other practice areas. A mixed method, sequential explanatory study design was used consisting of two phases. This article reports the quantitative phase (Phase One) which involved administration of the Manchester Clinical Supervision Scale (MCSS-26) to 207 occupational therapists. Frequency of supervision sessions, choice of supervisor and the type of supervision were found to be the predictor variables with a positive and significant influence on the quality of clinical supervision. Factors such as age, length of supervision and the area of practice were found to be the predictor variables with a negative and significant influence on the quality of clinical supervision. Factors that influence the perceived quality of clinical supervision among occupational therapists have been identified. High quality clinical supervision is an important component of clinical governance and has been shown to be beneficial to practitioners, patients and the organisation. Information on factors that make clinical supervision effective identified in this study can be added to existing supervision training and practices to improve the quality of clinical supervision. © 2016 Occupational Therapy Australia.

Iranian women's perceptions of family-planning services quality: a client-satisfaction survey.

PubMed

Nakhaee, N; Mirahmadizadeh, A-R

2005-09-01

As Iran (IR) is included among the most successful developing countries in family planning, clarification and expression of the ideas and needs of women receiving the services not only have a great positive impact on national policies but also may be of interest to other nations. This research was conducted to clarify the client perceptions of the quality of family planning services in the capital cities of the two largest provinces of Iran. A representative sample of 909 women aged 15-50 referred to health centers were interviewed by skillful interviewers in a private area after obtaining informed consent. A questionnaire consisting of baseline data and 17 five-point Likert-scaled items measuring the satisfaction of clients and perceived importance of each item was developed by investigators. Half were aged 26-35 years, and most (84%) were housewives. The highest percentage of dissatisfaction was reported in relation to 'privacy protection' item. However, when the importance score was included, too, 'provision of sufficient information regarding other contraceptive methods' and 'unavailability of all methods' implicated the areas where priorities should be focused. The satisfaction levels obtained by the survey should be carefully heeded, and the supply chain and provision of information to the clients may be the first priorities in the process of improving the quality of care.

The impact of clinical librarian services on patients and health care organisations.

PubMed

Brettle, Alison; Maden, Michelle; Payne, Clare

2016-06-01

Systematic reviews have found limited evidence of effectiveness and impact of clinical librarians (CLs) due to the poor quality of reporting, scale and design of previous studies. To measure specific CL impact on organisational and patient outcomes using a robust approach that helps CLs develop research skills. Questionnaire and interviews. Clinical librarians contribute to a wide range of outcomes in the short and longer term reflecting organisational priorities and objectives. These include direct contributions to choice of intervention (36%) diagnosis (26%) quality of life (25%), increased patient involvement in decision making (26%) and cost savings and risk management including avoiding tests, referrals, readmissions and reducing length of stay (28%). Interventions provided by CL's are complex and each contributes to multiple outcomes of importance to health care organisations. This study is unique in taking a wide view of potential and specific impacts to which CLs contribute across health care organisations. It is the largest UK evaluation of CL services to date and demonstrates CLs affect direct patient care, improve quality and save money. Future researchers are urged to use the tools presented to collect data on the same outcomes to build a significant and comprehensive international evidence base about the effectiveness and impact of clinical librarian services. © 2016 Health Libraries Group.

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers

PubMed Central

Murphy, Julia; Bindman, Andrew B.

2015-01-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs. PMID:26509286

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

PubMed Central

2011-01-01

Background Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). Methods Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. Results The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. Conclusion The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact. PMID:22008721

Web-scale discovery in an academic health sciences library: development and implementation of the EBSCO Discovery Service.

PubMed

Thompson, Jolinda L; Obrig, Kathe S; Abate, Laura E

2013-01-01

Funds made available at the close of the 2010-11 fiscal year allowed purchase of the EBSCO Discovery Service (EDS) for a year-long trial. The appeal of this web-scale discovery product that offers a Google-like interface to library resources was counter-balanced by concerns about quality of search results in an academic health science setting and the challenge of configuring an interface that serves the needs of a diverse group of library users. After initial configuration, usability testing with library users revealed the need for further work before general release. Of greatest concern were continuing issues with the relevance of items retrieved, appropriateness of system-supplied facet terms, and user difficulties with navigating the interface. EBSCO has worked with the library to better understand and identify problems and solutions. External roll-out to users occurred in June 2012.

[Job satisfaction and improvement factors in primary care professionals].

PubMed

Pérez-Ciordia, I; Guillén-Grima, F; Brugos, A; Aguinaga, I

2013-09-06

The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1 to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34). The workers at urban health centers (OR: 1.71; CI: 1.10-2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered.

Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania.

PubMed

Makene, Christina Lulu; Plotkin, Marya; Currie, Sheena; Bishanga, Dunstan; Ugwi, Patience; Louis, Henry; Winani, Kiholeth; Nelson, Brett D

2014-11-19

Every year, more than a million of the world's newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities - for example, improving steps to help newborns breathe at birth - have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.

A new three-dimensional manufacturing service composition method under various structures using improved Flower Pollination Algorithm

NASA Astrophysics Data System (ADS)

Zhang, Wenyu; Yang, Yushu; Zhang, Shuai; Yu, Dejian; Chen, Yong

2018-05-01

With the growing complexity of customer requirements and the increasing scale of manufacturing services, how to select and combine the single services to meet the complex demand of the customer has become a growing concern. This paper presents a new manufacturing service composition method to solve the multi-objective optimization problem based on quality of service (QoS). The proposed model not only presents different methods for calculating the transportation time and transportation cost under various structures but also solves the three-dimensional composition optimization problem, including service aggregation, service selection, and service scheduling simultaneously. Further, an improved Flower Pollination Algorithm (IFPA) is proposed to solve the three-dimensional composition optimization problem using a matrix-based representation scheme. The mutation operator and crossover operator of the Differential Evolution (DE) algorithm are also used to extend the basic Flower Pollination Algorithm (FPA) to improve its performance. Compared to Genetic Algorithm, DE, and basic FPA, the experimental results confirm that the proposed method demonstrates superior performance than other meta heuristic algorithms and can obtain better manufacturing service composition solutions.

Proposed DoD (Department of Defense) Internet Protocol Standard.

DTIC Science & Technology

1982-07-06

parameters fall into two categories: service quality parameters and service options. Service quality parameters influence the transmission service provided...Corporation 6 July 1982 -7- TM-7172/481/OO o Service Quality Parameters - Precedence : attempts preferential treatment for high importance datagrams...select the transmission quality. IP passes the type of service (TOS) command set for service quality to the SNP where it is mapped into subnetwork

Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa

PubMed Central

2014-01-01

Background Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa. Methods On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools. Results We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services. Conclusions Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa. PMID:24916010

Relationship among health-related quality of life, depression and awareness of home care services in elderly patients.

PubMed

Polat, Ülkü; Bayrak Kahraman, Burcu; Kaynak, İlknur; Görgülü, Ümit

2016-11-01

The present descriptive study was carried out to determine the relationship between health-related quality of life, depression and awareness of home care services among elderly patients. Patients aged 65 years or older staying at the surgery and internal medicine clinics were included in the study. The "Patient Introduction Form," "Short Form-36 Quality of Life Questionnaire" and "Geriatric Depression Scale" were utilized in the collection of data. In the present study, it was determined that only approximately half of elderly patients (54.9%) knew the concept of home care, most of them had not previously received home care and requested home care related to medical care. The mean scores were lower in some areas of the quality of life questionnaire in some factors that could influence home care awareness. These factors were determined as: female sex, history of falling, chronic illness, functionally, moderately or severely dependent, no previous receipt of home care and wishing to receive home care. The home care requirement of elderly patients can be influenced by many physiological, psychological and social factors that can affect their quality of life. Thus, it is of utmost importance that medical professionals evaluate the quality of life of elderly individuals and its influencing factors. Geriatr Gerontol Int 2016; 16: 1211-1219. © 2015 Japan Geriatrics Society.

Measuring patients' experiences with rheumatic care: the consumer quality index rheumatoid arthritis.

PubMed

Zuidgeest, Marloes; Sixma, Herman; Rademakers, Jany

2009-12-01

Rheumatologists and other caregivers can learn from patients’ experiences with the quality of care that can be measured with the CQ-index Rheumatoid Arthritis (CQ-index RA) survey. Patients with RA (n = 590) received this survey were they rated their actual experiences and what they find important in rheumatic healthcare. Descriptive analyses and psychometric methods were used to test the reliability. The response rate was 69%. The items in the pilot instrument could be grouped into 10 scales (α ranged from 0.77 to 0.94). The most important quality aspects according to patients concerned the alertness when prescribing medication. Providing patients with information on a special website of the hospital about RA was the highest quality improvement aspect. The results of this study show that the CQ-index RA is a reliable instrument for quality assessment from the patients’ perspective. The instrument provides rheumatologists and other caregivers with feedback for service improvement initiatives.

A study protocol for tracking quality of life among U.S. service members wounded in Iraq and Afghanistan: the Wounded Warrior Recovery Project.

PubMed

Woodruff, Susan I; Galarneau, Michael R; Luu, Bethi N; Sack, Daniel; Han, Peggy

2014-03-01

There is a need for more work to understand the quality of life (QOL) outcomes of survivors of Operations Enduring Freedom and Iraqi Freedom combat injury to improve care and treatment, and prevent poor physical, psychological, and social outcomes. We describe the study design and methods of the Wounded Warrior Recovery Project, a study supported by the Department of Defense that will track close to 10,000 military personnel wounded in Operations Enduring Freedom and Iraqi Freedom. The overall objective of the 6-year longitudinal study is to track changes in QOL and describe variations in those changes as they relate to sociodemographic factors, injury characteristics, service-related factors, clinical/diagnostic measures including traumatic brain injury and posttraumatic stress disorder, and medical procedures and services. The Wounded Warrior Recovery Project study will be among the first longitudinal population-based investigations of QOL outcomes after combat injury and will provide a basis upon which large-scale epidemiological studies can be conducted. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Rural vs urban hospital performance in a 'competitive' public health service.

PubMed

Garcia-Lacalle, Javier; Martin, Emilio

2010-09-01

In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals. Copyright 2010 Elsevier Ltd. All rights reserved.

Emergency recompression: clinical audit of service delivery at a national level.

PubMed

Ross, John As; Sayer, Martin Dj

2009-03-01

Clinical audit is an essential element to the maintenance or improvement of delivery of any medical service. During the development phase of a National Recompression Registration Service for Scotland, clinical audit was initiated to provide a standardised tool to monitor the quality of outcome with respect to the severity of presentation. A functional audit process was an essential consideration for planned future measurement of treatment efficacy at local (single hyperbaric unit) and national (multiple hyperbaric units) scales. The audit process was designed to be undemanding, robust and informative, irrespective of the experience of treatment centre and of the clinician in charge of treatment. The clinical records from 104 cases of divers with decompression illness were used to derive and evaluate measures of severity and clinical outcome that could be used for audit and quality assurance. The various measures of disease severity were examined against clinical outcome and days spent in care after admission to a hyperbaric unit. An initial version of the clinical audit format that was developed from this process is presented.

The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran.

PubMed

Arab, M; Tabatabaei, Sm Ghazi; Rashidian, A; Forushani, A Rahimi; Zarei, E

2012-01-01

Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty. A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty. The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient's loyalty in the private hospitals of Tehran. The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share.

Sleep pattern and decision-making in physicians from mobile emergency care service with 12-h work schedules.

PubMed

Castro, Eleni de Araújo Sales; de Almondes, Katie Moraes

2018-06-01

Shift work schedules are biological standpoint worse because compel the body to anticipate periods of wakefulness and sleep and thus eventually cause a disruption of biological rhythms. The objective of this study is to evaluate the sleep pattern and decision-making in physicians working in mobile units of emergency attention undergoing day shift and rotating shift. The study included 26 physicians. The instruments utilized were a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index, the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire of Horne-Ostberg, the Iowa Gambling Task (IGT) and hypothetical scenarios of decision-making created according to the Policy-Capturing Technique. For inclusion and exclusion criteria, the participants answered the Chalder Fatigue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory and the Inventory of Stress Symptoms for adults of Lipp. It was found good sleep quality for physicians on day shift schedule and bad sleep quality for physicians on rotating shift schedule. The IGT measure showed no impairment in decision-making, but the hypothetical scenarios revealed impairment decision-making during the shift for both schedules. Good sleep quality was related to a better performance in decision-making. Good sleep quality seems to influence a better performance in decision-making.

Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service.

PubMed

Velsen, Lex van; Tabak, Monique; Hermens, Hermie

2017-01-01

For many eServices, end-user trust is a crucial prerequisite for use. For the telemedicine context however, knowledge about the coming about and measurement of end-user trust is scarce. To develop and validate the PAtient Trust Assessment Tool (PATAT): a survey instrument to quantitatively assess patient trust in a telemedicine service. Informed by focus groups, we developed a survey that includes measurement scales for the following factors: trust in the care organization, care professional, treatment, and technology, as well as a scale that assesses a holistic view on trust in the telemedicine service. The survey was completed by 795 patients that use a telemedicine application to manage their anticoagulation treatment. Data were analyzed by means of Partial Least Squares Structural Equation Modeling (PLS-SEM). The measurement model yielded good to excellent quality measures, after the removal of one item. The causal model resulted in high explained variance (R 2 =0.68). Trust in healthcare professionals and the treatment had a small effect on overall trust, while trust in the technology displayed a large effect. Trust in the care organization did not result in a significant effect on overall trust. The PATAT is a valid means to assess patient trust in a telemedicine service and can be used to benchmark such a service or to elicit redesign input. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

GMES and Down-stream Services Following User Requirements: Examples on Regional And Coastal Scale

NASA Astrophysics Data System (ADS)

Noehren, I.; Breitbach, G.; Schroeder, F.

2012-04-01

MyOcean as part of the Global Monitoring for Environment and Security (GMES) services provides information on the state of the oceans on a regular basis. The products are delivered on a global as well as on a regional scale like EU, covering the physical state of the ocean and primary ecosystem parameters. For local or coastal scales these Core Services very often do not meet the requirements of the potential end-user who needs information on e. g. marine safety, oil spills, marine resources and coastal management. For these local information needs Downstream Services derived from GMES Core Services, e.g. MyOcean products, but also directly from observation infrastructure are necessary. With Cosyna (Coastal Observation System for Northern and Arctic Seas) a national project between MyOcean and downstream services is established. The core of the project is an integrated pre-operational observation system which combines in-situ observations and remote sensing procedures with numerical models to obtain synoptic data sets of the southern North Sea and make basic infrastructure and continuous data available to the scientific community. The network provides intermediate products in terms of quality-assured time series and maps with high temporal and spatial resolution; end-users might produce their own end products. Integrated products cover processed information based on a combination of different observations and models, accompanied by instructions of use and optionally by interpretations. To enhance operational services in coastal areas improved forecasts with coupled models and data assimilation are developed in the EC funded FIELD_AC project (Fluxes, Interactions and Environment at the Land-Ocean Boundary. Downscaling, Assimilation and Coupling). The application area of the German partner is the German Bight. By means of a strong interaction with the Cosyna observational network main emphasis is laid on the user needs (e.g. of national agencies, coastal and harbour authorities, maritime service providers, marine consulting companies, etc) which are and will be addressed in different project user workshops.

Multi-granularity Bandwidth Allocation for Large-Scale WDM/TDM PON

NASA Astrophysics Data System (ADS)

Gao, Ziyue; Gan, Chaoqin; Ni, Cuiping; Shi, Qiongling

2017-12-01

WDM (wavelength-division multiplexing)/TDM (time-division multiplexing) PON (passive optical network) is being viewed as a promising solution for delivering multiple services and applications, such as high-definition video, video conference and data traffic. Considering the real-time transmission, QoS (quality of services) requirements and differentiated services model, a multi-granularity dynamic bandwidth allocation (DBA) in both domains of wavelengths and time for large-scale hybrid WDM/TDM PON is proposed in this paper. The proposed scheme achieves load balance by using the bandwidth prediction. Based on the bandwidth prediction, the wavelength assignment can be realized fairly and effectively to satisfy the different demands of various classes. Specially, the allocation of residual bandwidth further augments the DBA and makes full use of bandwidth resources in the network. To further improve the network performance, two schemes named extending the cycle of one free wavelength (ECoFW) and large bandwidth shrinkage (LBS) are proposed, which can prevent transmission from interruption when the user employs more than one wavelength. The simulation results show the effectiveness of the proposed scheme.

Strategy, structure, and patient quality outcomes in ambulatory surgery centers (1997-2004).

PubMed

Chukmaitov, Askar; Devers, Kelly J; Harless, David W; Menachemi, Nir; Brooks, Robert G

2011-04-01

The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.

Cultural values and health service quality in China.

PubMed

Polsa, Pia; Fuxiang, Wei; Sääksjärvi, Maria; Shuyuan, Pei

2013-01-01

Several service quality studies show how cultural features may influence the way service quality is perceived. However, few studies specifically describe culture's influence on health service quality. Also, there are few studies that take into account patients' health service quality perceptions. This article seeks to present a first step to fill these gaps by examining patients' cultural values and their health service quality assessments. The study draws on published work and applies its ideas to Chinese healthcare settings. Data consist of hospital service perceptions in the People's Republic of China (PRC), a society that is socially, economically and culturally undergoing major changes. In total, 96 patients were surveyed. Data relationships were tested using partial least square (PLS) analysis. Findings show that Chinese patients' cultural values and their health service assessments are related and that the cultural values themselves seem to be changing. Additionally, further analyses provided interesting results pointing to which cultural values influenced service quality perceptions. The strongest service quality predictor was power distance. The sample is relatively small and collected from only one major hospital in China. Therefore, future research should extend the sample size and scope. Follow-up research could also include cross-cultural investigations of perceived health service quality to substantiate cultural influences on health service quality perceptions. In line with similar research in other contexts, the study confirms that power distance has a significant relationship with service quality perceptions. The study contributes to existing health service literature by offering patients' views on health service quality and by describing relationships between health service perceptions and cultural values--the study's main contribution.

Development and evaluation of an instrument to measure parental satisfaction with quality of care in neonatal follow-up.

PubMed

Butt, Michelle L; Pinelli, Janet; Boyle, Michael H; Thomas, Helen; Hunsberger, Mabel; Saigal, Saroj; Lee, David S; Fanning, Jamie K; Austin, Patricia

2009-02-01

The goal of this study was to develop and subsequently evaluate the psychometric properties of a new discriminative instrument to measure parental satisfaction with the quality of care provided in neonatal follow-up (NFU) programs. The methodological framework for developing and evaluating measurement scales described by Streiner and Norman (Health Measurement Scales: A Practical Guide to Their Development and Use. 3rd ed. New York: Oxford University Press; 2003) was used for the study. Informing the phases of the research was a sample of 24 health care professionals and 381 parents who use NFU services. A comprehensive list of items representing the construct, parental satisfaction with quality of care, was generated from published reliable and valid instruments, research studies, focus groups with health care experts, and focus groups with parents. Using a clinimetric approach, the 62 items generated were reduced to 39 items based on parents' ratings of importance and refinement of the items by the research team. After content validation and pretesting, the instrument was tested with parents and underwent item-analysis. The resulting 16-item instrument was composed of 2 subscales, Process and Outcomes. Evaluation of the instrument's psychometric properties indicated adequate test-retest reliability (intraclass correlation coefficient = 0.72) and internal consistency (Process subscale, alpha = 0.77; Outcomes subscale, alpha = 0.90; overall instrument, alpha = 0.90), as well as good content and construct validity. A confirmatory factor analysis supported the multidimensionality of the construct. This new instrument provides clinicians and policy-makers with a tool to assess parental satisfaction with the quality of care in NFU, so areas of dissatisfaction can be identified and changes implemented to optimize service provision.

A Quality Process Approach to Electronic System Reliability: Supplier Quality Assessment Procedure. Volume 2

DTIC Science & Technology

1993-11-01

AND SUPPORT SERVICE QUALITY ....... 16 3.5.7 SUPPLIER QUALITY ............................................................................. 16 3.6...RESULTS ......................................................................................................... 16 3.6.1 PRODUCT AND SERVICE QUALITY RESULTS...10 5.6 Business Process and Support Service Quality 20 5.7 Supplier Quality 20 6.0 Results 180 6.1 Product and Service Quality Results 90 6.2 Business

Quantitative comparison of measurements of urgent care service quality.

PubMed

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.

Factors Affecting Medical Service Quality.

PubMed

Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

Levels and predictors of patient satisfaction with doctor home-visit services in Australia.

PubMed

Ifediora, Chris O; Rogers, Gary D

2017-02-01

The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household. This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Professional values of Turkish nurses: A descriptive study.

PubMed

Cetinkaya-Uslusoy, Esin; Paslı-Gürdogan, Eylem; Aydınlı, Ayse

2017-06-01

Professional values improve the quality of nurses' professional lives, reduce emotional exhaustion and depersonalization, increase personal success, and help to make collaborations with the members of the healthcare team more frequent. The purpose of this study was to describe the professional values of Turkish nurses and to explore the relationships between nurses' characteristics. This was a descriptive study of a convenience sample consisting of 269 clinical nurses. A questionnaire was used to identify socio-demographic characteristics, and the Nurses' Professional Values Scale was applied. Ethical considerations: Permission to conduct the study was received from the hospital and the Institutional Review Boards of the Süleyman Demirel University ethic committee. The mean scale score of the participant nurses was 165.41 ± 20.79. The results of this study revealed that human dignity was the most important professional value for nurses, and the importance attached to these values showed statistically significant differences by age, length of service, educational level, marital status, position at work, and receiving relevant in-service training. Nurses' Professional Values Scale scores showed that nurses give above average and attached importance to professional values.

A multi-approach and multi-scale study on water quantity and quality changes in the Tapajós River basin, Amazon

NASA Astrophysics Data System (ADS)

Bezerra Nóbrega, Rodolfo Luiz; Lamparter, Gabriele; Hughes, Harold; Chenjerayi Guzha, Alphonce; Santos Silva Amorim, Ricardo; Gerold, Gerhard

2018-04-01

We analyzed changes in water quantity and quality at different spatial scales within the Tapajós River basin (Amazon) based on experimental fieldwork, hydrological modelling, and statistical time-trend analysis. At a small scale, we compared the river discharge (Q) and suspended-sediment concentrations (SSC) of two adjacent micro-catchments ( < 1 km2) with similar characteristics but contrasting land uses (forest vs. pasture) using empirical data from field measurements. At an intermediary scale, we simulated the hydrological responses of a sub-basin of the Tapajós (Jamanxim River basin, 37 400 km2), using a hydrological model (SWAT) and land-use change scenario in order to quantify the changes in the water balance components due to deforestation. At the Tapajós' River basin scale, we investigated trends in Q, sediments, hydrochemistry, and geochemistry in the river using available data from the HYBAM Observation Service. The results in the micro-catchments showed a higher runoff coefficient in the pasture (0.67) than in the forest catchment (0.28). At this scale, the SSC were also significantly greater during stormflows in the pasture than in the forest catchment. At the Jamanxim watershed scale, the hydrological modelling results showed a 2 % increase in Q and a 5 % reduction of baseflow contribution to total Q after a conversion of 22 % of forest to pasture. In the Tapajós River, however, trend analysis did not show any significant trend in discharge and sediment concentration. However, we found upward trends in dissolved organic carbon and NO3- over the last 20 years. Although the magnitude of anthropogenic impact has shown be scale-dependent, we were able to find changes in the Tapajós River basin in streamflow, sediment concentration, and water quality across all studied scales.

Predictors of poststroke health-related quality of life in Nigerian stroke survivors: a 1-year follow-up study.

PubMed

Hamza, Ashiru Mohammad; Al-Sadat, Nabilla; Loh, Siew Yim; Jahan, Nowrozy Kamar

2014-01-01

This study aims to identify the predictors in the different aspects of the health-related quality of life (HRQoL) and to measure the changes of functional status over time in a cohort of Nigerian stroke survivors. A prospective observational study was conducted in three hospitals of Kano state of Nigeria where stroke survivors receive rehabilitation. The linguistic-validated Hausa versions of the stroke impact scale 3.0, modified Rankin scale, Barthel index and Beck depression inventory scales were used. Paired samples t-test was used to calculate the amount of changes that occur over time and the forward stepwise linear regression model was used to identify the predictors. A total of 233 stroke survivors were surveyed at 6 months, and 93% (217/233) were followed at 1 year after stroke. Functional disabilities were significantly reduced during the recovery phase. Motor impairment, disability, and level of depression were independent predictors of HRQoL in the multivariate regression analysis. The involvement of family members as caregivers is the key factor for those survivors with improved functional status. Thus, to enhance the quality of poststroke life, it is proposed that a holistic stroke rehabilitation service and an active involvement of family members are established at every possible level.

Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults.

PubMed

Kwok, Thomas M K; Tong, C Y

2014-05-01

This was a quasi-experimental study to compare the effects of center-based training with home-based training on physical function, quality of life and fall incidence in older adults. Fifty older adults were recruited to receive exercise training for 6 months. Participants in the center-based group received training under supervision of a physiotherapist at the day training center. Those in the home-based group received training assisted by a care worker at home. The outcome measures were the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS), Numeric Pain Rating Scale (NPRS), Short-form 12 (SF-12) and fall incidence. Assessments were performed on all participants before and after the 6-month intervention period. Center-based training supervised by a physiotherapist was found to have beneficial effects on physical function, quality of life and fall incidence while home-based training assisted by a care worker had no effect on physical condition and self-rated health status in community dwelling older adults. Service agents should provide center-based or home-based training to the ageing population in a user-friendly way with consideration of factors such as rehabilitation potential and accessibility of transportation.

The role of soil communities in improving ecosystem services in organic farming

NASA Astrophysics Data System (ADS)

Zandbergen, Jelmer; Koorneef, Guusje; Veen, Cees; Schrama, Jan; van der Putten, Wim

2017-04-01

Worldwide soil fertility decreases and it is generally believed that organic matter (OM) addition to agricultural soils can improve soil properties leading to beneficial ecosystem services. However, it remains unknown under which conditions and how fast biotic, physical and chemical soil properties respond to varying quality and quantity of OM inputs. Therefore, the aims of this research project are (1) to unravel biotic, physical and chemical responses of soils to varying quantity and quality of OM addition; and (2) to understand how we can accelerate the response of soils in order to improve beneficial soil ecosystem services faster. The first step in our research project is to determine how small-scale spatio-temporal patterns in soil biotic, physical and chemical properties relate to crop production and quality. To do this we combine field measurements on soil properties with remote and proximate sensing measures on crop development and yield in a long-term farming systems experiment in the Netherlands (Vredepeel). We hypothesize that spatio-temporal variation in crop development and yield are strongly related to spatio-temporal variation in soil parameters. In the second step of our project we will use this information to identify biological interactions underlying improving soil functions in response to OM addition over time. We will specifically focus on the role of soil communities in driving nutrient cycling, disease suppression and the formation of soil structure, all crucial elements of key soil services in agricultural soils. The knowledge that will be generated in our project can be used to detect specific organic matter qualities that support the underlying ecological processes to accelerate the transition towards improved soil functioning thereby governing enhanced crop yields.

The Air Quality Health Index and Asthma Morbidity: A Population-Based Study

PubMed Central

Shen, Shixin; Atenafu, Eshetu G.; Guan, Jun; McLimont, Susan; Stocks, Brian; Licskai, Christopher

2012-01-01

Background: Exposure to air pollution has been linked to the exacerbation of respiratory diseases. The Air Quality Health Index (AQHI), developed in Canada, is a new health risk scale for reporting air quality and advising risk reduction actions. Objective: We used the AQHI to estimate the impact of air quality on asthma morbidity, adjusting for potential confounders. Methods: Daily air pollutant measures were obtained from 14 regional monitoring stations in Ontario. Daily counts of asthma-attributed hospitalizations, emergency department (ED) visits, and outpatient visits were obtained from a provincial registry of 1.5 million patients with asthma. Poisson regression was used to estimate health services rate ratios (RRs) as a measure of association between the AQHI or individual pollutants and health services use. We adjusted for age, sex, season, year, and region of residence. Results: The AQHI values were significantly associated with increased use of asthma health services on the same day and on the 2 following days, depending on the specific outcome assessed. A 1-unit increase in the AQHI was associated with a 5.6% increase in asthma outpatient visits (RR = 1.056; 95% CI: 1.053, 1.058) and a 2.1% increase in the rate of hospitalization (RR = 1.021; 95% CI: 1.014, 1.028) on the same day and with a 1.3% increase in the rate of ED visits (RR = 1.013; 95% CI: 1.010, 1.017) after a 2-day lag. Conclusions: The AQHI values were significantly associated with the use of asthma-related health services. Timely AQHI health risk advisories with integrated risk reduction messages may reduce morbidity associated with air pollution in patients with asthma. PMID:23060364

Capturing the Palliative Home Care Experience From Bereaved Caregivers Through Qualitative Survey Data: Toward Informing Quality Improvement.

PubMed

Bainbridge, Daryl; Bryant, Deanna; Seow, Hsien

2017-02-01

Measuring palliative care experience using patient-reported outcomes is becoming important for assessing and improving quality, although most validated outcome tools solely use scaled questions. We analyzed open-text survey responses from bereaved caregivers to identify strengths and weaknesses in the quality of end-of-life care services and to assess the usefulness of qualitative survey data for quality improvement. This was a retrospective observational study involving bereaved caregivers of decedents who had received palliative home care services in one of six health care regions in Ontario, Canada. Using the U.K.'s validated Views of Informal Carers-Evaluation of Services survey, respondents were asked what was good and what was bad about the services provided in the last three months of life as separate open-text questions. A qualitative constant comparison approach was used to derive themes from the responses. Among 330 caregivers who completed the survey, 271 (82%) caregivers responded to the open-text questions: 93% of those commented on something that was good about care and 55% on something that was bad. The care experiences were generally positive, with the exception of specific individuals or settings that were perceived as adverse. The qualitative data were more informative about deficiencies in care compared with the quantitative data. The qualitative survey data in this study provided key recommendations toward making care more responsive to the needs of dying patients and their families. Capturing the narrative responses of bereaved caregivers is feasible and informative for palliative care program development. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Translation, cross-cultural adaptation and psychometric evaluation of yoruba version of the short-form 36 health survey.

PubMed

Mbada, Chidozie Emmanuel; Adeogun, Gafar Atanda; Ogunlana, Michael Opeoluwa; Adedoyin, Rufus Adesoji; Akinsulore, Adesanmi; Awotidebe, Taofeek Oluwole; Idowu, Opeyemi Ayodiipo; Olaoye, Olumide Ayoola

2015-09-14

The Short-Form Health Survey (SF-36) is a valid quality of life tool often employed to determine the impact of medical intervention and the outcome of health care services. However, the SF-36 is culturally sensitive which necessitates its adaptation and translation into different languages. This study was conducted to cross-culturally adapt the SF-36 into Yoruba language and determine its reliability and validity. Based on the International Quality of Life Assessment project guidelines, a sequence of translation, test of item-scale correlation, and validation was implemented for the translation of the Yoruba version of the SF-36. Following pilot testing, the English and the Yoruba versions of the SF-36 were administered to a random sample of 1087 apparently healthy individuals to test validity and 249 respondents completed the Yoruba SF-36 again after two weeks to test reliability. Data was analyzed using Pearson's product moment correlation analysis, independent t-test, one-way analysis of variance, multi trait scaling analysis and Intra-Class Correlation (ICC) at p < 0.05. The concurrent validity scores for scales and domains ranges between 0.749 and 0.902 with the highest and lowest scores in the General Health (0.902) and Bodily Pain (0.749) scale. Scale-level descriptive result showed that all scale and domain scores had negative skewness ranging from -2.08 to -0.98. The mean scores for each scales ranges between 83.2 and 88.8. The domain scores for Physical Health Component and Mental Health Component were 85.6 ± 13.7 and 85.9 ± 15.4 respectively. The convergent validity was satisfactory, ranging from 0.421 to 0.907. Discriminant validity was also satisfactory except for item '1'. The ICC for the test-retest reliability of the Yoruba SF-36 ranges between 0.636 and 0.843 for scales; and 0.783 and 0.851 for domains. The data quality, concurrent and discriminant validity, reliability and internal consistency of the Yoruba version of the SF-36 are adequate and it is recommended for measuring health-related quality of life among Yoruba population.

Why do electricity policy and competitive markets fail to use advanced PV systems to improve distribution power quality?

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

McHenry, Mark P.; Johnson, Jay; Hightower, Mike

The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG) exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the networkmore » characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. As a result, we discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.« less

Why do electricity policy and competitive markets fail to use advanced PV systems to improve distribution power quality?

DOE PAGES

McHenry, Mark P.; Johnson, Jay; Hightower, Mike

2016-01-01

The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG) exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the networkmore » characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. As a result, we discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.« less

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Health and climate related ecosystem services provided by street trees in the urban environment.

PubMed

Salmond, Jennifer A; Tadaki, Marc; Vardoulakis, Sotiris; Arbuthnott, Katherine; Coutts, Andrew; Demuzere, Matthias; Dirks, Kim N; Heaviside, Clare; Lim, Shanon; Macintyre, Helen; McInnes, Rachel N; Wheeler, Benedict W

2016-03-08

Urban tree planting initiatives are being actively promoted as a planning tool to enable urban areas to adapt to and mitigate against climate change, enhance urban sustainability and improve human health and well-being. However, opportunities for creating new areas of green space within cities are often limited and tree planting initiatives may be constrained to kerbside locations. At this scale, the net impact of trees on human health and the local environment is less clear, and generalised approaches for evaluating their impact are not well developed.In this review, we use an urban ecosystems services framework to evaluate the direct, and locally-generated, ecosystems services and disservices provided by street trees. We focus our review on the services of major importance to human health and well-being which include 'climate regulation', 'air quality regulation' and 'aesthetics and cultural services'. These are themes that are commonly used to justify new street tree or street tree retention initiatives. We argue that current scientific understanding of the impact of street trees on human health and the urban environment has been limited by predominantly regional-scale reductionist approaches which consider vegetation generally and/or single out individual services or impacts without considering the wider synergistic impacts of street trees on urban ecosystems. This can lead planners and policymakers towards decision making based on single parameter optimisation strategies which may be problematic when a single intervention offers different outcomes and has multiple effects and potential trade-offs in different places.We suggest that a holistic approach is required to evaluate the services and disservices provided by street trees at different scales. We provide information to guide decision makers and planners in their attempts to evaluate the value of vegetation in their local setting. We show that by ensuring that the specific aim of the intervention, the scale of the desired biophysical effect and an awareness of a range of impacts guide the choice of i) tree species, ii) location and iii) density of tree placement, street trees can be an important tool for urban planners and designers in developing resilient and resourceful cities in an era of climatic change.

Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery

PubMed Central

Omondi Aduda, Dickens S.; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

2015-01-01

Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning. PMID:25706119

The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran

PubMed Central

Arab, M; Tabatabaei, SM Ghazi; Rashidian, A; Forushani, A Rahimi; Zarei, E

2012-01-01

Background: Service quality is perceived as an important factor for developing patient’s loyalty. The aim of this study was to determine the hospital service quality from the patients’ viewpoints and the relative importance of quality dimensions in predicting the patient’s loyalty. Methods: A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient’s loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient’s loyalty. Result: The mean score of service quality and patient’s loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient’s loyalty in the private hospitals of Tehran. Conclusion: The patients’ experience in relation to the private hospitals’ services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient’s loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share. PMID:23193509

Service quality in community pharmacy: an exploration of determinants.

PubMed

White, Lesley; Klinner, Christiane

2012-01-01

Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs' understanding of service quality and its determinants. This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality. Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants' perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers. From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management. The study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Economies of Scale: 9-1-1 Center Consolidation as a Means to Strengthen the Homeland Security Enterprise

DTIC Science & Technology

2014-03-01

searching existing data sources, gathering and maintaining the data needed , and completing and reviewing the collection of information. Send...facility, personnel, and technology needs exist.  Consolidation leads to more focused, institutionalized quality control and service improvement...and the numerous variables that exist between 9-1-1 center budgets. Further research is needed to accurately quantify these pre- and post

Developing a theoretical model and questionnaire survey instrument to measure the success of electronic health records in residential aged care.

PubMed

Yu, Ping; Qian, Siyu

2018-01-01

Electronic health records (EHR) are introduced into healthcare organizations worldwide to improve patient safety, healthcare quality and efficiency. A rigorous evaluation of this technology is important to reduce potential negative effects on patient and staff, to provide decision makers with accurate information for system improvement and to ensure return on investment. Therefore, this study develops a theoretical model and questionnaire survey instrument to assess the success of organizational EHR in routine use from the viewpoint of nursing staff in residential aged care homes. The proposed research model incorporates six variables in the reformulated DeLone and McLean information systems success model: system quality, information quality, service quality, use, user satisfaction and net benefits. Two variables training and self-efficacy were also incorporated into the model. A questionnaire survey instrument was designed to measure the eight variables in the model. After a pilot test, the measurement scale was used to collect data from 243 nursing staff members in 10 residential aged care homes belonging to three management groups in Australia. Partial least squares path modeling was conducted to validate the model. The validated EHR systems success model predicts the impact of the four antecedent variables-training, self-efficacy, system quality and information quality-on the net benefits, the indicator of EHR systems success, through the intermittent variables use and user satisfaction. A 24-item measurement scale was developed to quantitatively evaluate the performance of an EHR system. The parsimonious EHR systems success model and the measurement scale can be used to benchmark EHR systems success across organizations and units and over time.

Risk and markets for ecosystem services.

PubMed

Bendor, Todd K; Riggsbee, J Adam; Doyle, Martin

2011-12-15

Market-based environmental regulations (e.g., cap and trade, "payments for ecosystem services") are increasingly common. However, few detailed studies of operating ecosystem markets have lent understanding to how such policies affect incentive structures for improving environmental quality. The largest U.S. market stems from the Clean Water Act provisions requiring ecosystem restoration to offset aquatic ecosystems damaged during development. We describe and test how variations in the rules governing this ecosystem market shift risk between regulators and entrepreneurs to promote ecological restoration. We analyze extensive national scale data to assess how two critical aspects of market structure - (a) the geographic scale of markets and (b) policies dictating the release of credits - affect the willingness of entrepreneurs to enter specific markets and produce credits. We find no discernible relationship between policies attempting to ease market entry and either the number of individual producers or total credits produced. Rather, market entry is primarily related to regional geography (the prevalence of aquatic ecosystems) and regional economic growth. Any improvements to policies governing ecosystem markets require explicit evaluation of the interplay between policy and risk elements affecting both regulators and entrepreneurial credit providers. Our findings extend to emerging, regulated ecosystem markets, including proposed carbon offset mechanisms, biodiversity banking, and water quality trading programs.

Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study).

PubMed

Lionis, Christos; Papadakis, Sophia; Tatsi, Chrysanthi; Bertsias, Antonis; Duijker, George; Mekouris, Prodromos-Bodosakis; Boerma, Wienke; Schäfer, Willemijn

2017-04-05

Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients. This study was conducted as part of the Quality and Costs of Primary Care in Europe (QUALICOPC) study. A cross-sectional sample of patients were recruited from general practitioner's offices in Greece and surveyed. Patients rated five features of person-focused primary care: accessibility; continuity and coordination; comprehensiveness; patient activation; and doctor-patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. Comparisons were made between patients with and without chronic disease. The sample included 220 general practitioners from both public and private sector. A total of 1964 patients that completed the experience questionnaire and 219 patients that completed the patient values questionnaire were analyzed. Patients overall report a positive experiences with the general practice they visited. Several gaps were identified in particular in terms of wait times for appointments, general practitioner access to patient medical history, delivery of preventative services, patient involvement in decision-making. Patients with chronic disease report better experience than respondents without a chronic condition, however these patient groups report the same values in terms of qualities of the primary care system that are important to them. Data gathered may be used to improve the quality of primary health care services in Greece through an increased focus on patient-centered approaches. Our study has identified several gaps as well as factors within the primary care health system that patient's perceive as most important which can be used to prioritize quality improvement activities, especially within the austerity period. Study findings may also have application to other countries with similar context and infrastructure.

Detecting gradual and abrupt changes in water quality time series in response to regional payment programs for watershed services in an agricultural area

NASA Astrophysics Data System (ADS)

He, Tian; Lu, Yan; Cui, Yanping; Luo, Yabo; Wang, Min; Meng, Wei; Zhang, Kaijie; Zhao, Feifei

2015-06-01

Market-based watershed protection instruments can effectively improve water quality at various catchment scales. Two payments for watershed services (PWS) programs for water quality improvement have been successively implemented in the Huai River catchment and its sub-watershed, the Shaying River catchment, in Henan Province since 2009. To detect changes in water quality in response to PWS schemes, nonparametric statistical approaches were used to analyze gradual and abrupt trends in water quality, focusing on chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) at 26 monitoring stations in the Huai River watershed during 2006-2013. The nonparametric Mann-Kendall test and the Theil-Sen estimator were used to identify trends and their magnitudes in weekly water quality observations and the Pettitt test was applied to change-point analysis of water quality time series. We found decreasing concentration trends in the weekly water quality data set in this catchment, with water quality at most stations affected by the PWS schemes. The COD and NH3-N concentrations decreased at 26 stations by an average of 0.05 mg/L wk and 0.01 mg/L wk, respectively, from 2006 to 2013. Meanwhile, the mean concentrations of COD and NH3-N decreased at the 26 stations by an average of 18.03 mg/L and 4.82 mg/L, respectively, after the abrupt change points of the time-series trends of these two pollutants. We also estimated annual reductions in COD and NH3-N for each station based on average flow observations using the Theil-Sen approach along with the resulting economic benefits from 2009 to 2010. The COD and NH3-N reductions were 14604.50 and 6213.25 t/y, respectively, in the Huai River catchment in Henan Province. The total economic benefits of reductions in these two pollutants were 769.71 million ¥ in 2009 and 2010, accounting for 0.08% and 0.06%, respectively, of the GDP in the entire Huai River watershed of Henan Province. These results provide new insights into the linkages between PWS programs and water quality improvements at regional and local scales for effective management of water resources.

Scaling up Evidence-based Practices for Children and Families in New York State: Towards Evidence-based Policies on Implementation for State Mental Health Systems

PubMed Central

Hoagwood, Kimberly Eaton; Olin, S. Serene; Horwitz, Sarah; McKay, Mary; Cleek, Andrew; Gleacher, Alissa; Lewandowski, Eric; Nadeem, Erum; Acri, Mary; Chor, Ka Ho Brian; Kuppinger, Anne; Burton, Geraldine; Weiss, Dara; Frank, Samantha; Finnerty, Molly; Bradbury, Donna M.; Woodlock, Kristin M.; Hogan, Michael

2014-01-01

Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems. PMID:24460518

Climate forecasting services: coming down from the ivory tower

NASA Astrophysics Data System (ADS)

Doblas-Reyes, F. J.; Caron, L. P.; Cortesi, N.; Soret, A.; Torralba, V.; Turco, M.; González Reviriego, N.; Jiménez, I.; Terrado, M.

2016-12-01

Subseasonal-to-seasonal (S2S) climate forecasts are increasingly used across a range of application areas (energy, water management, agriculture, health, insurance) through tailored services using the climate services paradigm. In this contribution we show the value of climate forecasting services through several examples of their application in the energy, reinsurance and agriculture sectors. Climate services aim at making climate information action oriented. In a climate forecasting context the task starts with the identification of climate variables, thresholds and events relevant to the users. These elements are then analysed to determine whether they can be both reliably and skilfully predicted at appropriate time scales. In this contribution we assess climate predictions of precipitation, temperature and wind indices from state-of-the-art operational multi-model forecast systems and if they respond to the expectations and requests from a range of users. This requires going beyond the more traditional assessment of monthly mean values to include assessments of global forecast quality of the frequency of warm, cold, windy and wet extremes (e.g. [1], [2]), as well as of using tools like the Euro-Atlantic weather regimes [3]. The forecast quality of extremes is generally similar to or slightly lower than that of monthly or seasonal averages, but offers a kind of information closer to what some users require. In addition to considering local climate variables, we also explore the use of large-scale climate indices, such as ENSO and NAO, that are associated with large regional synchronous variations of wind or tropical storm frequency. These indices help illustrating the relative merits of climate forecast information to users and are the cornerstone of climate stories that engage them in the co-production of climate information. [1] Doblas-Reyes et al, WIREs, 2013 [2] Pepler et al, Weather and Climate Extremes, 2015 [3] Pavan and Doblas-Reyes, Clim Dyn, 2013

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life.

PubMed

Goettems, Marília L; Ardenghi, Thiago M; Demarco, Flávio F; Romano, Ana R; Torriani, Dione D

2012-10-01

The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services. A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05). The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist. © 2012 John Wiley & Sons A/S.

How did rapid scale-up of HIV services impact on workplace and interpersonal trust in Zambian primary health centres: a case-based health systems analysis

PubMed Central

Topp, Stephanie M; Chipukuma, Julien M

2016-01-01

Background In sub-Saharan Africa, large amounts of funding continue to be directed towards HIV-specific care and treatment, often with claims of ‘health system strengthening’ effect. Such claims rarely account for the impact on human relationships and decisions that are core to functional health systems. This research examined how establishment of externally funded HIV services influenced trusting relationships in Zambian health centres. Methods An in-depth, multicase study included four health centres selected for urban, peri-urban and rural characteristics. Case data included healthcare worker (HCW) interviews (60); patient interviews (180); direct observation of facility operations (2 weeks/centre) and key informant interviews (14) which were recorded and transcribed verbatim. Thematic analysis adopted inductive and deductive coding guided by a framework incorporating concepts of workplace trust, patient–provider trust, intrinsic and extrinsic motivation. Results HIV service scale-up impacted trust in positive and negative ways. Investment in HIV-specific infrastructure, supplies and quality assurance mechanisms strengthened workplace trust, HCW motivation and patient–provider trust in HIV departments in the short-term. In the health centres more broadly and over time, however, non-governmental organisation-led investment and support of HIV departments reinforced HCW's perceptions of the government as uninterested or unable to provide a quality work environment. Exacerbating existing perceptions of systemic workplace inequity and nepotism, uneven distribution of personal and professional opportunities related to HIV service establishment contributed to interdepartmental antagonism and reinforced workplace practices designed to protect individual HCW's interests. Conclusions Findings illustrate long-term negative effects of the vertical HIV resourcing and support structures which failed to address and sometimes exacerbated HCW (dis)trust with their own government and supervisors. The short-term and long-term effects of weakened workplace trust on HCWs' motivation and performance signal the importance of understanding how such relationships play a role in generating virtuous or perverse cycles of actor interactions, with implications for service outcomes. PMID:28588985

Using fuzzy gap analysis to measure service quality of medical tourism in Taiwan.

PubMed

Ho, Li-Hsing; Feng, Shu-Yun; Yen, Tieh-Min

2015-01-01

The purpose of this paper is intended to create a model to measure quality of service, using fuzzy linguistics to analyze the quality of service of medical tourism in Taiwan so as to find the direction for improvement of service quality in medical tourism. The study developed fuzzy questionnaires based on the characteristics of medical tourism quality of service in Taiwan. Questionnaires were delivered and recovered from February to April 2014, using random sampling according to the proportion of medical tourism companies in each region, and 150 effective samples were obtained. The critical quality of service level is found through the fuzzy gap analysis using questionnaires examining expectations and perceptions of customers, as the direction for continuous improvement. From the study, the primary five critical service items that improve the quality of service for medical tourism in Taiwan include, in order: the capability of the service provider to provide committed medical tourism services reliably and accurately, facility service providers in conjunction with the services provided, the cordial and polite attitude of the service provider eliciting a sense of trust from the customer, professional ability of medical (nursing) personnel in hospital and reliability of service provider. The contribution of this study is to create a fuzzy gap analysis to assess the performance of medical tourism service quality, identify key quality characteristics and provide a direction for improvement and development for medical tourism service quality in Taiwan.

Use of selected ambulatory dental services in Taiwan before and after global budgeting: a longitudinal study to identify trends in hospital and clinic-based services.

PubMed

Lin, Chienhung; Chao, Hailun

2012-09-25

The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern. This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared. Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding. The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan.

Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system.

PubMed

van der Kooy, Jacoba; Valentine, Nicole B; Birnie, Erwin; Vujkovic, Marijana; de Graaf, Johanna P; Denktaş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2014-12-03

The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to "aspects related to the way individuals are treated and the environment in which they are treated" during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept. The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum. A total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach's alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services. The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended.

Using Interorganizational Partnerships to Strengthen Public Health Laboratory Systems

PubMed Central

Kimsey, Paul; Buehring, Gertrude

2013-01-01

Due to the current economic environment, many local and state health departments are faced with budget reductions. Health department administrators and public health laboratory (PHL) directors need to assess strategies to ensure that their PHLs can provide the same level of service with decreased funds. Exploratory case studies of interorganizational partnerships among local PHLs in California were conducted to determine the impact on local PHL testing services and capacity. Our findings suggest that interorganizational forms of cooperation among local PHLs can help bolster laboratory capacity by capturing economies of scale, leveraging scarce resources, and ensuring access to affordable, timely, and quality laboratory testing services. Interorganizational partnerships will help local and state public health departments continue to maintain a strong and robust laboratory system that supports their role in communicable disease surveillance. PMID:23997305

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery.

PubMed

Brunero, S; Lamont, S; Fairbrother, G

2009-04-01

Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.

Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception.

PubMed

Kanamori, Shogo; Sow, Seydou; Castro, Marcia C; Matsuno, Rui; Tsuru, Akiko; Jimba, Masamine

2015-01-01

5S is a lean method for workplace organization; it is an abbreviation representing five Japanese words that can be translated as sort, set in order, shine, standardize, and sustain. The 5S management method has been recognized recently as a potential solution for improving the quality of government healthcare services in low- and middle-income countries. To assess how the 5S management method creates changes in the workplace and in the process and outcomes of healthcare services, and how it can be applicable in a resource-poor setting, based on data from a pilot intervention of the 5S program implemented in a health facility in Senegal. In this qualitative study, we interviewed 21 health center staff members 1 year after the pilot intervention. We asked them about their views on the changes brought on by the 5S program in their workplace, daily routines, and services provided. We then transcribed interview records and organized the narrative information by emerging themes using thematic analysis in the coding process. Study participants indicated that, despite resource constraints and other demotivating factors present at the health center, the 5S program created changes in the work environment, including fewer unwanted items, improved orderliness, and improved labeling and directional indicators of service units. These efforts engendered changes in the quality of services (e.g. making services more efficient, patient-centered, and safe), and in the attitude and behavior of staff and patients. The pilot intervention of the 5S management method was perceived to have improved the quality of healthcare services and staff motivation in a resource-poor healthcare facility with a disorderly work environment in Senegal. Quantitative and qualitative research based on a larger-scale intervention would be needed to elaborate and validate these findings and to identify the cost-effectiveness of such intervention in low- and middle-income countries.

An evaluation of a family planning mobile job aid for community health workers in Tanzania.

PubMed

Braun, Rebecca; Lasway, Christine; Agarwal, Smisha; L'Engle, Kelly; Layer, Erica; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

2016-07-01

The global rapid growth in mobile technology provides unique opportunities to support community health workers (CHWs) in providing family planning (FP) services. FHI 360, Pathfinder International and D-tree International developed an evidence-based mobile job aid to support CHW counseling, screening, service provision and referrals, with mobile forms for client and service data, and text-message reporting and reminders. The purpose of this study is to evaluate the acceptability and potential benefits to service quality from the perspective of CHWs and their clients. The mobile job aid was piloted in Dar es Salaam, Tanzania. Data collection tools included a demographic survey of all 25 CHWs trained to use the mobile job aid, in-depth interviews with 20 of the CHWs after 3 months and a survey of 176 clients who received FP services from a CHW using the mobile job aid after 6 months. Both CHWs and their clients reported that the mobile job aid was a highly acceptable FP support tool. CHWs perceived benefits to service quality, including timelier and more convenient care; better quality of information; increased method choice; and improved privacy, confidentiality and trust with clients. Most clients discussed multiple FP methods with CHWs; only 1 in 10 clients reported discussion of all 9 methods. This research suggests that mobile phones can be effective tools to support CHWs with FP counseling, screening and referrals, data collection and reporting, and communication. Challenges remain to support informed contraceptive choice. Future research should focus on implementation, including scale-up and sustainability. Mobile job aids can uniquely enhance FP service provision at the community level through adherence to standard protocols, real-time feedback and technical assistance, and provision of confidential care. This study can inform future efforts to support and expand the role of CHWs in increasing FP access and informed contraceptive choice. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception

PubMed Central

Kanamori, Shogo; Sow, Seydou; Castro, Marcia C.; Matsuno, Rui; Tsuru, Akiko; Jimba, Masamine

2015-01-01

Background 5S is a lean method for workplace organization; it is an abbreviation representing five Japanese words that can be translated as sort, set in order, shine, standardize, and sustain. The 5S management method has been recognized recently as a potential solution for improving the quality of government healthcare services in low- and middle-income countries. Objective To assess how the 5S management method creates changes in the workplace and in the process and outcomes of healthcare services, and how it can be applicable in a resource-poor setting, based on data from a pilot intervention of the 5S program implemented in a health facility in Senegal. Design In this qualitative study, we interviewed 21 health center staff members 1 year after the pilot intervention. We asked them about their views on the changes brought on by the 5S program in their workplace, daily routines, and services provided. We then transcribed interview records and organized the narrative information by emerging themes using thematic analysis in the coding process. Results Study participants indicated that, despite resource constraints and other demotivating factors present at the health center, the 5S program created changes in the work environment, including fewer unwanted items, improved orderliness, and improved labeling and directional indicators of service units. These efforts engendered changes in the quality of services (e.g. making services more efficient, patient-centered, and safe), and in the attitude and behavior of staff and patients. Conclusions The pilot intervention of the 5S management method was perceived to have improved the quality of healthcare services and staff motivation in a resource-poor healthcare facility with a disorderly work environment in Senegal. Quantitative and qualitative research based on a larger-scale intervention would be needed to elaborate and validate these findings and to identify the cost-effectiveness of such intervention in low- and middle-income countries. PMID:25854781

Population-Level Scale-Up of Cervical Cancer Prevention Services in a Low-Resource Setting: Development, Implementation, and Evaluation of the Cervical Cancer Prevention Program in Zambia

PubMed Central

Parham, Groesbeck P.; Mwanahamuntu, Mulindi H.; Kapambwe, Sharon; Muwonge, Richard; Bateman, Allen C.; Blevins, Meridith; Chibwesha, Carla J.; Pfaendler, Krista S.; Mudenda, Victor; Shibemba, Aaron L.; Chisele, Samson; Mkumba, Gracilia; Vwalika, Bellington; Hicks, Michael L.; Vermund, Sten H.; Chi, Benjamin H.; Stringer, Jeffrey S. A.; Sankaranarayanan, Rengaswamy; Sahasrabuddhe, Vikrant V.

2015-01-01

Background Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries. Methods In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Findings Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25–49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women. Interpretation We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps. PMID:25885821

Health-related quality of life and unmet healthcare needs in Huntington's disease.

PubMed

van Walsem, Marleen R; Howe, Emilie I; Ruud, Gunvor A; Frich, Jan C; Andelic, Nada

2017-01-07

Huntington's disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients' needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington's Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients' HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to higher HRQoL (β value 0.564; p < 0.001). The study findings suggest that patients with HD do not receive healthcare services that could have a positive impact on their HRQoL.

Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Kapambwe, Sharon; Muwonge, Richard; Bateman, Allen C; Blevins, Meridith; Chibwesha, Carla J; Pfaendler, Krista S; Mudenda, Victor; Shibemba, Aaron L; Chisele, Samson; Mkumba, Gracilia; Vwalika, Bellington; Hicks, Michael L; Vermund, Sten H; Chi, Benjamin H; Stringer, Jeffrey S A; Sankaranarayanan, Rengaswamy; Sahasrabuddhe, Vikrant V

2015-01-01

Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries. In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25-49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women. We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.

The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment.

PubMed

Mulder, Cornelis L; Jochems, E; Kortrijk, H E

2014-04-01

Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment. Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life. In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lower HoNOS scores, and also a lower quality of life. A motivation paradox seems inherent to this association between higher psychosocial problems levels, less motivation for treatment, and lower quality of life. Such a paradox has clinical relevance, as it may provide an ethical basis for outreach services which aim to engage marginally motivated SMI patients with severe psychosocial problems into mental health care.

Learning from the design and implementation of large-scale programs to improve infant and young child feeding.

PubMed

Baker, Jean; Sanghvi, Tina; Hajeebhoy, Nemat; Abrha, Teweldebrhan Hailu

2013-09-01

Improving and sustaining infant and young child feeding (IYCF) practices requires multiple interventions reaching diverse target groups over a sustained period of time. These interventions, together with improved maternal nutrition, are the cornerstones for realizing a lifetime of benefitsfrom investing in nutrition during the 1000 day period. Summarize major lessons from Alive & Thrive's work to improve IYCF in three diverse settings--Bangladesh, Ethiopia, and Vietnam. Draw lessons from reports, studies, surveys, routine monitoring, and discussions on the drivers of successful design and implementation of lYCF strategies. Teaming up with carefully selected implementing partners with strong commitment is a critical first step. As programs move to implementation at scale, strategic systems strengthening is needed to avoid operational bottlenecks. Performance of adequate IYCF counseling takes more than training; it requires rational task allocation, substantial follow up, and recognition of frontline workers. Investing in community demand for IYCF services should be prioritized, specifically through social mobilization and relevant media for multiple audiences. Design of behavior change communication and its implementation must be flexible and responsive to shifts in society's use of media and other social changes. Private sector creative agencies and media companies are well equipped to market IYCF. Scaling up core IYCF interventions and maintaining quality are facilitated by national-level coordinating and information exchange mechanisms using evidence on quality and coverage. It is possible to deliver quality IYCF interventions at scale, while creating new knowledge, tools, and approaches that can be adapted by others

Data envelopment analysis in service quality evaluation: an empirical study

NASA Astrophysics Data System (ADS)

Najafi, Seyedvahid; Saati, Saber; Tavana, Madjid

2015-09-01

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

Technology usage, quality management system, and service quality in Thailand.

PubMed

Sivabrovornvatana, Nilubon; Siengthai, Sununta; Krairit, Donyaprueth; Paul, Himangshu

2005-01-01

This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality. The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals. The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation. The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

EnviroAtlas: Providing Nationwide Geospatial Ecosystem Goods and Services Indicators and Indices to Inform Decision-Making, Research, and Education

NASA Astrophysics Data System (ADS)

Neale, A. C.

2016-12-01

EnviroAtlas is a multi-organization effort led by the US Environmental Protection Agency to develop, host and display a large suite of nation-wide geospatial indicators and indices of ecosystem services. This open access tool allows users to view, analyze, and download a wealth of geospatial data and other resources related to ecosystem goods and services. More than 160 national indicators of ecosystem service supply, demand, and drivers of change provide a framework to inform decisions and policies at multiple spatial scales, educate a range of audiences, and supply data for research. A higher resolution component is also available, providing over 100 data layers for finer-scale analyses for selected communities across the US. The ecosystem goods and services data are organized into seven general ecosystem benefit categories: clean and plentiful water; natural hazard mitigation; food, fuel, and materials; climate stabilization; clean air; biodiversity conservation; and recreation, culture, and aesthetics. Each indicator is described in terms of how it is important to human health or well-being. EnviroAtlas includes data describing existing ecosystem markets for water quality and quantity, biodiversity, wetland mitigation, and carbon credits. This presentation will briefly describe the EnviroAtlas data and tools and how they are being developed and used in ongoing research studies and in decision-making contexts.

Quality Disparities in Child Care for At-Risk Children: Comparing Head Start and Non-Head Start Settings

PubMed Central

Hillemeier, Marianne M.; Morgan, Paul L.; Farkas, George; Maczuga, Steven A.

2012-01-01

The study objectives are to describe child care type and quality experienced by developmentally at-risk children, examine quality differences between Head Start and non-Head Start settings, and identify factors associated with receiving higher-quality child care. Data are analyzed from the Early Childhood Longitudinal Survey, Birth Cohort, a prospective study of a nationally representative sample of US children born in 2001. The sample consisted of 7,500 children who were assessed at 48 months of age. The outcome of interest is child care quality, measured by the Early Childhood Environmental Rating Scale (center care) and the Family Day Care Rating Scale (family day care). Results of descriptive and multivariate regression analyses are presented. Less than one-third of poor children were in Head Start. Child care quality was higher in Head Start centers than other centers, particularly among poor children (4.75 vs. 4.28, p < 0.001), Hispanics (4.90 vs. 4.45, p < 0.001), and whites (4.89 vs. 4.51, p < 0.001). African Americans experienced the lowest quality care in both Head Start and non-Head Start centers. Quality disadvantage was associated with Head Start family care settings, especially for low birthweight children (2.04 in Head Start vs. 3.58 in non-Head Start, p < 0.001). Lower family day care quality was associated with less maternal education and African American and Hispanic ethnicity. Center-based Head Start provides higher quality child care for at-risk children, and expansion of these services will likely facilitate school readiness in these populations. Quality disadvantages in Head Start family day care settings are worrisome and warrant investigation. PMID:22392601

Patients' perceptions of service quality in China: An investigation using the SERVQUAL model.

PubMed

Fan, Li-Hua; Gao, Lei; Liu, Xin; Zhao, Shi-Hong; Mu, Hui-Tong; Li, Zhe; Shi, Lei; Wang, Ling-Ling; Jia, Xiao-Li; Ha, Min; Lou, Feng-Ge

2017-01-01

The doctor-patient relationship has been a major focus of society. Hospitals' efforts to improve the quality of their medical services have been to reduce the probability of doctor-patient conflicts. In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality. Twenty-seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics. There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients' perceptions of service quality are lower than their expectations. According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients.

The UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project--a feasibility study of large-scale clinical service peer review.

PubMed

Roberts, Christopher M; Buckingham, Rhona J; Stone, Robert A; Lowe, Derek; Pearson, Michael G

2010-10-01

Service provision and clinical outcomes for patients admitted with chronic obstructive pulmonary disease remain unacceptably variable despite guidelines and performance feedback of national audit, data. This study aims to assess the impact of mutual peer review on service improvement. The initial phase of this study was to assess the feasibility and determine the practicalities of delivering such a peer review programme on a large scale. All UK acute hospitals were invited to participate in a reciprocal peer review programme administered by a central team from three UK health organizations. Hospitals with the most resources were paired with those with the least (as defined in a baseline survey) and pairs randomized on a 3:2 basis into intervention or control groups. A number of key quality indicators were derived to measure service levels at the beginning and end of the study. Peer review teams included clinicians and managers from acute and primary care organizations and when possible a patient representative. Visits were focussed on four key areas of chronic obstructive pulmonary disease service. Teams were to agree service improvements and submit plans signed off by participants. Monthly change diaries were to be used to record progress towards agreed goals. A total of 100 hospitals participated in the programme. Overall, 52 of 54 peer review visits took place within a 4-week time frame and all units submitted service improvement plans within an agreed time frame. Secondary care representatives participated in all visits, primary care in 30 but patients in only 17. The mean number of diaries returned was 2, but 94% of units returned initial and final versions. It is possible to deliver successful large-scale mutual peer review using a limited but focussed programme. Participation of patients and use of change diaries requires further evaluation. © 2010 Blackwell Publishing Ltd.

General physical health advice for people with serious mental illness.

PubMed

Tosh, Graeme; Clifton, Andrew V; Xia, Jun; White, Margueritte M

2014-03-28

There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this. To review the effects of general physical healthcare advice for people with serious mental illness. We searched the Cochrane Schizophrenia Group's Trials Register (last update search October 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and registries of Clinical Trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. All randomised clinical trials focusing on general physical health advice for people with serious mental illness.. We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Seven studies are now included in this review. For the comparison of physical healthcare advice versus standard care we identified six studies (total n = 964) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.20, CI -0.47 to 0.87, very low quality of evidence) but another two did for the Quality of Life Medical Outcomes Scale - mental component (n = 487, 2 RCTs, MD 3.70, CI 1.76 to 5.64). There was no difference between groups for the outcome of death (n = 487, 2 RCTs, RR 0.98, CI 0.27 to 3.56, low quality of evidence). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (n = 363, 1 RCT, MD 36.90, CI 33.07 to 40.73) and service use: one or more primary care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer-term benefits such as reduced mortality or morbidity. On the other hand, it is possible clinicians are expending much effort, time and financial resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.

User satisfaction with child and adolescent mental health services: impact of the service unit level.

PubMed

Bjørngaard, Johan Håkon; Wessel Andersson, Helle; Osborg Ose, Solveig; Hanssen-Bauer, Ketil

2008-08-01

Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: Protocol for a randomized controlled trial

PubMed Central

Collins, Susan E.; Saxon, Andrew J.; Duncan, Mark H.; Smart, Brian F.; Merrill, Joseph O.; Malone, Daniel K.; Jackson, T. Ron; Clifasefi, Seema L.; Joesch, Jutta; Ries, Richard K.

2014-01-01

Background Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Aims Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. Methods This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4 weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. Discussion If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. PMID:24846619

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial.

PubMed

Collins, Susan E; Saxon, Andrew J; Duncan, Mark H; Smart, Brian F; Merrill, Joseph O; Malone, Daniel K; Jackson, T Ron; Clifasefi, Seema L; Joesch, Jutta; Ries, Richard K

2014-07-01

Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. Copyright © 2014 Elsevier Inc. All rights reserved.

Scaling up food production in the Upper Mississippi river basin: modeling impacts on water quality and nutrient cycling

NASA Astrophysics Data System (ADS)

Bowen, E. E.; Martin, P. A.; Schuble, T. J.; Yan, E.; Demissie, Y.

2010-12-01

Agricultural production imposes significant environmental stress on the landscape, both in the intensity and extent of agricultural activities. Among the most significant impacts, agriculture dominates the natural reactive nitrogen cycle, with excess reactive nitrogen leading to the degraded quality of inland and coastal waters. In the U.S., policymakers and stakeholders nationwide continue to debate strategies for decreasing environmental degradation from agricultural lands. Such strategies aim to optimize the balance among competing demands for food, fuel and ecosystem services. One such strategy increasingly discussed in the national debate is that of localizing food production around urban areas, developing what some have recently called “foodsheds”. However, the environmental impacts of localizing food production around population centers are not well-understood given the hard-to-generalize variety seen in management practices currently employed among local farms marketing food crops directly to consumers. As a first, landscape level study of potential impacts from scaling up this type of agriculture, we use the USDA Soil and Water Assessment Tool (SWAT) model to quantify environmental impacts from developing foodsheds for all population centers in the Upper Mississippi river basin. Specifically, we focus on nutrient cycling and water quality impacts determining direct greenhouse gas emissions and changes to nutrient runoff from increased food production in this watershed. We investigate a variety of scenarios in which food production is scaled up to the regional level using different types of farm management practices, ranging from conventional production of fruits and vegetables, to production of these products from small-scale, diversified systems integrating conservation easements. In addition to impacts on nutrient cycling and water quality, we also characterize relative levels of productivity in conjunction with overall demand for food associated with population centers to address one aspect of socio-economic concern.

GP Practices as a One-Stop Shop: How Do Patients Perceive the Quality of Care? A Cross-Sectional Study in Thirty-Four Countries.

PubMed

Schäfer, Willemijn L A; Boerma, Wienke G W; Schellevis, François G; Groenewegen, Peter P

2017-12-29

To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care. Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting. In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments. Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients. In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care. This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians. © Health Research and Educational Trust.