ChatBR: Automated assessment and improvement of bug report quality using ChatGPT

Background: Formal training in quality improvement (QI) methods is sporadic in medical educational settings. QI is a growing expectation for individual professional certifications and facility accreditations; future physicians will need to understand and apply QI methods as part of their practice. We developed a curriculum with both didactic and applied components to teach QI methods to cardiology fellows. Methods: The Fellows Applied Quality Training (FAQT) curriculum started in July 2013 with an initial cohort of 23 postgraduate trainees in general and subspecialty cardiovascular medicine fellowships. The FAQT is a multifaceted QI curriculum consisting of online learning modules, didactic training, and the start-to-finish completion of a team-based, self-directed quality improvement project under supervision of a faculty mentor. Trainees completed selected modules from the Institute of Healthcare Improvement Open School including basic terminology and background of QI methods. Trainees were assigned to small groups and challenged to identify an area in need, design an intervention to improve quality or safety, select an appropriate metric to measure, determine how to acquire the necessary data, implement their plan, analyze data to measure their success, and formally present the results. Prior to, during, and at the completion of the FAQT, trainees completed the 13 question self-assessment from the Quality Assessment and Improvement Curriculum. This assessment asks participants to rate their confidence to perform QI activities independently. The primary outcome of our investigation was an increase in the median confidence score reported on a 4 point scale (1=not at all confident, 2=slightly confident, 3=moderately confident, 4=extremely confident) compared by Wilcoxon signed rank test. Results: Prior to the FAQT, 15 trainees reported no prior formal QI training. Of those with prior training, 4 were practical and 4 had only didactic training. At baseline, the median score given on the assessment was 3.0. After completion of online training modules, the median score did not increase (3.0, p=0.51). At the conclusion of the self-directed projects, average confidence was higher (3.27, p=0.004). The proportion of fellows reporting they were “extremely” confident about using quality assessment and improvement in your future career increased from15% to 50% while the proportion reporting “slight” confidence decreased from 30% to 5%. Conclusion: At our institution, the majority of post-graduate medical trainees had no formal exposure to QI training. After completing a curriculum with practical application of QI methods, trainees reported an increase in their self-confidence to independently conduct QI; no increase was observed with didactic training alone.

and improving care. We use a narrow definition of a best practice, adapted from Donabedian’s framework of structures, processes, and outcomes of health care (3). In this construct, a “practice” is a process—the means by which a delivery system interacts with and influences patients. A “best practice” is a process that has been demonstrated to produce superior results, such as better patient outcomes. To illustrate a challenge confronting clinicians and managers in the course of quality-improvement work, we describe a common situation: A community mental health center named CMHC, Inc., decides to adopt a report card of performance measures to assess quality of care. The center selects measures that reflect the needs of its patient population and staff concerns about where care might fall short. One concern is that many of the patients may not be completing prescribed courses of antidepressants. Thus CMHC’s report card includes a measure to assess adherence after initiation of medication treatment for depression. The measure assesses the proportion of patients with major depressive disorder who complete a 12-week acute phase of antidepressant treatment. Data from CMHC are collected and analyzed, and clinicians and managers meet to review the results. They learn that 55 percent of patients initiating a new course of antidepressant

Chapter 10 - Quality Assessment and Quality Improvement in Model Engineering

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Statistical Benchmarks for Process Measures of Quality of Care for Mental and Substance Use Disorders

Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.

BackgroundWhile many residency programmes have implemented quality improvement (QI) training programmes, few have been rigorously evaluated.MethodsResidents at the authors' institution participated in a required course, the Quality Assessment and Improvement...

Mental health quality improvement goes global.

Terri L.WarholakDavid P.NauQuality & Safety in Pharmacy Practice2010McGraw- Hill MedicalNew York, NY273 pages, $54.95 (paperback). ISBN 978-0-07-160385-0

HCFA's health care quality improvement program and the cooperative cardiovascular project

Guest editorial: quality as an enduring and encompassing concept

Resident Case Review at the Departmental Level: A Win-Win Scenario

Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible. Using the American Board of Internal Medicine's (ABIM) Clinical Preventative Services Practice Improvement Module (CPS PIM), we have incorporated a longitudinal quality assessment and improvement curriculum (QAIC) into the 2 required 1-month ambulatory rotations during the postgraduate year 2. During the first block, residents complete the PIM chart reviews, patient, and system surveys. The second block includes resident reflection using PIM data and the group performing a small test of change using the Plan-Do-Study-Act (PDSA) cycle in the resident continuity clinic. To date, 3 resident quality improvement (QI) projects have been undertaken as a result of QAIC, each making significant improvements in the residents' continuity clinic. Resident confidence levels in QI skills (e.g., writing an aim statement [71% to 96%, P < .01] and using a PDSA cycle [9% to 89%, P < .001]) improved significantly. The ABIM CPS PIM can be used by Internal Medicine residency programs to introduce QI concepts into their residents' outpatient practice through encouraging practice-based learning and improvement and systems-based practice.

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This review contains 1 figure, 3 tables, and 56 references Keywords: Quality of care, performance measure, quality improvement, clinical practice, sigma six, transparency

Diarrhoeal diseases kill an estimated 2.5 million people each year, the majority being children under 5 years (Kosek et al. 2003). An estimated 4 billion cases annually account for 5.7% of the global burden of disease and place diarrhoeal disease as the third highest cause of morbidity and sixth highest cause of mortality (Pruess et al. 2002). Among children under 5 years in developing countries, diarrhoeal disease accounts for 21% of all deaths (Parashar et al. 2003). By inhibiting normal consumption of foods and adsorption of nutrients, diarrhoeal diseases are also an important cause of malnutrition, leading to impaired physical growth and cognitive development (Guerrant et al. 1999), reduced resistance to infection (Baqui et al. 1993) and potentially long-term gastrointestinal disorders (Schneider et al. 1978). Infectious agents associated with diarrhoeal disease are transmitted chiefly through the faecal-oral route (Byers et al. 2001). A wide variety of bacterial, viral and protozoan pathogens excreted in the faeces of humans and animals are known to cause diarrhoea. Many of these are potentially waterborne – transmitted through the ingestion of contaminated water (Leclerc et al. 2002). Accordingly, a number of interventions have been developed to treat water. These include (i) physical removal of pathogens (e.g. filtration, adsorption and sedimentation); (ii) chemical treatment (e.g. assisted sedimentation, chemical disinfection and ion exchange); or (iii) heat and ultra violet (UV) radiation. Because of the risk of recontamination (Clasen & Bastable 2003), interventions to improve water quality also include steps to maintain the microbiological quality of safe drinking water, such as piped distribution, residual disinfection and improved storage. These efforts are expected to receive additional priority as a result of the United Nation’s commitment to reduce by one-half of the 1.5 billion people without sustainable access to improved water, one of the United Nation’s Millennium Development Goals (United Nations 2000), and by the World Health Organization’s steps to accelerate the health gains of safe water to the remaining population by improved treatment and storage of water at the household level (Sobsey 2002). Health authorities generally accept that safe water plays an important role in preventing outbreaks of diarrhoeal disease (Hunter 1997). Accordingly, the most widely accepted standard for water quality allows no detectable level of harmful pathogens at the point of distribution (WHO 1993). However, in those settings in which diarrhoeal disease is endemic, much of the epidemiological evidence for increased health benefits following improvements in the quality of drinking water has been equivocal (Esrey & Habicht 1986; Lindskog et al. 1987; Cairncross 1989). As many of these same waterborne pathogens are also transmitted via ingestion of contaminated food and other beverages, by person-to-person contact, and by direct or indirect contact with infected faeces, improvements in water quality alone may not necessarily interrupt transmission (Briscoe 1984). As a result of this variety of risk factors, interventions for the prevention of diarrhoeal disease not only include enhanced water quality but also steps to (i) improve the proper disposal of human faeces (sanitation), (ii) increase the quantity and improve access to water (water supply), and (iii) promote hand washing and other hygiene practices within domestic and community settings (hygiene). As in the case of studies of water quality, there is a wide range in the reported measure of effect on diarrhoea morbidity of each of these other environmental interventions (Esrey et al. 1985). Even more fundamentally, there are also questions about the methods and validity of studies designed to assess the health impact of such interventions (Briscoe et al. 1986; Imo State Evaluation Team 1989). As part of a larger evaluation of interventions for the control of diarrhoeal disease (Feachem et al. 1983), Esrey et al. (1985) reviewed 67 studies to determine the health impact from improvements in water supplies and excreta disposal facilities (Esrey et al. 1985). The median reduction in diarrhoeal morbidity from improved water quality was 16% (range 0–90%). This compared with 22% for Tropical Medicine and International Health