Analysis Of Quality Assurance Data Research Articles

Long-term anticoagulation treatment in proximal femoral fractures as obstacle to surgery in the 24h time window? : Results of an analysis of Quality Assurance data on 32,252 treatment courses with osteosynthesis

Both in Germany and internationally there is avehement controversy about the appropriate time for care of proximal femoral fractures in older patients. The effort to achieve high quality and uniform standards of care culminated in the German healthcare system in the strict requirement of delay-free surgery within 24 h. Until now, in view of their high vulnerability patients who were severely injured were too often operated on late with the reference to ageneral medical condition that could be improved preoperatively. In particular, the fear of complications due to apre-existing long-term anticoagulation treatment was repeatedly emphasized. The present study is dedicated to the question of whether adelay in surgery of anticoagulated patients with proximal femoral fractures already during the inpatient course has adetrimental effect on the complication statistics and the mortality of the patients. The extent to which external quality assurance data are suitable for rebutting any objections to an operation as soon as possible are examined. The study is based on treatment data from the external inpatient quality assurance procedure of the federal state of North Rhine-Westphalia from the years 2018-2020. Patients with aproximal femoral fracture were considered. This includes femoral neck fractures and fractures in the area of the pertrochanteric to subtrochanteric region. Only cases with joint-preserving fracture care were selected. The data sets were analyzed using suitable statistical software. More general complications and deaths have been observed in anticoagulated patients. The trend of delayed fracture treatment under anticoagulant medication continues to be clearly visible. Apositive association between longer preoperative waiting time and undesirable courses can be confirmed. With respect to fracture care when taking anticoagulants, it must be critically examined to what extent arapid normalization of the coagulation situation is necessary and this actually improves the chances of low complication courses. Should the elimination of the anticoagulant effect by substitution or antidote appear necessary, this should not prevent early care.

Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse.

The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013. This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019. At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction. The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.

Impact of room service on nutritional intake, plate and production waste, meal quality and patient satisfaction and meal costs: A single site pre-post evaluation.

Room service is a patient-focused foodservice model gaining interest in Australian hospitals following demonstrated patient and organisational benefits. This study aimed to compare nutritional intake, waste, patient satisfaction, meal costs and meal quality between a bought-in, thaw-retherm foodservice model and a cook-fresh, on-demand room service model at a large tertiary public hospital. A retrospective analysis of quality assurance data compared thaw-retherm to room service. Nutritional intake and plate waste were measured using a visual intake analysis tool; production waste was measured using weighted analysis methodology; patient satisfaction was measured using a validated patient satisfaction survey; meal quality was assessed using a validated meal quality audit tool, and meal costs were obtained from hospital finance reports. Independent sample t-tests or nonparametric equivalent (Mann-Whitney U-test) for continuous variables and Pearson's Chi-square for categorical data were applied for comparative purposes. Average energy and protein intake, as well as percentage requirements met, improved between thaw-retherm and room service (4320 kJ/day vs 7265 kJ/day; 42.4 g/day vs 82.5 g/day; and 46% vs 80.7%; 49.9% vs 98.4%; all P < .001. Reductions in plate waste (40% vs 15%) and production waste (15% vs 5.6%, P < .001) were observed and food costs decreased by 9% with room service. Meal quality audit results improved, and patient satisfaction increased with % respondents satisfied increasing from 75.0% to 89.8% (χ2 9.985[2]; P=.007) for room service. This research demonstrates significant improvements in patient and organisational outcomes with room service compared to a thaw-retherm model in a large public hospital.

Use of social service counseling by cancer patients: an analysis of quality assurance data of 6339 breast cancer patients from 13 certified centers in Germany treated between 2015 and 2017

BackgroundIntegrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data.MethodsMultilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers.ResultsIn the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002).ConclusionThe analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.

Social Work in Medical Rehabilitation - A Review of Current Research

Quality assurance approaches by the German Statutory Pension Insurance emphasized the need of evidence-based practice for social work in medical rehabilitation. This study aims to show the state of research in rehabilitation science concerning social work and its effectiveness. The review is based on a literature search in 3 databases (Pubmed, Web of Sciences, Scopus) and a hand search in rehabilitation science journals and proceedings. 52 of 176 articles from 2000 to 2016 met the inclusion criteria. Social work is a common service in routine clinical practice with a substantial variation on the institutional level and between indications. Analysis of quality assurance data and observational studies showed negative as well as positive effects. The results indicate the need of an evidence-based practice of social work in medical rehabilitation.

WITHDRAWN: Performance of Community Blood Glucose Meters in Calgary, Alberta: An Analysis of Quality Assurance Data

The self-monitoring of blood glucose plays a critical role in management of diabetes mellitus. Although laboratory comparisons of glucose meter accuracy are often acceptable, clinical comparisons show frequent inaccuracies. In this paper, we evaluate the accuracy of self-monitoring blood glucose meters using glucose meter and serum comparisons from a large Canadian laboratory. This study was performed using secondary data obtained from the Laboratory Information System of Calgary Services, the sole provider of laboratory testing to Calgary and surrounding areas. We examined anonymous quality assurance data for glucose meter comparisons performed on home glucose meters between January 1, 2010, and April 30, 2013. A total of 39 542 comparisons were recorded on 18 540 different subjects. Overall, 6.7% of differences were greater than the current International Standards Organization standard of 15%, and 3.7% exceeded the Canadian guideline of 20%. Glucose meter checks were infrequently performed (on average, once per 1.6 years). A significant subset of meter results was inaccurate.

Stress and Resources in Women Attending an Inpatient Prevention/Rehabilitation Measure for Parents: Secondary Analysis of Quality Assurance Data

Questionnaire data from two projects on the development of quality assurance instruments for an inpatient rehabilitation/prevention program for parents were used for a secondary analysis. In this analysis, the associations of gains in a psychosocial resource (parenting self-efficacy) and two types of stressors experienced by mothers at the start of treatment (parenting hassles, depressive symptoms) with general life satisfaction and satisfaction with health at the end of treatment were explored. Structural equation modeling was applied to data from N = 1724 female patients. Potential resource-stressor interactions were tested using the Latent Moderated Structural Equations approach. Results showed that parenting hassles were negatively associated with general life satisfaction and satisfaction with health while self-efficacy gains were weakly positively correlated with both variables. No interaction of parenting hassles and self-efficacy gains was found. Depressive symptoms were negatively associated with both satisfaction measures. In these models, self-efficacy gains were not substantially correlated with life satisfaction, but showed a small association with satisfaction with health. There was no significant interaction of depressive symptoms and self-efficacy gains. The findings imply that interventions for distressed mothers—as exemplarily illustrated by this inpatient setting—should focus on identifying and reducing initial stressors as these may continue to impair mothers’ subjective health despite gains in parenting-related resources.

Solution to Nonnormality in Quality Assurance and Acceptance Quality Characteristics Data

Previous studies have identified high nonnormality in the form of skewness and kurtosis in highway construction data (hot-mix asphalt, portland cement concrete pavement, and aggregate materials) on the basis of analysis of field quality assurance data. [The authors use “nonnormality,” rather than “abnormality,” and define it as a term used in any discipline that involves statistical data analysis. —Ed.] The presence of high nonnormality in lot data is a significant finding because such nonnormality violates most state transportation agencies' normality assumption for quality assurance data analysis (e.g., F-test and t-test) and quality measure calculation (e.g., percent within limits). High nonnormality can have several adverse effects, such as increased variability in lot data and decreased efficiency of statistical verification tests in finding differences between contractor's and agency's data sets. Most important, however, nonnormal lot data tend to misdirect contractor payment; such misdirection can manifest in incorrectly penalizing contractors that deliver acceptable construction and rewarding contractors that deliver poor construction. A modified Box–Cox transformation using the golden section search algorithm is proposed: it can substantially reduce pay biases due to nonnormality even when lot sample size is small. The method is efficient and ensures fair and equitable payment to state agencies and contractors.

Use of Chemical Warming Packs During Delivery Room Resuscitation Is Associated With Decreased Rates of Hypothermia in Very Low-Birth-Weight Neonates

: Hypothermia is an independent contributor to neonatal mortality. All very low-birth-weight (VLBW) newborns have the potential to undergo cold stress or frank hypothermia during delivery room stabilization. Thus, clinicians aiming to maintain normothermia in VLBW neonates are compelled to use multiple adjuncts of unknown efficacy or safety. : To evaluate the effectiveness of thermoregulation procedures in maintaining normothermia during delivery room resuscitation and to assess the impact of an unanticipated change in equipment at our institution on the admission temperatures of VLBW newborns. : Institutional review board-approved, retrospective analysis of quality assurance data submitted to the Vermont-Oxford Network (VON) for 24 consecutive months starting January 2006. We compared the rate of hypothermia (admission temperature < 36.5°C) in our NICU during 2006 with the aggregate rates reported by VON. We then compared the rates of hypothermia and mean admission temperatures in our NICU during period 1 (when chemical warming packs were used routinely, in addition to plastic wrapping and warm blankets) and period 2 (after packs were discontinued owing to an incident of focal skin injury). : In 2006, 42% of VLBW babies in our NICU had an admission temperature of less than 36.5°C compared with the VON rate of 61% (interquartile range 48%, 76%). During period 1, 39% of 183 VLBW neonates were hypothermic compared with 68% of 103 during period 2 (P < .001). Mean admission temperatures during periods 1 and 2 were 36.5°C and 36.1°C, respectively (P < .001). A control chart showed the shift in temperatures occurring as period 2 began. No change in practice other than discontinuation of the warming packs was instituted during period 2. The incidence of temperatures greater than 38°C (hyperthermia) was 1.6% during period 1 and 1.0% during period 2. : The results associated with this isolated change in practice at our institution suggest that chemical warming packs were a useful adjunct in achieving above-average rates of normothermia during delivery room resuscitation of VLBW newborns. Their potential adverse effects should be weighed against the increased risk of mortality associated with hypothermia in this population.

A comparison of variability in Papanicolaou and liquid‐based cytology inadequacy rates using Shewhart control charts

To use Shewhart control charts to compare variability in inadequacy rates from Papanicolaou (Pap) and liquid-based cytology (LBC). Retrospective analysis of quality assurance data. Eleven Welsh cytology laboratories. Shewhart 'p' charts were plotted for proportions of slides reported as inadequate. Charts were compared for statistical control. Evidence of statistical control in the processes. Control charts allowed easy interpretation of patterns in the data. Variability in inadequacy rates was much lower for LBC than for Pap cytology. Monitoring inadequate rates with Shewhart charts provides more information than tabular monitoring reports, assisting in quality improvement. With respect to inadequacy rates, LBC is less variable than Pap cytology.

Integration of Quality Assurance Activities into a Computerized Patient Data Management System in an Intensive Care Unit

A prototype computer-based patient data management system (PDMS) was developed for a surgery-anesthesiology intensive care unit (ICU) to reduce the time and staff needed to implement quality assurance (QA) functions. Goals of the system were to make QA functions routine and minimally intrusive to the daily operation of the ICU. PDMS collects general data (eg, admissions and discharges, lengths of stay, and bed utilization rates) and specialized data (eg, specific indicators) unique to the ICU and performs prospective monitoring for the occurrence of specific events (occurrence screening) and retrospective examinations of patient records (targeted reviews). Preliminary results suggest that PDMS facilitates the acquisition and analysis of QA data and reduces the time needed to acquire these data. Research to validate these claims and efforts to improve and expand the prototype system with a permanent production system are in progress.