Quality Assessment Improvement Research Articles

Engaging Remote Aboriginal Communities in COVID-19 Public Health Messaging via Crowdsourcing.

Health comunication is a critical component of pandemic mitigation, but mainstream prevention messaging often lacks social, cultural and linguistic relevance to vulnerable populations. This community case study presents a novel, highly participatory pandemic prevention communication campaign that engaged individuals in remote Aboriginal communities of the Northern Territory of Australia directly in prevention messaging via crowdsourcing, and distributed videos to remote area post-codes via targeted Facebook advertising. Facebook metrics, administrative campaign data and national statistics are used to assess campaign reach and engagement. The case study discusses lessons learned from the campaign, including how seeking unscripted COVID-19 prevention video messaging can support community ownership of pandemic messaging, rapid content generation, and a high level of Facebook user engagement. It also discusses the effectiveness of targeting remote area post-codes via Facebook advertising both to reach the target audience, and to support quality improvement assessments to inform health communication decision-making in a low resource setting.

An Intention-to-Treat-Analysis of the Efficacy of Immunotherapy Using Mycobacterium W Vaccine and Purified Protein Derivative of Tuberculin for Warts With Assessment of Improvement in Quality of Life.

IntroductionLately, immunotherapy has evolved as a safe and reliable management option for treatment of warts. Various immunogens among others in use include vaccines and antigens like purified Protein Derivative of Tuberculin (PPD) and mycobacterium w (Mw) or mycobacterium indicum prani vaccines.ObjectivesThe study was aimed to assess the effectiveness and safety profile of intralesional Mw vaccine against intralesional PPD for the management of multiple warts with assessment of the improvement in quality of life (QoL) using the Dermatology Life Quality Index questionnaire.MethodsPatients aged above 12 years with ≥2 warts were recruited for the study. These individuals were randomized into groups A and B, namely Mw vaccine (group A) and PPD Tuberculin (group B). At each visit, 0.1–0.2 ml of active antigen was infiltrated intralesionally into the largest/mother wart. The injections were repeated after every 4 weeks, for the next 12 weeks. QoL improvement was measured.ResultsThis intention to treat analysis was completed by 102 patients, of which 55 were in group A and 47 in group B. The rate of complete clearance was comparable in group A (76.3%) with the one in group B (65.9%, P = 0.064). Prior to treatment initiation, the most severely impacted domain of life by warts was ‘symptoms and feelings’. There was a statistically significant improvement in QoL at the end of the treatment ( P <0.01).ConclusionMw vaccine holds leverage over PPD with a marginally higher rate of clearance and less adverse events for managing warts.

Parental acceptability of pediatric forearm manipulations in a UK district hospital emergency department.

Purpose:Pediatric forearm fractures are a common presentation to Accident and Emergency departments. Standard treatment for the majority of these is manipulation under sedation within the department, followed by cast application. Concerns have been raised about the acceptability of such interventions, and reluctance to perform these procedures has led to increased admissions and manipulations performed under general anesthetic.Methods:A prospective case series of all pediatric patients with forearm fractures who underwent a manipulation under sedation in the Accident and Emergency department was collected over 12 months. All parents were invited to complete an acceptability questionnaire, adapted from the Swedish Pyramid Questionnaire for Treatment, based on their experiences.Results:A total of 77 patients were included and their parents were asked to complete a Swedish Pyramid Questionnaire of Treatment. Forty-four parents (55%) agreed to fill out the questionnaire. Patient demographics and fracture characteristics were compared between the group that responded and those that did not, with no significant differences. Average level of satisfaction was 9.4/10 (range = 7–10). 98% of respondents were satisfied with the level of analgesia provided, but only 86% with the timeliness of administration.Conclusion:This parent-focused evaluation of treatment confirms high levels of parental satisfaction with the management of pediatric forearm fractures in Accident and Emergency, with regard to care, analgesia, and information. It provides insights about parental concern relating to the injury and their anxiety as information useful to further improving care, a template for assessing quality improvement and should be considered as part of further studies in this field.Level of evidence:Level IV case series.

Efficient and Quality-Optimized Metagenomic Pipeline Designed for Taxonomic Classification in Routine Microbiological Clinical Tests.

Metagenomics analysis is now routinely used for clinical diagnosis in several diseases, and we need confidence in interpreting metagenomics analysis of microbiota. Particularly from the side of clinical microbiology, we consider that it would be a major milestone to further advance microbiota studies with an innovative and significant approach consisting of processing steps and quality assessment for interpreting metagenomics data used for diagnosis. Here, we propose a methodology for taxon identification and abundance assessment of shotgun sequencing data of microbes that are well fitted for clinical setup. Processing steps of quality controls have been developed in order (i) to avoid low-quality reads and sequences, (ii) to optimize abundance thresholds and profiles, (iii) to combine classifiers and reference databases for best classification of species and abundance profiles for both prokaryotic and eukaryotic sequences, and (iv) to introduce external positive control. We find that the best strategy is to use a pipeline composed of a combination of different but complementary classifiers such as Kraken2/Bracken and Kaiju. Such improved quality assessment will have a major impact on the robustness of biological and clinical conclusions drawn from metagenomic studies.

Sustaining program implementation: A co-constructed technical assistance process to support continuous high-quality implementation of the Therapeutic Crisis Intervention program

Strategies for sustaining a program beyond initial implementation remain one of the most poorly understood aspects of high-quality program implementation. This paper describes the Quality Improvement and Fidelity Assessment Process (QIFAP), a program purveyor-agency partnership that uses a unique, multi-step method for supporting sustained implementation of the Therapeutic Crisis Intervention (TCI) system to manage crises in child serving organizations. It outlines the steps of the process and highlights how specific activities are linked to current knowledge and principles from implementation science. The QIFAP occurs over a period of about three months, during which time program developers and agency representatives conduct staff surveys, a two-day site visit, and fidelity assessments in order to gather information, discuss findings, and plan steps for improving the TCI system in the organization. The process is guided by principles that emphasize the importance of organization leadership, building relationships, co-learning, using an individualized approach, data informed decision making, acknowledging risk, and congruence. We describe ways in which the strategies and approaches within the QIFAP are rooted in implementation science literature. Thus, the model represents an illustration of how research-based knowledge can work in practice to support long-term, high-quality program implementation.

"Improved quality assessment of cornelian cherry (Cornus mas L.) fruit with regard to their processing potential".

The sensory properties and appropriateness of cornelian cherry (Cornus mas L.) for processing is very closely related to its ripening stage, recognizable by firmness and skin colour to some extent. Due to the non-uniform ripening on the trees the quality of the fruits offered on the market depends very much on the harvest-method. Today, processors, who usually do not buy fresh fruits but frozen fruits or puree on the market, don`t have a suitable means for the accurate quality assessment of the raw material they need for the processing of high-quality products. The results of this work show for the first time that from the selected parameters (carbohydrates, organic acids, phenols) only flavonols, especially kaempferol-3-glucoside is appropriate to determine the stage of ripeness of cornelian cherries properly independent from species, provenance and crop year. Kaempferol 3-O-glucoside of about 1.75mg/Kg in wild genotypes and of about 0.80mg/Kg in most big cornelian cherry species can serve as a reference for sufficient ripeness and therefore for high fruit quality.

Power quality assessment and power quality improvement in hospital facility

The power quality (PQ) assessment is carried out at a KIMS hospital facility by conducting the harmonic study as per IEEE3002.8 guidelines. As per PQ data obtained, the hospital facility is experiencing a significant number of PQ disturbances and violating IEEE519 limits for PQ in special application systems. It is found necessary to use a compensator for PQ improvement. A cost-effective compensator, DVR, is designed to improve PQ in the hospital facility. The designed DVR controller model is tested in the RT-LAB hardware-in-the-loop real-time simulation platform using OPAL-RT with multicore FPGA processors to validate the compatibility of the designed controller to be applied for real system implementation. Thus, PQ assessment helps in the appropriate design of compensating controllers to suit practicality. A comparative study of choice of designed DVR controllers such as PI, Fuzzy, ANN, ANFIS-PI optimised and ANFIS-Fuzzy optimised controllers tested in real-time for different cases and for different loading conditions are summarised.

Power quality assessment and power quality improvement in a hospital facility

Power quality assessment and power quality improvement in a hospital facility

Professional Roles of Oncologic Specialty Physical Therapists in the United States

Background: Oncologic specialty physical therapists (OncPTs) are a growing discipline in the cancer workforce. The complexities of cancer care delivery and the multidimensional nature of cancer care teams require oncology providers to serve in professional roles beyond clinical care. This project aims to assess the professional roles that OncPTs play in cancer care delivery. Methods: A 27-item survey was developed by the Oncologic Specialty Council of the American Board of Physical Therapy Specialties and sent electronically to board-certified oncologic clinical specialists in the United States. The survey was open for 45 days. Demographics of the population and frequency data were analyzed in Qualtrics. Results: Fifty-seven complete surveys were received out of 106 eligible specialists (response rate 53%). Respondents were predominantly female (91%) and White (78%). Fifty-six percent (n = 32) had greater than 15 years of practice experience and 68% (n = 39) held DPTs. Seventy-three percent reported greater than 50% of their work week dedicated to oncology practice and 52.6% reported providing consultations or treatment in the physical space of a cancer center. All respondents have been board-certified OncPTs for at least 1 year. Providing clinical care accounted for 71% of the cohorts' work time and 14% was spent in program development (outside of clinical care). Specialists reported oncology-specific program development responsibilities across 3 themes: workforce development (mentoring and teaching peers and staff), establishing clinical practice standards (standardizing assessment tools and clinical pathways), and program assessment (quality improvement and research). The OncPT professional roles included leadership responsibilities within their health system (n = 24) and leadership or committee roles in rehabilitation-specific professional organizations (n = 55). No respondents reported serving in roles regarding research mentorship or advising on state policy or payer issues, and 1 respondent identified a role in advising on federal policy issues. Conclusion: Oncologic specialty physical therapists primarily serve clinical patient care roles. Aside from clinical practice, program development roles focus on rehabilitation-centric staff and student education and clinical pathways for rehabilitation care delivery. However, at the cancer care delivery system level, participation in professional roles beyond the rehabilitation clinic is less frequent. Gaps in participation are identified at the societal level with no representation from this cohort in payment and policy initiatives at the state and federal levels. We provide a roadmap to action that describes multilevel interventions to improve the integration of OncPTs into cancer care delivery. These findings may inform competencies for clinical specialists and guide residency program development.

An Effective and Secure Quality Assurance System for a Computer Science Program

Improving the quality assurance (QA) processes and acquiring accreditation are top priorities for academic programs. The learning outcomes (LOs) assessment and continuous quality improvement represent core components of the quality assurance system (QAS). Current assessment methods suffer deficiencies related to accuracy and reliability, and they lack well-organized processes for continuous improvement planning. Moreover, the absence of automation, and integration in QA processes forms a major obstacle towards developing efficient quality system. There is a pressing need to adopt security protocols that provide required security services to safeguard the valuable information processed by QAS as well. This research proposes an effective methodology for LOs assessment and continuous improvement processes. The proposed approach ensures more accurate and reliable LOs assessment results and provides systematic way for utilizing those results in the continuous quality improvement. This systematic and well-specified QA processes were then utilized to model and implement automated and secure QAS that efficiently performs quality-related processes. The proposed system adopts two security protocols that provide confidentiality, integrity, and authentication for quality data and reports. The security protocols avoid the source repudiation, which is important in the quality reporting system. This is achieved through implementing powerful cryptographic algorithms. The QAS enables efficient data collection and processing required for analysis and interpretation. It also prepares for the development of datasets that can be used in future artificial intelligence (AI) researches to support decision making and improve the quality of academic programs. The proposed approach is implemented in a successful real case study for a computer science program. The current study serves scientific programs struggling to achieve academic accreditation, and gives rise to fully automating and integrating the QA processes and adopting modern AI and security technologies to develop effective QAS.

Evaluation of assessment marks in the clinical years of an undergraduate medical training programme: Where are we and how can we improve?

Background. In high-stakes assessments, the accuracy and consistency of the decision to pass or fail a student is as important as the reliability of the assessment. Objective. To evaluate the reliability of results of high-stakes assessments in the clinical phase of the undergraduate medical programme at the University of the Free State, as a step to make recommendations for improving quality assessment. Methods. A cohort analytical study design was used. The final, end-of-block marks and the end-of-year assessment marks of both fourth-year and final-year medical students over 3 years were compared for decision reliability, test-retest reliability, stability and reproducibility. Results. 1 380 marks in 26 assessments were evaluated. The G-index of agreement for decision reliability ranged from 0.86 to 0.98. In 88.9% of assessments, the test-retest correlation coefficient was &lt;0.7. Mean marks for end-of-block and end-of-year assessments were similar. However, the standard deviations of differences between end-of-block and end-of-year assessment marks were high. Multiple-choice questions (MCQs) and objective structured clinical examinations (OSCEs) yielded good reliability results. Conclusion. The reliability of pass/fail outcome decisions was good. The test reliability, as well as stability and reproducibility of individual student marks, could not be accurately replicated. The use of MCQs and OSCEs are practical examples of where the number of assessments can be increased to improve reliability. In order to increase the number of assessments and to reduce the stress of high-stake assessments, more workplace-based assessment with observed clinical cases is recommended.

Bridging health technology assessment and healthcare quality improvement using international consortium of health outcomes measurement standard sets.

Although health technology assessment (HTA) and healthcare quality improvement are distinct processes, a greater level of alignment in outcome measures used may increase the quality and efficiency of data collection. This study evaluates the agreement in outcome measures used in oncology for healthcare quality improvement and HTAs, and how these align to the International Consortium for Health Outcomes Measurement (ICHOM) standard sets. We conducted a cross-sectional comparative analysis of ICHOM sets focusing on oncological indications and publicly available measures for healthcare quality and HTA reports published by the National Health Care Institute from the Netherlands and the National Institute for Health and Care Excellence from the United Kingdom. All ICHOM sets and HTAs used overall survival, whereas quality improvement used different survival estimates. Different progression estimates for cancer were used in HTAs, ICHOM sets, and quality improvement. Data on health-related quality of life (HRQoL) was recommended in all ICHOM sets and all HTAs, but selectively for quality improvement. In HTAs, generic HRQoL questionnaires were preferred, whereas, in quality improvement and ICHOM sets, disease-specific questionnaires were recommended. Unfavorable outcomes were included in all HTAs and all ICHOM sets, but not always for quality improvement. Although HTA and quality improvement use outcome measures from the same domains, a greater level of alignment seems possible. ICHOM may provide input on standardized outcome measures to support this alignment. However, residual discrepancies will remain due to the different objectives of HTA and quality improvement.

COVID-19 Teleconferencing Experiences of Caregivers &amp; Spouses with Dementia from QA/QI Support Group Study

In summer 2020, researchers conducted a Quality Assurance and Quality Improvement (QA/QI) assessment of the NYU Langone Alzheimer’s Disease and Related Dementias Family Support Program’s adaptations in response to COVID by interviewing 10 participating spouse caregivers of persons with dementia (PWD). The primary adaptations were shifting from in-person to online services, changing support groups from biweekly to weekly, and offering an arts-based group for PWD daily rather than weekly. In the course of these interviews, all respondents described their adaptation to remote teleconferencing programming, and five also contrasted their experiences with those of the PWD. Methods: After transcription and de-identification, a codebook was created from the transcript content that included a priori topics of interest as well as emergent themes using framework analysis. These transcripts were then coded by two independent coders through an iterative process and consultation with the codebook creator, who also resolved any discrepancies between coders. Results: Respondents reported largely successful transitions to teleconferencing for themselves, though missing the physical contact afforded by meeting in-person. However, they also described some interactional challenges related to participants talking over one another, and suggested more active moderating to facilitate greater turn-taking. The respondents’ descriptions of the PWD’s response suggested a much less successful transition to teleconferencing. Challenges and barriers included lack of interest, difficulty following or participating in conversation, and teleconferencing creating confusion, such making it “hard for her to separate out when everybody's in the same place or not."

Psikoterapi Pemberdayaan: Berbagi Tiga Hal Baik untuk Mengatasi Burnout Perawat di Era COVID-19

This study aims to identify problems and determine improvement strategies to overcome burnout nurses. The research method used is a case report to assess quality improvement with an 8-step approach to change starting from problems with observation and screening of burnout using the Maslach Burnout Inventory Human Services Survey (MBI-HSS), analysis using a fishbone approach, determining improvement strategies, implementing and program evaluation. The results showed that 55% of nurses experienced a decrease in self-esteem, but through the Empowerment Psychotherapy program: Three Good Things, which was carried out for two weeks, it was able to reduce the burnout level of nurses as assessed by the Mini Z burnout survey. In conclusion, Empowerment Psychotherapy: Three Good Things can overcome nurse burnout problems. It is recommended that the implementation of this program be carried out thoroughly in all work units.&#x0D; Keywords: Burnout Management, Nurses, Empowerment Psychotherapy, Three Good Things

Pediatric Home Tracheostomy Care: The Importance of Knowledge Assessment

Assessment of caregiver knowledge is an essential part of home healthcare education for pediatric tracheostomy care, however, there is a paucity of evidence in long term. This study aims to determine how caregiver knowledge and misconceptions, as assessed by our knowledge test, changed over a 12-month period following our educational program and whether the test score was associated with any demographics of the caregivers and children with tracheostomy. A prospective cohort study was undertaken to evaluate the knowledge at 3 timepoints after tracheostomy education: baseline (T1), 6 months (T2), and 12 months (T3). Test scores were analyzed for trend and relationship with demographics. Items for which less than 80% caregivers gave correct responses at T1 were considered common misconceptions. Fifty-four caregivers were enrolled. Out of a maximum score of 25, the median (IQR) scores were 22 (21-23), 23 (22-24), and 23 (22-25), at T1, T2, and T3, respectively. The scores at T2 and T3 were significantly higher than at T1 ( P ≤ .01). One common misconception “how to manage when suction got less secretion than expected” was found at all timepoints. Caregivers of children with &gt;2 comorbidities scored slightly higher than those of children with 0 to 2 comorbidities ( P = .01). In conclusion, our caregivers achieved high knowledge scores which increased over the 12-month study period potentially because of repeated assessment and practical experience. Common misconceptions and a factor associated with the knowledge were also identified. These advantages highlighted the importance of knowledge assessment for quality improvement.

Evaluation of an oncology diagnostic and screening clinic at a large safety net hospital.

94 Background: Increasingly, dedicated clinics have been established to expedite patients with suspicion of malignancy into cancer care. The Lyndon B. Johnson General Hospital (LBJGH) is part of the Harris County Hospital District (HCHD), serving the third largest county in the United States. A 2012 study at our institution found long mean ambulatory wait times for the diagnosis of breast, colon, and lung cancers (77.1 days, 65.4 days, and 70.8 days, respectively). The LBJGH Oncology Diagnostic and Screening clinic (DSC) was subsequently established to reduce ambulatory diagnostic times, decrease frequency of admissions, and improve patient outcomes. Our present study sought to establish the effectiveness of the DSC in bringing patients into care. Methods: The charts of 100 new patients seen in the DSC between August 2018 and November 2020 were reviewed. Demographic data, insurance status, date of referral to the DSC, date of first DSC visit, date biopsy or outside pathology ordered, date biopsy performed or outside pathology obtained, total number of visits to the DSC, and total time from initial DSC visit to initial oncology clinic visit were collected, as well as cancer stage upon arrival to the oncology clinic. The project was approved by the MD Anderson Quality Improvement Assessment Board and the Harris Health Quality Improvement Committee. Results: 57% of patients seen in the DSC were referred by the emergency department, and 23% by a PCP. The median time from referral to initial visit in the DSC was 19 days. 26% of patients had a known cancer diagnosis at the time of referral. The median time from biopsy ordered to performed was 39 days, and the median time from pathology requested to obtained was 23 days. The median total number of visits per patient to the DSC was 2. 48% of patients seen in the DSC were ultimately diagnosed with cancer, 29% had a benign condition, and 23% were lost to follow up. Of those patients with confirmed malignancy, 46% of patients had stage IV disease at their first oncology clinic visit. The average time from initial DSC visit to initial visit at the oncology clinic was 53 days. Conclusions: Establishment of an oncology DSC has improved the ambulatory wait time for entry into oncologic care from an average of approximately 70 days to an average of 53 days. However, almost half of patients referred from the DSC had stage IV disease at their initial oncology visit, indicating an urgent need to further expedite entry of these patients into oncologic care. Avenues for future quality improvement efforts include an expedited process to obtain outside pathology results, implementation of an “e-consult” option for PCPs to avoid unnecessary referrals, and a close analysis of insurance and financial barriers to entry into care. Reference: Mougalian SS, Wang J, Zarzour M et al. Feasibility and savings of a suspicion of cancer clinic at a large county hospital. JCO 2012; 30 (34 supplement): 104.

Patterns of virtual care among long-term cancer survivors.

335 Background: The recent pandemic led to an untypical demand for virtual care visits in our comprehensive cancer center. Our institution responded to this paradigm shift by offering virtual care to all cancer patients, including cancer survivors. In place of an in-person visit, patients were offered a live video or telephone (audio) appointment for their survivorship clinic visit. We conducted a quality improvement study to identify patterns in the type of virtual visits preferred by patients scheduled for appointments in eight dedicated survivorship clinics. Methods: We conducted a retrospective review of 4784 patients’ medical records who were seen in eight site-specific survivorship clinics from April 2020 – April 2021. Variables reviewed included type of visit, i.e. telephone, live video, or in-person, and patient characteristics such as age, gender, clinic, and distance from cancer center. Descriptive statistics were performed to assess for patterns of virtual care. The review was approved by the Quality Improvement Assessment Board. Results: Virtual care visits varied by clinic (0-86%). Five clinics ((breast, lymphoma, sarcoma, melanoma, and gynecological) performed &lt; 3% of visits using virtual format. A sub-analysis of the 8 clinics performing virtual visits demonstrates 59.5% virtual activity (19.23% phone compared to 39.3% video). Older patients were more likely to use any form of virtual visit compared to in-person (58.9% for those ≥ 65 vs. 54.9% for 18-39). Older patients were more likely to prefer phone visits (25.5% for ≥ 65 vs. 11.2% for 18-39). Local patients were more likely to utilize virtual visits (63% for patients &lt; 75 miles vs. 45% for patients &gt; 500 miles). Patients who lived furthest from the cancer center were more likely to travel in for their appointment, though this population contained fewer patients than those within 75 miles. Use of virtual visits for survivorship care varied, depending on the types of clinical diagnostic tests or examinations required for an annual visit. Conclusions: Our results indicate the use of virtual care was optimal when only lab testing was ordered by their provider. Older adults, with no or limited access to and knowledge of digital technology (computers, smartphones, and others similar tools) may need additional support to engage in video visits. Our findings suggest virtual care can be successfully implemented in the care of survivors. Further research would help determine best-practice approaches to facilitating patient engagement in virtual visits since telemedicine continues to evolve as a standard method to deliver safe and optimal cancer care.

Implementation of ePROs in the care of long-term cancer survivors.

334 Background: Standard methods for implementation of electronic patient reported outcomes (ePROs) in the routine care of cancer survivors remain unclear. To address this gap, we assessed the technical and operational feasibility of implementing ePROs into the clinical workflow of four survivorship clinics, Genitourinary (GU), Head &amp; Neck (HN), Thyroid (THY), and Stem Cell Transplant (SCT). Methods: This quality improvement study was conducted from 9/1/2019 to 4/30/2021. Benchmarks of ≥ 50% were established for two outcomes including: (1) Delivery Rate - percentage of patients who received the ePRO prior to their clinic visit and (2) Adherence Rate - percentage of patients who completed one ePRO. Data were collected at T0 (Baseline) (09/01/2019 to 12/31/2020) and T1 (1/1/2021 to 4/30/2021). Patients completed the survey 3-7 days prior to a clinic visit. The timing to capture ePROs’ data was tailored to the specific cancer site. Operational steps were: 1) questionnaire was ordered for scheduled survivorship appointment; 2) electronic medical record system (EMRS) pushed the questionnaire to the patient portal app with a message asking the patient to complete and submit the ePROs survey, 3) data was pushed back to the provider by the EMRS; and 4) results stored in the medical record were accessed by the provider prior to or on the day of the patient’s visit. Data were collected and stored using the EPIC Data Universes and reported through Microsoft Power BI. This institutional Quality Improvement Assessment Board approved this study. Results: The Table shows the improvement in the benchmark for sent and adherence rates between T0 and T1. A few clinics showed room for improvement. Patient engagement facilitators included being scheduled for a virtual visit and having staff sent prompts prior to visits. Challenges were: (1) variation in the time ePROs were available in the medical records, 2) inconsistent linking of scheduled visits and prompt to send the survey, and 3) patients’ not opening, completing, or submitting the survey even when prompted to do so. Opportunities included (1) developing a patient education flyer describing ePROs’ role in patient care, (2) providing instruction on the completion and completion of how to complete the ePRO, and (3) conducting staff education sessions on how to link scheduled visits with ePROs’ patient prompts. Conclusions: Our preliminary results indicate that integration ePROs can be considered an acceptable approach to improve follow-up care of cancer survivors but with room for improvement in some clinics. Future evaluation will further explore patients’ ePROs’ impact on clinical outcomes and patient engagement.[Table: see text]

Delivery room thermal care interventions in preterm neonates.

Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Pullattayil AK, Thanigainathan S, Trevisanuto D, Roehr CC. Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr. 2021 May 24:e210775. 10.1001/jamapediatrics.2021.0775. Epub ahead of print. PMID: 34028513; PMCID: PMC8145154. Preterm neonates are at increased risk for hypothermia after birth which is an independent predictor for neonatal mortality and morbidity.1, 2 Maintaining normal temperature is a key initial step in stabilisation of the newborn at birth.3 Several interventions to prevent hypothermia in the delivery room have been studied either solely or in combinations.4-7 The neonatal life support task force suggested using a combination of different interventions to prevent hypothermia on neonatal admission to the NICU.3 However, this suggestion was based on relatively old evidence with weak recommendations and very low certainty. This network meta-analysis was conducted on 34 randomised and quasi-randomised controlled trials including 3688 preterm, ≤36 weeks gestation and infants aiming to identify thermal care intervention in the delivery room that can best reduce neonatal hypothermia and improve clinical outcomes. The researchers compared eight interventions to routine care and found that most of the interventions were associated with higher core body temperature. They found that plastic bag or wrap alone, thermal mattress, and plastic bag or wrap with heated humidified gas were associated with reduced risk of moderate to severe hypothermia compared with routine care. The SUCRA analysis showed that the combination of plastic bag or wrap with a thermal mattress was the best intervention to improve core body temperature at admission, but direct evidence from pairwise comparisons indicated that this combination increases the risk of hyperthermia. In sensitivity analyses, plastic bag and plastic wrap were equally good at maintaining core body temperature, the effect of interventions in improving temperature was consistent among preterm infants ≤30 weeks gestation, and drying did not make a difference compared to no drying before the application of plastic bag or wrap. Authors found that the use of a plastic bag or wrap with heated humidified gas was associated with reduced risk of major brain injury and a plastic bag or wrap with a plastic cap was associated with lower risk of mortality. Major strengths of this study are the use of network meta-analysis which can inform comparative effectiveness in the presence of multiple interventions, the systematic search strategy, and clinically relevant interventions and outcomes. However, the study is limited by wide differences in the method of temperature measurement between included trials, inability to perform analysis of some secondary outcomes due to data limitation, small sample size of the included trials and low event rates for the primary outcome leading to possible selective reporting and publication bias, and inability to access unpublished data from the included studies.5 Although, the majority of thermal care interventions were associated with better core body temperature and decreased risk of moderate to severe hypothermia at admission or within the first 2 h of life compared with routine care, the certainty of evidence ranged from very low to moderate for the primary and secondary outcomes. Future, adequately powered, randomised controlled trials are needed to determine the best combination of interventions to prevent hypothermia with no risk of hyperthermia and to assess quality improvement bundle of hypothermia preventive measures to assess the individual benefit for each newborn. https://ebneo.org/preterm-thermal-care None.

Health Outcomes Management Evaluation-A National Analysis of Dutch Heart Care.

AimsA group of heart centres in the Netherlands have been at the forefront internationally to implement the principles of value-based healthcare. This study aims to give an up-to-date assessment of outcome-based quality improvement in 2020 at a national level in Dutch heart care.Methods and resultsPhysicians and healthcare professionals for each participating hospital filled out a questionnaire with 26 detailed questions on quality improvement and organization of care. In total, 20 hospitals participated; 11 heart centres with thoracic surgery and 9 without thoracic surgery. Results show that outcome reports are actively used within the heart centres to support quality improvement initiatives. In 50% of the centres, apart from physicians, also nurses and hospital management are involved. For 60% of the heart centres, outcome measurement is embedded in strategy and annual plans. The stage of development of supporting IT infrastructure (outcome measurement in the Electronic Health Record and dashboards) is very diverse. A wide range of different learning strategies supports outcome-based quality improvement.ConclusionHealth outcomes have become a relevant element in quality improvement and organization of Dutch heart centres. Earlier research shows that in 2012–2016 heart centres focused mainly on measuring outcomes. Now in 2020, heart centres are more able to actually use the acquired insights based on these measurements to initiate improvement projects. The diversity in how this is done indicates that this field is still strongly developing and shows potential for heart centres to share best practices in the implementation of value-based healthcare.