Quality Assessment Improvement Research Articles

Longitudinal Digital Glucometric Benchmarking to Evaluate the Impact of Institutional Diabetes Care Initiatives in Adults With Diabetes Mellitus Over the 2016-2020 Period.

While glucometric benchmarking has been used to compare glucose management between institutions, the value of longitudinal intra-institution benchmarking to assess quality improvement changes is not established. A prospective six-month observational study (October 2019-March 2020 inclusive) of inpatients with diabetes or newly detected hyperglycemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Networked blood glucose (BG) meters were used to collect capillary BG levels. Outcomes were measures of glycemic control assessed by mean and threshold glucometric measures and comparison with published glucometric benchmarks. Intra-institution comparison was over the 2016-2020 period. In all, 620 admissions (588 unique individuals) met the inclusion criteria, contributing 15 164 BG results over 4023 admission-days. Compared with the 2016 cohort from the same institution, there was increased BG testing (3.8 [SD = 2.2) vs 3.3 [SD = 1.7] BG measurements per patient-day, P < .001), lower mean patient-day mean glucose (PDMG; 8.9 mmol/L [SD = 3.2] vs 9.5 mmol/L [SD = 3.3], P < .001), and reduced mean and threshold measures of hyperglycemia (P < .001 for all). Comparison with institutions across the United States revealed lower incidence of mean PDMG >13.9 or >16.7 mmol/L, and reduced hypoglycemia (<3.9, <2.8, and <2.2 mmol/L), when compared with published benchmarks from an earlier period (2009-2014). Comprehensive digital-based glucometric benchmarking confirmed institutional quality improvement changes were followed by reduced hyperglycemia and hypoglycemia in a five-year comparison. Longitudinal glucometric benchmarking enables evaluation and validation of changes to institutional diabetes care management practices.

Implementation of Frailty Assessment Improves Veterans Affairs Surgical Quality Improvement Program Risk Assessment in General and Vascular Surgery Patients

INTRODUCTION: Frailty has been recognized as an important factor in preoperative risk evaluation. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) Surgical Risk Calculator, derived from chart elements, predicts surgical risk and incorporates many factors now recognized as markers of frailty. We examined the impact on VASQIP Surgical Risk prediction after implementation of a robust frailty assessment. METHODS: A prospective frailty assessment quality improvement project was implemented in general surgery (GenS) and vascular surgery (VascS) for new and preoperative VA patients starting October 2020. We examined the effectiveness of this assessment by comparing VASQIP Surgical Risk prediction with and without use of frailty assessment data. For comparison purposes, 3 operative case complexity groups were identified. RESULTS: A total of 205 patients were screened: 145 (71%) GenS and 60 (29%) VascS. Frailty screening identified issues not captured on routine surgical assessment in 77 (38%) patients; 20 (26%) of these patients were less than 65 years of age. The most common frailty factors captured include cognitive impairment (46% GenS, 47% VascS), dyspnea (19% GenS, 20% VascS), and impaired functional status (14% GenS, 13% VascS). Frailty identification increased VASQIP risk prediction with significant differences post–frailty assessment (p < 0.005; Table 1). Risk of 30-day surgical site infection, ICU admission, and postoperative admission also increased: 1% to 1.2%, 23% to 27.4%, and 72% to 79%, respectively (p < 0.001). Increasing case complexity was associated with higher score differences (p < 0.0001; Table 1). Table 1. - VASQIP Surgical Risk Score Comparison Variable 30-d mortality risk: pre-/postscreen * 180-d mortality risk: pre-/postscreen * 30-d morbidity risk: pre-/postscreen * p Value † Entire group 0.24%/0.31% 1.03%/1.17% 3.55%/3.84% <0.0001 Cases with differences 0.33%/0.61% 1.27%/2.21% 4.18%/4.77% <0.0001 Low case complexity 0.13%/0.15% 0.53%/0.66%‡ 1.78%/1.78%‡ <0.005‡ Moderate case complexity 0.17%/0.20% 0.85%/1.14% 2.14%/2.62% <0.0001 High case complexity 0.30%/0.38% 1.11%/1.42% 4.8%/6.14% <0.0001 Vascular surgery 0.51%/0.62% 1.20%/1.52% 4.24%/4.29% <0.005 General surgery 0.14%/0.18% 0.71%/1.01% 2.80%/3.48% <0.0001 *Median risk percentage displayed. Risk scores calculated with VASQIP Surgical Risk Calculator.†Wilcoxon Signed Ranks Test performed.‡Only 30-day mortality is <0.005; 180-day morality and 30-day morbidity differences were not statistically significant. CONCLUSION: Implementation of frailty assessment, in general, and vascular surgery patients significantly improves VASQIP Surgical Risk prediction. These findings emphasize the prevalence of frailty and the importance of presurgical frailty assessment for both geriatric and nongeriatric patients.

Scenario Analysis of Air Quality Improvement in Warsaw, Poland, by the End of the Current Decade

Very low air quality in the Warsaw conurbation, Poland, similarly to the case in many large European cities, poses a serious threat to the residents’ health, being a significant source of premature mortality. Many results presented in earlier publications indicated local heating installations and car traffic as the main emission categories responsible for this adverse population exposure, where the dominant polluting compounds are NOx, PM10, PM2.5, and BaP. The last two mainly originate from individual household heating installations, both in the city of Warsaw and in its vicinity. To reduce the health risk of air pollution, the city authorities have recently made fundamental decisions, related to the individual housing sector, aimed at the radical decarbonization of all heating installations in Warsaw and its surroundings. On the other hand, the ongoing modernization of the city’s car fleet (including individual and public transport), taking into account the restrictive EU emission standards, as well as the quickly growing share of electric and hybrid cars (BEVs and PHEVs), gives a good prospect of a fundamental improvement in air quality in Warsaw conurbation. The main subject of the paper is a quantitative assessment of the air quality improvement in the current decade (by 2030), resulting from the above modernization activities. The final results are expressed as the attributed reduction in population exposure, which was found to be 28–30% with respect to NOx and PM, and the associated health risk, i.e., 204 fewer avoidable deaths with respect to NOx and 607 fewer with respect to PM2.5.

Quality improvement project: Implementation of I-PASS, a structured patient hand-off tool to improve communication, increase patient safety, and prevent burnout among palliative care providers at a comprehensive cancer center.

65 Background: Communication among the health care providers plays a crucial role in team-based practices, and a standardized communication platform is essential. Our palliative care consult service (PCCS) at a university-based cancer center manages cancer-related symptoms. The handoff process among the providers takes place via encrypted emails shared among the providers. The current demand for palliative care (PC) among the cancer population led to increased patient encounters and associated handoff emails. Numerous handoff emails (sometimes up to 25-30/day) can lead to missing/overlooked information, cause burnout among the providers, and affect patient safety. Studies have shown that implementing I-PASS into clinical practices has significantly reduced medical errors without increasing documentation time. We aimed to improve communication among the PC providers, prevent burnout and increase patient safety by using a built-in I-PASS handoff tool on electronic medical records (EMR). Methods: In January 2021, we formed a team to develop a quality improvement (QI) project to implement I-PASS for our PCCS at our institution. The institutional Quality Improvement Assessment Board approved this QI project. Our team started with Plan, Do, Study, Act. After extensive brainstorming, we mapped out the Cause-and-effect diagram (Fishbone). We laid out a Process mapping through a flowchart and Feasibility impact matrix. The implementation process took place in 4 phases. Phase 1: A per-implementation survey. Phase 2: Extensive training sessions for PC clinicians, both, 1:1 and group sessions. Phase 3: October 2021 I-Pass implementation went live. Phase 4: post-implementing survey to assess provider reception. Results: Based on real-time assessment on EMR, at four months mark, we reached the 100% utilization goal for I-PASS among PC clinicians. In Pre vs. Post-implementation survey, providers perceived they could identify their patient's related information, save time, update handoff daily and locate their assignments without any efforts on I-PASS compared to email handoff (p &lt; 0.0001). Overall, 95% of the PC providers found I-PASS helpful. Conclusions: Standardized communication tools such as I-PASS have proven safe and effective and help prevent provider burnout by improving overall workflow. Future studies need to focus on steps to continue developing tools to help modify the handoff on Smartphone EMR applications such as HAIKU.

A pain and stress assessment and management quality improvement initiative to align with the BEST START recommendations

The aim of this quality improvement project was to improve and standardise pain and stress management practices and processes within a 34-bed Level III neonatal unit. Results demonstrated a statistically significant improvement in staff perceptions regarding education and training specific to traumatic stress as well as pain and stress assessment and management practices (p < 0.05). Building more confidence and competence with staff to utilise breastfeeding and skin-to-skin practices as primary non-pharmacologic interventions during painful and stressful procedures is a future opportunity for continued quality improvement. As NICU practice continues to evolve, clinicians must not lose sight of their role as advocates in meeting the human needs of those they serve within this highly technological environment. Pain and stress assessment and management is a first step in providing loving, compassionate, trauma informed, developmental care.

Elucidating tricuspid Doppler signal interpolation and its implication for assessing pulmonary hypertension.

Doppler echocardiography plays a central role in the assessment of pulmonary hypertension (PAH). We aim to improve quality assessment of systolic pulmonary arterial pressure (SPAP) by applying a cubic polynomial interpolation to digitized tricuspid regurgitation (TR) waveforms. Patients with PAH and advanced lung disease were divided into three cohorts: a derivation cohort (n = 44), a validation cohort (n = 71), an outlier cohort (n = 26), and a non‐PAH cohort (n = 44). We digitized TR waveforms and analyzed normalized duration, skewness, kurtosis, and first and second derivatives of pressure. Cubic polynomial interpolation was applied to three physiology‐driven phases: the isovolumic phase, ejection phase, and “shoulder” point phase. Coefficients of determination and a Bland−Altman analysis was used to assess bias between methods. The cubic polynomial interpolation of the TR waveform correlated strongly with expert read right ventricular systolic pressure (RVSP) with R 2 > 0.910 in the validation cohort. The biases when compared to invasive SPAP measured within 24 h were 6.03 [4.33; 7.73], −2.94 [1.47; 4.41], and −3.11 [−4.52; −1.71] mmHg, for isovolumic, ejection, and shoulder point interpolations, respectively. In the outlier cohort with more than 30% difference between echocardiographic estimates and invasive SPAP, cubic polynomial interpolation significantly reduced underestimation of RVSP. Cubic polynomial interpolation of the TR waveform based on isovolumic or early ejection phase may improve RVSP estimates.

A systematic assessment of city-level climate change mitigation and air quality improvement in China

China is facing dual challenges of air pollution and climate change. By using city-level data, we comprehensively assessed air quality and CO2 emission changes from 2015 to 2019 for 335 Chinese cities. We selected important regions for air pollution control and categorized all cities into different classes according to their development levels. Our novel approach revealed new insights on different patterns of changes of PM2.5, O3, and CO2 by region and city class. We found that PM2.5 concentrations decreased remarkably due to mandatory city-level reduction targets, especially in the Beijing-Tianjin-Hebei (−27%) region. Nonetheless, O3 concentrations and CO2 emissions increased in 91% and 69% of Chinese cities, respectively. Observed CO2 emission reductions in more developed cities were mainly due to prominent energy intensity reduction and energy structure improvement. Our study indicates a lack of synergy in air pollution control and CO2 mitigation under current policies in China. To address both challenges holistically, we suggest setting mandatory city-level CO2 emission reduction targets and reinforcing clean energy and energy efficiency measures.

Yoga for firefighters: Evaluation of a quality improvement program in California fire departments

BackgroundFirefighters experience high levels of physical and mental challenges. Yoga interventions have suggested benefits for firefighters. MethodsThis study reports results from a quality improvement assessment at fire departments with a 10-class yoga program. Main outcome is the total score on the Functional Movement Scale (FMS), an observer-based objective performance measure. A score of at least 14 [range 0–20] is considered as protective against injury. Secondary outcome is the score on the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire, a self-report measure for interoceptive bodily awareness as a parameter for a mechanism of action with yoga. We used descriptive statistics and regression analyses. ResultsBoth total FMS and MAIA scores improved statistically significantly. The strongest performance improvement was seen in trunk stability. The mean FMS score improved from below 14 to 14 and higher indicating a decrease in the risk for injury. Changes in FMS and MAIA did not appear to be correlated. DiscussionDespite the limitation of the study design, the findings support the potential benefits from a yoga program for firefighters.

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 a hospital facility

Power quality assessment and power quality improvement in a hospital facility

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.

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.