Changes In Quality Indicators Research Articles

Improving maternity care in the Dominican Republic: a pilot study of a community-based participatory research action plan by an international healthcare team.

This article is a report of the process and results of a feasibility pilot study to improve the quality of maternity care in a sample of 31 women and their newborns delivering in a public, tertiary hospital in the Dominican Republic. The pilot study was the first "action step" taken as a result of a formative, community-based participatory research (CBPR) study conducted between 2008 and 2010 by an interdisciplinary, international partnership of U.S. academic researchers, Dominican medical/nursing personnel, and Dominican community health workers. Health personnel and community health workers separately identified indicators most important to measure quality of antepartum maternity care: laboratory and diagnostic studies and respectful, interpersonal communication. At the midpoint and the completion of data collection, the CBPR team evaluated the change in quality indicators to assess improvement in care. The pilot study supports the idea that joint engagement of community health workers, health personnel, and academic researchers with data creation and patient monitoring is motivating for all to continue to improve services in the cultural context of the Dominican Republic.

Implementing and Evaluating Electronic Standing Orders in Primary Care Practice: A PPRNet Study

A standing order (SO) authorizes nurses and other staff to carry out medical orders per practice-approved protocol without a clinician's examination. This study implemented electronic SOs into the daily workflow of primary care practices; identified methods and strategies; determined barriers and facilitators; and measured changes in quality indicators resulting from electronic SOs. Within 8 practices using the Practice Partner® electronic health record (EHR), a customized health maintenance template provided SOs for screening, immunization, and diabetes measures. EHR data extracts were used to calculate the presence and use of these measures on health maintenance templates and performance over 21 months. Qualitative observation/interviews at practice site visits, network meetings, and correspondence enabled synthesis of implementation issues. Improvements in template presence, use, and performance were found for 14 measures across all practices. Median improvements in screening ranged 6% to 10%; immunizations, 8% to 17%, and diabetes, 0% to 18%. Two practices achieved significant improvement on 14 of the 15 measures. All practices significantly improved on at least 3 of the measures. A small sample of primary care practices implemented SOs for screening, immunizations and diabetes measures supported by PPRNet researchers. Technical competence and leadership to adapt EHR reminder tools helped staff adopt new roles and overcome barriers.

Reporting of quality indicators and improvement in hospital performance: the P.Re.Val.E. Regional Outcome Evaluation Program.

To evaluate whether reporting of hospital performance was associated with a change in quality indicators in Italian hospitals. Nationwide Hospital Information System for 2006-2009. We performed a pre-post evaluation in Lazio (before and after disclosure of the Regional Outcome Evaluation Program P.Re.Val.E.) and a comparative evaluation versus Italian regions without comparable programs. We analyzed risk-adjusted proportions of percutaneous coronary intervention (PCI), hip fractures operated on within 48 hours, and cesarean deliveries. Using standardized ICD-9-CM coding algorithms, we selected 381,053 acute myocardial infarction patients, 250,712 hip fractures, and 1,736,970 women who had given birth. In Lazio PCI within 48 hours changed from 22.49 to 29.43 percent following reporting of the P.Re.Val.E results (relative increase, 31 percent; p < .001). In the other regions this proportion increased from 22.48 to 27.09 percent during the same time period (relative increase, 21 percent; p < .001). Hip fractures operated on within 48 hours increased from 11.73 to 15.78 percent (relative increase, 34 percent; p < .001) in Lazio, and not in other regions (29.36 to 28.57 percent). Cesarean deliveries did not decrease in Lazio (34.57-35.30 percent), and only slightly decreased in the other regions (30.49-28.11 percent). Reporting of performance data may have a positive but limited impact on quality improvement. The evaluation of quality indicators remains paramount for public accountability.

University Rankings in Action? The Importance of Rankings and an Excellence Competition for University Choice of High-Ability Students

This paper analyzes how high-ability students respond to different indicators of university quality when applying for a university. Are some quality dimensions of a ranking, e.g. research reputation or mentoring more important than others? I estimate a random utility model using administrative application data of all German medical schools. As identification relies on the variation in quality indicators over time, I can disentangle the response to changes in quality indicators from the common knowledge regarding the overall university attractiveness. Results show that the ranking provides more relevant information in the quality dimensions mentoring, infrastructure and students' satisfaction than with respect to research.

Effect of electron beam irradiation on quality indicators of peanut butter over a storage period

Electron beam (e-beam) irradiation is an effective non-thermal processing step for the reduction of Salmonella in peanut butter. The objective of this study was to evaluate the effects of e-beam irradiation on quality indicators of peanut butter. Peanut butter samples were exposed to a range of e-beam doses and examined over a 14-day period at 22°C. Colour analysis (L∗, a∗, b∗), spreadability, peroxide values (PV) and thiobarbituric acid reactive substances test (TBARS) for lipid oxidation were monitored, fatty acid and amino acid profiles were verified and protein degradation was determined by sodium dodecyl sulphate–polyacrylamide gel electrophoresis (SDS–PAGE). Changes in colour, PV, and TBARS were observed as e-beam dose increased. No significant changes in spreadability were observed (P>0.05). When applied to peanut butter, e-beam irradiation will produce significant changes in quality indicators; future studies should include sensory evaluation and consumer acceptance studies.

Improvement of wheat quality in cultivars released in Serbia during the 20thcentury

Twenty wheat varieties were analyzed to assess the contribution of 40-year breeding process to the advancement of wheat technological quality. A trial using a randomized block design with three replications was carried out during five growing seasons (2001–2005) that varied in temperature and rainfall conditions. Changes of quality were analyzed in the varieties from different breeding periods using linear regression analysis. Changes of quality indicators were expressed by regression coefficients. The studied varieties were released at 3–4-year intervals. The annual changes in genetic potentials were as follows: protein content — −0.03%, wet gluten — −0.14%, farinograph absorption — 0.04%, dough energy — 1.53 cm 2 , loaf volume — 2.94 ml, and baking score — 0.07. The decreases in the protein and wet gluten contents were compensated for by an improvement in protein quality. The increase in gluten structure stability and appropriate combinations of high molecular weight glutenin subunits have contributed t...

The influence of giant fibres on utility for production of massaged products of porcine muscle longissimus dorsi

Musculus longissimus dorsi (L) originating from 6 genotype groups of pigs was examined. Three among these were parental lines: Pietrain (Pi), Duroc (D), Polish Large White x Polish Landrace (PLW x PL), the other three crossbreeds obtained by crossing the aforementioned parental lines: (PLW x PL) x Pi, (PLW x PL) x (PixD) and (PLW x PL) x (D x Pi). It was found that there exists a variety of numbers and sizes of giant fibres and sizes of muscle fibres in the L muscle of the groups of animals, which results in a diversity of quality and susceptibility to massaging. The largest number of giant fibres and the greatest sizes of normal and giant fibres, along with the largest losses after heat treatment, the highest hardness, shear force, the lowest juiciness and attractiveness were found in the L muscle of Pi. Muscle of this breed was characterised by the least change in quality indicators during massaging. The decrease of Pi breed genes in the crossbreed genotype, resulted in reduction in the quantity of giant fibres and fibre sizes in comparison with pure Pi breed, which increased quality of crossbreeds' muscles and their susceptibility to massaging.

Multisite, quality‐improvement collaboration to optimise cardiac care in Queensland public hospitals

To evaluate changes in quality of in-hospital care of patients with either acute coronary syndromes (ACS) or congestive heart failure (CHF) admitted to hospitals participating in a multisite quality improvement collaboration. Before-and-after study of changes in quality indicators measured on representative patient samples between June 2001 and January 2003. Nine public hospitals in Queensland. Consecutive or randomly selected patients admitted to study hospitals during the baseline period (June 2001 to January 2002; n = 807 for ACS, n = 357 for CHF) and post-intervention period (July 2002 to January 2003; n = 717 for ACS, n = 220 for CHF). Provision of comparative baseline feedback at a facilitative workshop combined with hospital-specific quality-improvement interventions supported by on-site quality officers and a central program management group. Changes in process-of-care indicators between baseline and post-intervention periods. Compared with baseline, more patients with ACS in the post-intervention period received therapeutic heparin regimens (84% v 72%; P < 0.001), angiotensin-converting enzyme inhibitors (64% v 56%; P = 0.02), lipid-lowering agents (72% v 62%; P < 0.001), early use of coronary angiography (52% v 39%; P < 0.001), in-hospital cardiac counselling (65% v 43%; P < 0.001), and referral to cardiac rehabilitation (15% v 5%; P < 0.001). The numbers of patients with CHF receiving beta-blockers also increased (52% v 34%; P < 0.001), with fewer patients receiving deleterious agents (13% v 23%; P = 0.04). Same-cause 30-day readmission rate decreased from 7.2% to 2.4% (P = 0.02) in patients with CHF. Quality-improvement interventions conducted as multisite collaborations may improve in-hospital care of acute cardiac conditions within relatively short time frames.