Clinical Quality Performance Research Articles

The association between care integration and care quality.

The study aims to analyze the relationship between care integration and care quality, and to examine if the relationship varies by patient risk. The key independent variables used validated measures derived from a provider survey of functional (i.e., administrative and clinical systems) and social (i.e., patient integration, professional cooperation, professional coordination) integration. Survey responses represented data from a stratified sample of 59 practice sites from 17 health systems. Dependent variables included three quality measures constructed from patient-level Medicare data: colorectal cancer screening among patients at risk, patient-level 30-day readmission, and a practice-level Healthcare Effectiveness Data and Information Set (HEDIS) composite measure of publicly reported, individual measures of ambulatory clinical quality performance. We obtained quality- and beneficiary-level covariate data for the 41,966 Medicare beneficiaries served by the 59 practices in our survey sample. We estimated hierarchical linear models to examine the association between care integration and care quality andthe moderating effect of patients' clinical risk score. We graphically visualized the moderating effects at ±1 standard deviation of our z-standardized independent and moderating variables and performed simple slope tests. Our analyses uncovered a strong positive relationship between social integration, specifically patient integration, and the quality of care a patient receives (e.g., a 1-point increase in a practice's patient integration was associated with 0.31-point higher HEDIS composite score, p < 0.01). Further, we documented positive and significant associations between aspects of social and functional integration on quality of care based on patient risk. The findings suggest social integration matters for improving the quality of care and that the relationship of integration to quality is not uniform for all patients. Policymakers and practitioners considering structural integrations of health systems should direct attention beyond structure to consider the potential for social integration to impact outcomes and how that might be achieved.

Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017.

Medicare Advantage (MA) enrollment growth could make it difficult for MA plans to maintain their track record of limiting discretionary utilization while delivering higher-quality care than traditional Medicare. We compared quality and utilization measures in Medicare Advantage and traditional Medicare in 2010 and 2017. Clinical quality performance was higher in MA health maintenance organizations (HMOs) and preferred provider organizations (PPOs) than in traditional Medicare for almost all measures in both years. MA HMOs outperformed traditional Medicare on all measures in 2017. MA HMOs' performance on nearly all seven patient-reported quality measures improved, and MA HMOs outperformed traditional Medicare on five of those measures in 2017. MA PPOs performed the same as or better than traditional Medicare on all but one patient-reported quality measure in 2010 and 2017. The number of emergency department visits was 30percent lower, the number of elective hip and knee replacements was approximately 10percent lower, and the number of back surgeries was almost 30percent lower in MA HMOs than in traditional Medicare in 2017. Utilization trends were similar in MA PPOs, but differences from traditional Medicare were narrower. Despite increased enrollment, overall utilization remains lower in Medicare Advantage than in traditional Medicare, whereas quality performance is the same or higher.

Alternative information processing mechanisms in hospital supply chains: Impact on cost, quality, and patient satisfaction

AbstractHospitals are under tremendous pressure to improve multiple performance dimensions that may be at odds, including cost containment, clinical quality, and patient satisfaction. The need to improve performance on multiple fronts is compounded by sources of uncertainty that include upstream diversity of supply chain (SC) partners, internal diversity of clinical specialties provided, and downstream diversity of patient conditions. Information processing theory (IPT) suggests two strategies for dealing with uncertainty: reduce the amount of information elevated to higher levels for processing and accommodate the amount of information by increasing information processing at other levels. We apply IPT to investigate (i) the relationship between the two information processing strategies in a hospital's SC and its cost containment, clinical quality, and patient satisfaction performance, and (ii) how these relationships may be moderated by diversity in the hospital's SC partners, clinical specialties, and patients, the common sources of uncertainty in hospital SCs. These questions were examined using regression analysis of primary data from acute care hospitals matched with secondary data from the Centers for Medicare and Medicaid Services, American Hospital Association and the Agency for Healthcare Research and Quality measuring hospital operating characteristics and performance. The analysis yielded several important findings: (i) while a slack resources strategy (uncertainty reduction) is effective for improving patient satisfaction performance, it is ineffective for reducing cost, (ii) a lateral relations strategy (uncertainty accommodation) is effective in improving all three performance dimensions, and (iii) these relationships are moderated differentially by the three diversity dimensions only for lateral relations. These findings offer important managerial insights about hospitals’ efforts to improve potentially conflicting performance outcomes and suggest interesting opportunities for future research applying IPT to this important topic.

Effects of affiliation network membership on hospital quality and financial performance.

To examine the effects of hospital membership in affiliation networks-franchise-like networks sponsored by high-quality health systems in which affiliate hospitals pay an annual fee for access to sponsor's operational and clinical resources-on clinical quality, patient experience ratings, and financial performance of affiliates and their competitors. Network membership data from press releases and websites of four sponsors (Mayo Clinic, Cleveland Clinic, MD Anderson, Memorial Sloan Kettering), American Hospital Association's Annual Survey, Centers for Medicare & Medicaid Services' Hospital Compare, and Healthcare Cost Report Information System, all for 2005-2016. We used a quasi-experimental design and estimated hospital-level regressions with hospital-fixed effects. Dependent variables were measures of clinical quality, patient experience, and financial performance. Independent variables included an indicator for affiliate versus nonaffiliate and fixed effects for hospital characteristics and year. To analyze effects on competitors, we repeated analyses by comparing hospitals in the same county as an affiliate to nonaffiliated, noncompetitor hospitals. Membership was obtained through press releases and network websites then linked across datasets by name and Medicare's identification number. Across networks, affiliates (N=199) experienced insignificant clinical quality changes but increased net income by $38,500 and operating margin by 6.6% (p values=0.01-0.08) compared to nonaffiliates. Multispecialty affiliates improved on no measures. Cancer-specific affiliates improved their net income ($96,900) and operating margin (3.6%; p-values < 0.05). Affiliates' competitors experienced mixed changes in clinical measures relative to hospitals without affiliates in market (p-value < 0.05) but no financial effects. Affiliation was not associated with patient experience ratings for affiliates nor competitors. Despite quality-focused missions, affiliation networks are not guaranteed to improve public measures of quality in affiliated hospitals, although hospitals in these communities improve financially. Future research should assess the conditions and mechanisms by which affiliation improves quality consistently and which forms of quality.

Effect of a multifaceted intervention to improve clinical quality of care through stepwise certification (SafeCare) in health-care facilities in Tanzania: a cluster-randomised controlled trial

SummaryBackgroundQuality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania.MethodsIn this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (1:1) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (control). Implementing staff and participants were masked to outcome measurement and the primary outcomes were measured by fieldworkers who had no knowledge of the study group allocation. The primary outcomes were health worker compliance with infection prevention and control (IPC) practices as measured by observation of provider–patient interactions, and correct case management of undercover standardised patients at endline (after a minimum of 18 months). Analyses were by modified intention to treat. The trial is registered with ISRCTN, ISRCTN93644888.FindingsBetween March 7 and Nov 30, 2016, we enrolled and randomly assigned 237 health facilities to the intervention (n=118) or control (n=119). Nine facilities (seven intervention facilities and two control facilities) closed during the trial and were not included in the analysis. We observed 29 608 IPC indications in 5425 provider–patient interactions between Feb 7 and April 5, 2018. Health facilities received visits from 909 standardised patients between May 3 and June 12, 2018. Intervention facilities had a 4·4 percentage point (95% CI 0·9–7·7; p=0.015) higher mean SafeCare standards assessment score at endline than control facilities. However, there was no evidence of a difference in clinical quality between intervention and control groups at endline. Compliance with IPC practices was observed in 8181 (56·9%) of 14 366 indications in intervention facilities and 8336 (54·7%) of 15 242 indications in control facilities (absolute difference 2·2 percentage points, 95% CI −0·2 to −4·7; p=0·071). Correct management occurred in 120 (27·0%) of 444 standardised patients in the intervention group and in 136 (29·2%) of 465 in the control group (absolute difference −2·8 percentage points, 95% CI −8·6 to −3·1; p=0·36).InterpretationSafeCare did not improve clinical quality as assessed by compliance with IPC practices and correct case management. The absence of effect on clinical quality could reflect a combination of insufficient intervention intensity, insufficient links between structural quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement.FundingUK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).

Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective?

BackgroundIn 2016, the tiered healthcare model featuring “specialists + general practitioners + health managers” in Xiamen was recognized by the Medical Reform Office of State Council and was promoted as a model to replace hospital-centric care with community-based care. This study evaluated the impact of the Xiamen's tiered healthcare system reform on health outcomes and healthcare spending among chronic disease patients. MethodsData were derived from Xiamen's electronic health record (EHR) and medical claims systems. The sample included 154,651 individuals with hypertension and 50,722 individuals with diabetes from Xiamen between 2012 and 2016. The dependent variables included rates of disease under control and total treatment costs. Patients were grouped by the types of chronic disease management: precision management, regular management, or without management. Kaplan-Meier, Cox survival analysis and PSM + DID method (Propensity score matching and difference-in-difference method) were used to compare the management outcomes by group. FindingsThe precision management group showed better clinical quality performance than the regular management group. Under-control disease rates in the precision management group showed a continuous improvement trend, while the regular management group showed a ceiling effect after ten months. Under-control rates in the precision management group increased over 40% for hypertension and over 30% for diabetes, higher than that increases found in the regular management group. Reform was also associated with consistent reductions in annual per capita total treatment costs across groups. The cost-savings in the precision management group between 2014 and 2016 was 381 Chinese yuan (CNY) for hypertension and 1117 CNY for diabetes, compared with the group without management. InterpretationThe results in this study demonstrated the associations between tiered healthcare system reform and better clinical quality performance and improved treatment cost-saving. Developing methods to promote the policy and increase implementation are also important aspects of healthcare reform.

Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a...

Assessment of Variation in Electronic Health Record Capabilities and Reported Clinical Quality Performance in Ambulatory Care Clinics, 2014-2017

Electronic health records (EHRs) are widely promoted to improve the quality of health care, but information about the association of multifunctional EHRs with broad measures of quality in ambulatory settings is scarce. To assess the association between EHRs with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care. This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system that responded to the Healthcare Information and Management Systems Society Annual Survey and reported performance measures in 2014 to 2017. Statistical analysis was performed from July 10, 2019, through February 26, 2021. A composite measure of EHR capability that considered 50 EHR capabilities in 7 functional domains, grouped into the following ordered categories: no functional EHR, EHR underuser, EHR, neither underuser or superuser, EHR superuser; as well as a standardized composite of ambulatory clinical performance measures that included 3 to 25 individual measures (median, 13 individual measures). In 2014, 381 of 746 clinics (51%) were EHR superusers; this proportion increased in each subsequent year (457 of 846 clinics [54%] in 2015, 510 of 881 clinics [58%] in 2016, and 566 of 932 clinics [61%] in 2017). In each cross-sectional analysis year, EHR superusers had better clinical quality performance than other clinics (adjusted difference in score: 0.39 [95% CI, 0.12-0.65] in 2014; 0.29 [95% CI, -0.01 to 0.59] in 2015; 0.26 [95% CI, -0.05 to 0.56] in 2016; and 0.20 [95% CI, -0.04 to 0.45] in 2017). This difference in scores translates into an approximately 9% difference in a clinic's rank order in clinical quality. In longitudinal analyses, clinics that progressed to EHR superuser status had only slightly better gains in clinical quality between 2014 and 2017 compared with the gains in clinical quality of clinics that were static in terms of their EHR status (0.10 [95% CI, -0.13 to 0.32]). In an exploratory analysis, different types of EHR capability progressions had different degrees of associated improvements in ambulatory clinical quality (eg, progression from no functional EHR to a status short of superuser, 0.06 [95% CI, -0.40 to 0.52]; progression from EHR underuser to EHR superuser, 0.18 [95% CI, -0.14 to 0.50]). Between 2014 and 2017, ambulatory clinics in Minnesota, Washington, and Wisconsin with EHRs having greater capabilities had better composite measures of clinical quality than other clinics, but clinics that gained EHR capabilities during this time had smaller increases in clinical quality that were not statistically significant.

Preventive Care and Chronic Disease Management Comparison of Appalachian and Non-Appalachian Community Health Centers in the United States.

IntroductionThe Appalachian region is often characterized by poor health outcomes and economic depression. Health centers (HCs) are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary healthcare services in high need areas, including Appalachia, where economic, geographic, or cultural factors can hinder access to healthcare services.PurposeThe study compares the clinical quality performance in preventive care and chronic disease management between Appalachian HCs and their non-Appalachian counterparts.MethodsUsing 2015 Uniform Data System (UDS) health center data, bivariate and multivariate linear regression analyses examine the association of Appalachian HC with performance on preventive and chronic care clinical quality measures (CQMs).ResultsIn the multivariate analysis, patients served at Appalachian HCs are more likely to receive colorectal cancer screening and pediatric weight assessment and counseling than at non-Appalachian HCs. No statistically significant differences in performance observed among other CQMs. The percentage of Medicaid patients and total physician FTEs have positive associations with preventive care in colorectal and cervical cancer screening, pediatric weight assessment and counseling, and tobacco screening and cessation intervention as well as chronic disease management of aspirin therapy for ischemic vascular disease and hypertension control in the multivariate model.ImplicationsOverall Appalachian HCs perform as well as or better than non-Appalachian HCs in delivering preventive and chronic care services. Further examination of clinical quality improvement programs, insurance payer mix, and practice size among Appalachian HCs could advance the replication of clinical quality success for clinics in similar underserved communities.

Impact of health information technology optimization on clinical quality performance in health centers: A national cross-sectional study.

Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.

Being on the Productivity Frontier: Identifying “Triple Aim Performance” Hospitals

Hospital decision‐makers face trade‐offs that make it difficult to obtain the trifecta of high performance on clinical quality, patient experience, and technical efficiency. We use the term “triple aim performance” (TAP) to refer to the simultaneous achievement of these three goals. Using datasets from 2010 and 2012 and data envelopment analysis, we identify about 20 triple aim performance hospitals in each year among U.S. acute care hospitals with at least 200 beds. We also examine factors that influence the probability of being a TAP hospital. We find that the percentage of physicians employed by the hospital has a positive and significant relationship with TAP, and that bed utilization rate has a positive relationship with technical efficiency, but a negative relationship with clinical quality and patient experience performance.

Feasibility study of a novel general purpose CZT-based digital SPECT camera: initial clinical results

BackgroundThe performance of a prototype novel digital single-photon emission computed tomography (SPECT) camera with multiple pixelated CZT detectors and high sensitivity collimators (Digital SPECT; Valiance X12 prototype, Molecular Dynamics) was evaluated in various clinical settings.Images obtained in the prototype system were compared to images from an analog camera fitted with high-resolution collimators. Clinical feasibility, image quality, and diagnostic performance of the prototype were evaluated in 36 SPECT studies in 35 patients including bone (n = 21), brain (n = 5), lung perfusion (n = 3), and parathyroid (n = 3) and one study each of sentinel node and labeled white blood cells. Images were graded on a scale of 1–4 for sharpness, contrast, overall quality, and diagnostic confidence.ResultsDigital CZT SPECT provided a statistically significant improvement in sharpness and contrast in clinical cases (mean score of 3.79 ± 0.61 vs. 3.26 ± 0.50 and 3.92 ± 0.29 vs. 3.34 ± 0.47 respectively, p < 0.001 for both). Overall image quality was slightly higher for the digital SPECT but not statistically significant (3.74 vs. 3.66).ConclusionCZT SPECT provided significantly improved image sharpness and contrast compared to the analog system in the clinical settings evaluated. Further studies will evaluate the diagnostic performance of the system in large patient cohorts in additional clinical settings.

Successful Incorporation of Performance Based Payments for Trauma Center Readiness Costs into the Georgia Trauma System

As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.

Assessing the relationship between patient satisfaction and clinical quality in an ambulatory setting.

Purpose The purpose of this paper is to assess the relationship between patient satisfaction and a variety of clinical quality measures in an ambulatory setting to determine if there is significant overlap between patient satisfaction and clinical quality or if they are separate domains of overall physician quality. Assessing this relationship will help to determine whether there is congruence between different types of clinical quality performance and patient satisfaction and therefore provide insight to appropriate financial structures for physicians. Design/methodology/approach Ordered probit regression analysis is conducted with overall rating of physician from patient satisfaction responses to the Clinician and Groups Consumer Assessment of Healthcare Providers and Systems survey as the dependent variable. Physician clinical quality is measured across five composite groups based on 26 Healthcare Effectiveness Data and Information Set (HEDIS) measures aggregated from patient electronic health records. Physician and patient demographic variables are also included in the model. Findings Better physician performance on HEDIS measures are correlated with increases in patient satisfaction for three composite measures: antibiotics, generics, and vaccination; it has no relationship for chronic conditions and is correlated with decrease in patient satisfaction for preventative measures, although the negative relationship for preventative measures is not robust in sensitivity analysis. In addition, younger physicians and male physicians have higher satisfaction scores even with the HEDIS quality measures in the regression. Research limitations/implications There are four primary limitations to this study. First, the data for the study come from a single hospital provider organization. Second, the survey response rate for the satisfaction measure is low. Third, the physician clinical quality measure is the percent of the physician's relevant patient population that met the HEDIS measure rather than if the measure was met for the individual patient. Finally, it is not possible to distinguish if the significant coefficient estimates on the physician age and gender variables are capturing systematic differences in physician behavior or capturing patient bias. Practical implications The results suggest patient satisfaction and physician clinical quality may be complementary, capturing similar aspects of overall physician quality, across some clinical quality measures but for other measures satisfaction and clinical quality are unrelated or negatively related. Therefore, for some clinical quality metrics, it will be important to separately compensate clinical quality and satisfaction and understand the relationship between metrics. Finally, the strong relationship between the level of patient satisfaction and physician age, physician gender, and patient age are important to consider when designing a physician compensation package based on patient satisfaction; if these differences reflect patient bias they could increase inequality among medical staff if compensation is based on patient satisfaction. Originality/value This study is the first to use physician organization data to examine patient satisfaction and physician performance on a variety of HEDIS quality metrics.

First results of the integration of a dose monitoring system in the National Breast Screening Program

To demonstrate how a PACS integrated dose monitoring system, Gray Detector, can help to monitor client dose in a breast screening program, ultimately facilitating the optimisation of acquisition parameters in order to enhance image quality and minimise the dose BreastCheck, The National Breast Screening Program evaluated the RIS-PACS integrated dose monitoring system Gray Detector. For each projection of a screening examination, the displayed average glandular dose (AGD), compression force, compressed breast thickness, selected automatic exposure control (AEC) mode, kV and mAs were recorded. Preliminary data have been collected for three months which have enabled comparison of a number of mammography system types and comparison between systems of the same type, in terms of dose, compression force and other key characteristic parameters. Patient dose data collected so far confirm the results of our annual dose survey. All the mammography systems were monitored on a daily basis. The daily presentation of data provides a useful QA tool, highlighting potential problems with individual mammography systems and illustrating the dependency of client dose on other clinical parameters such as compressed breast thickness and compression force. This will enable standardisation of the acquisition technique in order to reduce client dose and optimize the image quality. A summary of these preliminary results will be presented. The Gray Detector software provides useful functionality for monitoring key parameters of the breast screening examination including in particular, the AGD which may be used to monitor and improve clinical quality performance in the screening program. To demonstrate how a PACS integrated dose monitoring system, Gray Detector, can help to monitor client dose in a breast screening program, ultimately facilitating the optimisation of acquisition parameters in order to enhance image quality and minimise the dose BreastCheck, The National Breast Screening Program evaluated the RIS-PACS integrated dose monitoring system Gray Detector. For each projection of a screening examination, the displayed average glandular dose (AGD), compression force, compressed breast thickness, selected automatic exposure control (AEC) mode, kV and mAs were recorded. Preliminary data have been collected for three months which have enabled comparison of a number of mammography system types and comparison between systems of the same type, in terms of dose, compression force and other key characteristic parameters. Patient dose data collected so far confirm the results of our annual dose survey. All the mammography systems were monitored on a daily basis. The daily presentation of data provides a useful QA tool, highlighting potential problems with individual mammography systems and illustrating the dependency of client dose on other clinical parameters such as compressed breast thickness and compression force. This will enable standardisation of the acquisition technique in order to reduce client dose and optimize the image quality. A summary of these preliminary results will be presented. The Gray Detector software provides useful functionality for monitoring key parameters of the breast screening examination including in particular, the AGD which may be used to monitor and improve clinical quality performance in the screening program.

Gray detector, a dose monitoring software for radiology departments

The aim of this work is to present the gray detector, a web-based patient radiation dose monitoring software developed to answer on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, (Council Directive 2013/59/Euratom) This software provides to capture, track and report radiation dose directly from any imaging device or PACS, completely vendor neutral solution, and it is the simple yet scalable way to document dose, set reference levels, benchmark performance, manage protocols and identify outliers. The solution gives the possibility to integrate all the information about the dose with the data in RIS: in this way there is the possibility to context the dosimetric data and to follow the optimization of the radiologic risk management and the ratio risk/benefit of the image. Gray detector manages all diagnostic modality tracking and archiving all dosimetry data: CT, Mammography, Interventional, Cardiovascular, Radiography and Nuclear Medicine. It is compatible with DICOM SR and DICOM MPPS messages, Query & Retrieve DICOM image header (for non MSSP/SR DICOM modality), to extract all relevant information from dose and maximize data collection, crossing the fundamental data stored in the RIS database. All data collected can be viewed through customizable charts or exported according to standard formats gray detector has an “alert system”, that gives the possibility to send email and display messages when the modality gives an over dose, based on DRL The integration of the gray detector with information systems, may improve clinical quality performance in diagnostic imaging The aim of this work is to present the gray detector, a web-based patient radiation dose monitoring software developed to answer on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, (Council Directive 2013/59/Euratom) This software provides to capture, track and report radiation dose directly from any imaging device or PACS, completely vendor neutral solution, and it is the simple yet scalable way to document dose, set reference levels, benchmark performance, manage protocols and identify outliers. The solution gives the possibility to integrate all the information about the dose with the data in RIS: in this way there is the possibility to context the dosimetric data and to follow the optimization of the radiologic risk management and the ratio risk/benefit of the image. Gray detector manages all diagnostic modality tracking and archiving all dosimetry data: CT, Mammography, Interventional, Cardiovascular, Radiography and Nuclear Medicine. It is compatible with DICOM SR and DICOM MPPS messages, Query & Retrieve DICOM image header (for non MSSP/SR DICOM modality), to extract all relevant information from dose and maximize data collection, crossing the fundamental data stored in the RIS database. All data collected can be viewed through customizable charts or exported according to standard formats gray detector has an “alert system”, that gives the possibility to send email and display messages when the modality gives an over dose, based on DRL The integration of the gray detector with information systems, may improve clinical quality performance in diagnostic imaging

APA Joins Call for Reform of ‘Meaningful Use’ Program

APA and other medical organizations are urging CMS to focus on promoting interoperability and innovation as vendors respond to the demands of physicians and hospitals to progress past the current program where vendors must meet check-the-box requirements.

Quantification of CSF biomarkers using an electrochemiluminescence-based detection system in the differential diagnosis of AD and sCJD.

The identification of reliable diagnostic tools for the differential diagnosis between sporadic Creutzfeldt-Jakob Disease (sCJD) and Alzheimer's disease (AD) remains impeded by the existing clinical, neuropathological and molecular overlap between both diseases. The development of new tools for the quantitative measurement of biomarkers is gaining experimental momentum due to recent advances in high-throughput screening analysis and with the optimization of assays for their quantification in biological fluids, including cerebrospinal fluid (CSF). Electrochemiluminescence (ECL)-based immunoassays have demonstrated to achieve clinical quality performance in a variety of sample types due to its high sensitivity and dynamic range. Here, we quantified the CSF levels of Tau-protein, β-amyloid 1-42 (Aβ42) and α-synuclein, as important biomarkers in CSF used in the differential diagnosis of neurodegenerative disorders in 12 AD, 12 sCJD and 12 control cases by singleplex ECL-based technology. Its performance has been compared to classical enzyme-linked immunosorbent assays (ELISA) to confront their clinical accuracy. ECL-based technology validates previous data obtained with ELISA and presents a higher performance in the discrimination of three analysed groups as determined by increased area under the curve (AUC) values for the three biomarkers. Importantly, α-synuclein levels detected by ECL allow an excellent discrimination between sCJD cases and AD and control cases, unveiling a new clinical approach for the differential diagnosis of sCJD.

Clinical Quality Performance Measurement: An Example of a University Hospital

AIM:In our study, in terms of clinical quality measurement approach, we aimed to focus on whether there was a considerable difference between the treatment received and the treatment required to be taken by patients by using nine packages. METHODS: The research was conducted as retrospective study, which was carried out in a university hospital with 300 beds between January 01 and August 30, 2012. Patient records were determined by a random sampling method. The 9 performance measurement sets developed by were used as a tool of data collection, which consisted of heart attack care, intensive care, Childern’s asthma care, pnuemonia care, heart failure care, venous thromboembolism care, stroke care, perinatal care, and inpatient psyciatric care. The findings were analyzed in comparison with the findings of The Joint Commission RESULTS: The mixed compatibility rate of all packages was determined to be 55,33%. Only the pneumonia package package was determined to be incompatible with Turkey. The heart attack package was found to be very close to the average of the findings of The Joint Commission. Paralysis of the package was at least compliance package, which was found to be 20.08%. The average of pre-natal care (48,6 %) was found 0.5 point higher than the average of The Joint Commission. The only a heart attack package (%97,9) passed the threshold of 90 %. CONCLUSION: We determined that The Accountability Measures of the Joint Commission could be applied in the present conditions of Turkey. Only the Pneumonia package needs new requirements to be specified for Turkey. There is no need for a compatibility studies as for the others. Surgical care, heart attack, perinatal and venous thromboembolism packages are the ideal packages for Turkey.

Clinical process analysis: Embedding performance improvement skills for measurable and sustainable change.

67 Background: The Clinical Process Analysis methodology, based on Time Driven Activity Based Costing (Kaplan), aligns data reporting with frontline processes to drive improvement in clinical quality and financial performance. After the completion of 6 ambulatory centers (with 6 in progress), the program evolved to include a Performance Improvement (PI) Phase. The goal: embed PI skills in all clinical operations; provide resources for PI project initiation, facilitation, and sustainability; and continue collaboration with MD Anderson Cancer Center process owners through measurable improvement in safety, timeliness, effectiveness, efficiency, equity and patient-centeredness. (IOM 2001). Methods: The center and the CPA Team utilize institutional dashboards and multiple data resources to establish the project scope. The scope is converted to a Blueprint which outlines a timeline of the project, a list of required resources, and center-specific data. The CPA Team interviews frontline staff, clinical leadership and financial teams to create a current state process flow chart. Opportunities for Improvement (OFI), operational and clinical variations, cycle times and other management reporting metrics are included on the charts, as well as patient experience audio, as gathered by an MD Anderson marketing team. OFIs are evaluated, categorized, and prioritized by clinical leadership, and the CPA Team works with the center’s designated PI team to develop and implement Quick Fixes, PDSA and more extensive projects. Results: In 6 completed ambulatory centers in FY13: 176 Opportunities for Improvement, $936,463 Savings. Summary reports provide direct labor costs and estimated times, per resource type, for center activities. Per MDs, managers, staff and financial experts, other uses for process flow charts include: tracking patient flow; resource utilization; customer satisfaction; patient education; and on-boarding staff. Conclusions: In FY14, the CPA Program will focus on patient access in 15 centers, gathering data to identify trends and common themes to implement Best Practices across the institution.