Current Quality Indicators Research Articles

Increased Risk and Unique Clinical Course of Patient Safety Indicator-3 Pressure Injuries Among COVID-19 Hospitalized Patients.

The COVID-19 pandemic introduced unique challenges to healthcare systems, particularly in relation to patient safety and adverse events during hospitalization. There is limited understanding of COVID-19's association with some patient safety indicators (PSIs). This study aimed to investigate the impact of COVID-19 infection on the rate of PSI-3 events and its implications on quality metrics. We compared PSI-3 event rates between COVID-19-infected and uninfected patients and examined the clinical characteristics of COVID-19 patients experiencing PSI-3 events. This is a retrospective study at Mayo Clinic hospitals between January 2020 and February 2022, analyzing patients meeting PSI-3 denominator eligibility criteria. PSI-3 events were identified using AHRQ WinQI software. Patients were categorized based on COVID-19 status. Patient demographics, characteristics, and PSI-3 rates were compared. A case series analysis described clinical details of COVID-19 patients with PSI-3 events. Of 126,781 encounters meeting PSI-3 criteria, 8674 (6.8%) had acute COVID-19 infection. COVID-19-infected patients were older, more likely to be male, non-white, and had private insurance. PSI-3 rates were significantly higher in COVID-19 patients (0.21% versus 0.06%, P < 0.0001), even after risk adjustment (adjusted risk ratio, 3.24, P < 0.0001). The case series of 17 COVID-19 patients with PSI-3 events showed distinctive clinical characteristics, including higher medical device-related pressure injuries, and greater predisposition for head, face, and neck region. Acute COVID-19 infection correlates with higher PSI-3 event rates. Current quality indicators may require adaptation to address the pandemic's complexities and impact on patient safety. Further research is needed to comprehensively understand the intricate relationship between COVID-19 and patient outcomes.

A Novel Perspective on the Quality Index for Fused Satellite Images

Blind Image Quality Assessment for Remote Sensing Applications has garnered a significant amount of interest from the community, presenting a problem that is both persistent and difficult to solve. The current quality indicators are, for the most part, in agreement with each individual's subjective perception. Traditional handcrafted quality measures focus on detecting low-level features such as contour, edge, color, texture, and shape. These are the attributes that will be measured. Nevertheless, it is possible that they will disregard the essential semantics that lie behind the warped image. Within the scope of popular deep learning, the process of acquiring multilayer features is a straightforward exercise. The unfortunate reality is that a significant number of these models either ignore superficial traits or focus only on high-level variables, which ultimately leads to poor prediction performance. In order to successfully portray varying degrees of distortion, the fusion features make advantage of the laws that govern the human visual system in order to extract both local and global components of information. In conclusion, the ultimate quality score is determined by considering the features of both the local and global levels. In this investigation, we developed two different NR-IQA methods. In one, a markov random field is used, while in the other, a sparse approximation variational autoencoder is established as the foundation. The effectiveness of our work is shown by the evaluation of multiple IQA datasets, where our model consistently generates findings that are at the leading edge of the field. This evaluation does not make use of any quality standards; rather, it compares it against a variety of well-known cutting-edge techniques and average opinion ratings based on the opinions of different people. Quality ratings are accurately predicted by the regression models that have been provided.

Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol.

Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors. German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656. DERR1-10.2196/56487.

Enhancing the Quality of Upper Gastrointestinal Endoscopy: Current Indicators and Future Trends

The quality of upper gastrointestinal endoscopy (EGD) is crucial and carries significant consequences for patient outcomes, the employment of healthcare resources, and the future course of gastroenterology as a medical specialty. In this review, we navigate through the terrain of the Quality Indicators (QIs) for EGD, shedding light on their indispensable function in ensuring and augmenting the quality of patient care throughout the pre-procedural, intra-procedural, post-procedural, and outcome-oriented facets of the practice. We delve into the comprehensive scope of the QIs and the challenges impeding the delivery of high-quality EGD, from variability in practitioner training and patient compliance to the systemic limitations of current QIs and the barriers hindering the adoption of advanced techniques. Future directions for bolstering the quality of EGD are highlighted, encapsulating the integration of emergent endoscopic technologies, the evolution of patient-centered metrics, the refinement of endoscopist training and credentialing processes, and the promise held by Artificial Intelligence (AI). Particular emphasis is placed on the role of advanced endoscopic techniques and equipment in enhancing EGD quality. This article presents a cogent narrative, promoting the pursuit of excellence in EGD as an ever-evolving endeavor that necessitates the collective dedication of clinicians, researchers, educators, and policymakers.

Quality indicators in atrial fibrillation ablation (RIQAFA). A national registry from the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE)

Introduction and ObjectivesAtrial fibrillation (AF) is the most common sustained arrhythmia, with significant burden for patients. Catheter ablation is safe and superior for symptom improvement. The purpose of this work was to assess how clinical practice compares with current scientific evidence and quality indicators for AF ablation. MethodsThe Portuguese Association of Arrhythmology, Pacing and Electrophysiology conducted a prospective registry among Portuguese centers to assess clinical practice regarding management of patients referred for ablation and the methodology used in the procedures and related outcomes. ResultsA total of 337 patients were referred for ablation, 102 (37.91%) female, age 65 (56–70.8) years. The median CHADS2-VaSC2 thromboembolic risk score was 2 (1–3), and 308 (92.49%) were on anticoagulants. AF was mainly paroxysmal (224, 66.97%) and symptomatic (mEHRA score 3; 2–3). Before ablation most patients (273, 81.49%) underwent cardiac computed tomography and only 24 (7.36%) procedures were performed with uninterrupted anticoagulation. For ablation, Carto® (194; 59.15%) and Ensite® (55; 16.77%) were mainly used, and the preferential strategy was pulmonary vein isolation (316; 94.61%). Acute complications occurred in five (1.49%) patients, while most had symptom improvement at one month (200; 86.21%), sustained at one year. There were 40 (12.6%) relapses within 30 days and 19 (26.39%) at one year. ConclusionsIn a population of patients with AF referred for ablation in Portuguese centers, patient management is provided according to the best scientific evidence and there is a high standard of practice with respect to the quality of AF ablation practice.

Kajian Teknis Pemeliharaan Transformator Arus Pada Gardu Induk Pltu Tanjung Awar – Awar Babat

The current transformer is an electric power instrumentation device that functions to change a higher current value to a lower value for protection and measurement purposes. Field conditions and service life cause the current transformer to decrease and not function. Therefore, it is important to do this research to determine the current condition of the current transformer. The method used to obtain current transformer quality indicators is the insulation resistance test method and the tangent delta test method. The results of testing the insulation resistance of current transformers at GI Tanjung Awar Awar Babat in 2020-2021 using the VDE standard (Catalogue 228/4) and IEEE std 43-2000 show that the insulation resistance value of all current transformers has increased by an average of 81900Ω from the previous period but, this value is still in good criteria, namely 170 + 1 MΩ and there is an increase in the current transformer grounding resistance test from the previous period with an average of 0.176 however, according to the PLN book 605.K/DIR/2010 the results of the ground resistance test have good criteria. of &lt; 1. Based on ANSI C 57.12.90 and IEEE C57.152-2013 standards, the tan delta test results are still in good condition because the tan delta value is not more than 0.5%. Current transformer tan delta testing in 2020-2021 has decreased, indicating that the insulation performance of current transformers in 2021 is better than in 2020.

Research Progress of Nursing Quality Evaluation Index System in Post-Anesthesia Care Unit

Objective: To explore the construction of the nursing quality evaluation index system of Post-Anesthesia Care Unit (PACU) at home and abroad, in order to provide a reference for the construction of the quality evaluation index system of PACU in China. Methods: A comprehensive and systematic search was made for domestic and foreign literature related to the construction of PACU nursing quality index evaluation system, and a systematic review and evaluation of its clinical application status was carried out. Conclusion: Through the exploration and analysis of the current nursing quality indicators in PACU at home and abroad, it is pointed out that the limitations of the construction of PACU nursing quality indicators in China are mainly: limited scope of construction, single index content, unclear responsibilities of anesthesia nurses, and knowledge of related oral diseases Inadequate training and variable quality of care-building indicators. Combined with the current national conditions and relevant policies in our country, this paper puts forward some suggestions on the construction of relevant nursing quality indicators, in order to provide a reference for the construction of the nursing quality evaluation index system of PACU, to provide professional identification and career development for anesthesia nurses, and to accelerate the specialty of anesthesia nursing. development, which has theoretical research significance.

Days Spent at Home in the Last 6 Months of Life. a Potential Patient-Determined Quality Indicator for Patients with Hematologic Malignancies at the End of Life

Despite advances in the management of patients with hematologic malignancies, a significant proportion of patients will still die of their disease. Current quality indicators at the end of life (EOL) focus on whether patients receive aggressive interventions, including chemotherapy in the last days of life. However, frail patients and caregivers themselves have recently highlighted that “time spent at home” represents the most important measure of EOL quality care (Groff et al., NEJM 2016). This potential patient-determined quality indicator has not been previously studied in patients with hematologic malignancies.We used population-based health system administrative databases from Ontario, Canada. We identified a cohort of all adult patients who died of a hematologic malignancy from January 2005 to December 2013 within the Ontario Cancer Registry. The primary outcome of “days at home” in the last 6 months of life was defined as: 180 days minus the number of days in an acute care facility (inpatient, emergency department, and same day surgery stays), an inpatient rehabilitation facility, skilled nursing facility, or chronic care facility. We further identified patient variables (including comorbidities identified by a mortality risk score by Austin and van Walraven, Med Care 2011) and system level variables (including palliative care consultation prior to the last 6 months of life) that predicted for number of days at home and identified trends over time. We used a logistic regression model to identify relevant predictors of time spent at home beyond the median.During the relevant time-period, 6792 patients with hematologic malignancies died in Ontario. Median age was 72 (IQR 62-80) at the time of cancer death and 58% of patients were male. Median comorbidity score, measured by the mortality risk score, was moderate-to-high at 27 (IQR 20-34), 15% of patients were rural-based, and 27% had received palliative care consultation prior to the last 6 months of life. The median number of days at home in the last 6 months of life was 166 days; 81% of patients spent more than 120 days at home over the last 6 months of life. Increased age (per five year increase OR 1.14; CI 1.12-1.17; p<0.0001), male gender (OR 1.30; CI 1.17-1.44; p<0.0001), and an extended time period from diagnosis until death (per 5 year increase OR 1.02; CI 1.01-1.03; p=0.0021) were independent predictors of spending more than the median number of days at home. Patients who had received palliative care consultation prior to the 6 months were also more likely to spend time at home compared to those who had not been seen by palliative care (OR 1.34; CI 1.20-1.49; p<0.0001). In contrast, patients with more comorbidities according to the mortality risk score were less likely to spend time at home (OR 0.96; CI 0.96-0.97; p<0.0001). There was evidence of geographic/regional variation in ability to die at home (p<0.0001). Rural status (p=0.26) and year of death (trend analysis p=0.50) were not associated with the outcome of days at home in the last 6 months of life.In a large population of patients who die from hematologic malignancies, >80% of patients spend >120 days at home in the last 6 months of life. Certain demographic features of patients more likely to die at home suggest an important role for access to caregiver support (i.e. spousal/family support). Importantly, earlier access to palliative care may increase the likelihood that patients can die at home, representing a modifiable/actionable factor for physicians to consider to improve the quality of care in patients who are nearing the end of life. DisclosuresNo relevant conflicts of interest to declare.

Model and structure of the network internet of things for monitoring milk quality

Belarusian state University of Informatics and Radioelectronics, Minsk, Republic of Belarus The quality of milk is evaluated by a number of control points, which include a number of indicators, such as fat content, protein, lactose, density, etc. It is proposed to use the Internet of things (IoT) technology to control the quality of milk from distributed dairy farms. A multi-agent model of IoT network and the structure of such an IoT network for monitoring the quality of milk from different farms is presented. The model is represented by a variety of agents: milk analyzers, converter, storage of quality indicators, their processing, decision-making, monitoring of milk quality indicators. The structure of the IoT network includes milk analyzers, gateways-converters, a cloud platform, and mobile devices. The cloud platform rents a server that hosts knowledge and data bases, special software (solver) for processing and making decisions on milk quality, and a farm website. The database of the cloud structure server stores milk quality characteristics, and the knowledge base stores the rules for processing them. The solver outputs deviations from the current milk quality indicators from the standards. The site is used for communication of specialists in milk quality control. Monitoring of milk quality characteristics is implemented from mobile devices of specialists with access to the site components. The 4th generation LTE network using NB-IoT technology was chosen as the network for transmitting information from dairy farms to the cloud. The review of milk analyzers of both domestic and foreign companies is carried out. A gateway solution for querying milk analyzers and transmitting parameters to the cloud infrastructure is presented. Popular cloud platforms for building a network of IoT are presented.

On the Nature of Quality in the Contexts of Academic Publication and Sustainability

Six experienced academic reviewers and editors explored the nature of quality in academic publication processes in the contexts of sustainability, education for sustainability and the Sustainable Development Goals (SDGs). This article documents their exploration as a collaborative autoethnography structured around the authors’ personal reflections on matters such as: how current quality indicators define the quality of academic publications; how effective current quality assurance processes may be; how congruent open access publication processes may be with the ideals of sustainability and of the SDGs; and about what new and different indicators of quality might look like. An inductive analysis of their reflections yielded three emergent and reoccurring themes: casting doubt on the fitness for purpose of current academic publication processes and means to assure their quality; seeking justice for all involved in academic publication; and creating opportunities for change. In writing this article, authors considered these themes and how academia might address them.

Quality Indicators in Pediatric Palliative Care: Considerations for Latin America.

Pediatric palliative care is a growing field in which the currently available resources are still insufficient to meet the palliative care needs of children worldwide. Specifically, in Latin America, pediatric palliative care services have emerged unevenly and are still considered underdeveloped when compared to other regions of the world. A crucial step in developing pediatric palliative care (PPC) programs is delineating quality indicators; however, no consensus has been reached on the outcomes or how to measure the impact of PPC. Additionally, Latin America has unique sociocultural characteristics that impact the perception, acceptance, enrollment and implementation of palliative care services. To date, no defined set of quality indicators has been proposed for the region. This article explores the limitations of current available quality indicators and describes the Latin American context and how it affects PPC development. This information can help guide the creation of standards of care and quality indicators that meet local PPC needs while considering the sociocultural landscape of Latin America and its population.

Improving the technology of closed water supply at agro-industrial enterprises

The article analyzes the ways to improve the water supply system at agro-industrial enterprises. It is stated that the Institute of Water Problems and Land Reclamation of NAAS proposed to improve closed water supply systems at these enterprises to spend water and energy rationally and economically by developing highly efficient wastewater treatment technology to reuse wastewater and its sediments for technological needs.&#x0D; During the work, the main tasks to be solved were the analysis of the reasons of unsatisfactory operation of traditional wastewater treatment plants and their current quality indicators and improvement of the rational technological scheme of closed water supply at the agro-industrial enterprises.&#x0D; Scientific and practical results were obtained by analyzing the operation of wastewater treatment plants of industrial enterprises dealing with agricultural products processing, their quality indicators and known methods of improving technological schemes of biological wastewater treatment.&#x0D; It was specified that traditional technology of biological wastewater treatment do not ensure the proper treatment quality, as the quality of wastewater from enterprises has significantly deteriorated due to the inflow of harmful impurities (xenobiotics, heavy metal ions, etc.) and high concentrations of organic matter, the content of which amount to: suspended solids&gt; 1000 mg/dm3, COC&gt; 10000 mgO2/dm3, BOC5&gt; 6000 mgO2/dm3, BOCcomplete&gt; 2000 mgO2/dm3, nitrogen and phosphorus ≤50 mg/dm3, which prevents the effective operation of aeration tanks.&#x0D; The practicability of improving the "bioconveyor" technology by downward filtration through fibrous loading in bioreactors and upward filtration through floating filter loading in contact and clarifying filters to increase the efficiency of wastewater treatment was scientifically substantiated.&#x0D; It was proved that this method provides high efficiency of biological wastewater treatment by reducing the amount of sediment and the absence of reverse activated sludge, and thus reducing capital and operating costs.&#x0D; Natural mechanisms of household sewage treatment with reuse of water and sediments when cultivating agricultural crops are used as much as possible are used in the specified system of water supply at agro-industrial enterprises.&#x0D; The optimal design and technological parameters of these structures are determined using the recommendations developed on the basis of our experimental research.&#x0D; The proposed technology of closed water supply at agro-industrial enterprises provides for the separation of water supplied to consumers into technical and drinking one, as well as supplements of sewage treatment plants with bioreactors and contact-clarifying filters. Such systems ensure a minimum intake of water from natural water sources having its preliminary treatment directly in water reservoir, maximum use of treated wastewater and protection of the environment against wastewater pollution.

Impact of 9-Minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial

Although current quality indicators of colonoscopy recommend 6 minutes as the minimum standard for withdrawal time (WT), the impact of a WT longer than 6 minutes on neoplasia detection is unclear. A multicenter randomized controlled trial involving 1027 patients was conducted from January 2018 to July 2019. Participants were randomly divided into a 9-minute (n = 514) and 6-minute (n = 513) WT group, and a timer was used to adjust the withdrawal speed. The primary outcome was the adenoma detection rate (ADR). Intention-to-treat analysis showed a significantly higher ADR in the 9-minute versus 6-minute WT group (36.6% vs. 27.1%, P = .001). Prolonging WT from 6 to 9 minutes significantly increased ADR of the proximal colon (21.4% vs. 11.9%, P < .001) as well as of the less experienced colonoscopists (36.8% vs. 23.5%, P = .001). Improvements were also observed in the polyp detection rate (58.0% vs. 47.8%, P < .001), and mean number of polyps and adenomas detected per colonoscopy (1.1 vs. 0.9, P = .002; 0.5 vs. 0.4, P = .008, respectively). The higher ADRs in 9-minute WT were also confirmed by the per-protocol (PP) analysis and subgroup analyses, with an increased rate of sessile serrated lesion detection in the 9-minute WT by PP analysis (4.0% vs. 1.3%, P = .04). Multivariate logistic regression demonstrated that the 9-minute WT was independently associated with increased ADR (P = .005). Prolonging WT from 6 to 9 minutes significantly improved ADR, especially in the proximal colon and for less experienced colonoscopists. A 9-minute WT benchmark should be considered as one of the quality indicators of colonoscopy. ClinicalTrials.gov (identifier, NCT03399045).

Nationwide compliance with a multidisciplinary guideline on pancreatic cancer during 6-year follow-up

BackgroundCompliance with national guidelines on pancreatic cancer management could improve patient outcomes. Early compliance with the Dutch guideline was poor. The aim was to assess compliance with this guideline during six years after publication. Materials and methodsNationwide guideline compliance was investigated for three subsequent time periods (2012–2013 vs. 2014–2015 vs. 2016–2017) in patients with pancreatic cancer using five quality indicators in the Netherlands Cancer Registry: 1) discussion in multidisciplinary team meeting (MDT), 2) maximum 3-week interval from final MDT to start of treatment, 3) preoperative biliary drainage when bilirubin >250 μmol/L, 4) use of adjuvant chemotherapy, and 5) chemotherapy for inoperable disease (non-metastatic and metastatic). ResultsIn total, 14 491 patients were included of whom 2290 (15.8%) underwent resection and 4561 (31.5%) received chemotherapy. Most quality indicators did not change over time: overall, 88.8% of patients treated with curative intent were discussed in a MDT, 42.7% were treated with curative intent within the 3-week interval, 62.7% with a resectable head tumor and bilirubin >250 μmol/L underwent preoperative biliary drainage, 57.2% received chemotherapy after resection, and 36.6% with metastatic disease received chemotherapy. Only use of chemotherapy for non-metastatic, non-resected disease improved over time (23.4% vs. 25.6% vs. 29.7%). ConclusionNationwide compliance to five quality indicators for the guideline on pancreatic cancer management showed little to no improvement during six years after publication. Besides critical review of the current quality indicators, these outcomes may suggest that a nationwide implementation program is required to increase compliance to guideline recommendations.

Intravenous fluid resuscitation in the management of acute pancreatitis.

In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with predicted mild severity appears to have the highest benefit, whereas aggressive resuscitation in patients with predicted severe disease might be futile and deleterious. Lactated Ringer's solution is the preferred fluid type based on animal studies, clinical trials, and meta-analyses. There is a wide variation of fluid resuscitation approaches in current guideline recommendations, quality indicators, and worldwide practice patterns. There is lack of high-quality data that supports the use of early aggressive fluid resuscitation. Large, well designed, multicenter randomized controlled trials are needed to determine the optimal timing, fluid type, volume, rate, and duration of fluid resuscitation in acute pancreatitis.

Effect of Long-Term Storage on Hematopoietic Progenitor Cell Transplant Product Quality

Abstract Hematopoietic progenitor cell (HPC) transplant product quality indicators after prolonged cryopreservation are variable. A recent study in Europe demonstrated wide variability of cryopreservation times, from 1 to &gt;20 years, with most centers storing products for 5 or 10 years. Thawed HPC viability using various ex vivo means and in vivo by studying neutrophil and platelet engraftment has generally supported preservation of CD34+ viability with prolonged storage. However, sample size, methods, and timepoints varied, and clear guidelines currently do not exist regarding how long HPCs can be stored. This study’s objectives include an evaluation of HPC quality indicators over time and if HPC product age and/or viability correlates with HPC engraftment. Retrospective record review was conducted on 837 HPC products thawed between January 1, 2011, and December 31, 2018. HPC products were sampled and characterized at thawing by flow cytometry for total nucleated cell (TNC) recovery, CD34+ recovery, and CD34+ viability (by 7-AAD). Preestablished acceptability criteria for TNC recovery, CD34+ recovery, and CD34+ viability were &gt;80%, &gt;40%, and &gt;60%, respectively. If available, products with ANC engraftment data were further analyzed to correlate data with time to HPC engraftment. HPC products were stored between 3 and 5,943 days; 816 products were infused, ranging from 3 to 5,273 days in storage. Most (81%) HPC transplants occurred within the first year, 47 infusions occurred after storage &gt;5 years, and 4 infusions occurred after storage &gt;10 years. CD34 viability and percent recovery of TNC and CD34 were not significantly different as time in storage increased. Given sample paucity, 19 samples stored for &gt;10 years were analyzed in individual years and grouped. In total, 96.5% samples stored for &lt;1 year and 68% in samples stored &gt;10 years met acceptability criteria for &gt;60% CD34+ recovery; 98.9% samples stored &lt;1 year met the &gt;60% CD34+ viability acceptability threshold versus 90% of samples stored for &gt;10 years. The oldest sample infused after storage of 5,273 days (14.4 years) showed 42% TNC recovery, 19% CD34+ recovery, and 84% CD34 viability; ANC engraftment data were not available. Sixty-five samples containing ANC engraftment data showed that time to ANC engraftment ranged from 9 to 15 days. No clear trend was present for viability or CD34 recovery when compared with days to engraftment based on limited data. Although rare, infusion of HPC products of extended duration occurs. This study suggests that HPC product quality may decrease after extended cryopreservation based on preestablished acceptability criteria. The oldest sample infused had preserved CD34+ viability despite significantly less TNC and CD34+ recovery, suggesting thawing might select for more robust HPCs. More studies with older samples are needed to determine the clinical impact of cryopreservation and if modification of current quality indicators could be useful clinically.

Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

RationaleThere is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement...

1249-P: Development and Validation of a Measure for Appropriateness of Glucose-Lowering Therapy

Current diabetes quality indicators do not reflect considerations of clinical complexity, hypoglycemia risk, and treatment burden in identifying optimal therapeutic regimens and targets. Based on existing evidence and input from patients and clinician, payer, and quality measurement experts, we developed a metric that incorporates HbA1c level, comorbidity burden, and number/type of glucose lowering medications (Table) to classify patients as potentially overtreated, undertreated, or appropriately treated. Measure was tested in a national cohort of commercial and Medicare Advantage enrollees with diabetes using the OptumLabs® Data Warehouse. Among 215,429 adults ≥18 years (mean 65 years, 49.6% female, 59.4% white, 4.2% type 1 diabetes, 12.1% clinically complex, 52.7% with HbA1c &amp;lt;7%), 71.0% were treated appropriately, 21.3% undertreated, and 7.7% overtreated in 2015. Compared with current measures (HbA1c &amp;lt;8% for all), 4.4% low complexity and 12.6% high complexity patients were reclassified as no longer appropriately treated. Rates of hypoglycemia-related ED/hospitalization visits in 2016 were 7.0, 12.4, and 22.9 per 1000 persons/year for those appropriately, under-, and over-treated in 2015. Rates of hyperglycemia-related visits were 2.5, 12.2, and 4.6. Implementation of this measure to minimize over- and under-treatment through a patient-centered approach to glucose lowering therapy is planned. Disclosure R.G. McCoy: None. K.J. Lipska: Consultant; Self; Health Services Advisory Group (HSAG). Research Support; Self; National Institute on Aging. Other Relationship; Self; Centers for Medicare and Medicaid Services. H. Van Houten: None. N. Shah: None. Funding American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

Measuring quality in community nursing: a mixed-methods study

Background High-quality nursing care is crucial for patients with complex conditions and comorbidities living at home, but such care is largely invisible to health planners and managers. Nursing care quality in acute settings is typically measured using a range of different quality measures; however, little is known about how service quality is measured in community nursing. Objective To establish which quality indicators (QIs) are selected for community nursing; how these are selected and applied; and their usefulness to service users (patients and/or carers), commissioners and provider staff. Design A mixed-methods study comprising three phases. (1) A national survey was undertaken of ‘Commissioning for Quality and Innovation’ indicators applied to community nursing care in 2014/15. The data were analysed descriptively using IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY, USA). (2) An in-depth case study was conducted in five sites. Qualitative data were collected through observations, interviews, focus groups and documents. A thematic analysis was conducted using QSR NVivo 10 (QSR International, Warrington, UK). The findings from the first two phases were synthesised using a theoretical framework to examine how local and distal contexts affecting care provision impacted on the selection and application of QIs for community nursing. (3) Validity testing the findings and associated draft good practice guidance through a series of stakeholder engagement events held in venues across England. Setting The national survey was conducted by telephone and e-mail. Each case study site comprised a Clinical Commissioning Group (CCG) and its associated provider of community nursing services. Participants Survey – 145 (68.7%) CCGs across England. Case study NHS England national and regional quality leads (n = 5), commissioners (n = 19), provider managers (n = 32), registered community nurses (n = 45); and adult patients (n = 14) receiving care in their own homes and/or carers (n = 7). Findings A wide range of indicators was used nationally, with a major focus on organisational processes. Lack of nurse and service user involvement in indicator selection processes had a negative impact on their application and perceived usefulness. Indicator data collection was hampered by problematic information technology (IT) software and connectivity and interorganisational system incompatibility. Front-line staff considered indicators designed for acute settings inappropriate for use in community settings. Indicators did not reflect aspects of care, such as time spent, kindness and respect, that were highly valued by front-line staff and service user participants. Workshop delegates (commissioners, provider managers, front-line staff and service users, n = 242) endorsed the findings and drafted good practice guidance. Limitations Ongoing service reorganisation during the study period affected access to participants in some sites. The limited available data precluded an in-depth documentary analysis. Conclusions The current QIs for community nursing are of limited use. Indicators will be enhanced by involving service users and front-line staff in identification of suitable measures. Resolution of connectivity and compatibility challenges should assist implementation of new IT packages into practice. Modifications are likely to be required to ensure that indicators developed for acute settings are suitable for community. A mix of qualitative and quantitative methods will better represent community nursing service quality. Future work Future research should investigate the appropriate modifications and associated costs of administering QI schemes in integrated care settings. Funding The National Institute for Health Research Health Services and Delivery Research programme.

ТЕОРЕТИКО-МНОЖИННА МОДЕЛЬ ЯКІСНОГО СТАНУ ПРОМИСЛОВОЇ КІБЕРФІЗИЧНОЇ СИСТЕМИ

In the work the set-theoretical model of quality state of the industrial cyberphysical system which is based on qualimetric evaluation of the compliance of the current quality indicators of sensors of its sensory infrastructure with the expected value. Model assignment is use in systems of monitoring and diagnostics. The model gives a possibility of building of monitoring of the state of cyberphysical systems in the process of affirmation in real time as in operating conditions as during testing at production stages (start-up and adjustment works and experimental exploitation) and system support. The main difference from existing systems based on “related models” is applying of the “quality” approach as an universal one, which is not connected with specific physical or linguistic meaning of the measured value. Quality indicators in the given expressions define the quality state of components of sensor infrastructure of the cyberphisical system according to the ISO/IEC 25000 series of standards and correspond to the problem-oriented functional properties of quality, which determine how well the system execute its functions. Attribution of the current state of the components of the sensor infrastructure to the certain subrange of quality scale performs the function of difficulty reduction and gives a significant decline of data volume for operating in diagnostic systems. The applied methods of qualimetric measurements and evaluating are based on the entropy determination of simple and complex quality indicators of components of sensory-hardware, sensory-functional and sensory-software infrastructure. Offered approach also gives a possibility of evaluation of influence of interconnections of quality indicators of outer systems on the current state of the explored system in process of diagnostics of complicated and critical situations. Set-theoretical expressions for determination of quality state of functional blocks, hardware units, structure levels and their components are given. The graphical visualization of model of quality state of generalized sensory infrastructure and qualitative state of the functional block is given.