Health Quality Improvement Research Articles

Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety

BackgroundMedical errors, especially those resulting in patient harm, have a negative psychological impact on patients and healthcare workers (HCWs). Healing may be promoted if both parties are able to work...

A US National View of Prevalent and Newly Diagnosed Multiple Myeloma in 2021: A Retrospective Analysis of National All-Payer Claims Database

Introduction: Multiple myeloma (MM) is a rare and heterogeneous cancer with steadily improving patient survival in recent years due to advancement in therapies. Updates to the prevalence and incidence of MM using the latest nationally representative data are needed to support population health management, resource planning, and health economic assessments. Furthermore, disparities in disease burden, access to care, treatment patterns, and outcomes could exist across patient subpopulations with MM, prompting a need for comprehensive data to understand the population. Currently, there is a gap in such data due to the highly fragmented health care system in the US in which real-world evidence is often siloed and represents only a portion of the population. This study aims to provide a national view of MM by estimating the prevalence and incidence in US adults overall and by state/territory, payer type, race, and ethnicity in 2021. Methods: This is a retrospective study using the All-Payer Real-World Multiple Myeloma Research-Ready Data built using the US national all-payer claims database (APCD), which covers ~87% of the nationally insured population from 1/1/2014 to 1/31/2022. Data included adults with ≥2 claims with MM diagnosis (ICD-9-CM: 203.0x and ICD-10-CM: C90.0x) who had continuous capture with medical and pharmacy benefits for ≥12 months prior to and 30 days after the first MM diagnosis date. To be included in this study, patients also had to have ≥1 claim in 2021. The latest claim date in 2021 was defined as the index date. A subcohort of patients with newly diagnosed MM (NDMM; incident MM cases) were additionally required to have their first MM diagnosis date (the index date for the NDMM cohort) in 2021. Prevalence and incidence of MM were estimated using the number of patients in MM and NDMM cohorts, divided by the total APCD adult population with similar continuous capture eligibility. Prevalence and incidence were calculated for the overall population and stratified by state/territory, payer type, race, and ethnicity. Patient characteristics were captured at the index date and during the baseline period. The proportion of patients with NDMM who initiated their first treatment in 2021 and the time from diagnosis to their first treatment were captured. Results: A total of 63,281 MM and 9,674 NDMM patients met the study criteria. Mean age was 71.1 and 70.0 years, 51.4% and 52.9% were male, and 68.7% and 72.0% were covered by Medicare, respectively. Overall, about two-thirds of the patients had available race (74%), ethnicity (69%), and income data (76%), while 46% had education status. Among those with data, 15.6% of MM and 14.7% of NDMM cohorts were Black, 12.2% and 11.9% were Hispanic, 65.1% and 64.5% had an annual income ≤$50,000, and 67.5% and 67.2% had high school as their highest level of education. The overall prevalence of MM was 73.8 per 100,000 adults in 2021, with the prevalence being the highest among those who were Black (124.8), non-Hispanic (101.3), covered by Medicare (245.2), and residing in the US Virgin Islands (243.6) and Arkansas (126.5). The overall incidence of NDMM was 11.3 per 100,000 adults in 2021, and the incidence was highest among those who were Black (17.8), non-Hispanic (15.3), covered by Medicare (39.3), and those residing in Puerto Rico (24.5), the US Virgin Islands (22.8), and Washington (20.7; Tables 1 and 2). The mean Quan-Charlson comorbidity index (excluding MM diagnosis) was 2.8 for the MM cohort and 2.4 for the NDMM cohort. Commonly observed comorbidities for both cohorts included anemia (44.8% and 47.4%), diabetes with chronic complications (23.9% and 22.4%), peripheral neuropathy (24.8% and 15.2%), renal impairment (22.7% and 20.1%), and infections (21.9% and 14.4%). There were 3,377 (35%) patients with NDMM who initiated their first treatment in 2021, with a mean and median time to treatment of 50.8 (standard deviation = 67.5) and 27 days. Conclusions: While the prevalence and incidence of MM in 2021 estimated in this study were consistent with projected estimates from the literature, variations in rates of MM were observed across race, ethnicity, payer type, and state/territory, indicating potential disparities in the burden of MM. Such a comprehensive view of rates of MM could serve as a foundation for future health policy decisions, quality improvement, resource deployment, and initiatives to address health disparities across subpopulations. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Experiences of Stakeholders Using Social Media as a Tool for Health Service Design and Quality Improvement: A Scoping Review.

Health organisations and stakeholders use social media for a range of functions, including engaging stakeholders in the design and quality improvement (QI) of services. Social media may help overcome some of the limitations of traditional stakeholder engagement methods. This scoping review explores the benefits, risks, barriers and enablers for using social media as a tool for stakeholder engagement in health service design and QI. The searches were conducted on 16 August 2022. Inclusion criteria were: studies of any health service stakeholders, in any health setting, where social media was used as a tool for service design or QI. Data was analysed using deductive content analysis. A committee of stakeholders provided input on research questions, data analysis and key findings. 61 studies were included. Benefits included improved organisational communication and relationship building. Risks/limitations included low quality of engagement and harms to users. Limited access and familiarity with social media were frequently reported barriers. Making discussions safe and facilitating access were common enablers. The benefits, risks, barriers and enablers identified highlight the complexity of social media as an engagement tool for health service design and QI. Understanding these experiences may help implementers design more effective social media-based engagement activities.

Improvement in health status and quality of life in patients with osteoporosis treated with denosumab: results at a mean follow-up of six years.

The clinical efficacy and tolerability of denosumab in severe osteoporosis are well-known. However, the evaluation on general health and quality of life over time and compared to population norms is still lacking. We aimed at evaluating denosumab effectiveness in a real-world clinical sample with a 6-years average follow-up. In this retrospective-matched study with prospective data collection, a total of 101 patients affected by severe osteoporosis and treated with denosumab between 2014 and 2020 were evaluated. All patients completed the self-perceived quality of life (36-Item Short Form - SF-36) survey and visual analogue scale (VAS) before and after treatment. Overall, 13 patients died of causes unrelated to the procedure, 12 stopped therapy with denosumab, and 30 did not participate in the follow-up; thus, 46 patients completed the study. There were 44 (95.7%) women and 93.4% of patients reported history of osteoporotic fractures. The mean follow-up was 59±17.8 months and the mean age at follow-up was 73.9±10.6 years. We found a significant improvement in bodily pain (baseline 53.8±33.4, follow-up 62.7±26.6; p=0.002) and in general health (baseline 35±25.4, follow-up 41.7±24.2; p=0.002) over time. The bodily pain score at follow-up was similar to the mean of the age-matched healthy population (62.7±26.6 vs. 67.6±26, p=0.374). The MCS-36 scores were higher than the normative values before treatment and at follow-up (51.6±9.8 vs. 45.8±9, p=0.004 and 50.6±11.7 vs. 45.8±9, p=0.030, respectively). The PCS-36 score at follow-up was comparable to the normative values (39.4±10.4 vs. 42.7±9, p=0.107). Denosumab is effective to improve bone health and global mental and physical wellbeing, and quality of life over time.

Prevalence of not receiving a home visit by Community Health Agents in Brazil and associated factors.

This article aimed to identify the prevalence of not receiving a home visit by a community health agent (CHA) and the factors associated with it. This was a cross-sectional study, conducted with 38,865 health teams and 140,444 users in the entire country, who participated in the external evaluation of the Program of Access and Quality Improvement in Primary Health (PMAQ-AB, in Portuguese) in 2017/2018. The association between not receiving a home visit by a CHA and the characteristics of the towns, teams, and individuals were estimated by the prevalence ratio (PR) with 95% confidence intervals. The prevalence of not receiving a home visit by a CHA was 18.6% and the main causes were: CHA did not visit the home, lack of knowledge of the existence of CHAs in the neighborhood or unit, and no one present at the home when the CHA visited. The probability of receiving a home visit was higher in poorer regions like the Northeast Region of the country; in towns with a smaller population; among older age users with a lower income, users with chronic health conditions, or users who have someone with a physical disability at home. The results showed that there is a need to increase the coverage of CHA visits in the country, considering that their home visits improve equity in health care.

Prevalência do não recebimento de visita domiciliar pelo Agente Comunitário de Saúde no Brasil e fatores associados

Abstract This article aimed to identify the prevalence of not receiving a home visit by a community health agent (CHA) and the factors associated with it. This was a cross-sectional study, conducted with 38,865 health teams and 140,444 users in the entire country, who participated in the external evaluation of the Program of Access and Quality Improvement in Primary Health (PMAQ-AB, in Portuguese) in 2017/2018. The association between not receiving a home visit by a CHA and the characteristics of the towns, teams, and individuals were estimated by the prevalence ratio (PR) with 95% confidence intervals. The prevalence of not receiving a home visit by a CHA was 18.6% and the main causes were: CHA did not visit the home, lack of knowledge of the existence of CHAs in the neighborhood or unit, and no one present at the home when the CHA visited. The probability of receiving a home visit was higher in poorer regions like the Northeast Region of the country; in towns with a smaller population; among older age users with a lower income, users with chronic health conditions, or users who have someone with a physical disability at home. The results showed that there is a need to increase the coverage of CHA visits in the country, considering that their home visits improve equity in health care.

Bridging health equity and quality improvement in medical education.

Sukhera suggests that a deeper understanding of how QI education and health equity are interconnected requires critical reflection on why QI was developed, by whom, and for what purpose.

Toward 90-90-90 Goals for Global Mental Health

This Viewpoint discusses the adoption of 90-90-90 goals for global mental health, specifically targeting neurologic and substance use disorders, to prioritize mental health quality improvement within existing health services and destigmatize these conditions to promote treatment.

A survey study of Chinese adolescents' mental and interpersonal quality: Evidence from COVID-19 pandemic.

Since 2019, the COVID-19 pandemic, as a global public health emergency, has led to stringency measures (such as lockdown) of various degrees worldwide. As these measures such as social distancing measures and mandatory lockdown are intended to minimize social mobility, they have exerted remarkable impact on individuals' mental health, particularly, adolescents and children. The mental health problems caused include fear, anxiety, sense of isolation and development of more maladaptive behaviors due to prolonged lockdown and restricted interpersonal contact. However, well adaption status and stable interpersonal relationships play an important role in maintaining and promoting the mental health of adolescents and children. This study aims to gain a new sight of understanding of the mental health quality of Chinese adolescents during the COVID-19 Pandemic in terms of adaptation and interpersonal quality. The study is based on a survey on a total of 7,318 junior and senior high school students aged 12-18 years in various regions of China, and intended to examine the differences in adolescent mental health quality by sociodemographic variables such as gender, grade, urban and rural areas, only child, and parental education level. Our study finds that Chinese adolescents show an overall good adaptation and interpersonal quality during the lockdown. However there exists disparity across different categories in developmental patterns of adaptation and interpersonal quality. In addition, good family environment, moderate financial and emotional support, higher parental education level, etc. contribute to the cultivation and improvement of adolescents' mental health quality. Finally, we suggest that the government and researchers should pay more attention to adolescents' mental health issues in terms of adaption status and interpersonal relationships during the COVID-19 pandemic, especially for disadvantaged social groups such as girls, younger students, and low-income family students.

Viral hepatitis micro-elimination: models of care and barriers to implementation in 5 EU/EEA prisons

Abstract Introduction Coverage of essential prevention and control services and adequate monitoring schemes for viral hepatitis are often suboptimal in prison settings. Yet, evidence shows that targeted interventions are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison and the community at large. To promote transferability and improvement of prison health quality in EU/EEA the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will identify and disseminate models of care for viral hepatitis elimination in prisons. Methods The models of care were gathered using a data collection tool that has been designed for this purpose based on the literature review and agreed with an expert advisory group. Based on the results of the data collection, a survey for healthcare staff working in 5 selected prison institutions in the EU/EEA has been developed. Results The following models of care were collected: HCV micro-elimination in prison; transitional care for HCV treatment or HBV prevention/treatment; HCV or HBV care services tailored to women living in prison; HBV or HAV/HBV vaccination in prison settings. Harm reduction and drug treatment services in the prison are essential at all steps of the prevention and continuum of care. Among barriers identified were: engagement of people living in prison and prison governance structure, availability of infrastructural and human resources, daily prison organisation, inter-sectorial collaboration within prison and between prison and community services, training for prison staff and lack of systematic monitoring. Conclusions Evidence of effective and acceptable interventions in prison to prevent and control viral hepatitis is essential to foster inclusion of prison setting within national elimination programmes. Intra-EU benchmarking may help promote awareness, to allocate adequate resources, monitor of impact and ultimately the achievement of the elimination goal.

Expectations of patients for the implementation of new nursing technology

Abstract Background New technologies, including robots, incidence detection or patient mobilization units, are increasingly assumed to support nurses in their routines while improving care quality. In the Nursing Care Centre Hanover study (funded by the German ministry of education and research), new technologies are implemented in a hospital ward and used by nurses in their routines. As part of this study, hospital patients were interviewed regarding the question: What are patients’ expectations for the implementation of new technology into care delivery? Methods Between August 2019 and February 2020, 17 semi-structured interviews were conducted with patients from the project ward. To stimulate a response, 8 presentation of technologies by video and text (3 per interview) were given during the interviews. Interviews were recorded, transcribed and coded by evaluative, qualitative content analysis. The coded material was then interpreted in light of the research question. Results Patients anticipate positive and negative effects of new technology concerning themselves, but they also expect effects on nurses: Health, safety and health service quality improvements might be positive effects for patients, but they are concerned about emerging threads to health by unintended consequences. They raise concerns about the possible inabilities of elder patients to use technology properly. Patients expect physical and emotional stress release for nurses when using technology, but they fear the replacement of nurses. This would have negative consequences for patients, like social isolation due to being cared for by machines. Conclusions Patients have ambivalent perceptions of new technologies in nursing care. They have a differentiated view of possible consequences, not merely for themselves but also for nurses. In general, they are positive about the implementation, but this must be carried out under certain conditions, so that technology is used in a supportive, but not replacing, manner. Key messages • The patients’ perspective must be take into account for the implementation of nursing technology to avoid negative, unintended consequences. • Inclusion and consideration of older patients and their technology skills can be a relevant factor for advancing the adoption of new technology into care delivery.

Validity And Reliability of the Questionnaire to Measure the Patient Satisfaction With Nursing Care Quality-Turkish Version

Background: Patient satisfaction is an essential quality-result indicator of health services in hospital and ambulatory care settings. There are limited questionnaires to measure patient satisfaction with nursing care quality in Turkey. Purpose: This study aimed to assess the psychometric properties of the Turkish version of the Patient Satisfaction With Nursing Care Quality Questionnaire (PSNCQ). Methods: This methodological study was carried out in a bronchology unit of a state hospital in Istanbul between January and May 2021. The sample consisted of 149 participants and was recruited using convenience sampling. Data were collected using an online questionnaire. Results: The Content Validity Index of the questionnaire was calculated at .95. Item-total correlations ranged from .76 to .91 for 19 items. The minimum factor load was .781, and the questionnaire items explained 79% of the total variance. Alpha coefficient was calculated as .98 for the whole questionnaire. To test reliability analysis, the Spearman-Brown correlation value was 0.881, and the Guttman Split-Half value was 0.933. Test re-test correlation was .88. Confirmatory factor analysis confirmed the one-factor model. Conclusions/Implications for practice: Turkish version of the PSNCQ questionnaire is a valid and reliable tool for evaluating patient satisfaction with nursing care. Valid and reliable instruments are crucial to effectively assess patient satisfaction with nursing care to improve health quality.

Neurological Outpatients Prefer EEG Home-Monitoring over Inpatient Monitoring-An Analysis Based on the UTAUT Model.

Home monitoring examinations offer diagnostic and economic advantages compared to inpatient monitoring. In addition, these technical solutions support the preservation of health care in rural areas in the absence of local care providers. The acceptance of patients is crucial for the implementation of home monitoring concepts. The present research assesses the preference for a health service that is to be introduced, namely an EEG home-monitoring of neurological outpatients—using a mobile, dry-electrode EEG (electroencephalography) system—in comparison to the traditional long-time EEG examination in a hospital. Results of a representative study for Germany (n = 421) reveal a preference for home monitoring. Importantly, this preference is partially driven by a video explaining the home monitoring system. We subsequently analyzed factors that influence the behavioral intention (BI) to use the new EEG system, drawing on an extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. The strongest positive predictor of BI is the belief that EEG home-monitoring will improve health quality, while computer anxiety and effort expectancy represent the strongest barriers. Furthermore, we find the UTAUT model’s behavioral intention construct to predict the patients’ decision for or against home monitoring more strongly than any other patient’s characteristic such as gender, health condition, or age, underlying the model’s usefulness.

Engaging Stakeholders in Social Determinants of Health Quality Improvement Efforts.

Background Social determinants of health (SDOH) affect around 70% of health outcomes. However, it is not clear how to integrate SDOH into clinical practice and health care policy. This quality improvement project engaged stakeholders to identify SDOH factors relevant in an Alaska Native/American Indian health system and how to integrate SDOH data into electronic health records (EHRs). Methods The authors utilized an internal steering committee of clinical leadership; conducted focus groups with patients, practitioners, administrative staff, and clinical leaders; developed programmatic workgroups to engage with the health system; and coordinated with allied health systems. Results The Steering Committee members prioritized uses of SDOH data. Focus groups grounded work in local community values and refined SDOH subdomains. Workgroups developed data visualizations, such as EHR dashboards, to automate data collection for reporting and assess performance metrics. External stakeholders helped innovate ways to utilize SDOH data through community partnerships and advocacy work. Stakeholders liked how the holistic approach of SDOH looks at whole-person wellness and how it can improve patient-practitioner relationships and reduce health disparities. They were concerned about outdated SDOH data and how some sensitive SDOH could lead to unanticipated harms. Leaders emphasized developing an actionable, strengths-based SDOH framework. Conclusions Many initiatives call for integrating SDOH into health care and EHRs. Engaging diverse audiences helps guide the work. This engagement may be particularly helpful for minority-serving health systems. SDOH data collection can be stigmatizing for patients. Stakeholder engagement can mitigate that by identifying which SDOH data elements to prioritize, and how to utilize them.

No Quick Fixes: Integrating Population Health Education and Quality Improvement in a Large Residency Program.

The intersection of population health (PH), quality improvement (QI), and health disparities is increasingly a focus in graduate medical education. However, it remains unclear how trainees may best improve disparities within clinical training environments. We integrated PH education for residents participating in a practical QI experience in a continuity clinic serving an underserved population. We analyzed whether PH education increased confidence in creating care plans and implementing team-based care strategies after selection of one of three QI metrics with known health disparities led to improvement. Posteducational session, attendees had odds of confidence in creating care plans 10.0 (95% confidence interval [CI] 4.6-21.7) times the presession period, whereas nonattendees' confidence was unchanged (OR 1.63, 95% CI 0.78-3.4). Residents participating in the QI project did not have higher confidence in creating a care plan at baseline (20% vs. 9.6%, p = .09) nor any additional shift in confidence versus other residents (p = .57). There were no differences in QI metric performance rate trends for residents choosing a specific QI metric versus those that did not (p > .33 for all comparisons). PH didactics can increase resident confidence around PH topics. However, translating such learning into outcomes and improved health equity may require dedicated efforts across residency training.

The Effect of Pocket Books as Nutrition Counseling Media on Knowledge and Attitudes of Prospective Bride and Groom

The First Thousand Days of Life or 1000 HPK (Golden Period) is a critical period starting from conception until the child is 2 years old. Bride and groom are one of the target groups to improve health quality in 1000 HPK. Improving the quality of health can be done by providing pocket books as a medium for nutritional counseling. This research aims to determine the effect of pocket books as a medium for nutritional counseling on the knowledge and attitudes of prospective brides and grooms. This research uses the method true experiment research with randomized pre and posttest control group design. The number of respondents was 36 brides and grooms who registered at the Pedurungan Office of Religious Affairs (KUA) of Semarang City, which consisted of 19 interventions (given counseling and pocket books) and 17 controls (only counseled). Knowledge and attitude data were collected using a questionnaire. The test used to determine the effect between variables is the Paired Sample T-test. Results: There was an effect of pocket books as a medium of nutrition counseling on knowledge in the intervention group (p=0.000) and control (p=0.000) and intervention attitude (p=0.000), but there was no effect on control attitudes (p=0.438). Knowledge of respondents in the intervention group increased by 10.26 while attitudes increased by 11.32. This study concludes that the provision of pocket books as a medium for nutritional counseling has an effect on increasing the knowledge and attitudes of the bride and groom.

The Effect of Pocket Books as Nutrition Counseling Media on Knowledge and Attitudes of Prospective Bride and Groom

The First Thousand Days of Life or 1000 HPK (Golden Period) is a critical period starting from conception until the child is 2 years old. Bride and groom are one of the target groups to improve health quality in 1000 HPK. Improving the quality of health can be done by providing pocket books as a medium for nutritional counseling. This research aims to determine the effect of pocket books as a medium for nutritional counseling on the knowledge and attitudes of prospective brides and grooms. This research uses the method true experiment research with randomized pre and posttest control group design. The number of respondents was 36 brides and grooms who registered at the Pedurungan Office of Religious Affairs (KUA) of Semarang City, which consisted of 19 interventions (given counseling and pocket books) and 17 controls (only counseled). Knowledge and attitude data were collected using a questionnaire. The test used to determine the effect between variables is the Paired Sample T-test. Results: There was an effect of pocket books as a medium of nutrition counseling on knowledge in the intervention group (p=0.000) and control (p=0.000) and intervention attitude (p=0.000), but there was no effect on control attitudes (p=0.438). Knowledge of respondents in the intervention group increased by 10.26 while attitudes increased by 11.32. This study concludes that the provision of pocket books as a medium for nutritional counseling has an effect on increasing the knowledge and attitudes of the bride and groom.

Utilization of mango processing industrial waste into value added products

Around the world, the food processing industries produce significant amounts of food wastes or byproducts each year. The industries that process plant-based foods, such as those that process fruits and vegetables, cereals and pulses, nuts and oil seeds, etc., mostly create byproducts including bran, husk, pomace, seed, peel, shell, seeds, stems, and seed coat. When these waste products are disposed of as waste or used as cattle feed, they pollute the ecosystem and lose important nutrient components. By-products from the food processing industry are a prospective source of bioactive and functional chemicals that can be used for medicinal and nutritional purposes. Due to rising health consciousness among consumers, there is a tremendous increase in demand for novel functional foods. Functional foods are utilised to improve health quality and health maintenance while lowering health risks for conditions like cardiovascular disease, cancer, osteoporosis, obesity, diabetes, and metabolic disease. India is the world's secondlargest producer of fruits and vegetables. 10% of the fruit produced worldwide comes from it. Fruit wastes are a great source of phytochemicals and antioxidants. As a result, the functional characteristics of the waste from the processing of fruit can be used. The study's goal is to create sustaining and useful food products based on by-products from Tamil Nadu's mango processing industry. This study contributes to a more efficient use of mango processing industries economically. Key words: sustaining,phto-chemicals, Antioxidants,therapeutic

Evidence of Interventions and Strategies to Bridge the Quality Improvement Gap Led by HCW at the Frontline in SSA: A Scoping Review

Abstract Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when there was no new information. All evidence was scored based on the 6 criteria described by Backhouse et al., which clearly distinguish quality improvement from clinical audit and research. Inclusion criteria were studies that involved frontline health care workers to test “change ideas” and used data systems to measure improvement in service delivery. Results A total of 75 records were identified and including 52 from the peer review search and 23 records from the grey literature search. Only 15 of 47 countries had publications (peer-review or grey literature) describing QI initiatives. Most quality improvement (QI) initiatives were multicomponent and included knowledge transfer, skills building, mentorship and learning visits. Most publications reported QI initiatives aimed at reproductive, maternal, neonatal and child health (n=23) and HIV (n=14) service delivery. Only 6 had experimental designs. No publications were identified prior to 2012 and a rapid escalation of published quality improvement initiatives from 2012 to 2020 was seen. Conclusion QI is in the very nascent stage in SSA. Most large-scale public health QI initiatives are sector specific, siloed, and donor driven. QI initiatives within sector specific programs have not moved horizontally and have had limited ability to change the broader system. Energy must be exerted to change the status quo. Making health care safer and more effective is not spontaneous.

Ecosystem health assessment based on AHP-DPSR model and impacts of climate change and human disturbances: A case study of Liaohe River Basin in Jilin Province, China

Rapid urban development, increasing urban population, and drastic land-use changes may cause deterioration of ecosystem health and pose a serious threat to sustainable development. In this study, the analytic hierarchy process-driving-pressure-state-response (AHP-DPSR) model was used to evaluate the ecosystem health of the Liaohe River Basin in Jilin Province, China. The DPSR model was used to select indicators, and 29 indicators were selected for the ecosystem health evaluation index system, including four aspects of driving, pressure, state, and response. At the same time, the weights of each index were determined using AHP, and the spatiotemporal change pattern of ecosystem health in the past 15 years was assessed. The results of the ecosystem health assessment in the study area were spatially spread using ArcGIS software. Finally, the influence of climate and human activities on ecosystem health status was explored. Spatial autocorrelation analysis of the ecosystem health structure was conducted to provide suggestions for the subsequent improvement of ecosystem health quality and sustainable development in the region. The results showed the following: (1) From 2005 to 2020, the health level of the ecosystem in the study area generally showed a trend of improvement. The percentages of ecosystem health in the study area, from high to low in 2020 were 26%, 24%, 31%, 12%, and 7%. (2) The regions with high spatial autocorrelation in 2020 were Gongzhuling City, Dongliao County, Xi'an District, and Longshan District. These areas can be prioritized for ecological management of the region. (3) The spatial and temporal variation in ecosystem health in the Liaohe River Basin of Jilin Province is significantly influenced by precipitation, temperature, and GDP in the region. The conclusions of this study can provide policy references and scientific guidance for the ecological environmental protection and sustainable development of the Liaohe River Basin in Jilin Province.