Highest Priority Scores Research Articles

A comprehensive decision-making approach for the application of biochar in agriculture to enhance water security: A GIS-AHP based approach

In the context of climate change, biochar application is a promising approach to mitigate the adverse effects of climate change on agriculture. However, the selection of suitable biochar produced from food waste and optimization of loading rates to improve soil quality remains a significant challenge. This study explores the potential impact of biochar application using an integrated analytical hierarchy process (AHP) and geographical information system (GIS) approach. The study first aims to develop an AHP model to prioritize the appropriate biochar source and dosage for soil amendment. The different biochar sources considered are: peas pod shell, pistachio shell, and mixed vegetable waste. The AHP design evaluated the weight percentage of different types of biochar amendments ranging from 0 % to 8 % based on soil quality, nutrient analysis and water retention capacity. Furthermore, an integrated spatial analysis case study was conducted for fodder farms across Qatar using GIS mapping with seasonal variation to evaluate the impact of biochar on water management. According to the AHP decision making, 2 % mixed vegetable waste biochar achieved the goal with the highest priority score, with a value of 0.29, followed by 2 % pistachio shell biochar with a score of 0.22. This is attributed to the high water retention rate determined from the experimental study. The 2% biochar amendment retained 20 % more water compared to the 0 % biochar. Results from the GIS mapping identified priority areas for improving water retention and soil quality. The evapotranspiration maps for winter and summer generated using GIS provide valuable insights into the spatial disributio of biochar application across Qatar fodder farms. The outcomes may encourage policymakers and stakeholders to consider valorizing food waste into biochar.

Repression of PRMT activities sensitize homologous recombination-proficient ovarian and breast cancer cells to PARP inhibitor treatment.

An "induced PARP inhibitor (PARPi) sensitivity by epigenetic modulation" strategy is being evaluated in the clinic to sensitize homologous recombination (HR)-proficient tumors to PARPi treatments. To expand its clinical applications and identify more efficient combinations, we performed a drug screen by combining PARPi with 74 well-characterized epigenetic modulators that target five major classes of epigenetic enzymes. Both type I PRMT inhibitor and PRMT5 inhibitor exhibit high combination and clinical priority scores in our screen. PRMT inhibition significantly enhances PARPi treatment-induced DNA damage in HR-proficient ovarian and breast cancer cells. Mechanistically, PRMTs maintain the expression of genes associated with DNA damage repair and BRCAness and regulate intrinsic innate immune pathways in cancer cells. Analyzing large-scale genomic and functional profiles from TCGA and DepMap further confirms that PRMT1, PRMT4, and PRMT5 are potential therapeutic targets in oncology. Finally, PRMT1 and PRMT5 inhibition act synergistically to enhance PARPi sensitivity. Our studies provide a strong rationale for the clinical application of a combination of PRMT and PARP inhibitors in patients with HR-proficient ovarian or breast cancer.

A Blueprint for Multi-use Disease Modeling in Health Economics: Results from Two Expert-Panel Consultations.

The current use of health economic decision models in HTA is mostly confined to single use cases, which may be inefficient and result in little consistency over different treatment comparisons, and consequently inconsistent health policy decisions, for the same disorder. Multi-use disease models (MUDMs) (other terms: generic models, whole disease models, disease models) may offer a solution. However, much is uncertain about their definition and application. The current research aimed to develop a blueprint for the application of MUDMs. We elicited expert opinion using a two-round modified Delphi process. The panel consisted of experts and stakeholders in health economic modelling from various professional backgrounds. The first questionnaire concerned definition, terminology, potential applications, issues and recommendations for MUDMs and was based on an exploratory scoping review. In the second round, the panel members were asked to reconsider their input, based on feedback regarding first-round results, and to score issues and recommendations for priority. Finally, adding input from external advisors and policy makers in a structured way, an overview of issues and challenges was developed during two team consensus meetings. In total, 54 respondents contributed to the panel results. The term 'multi-use disease models' was proposed and agreed upon, and a definition was provided. The panel prioritized 10 potential applications (with comparing alternative policies and supporting resource allocation decisions as the top 2), while 20 issues (with model transparency and stakeholders' roles as the top 2) were identified as challenges. Opinions on potential features concerning operationalization of multi-use models were given, with 11 of these subsequently receiving high priority scores (regular updates and revalidation after updates were the top 2). MUDMs would improve on current decision support regarding cost-effectiveness information. Given feasibility challenges, this would be most relevant for diseases with multiple treatments, large burden of disease and requiring more complex models. The current overview offers policy makers a starting point to organize the development, use, and maintenance of MUDMs and to support choices concerningwhich diseases and policy decisions they will be helpful for.

Health research prioritization in Somalia: setting the agenda for context specific knowledge to advance universal health coverage.

Despite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia. We adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143). Two hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others. The developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.

Kaiser Permanente's Social Needs Network for Evaluation and Translation Empirical Research Agenda

Healthcare systems such as Kaiser Permanente are increasingly focusing on patients' social health. However, there is limited evidence to guide social health integration strategy. The purpose of this study was to identify social health research opportunities using a stakeholder-driven process. A modified Concept Mapping approach was implemented from June 2021 to February 2022. Stakeholders (n=746) received the prompt, "One thing I wish we knew more about to advance my work addressing social health..." An inductive content analysis approach was used to assign topics and synthesize and refine research-focused statements into research questions. Questions were then rated on impact and priority by researcher stakeholders (n=16). Mean impact and priority scores and an overall combined score were calculated. Question rankings were generated using the combined score. Brainstorming produced 148 research-focused statements. A final list of 59 research questions was generated for rating. Question topics were (1) Data, Measures, and Metrics; (2) Intervention Approach and Impact; (3) Technology; (4) Role of Healthcare Systems; (5) Community-Based Organizations; (6) Equity; (7) Funding; and (8) Social Health Integration. On a scale from 1 (low) to 10 (high), the mean impact score was 6.12 (range=4.14-7.79), and the mean priority score was 5.61 (range=3.07-8.64). Twenty-four statements were rated as both high impact (>6.12) and high priority (>5.61). The broad range of topics with high impact and priority scores reveals how nascent the evidence base is, with fundamental research on the nature of social risk and health system involvement still needed.

A social consensus to prioritize humanization strategies for Mental Health in Castilla y León

IntroductionHumanization in Mental Health is a concept that treat to conceal in the last decades the quality, efficiency and safety of care of complex diseases and conditions with individual values, needs and preferences and involves the patient and society in the decision-making priority.Objectivesto stablish and evaluate the priorities of different groups of interest in the development of a new humanization plan for mental healthMethodsDuring 2022 a Humanization plan for the Spanish region of Castilla y Leon (2.400.000 habs) was developed with a Delphi model. Participants included 36 stakeholders including mental health services, administration, social services, associations, patients and families. They stablished 32 objectives distributed in 7 strategic lines: 1. “People First” (Rights, Autonomy and Information); 2. “From People to Services” (Participation of users in mental heal services); 3. “Person-Centered-Assistance” 4. “Processes sensible to change” (reduction of coercion); 5. “Human ambient” (Improvement of units, psychosocial interventions). 6. Innovation, training and climate (not evaluated here). 7. “People without marks” (battle against stigma).Priorities in the lines were stablished by representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, patients and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score it from 0 to 10.Results500 subjects participated (38.6% Healthcare workers, 14% Mental Health Care users, 9.8% Social Services, 8.8% Associations, 7.8% Drug Services 6% Management of Health System, 5.8% Education Services, 3.8 Justice). Humanization was the most appreciated plan within the mental health plan 2022-2026 in Castilla y Leon (8.81±1.43).The Highest priority score was given to the Rights (8.68 + 1.54), Information (8.44 + 1.60) and Stigma (8.43 + 1.89) lines and the lowest were the evaluation of satisfaction (7.62 + 1.90) and Reduction of Coercion (7.29 + 2.12). Differences were found between groups. Scores in Rights and Autonomy (F:3.474; p<0.001) were highest in the Associations (9.32 +1.01) and lowest in the Justice group (7.68 + 1.67). In the information line the highest score (F:2.431; p=0,014) was in the Education Services (9.03 +0,94) compared to Scientific Societies (7,65 + 2,13). Highest score for Participation of Users (F:2,968; p=0,003) was in Social Services (8.76 +1.48) compared to Justice (7.47 +1.95). There were differences in the coercion reduction line (F:2.165; p=0,029) but no pairwise differences were foundImage:Image 2:ConclusionsHumanization approaches are well appreciated by different stakeholders. Priorities in our region start with rights, information and integration and mental health users in the health system and societyDisclosure of InterestNone Declared

Prioritizing agricultural pesticides to protect human health: A multi-level strategy combining life cycle impact and risk assessments

In this study, a multi-level strategy to prioritize pesticides for use in agriculture is proposed in support of protecting human health. The strategy includes four levels (production, application, distribution, and bioaccumulation) of screening approaches, for which the life cycle impact assessment (LCIA) and human health risk assessment (HHRA) models were applied to generate priority lists at each level. The LCIA model was used at the production level (i.e., chemical design; before pesticides being registered and entering the market), providing the inventory management based on environmental persistence and toxicity potential of pesticides, whereas the HHRA models were used at the other three levels, assessing human health risks based on pesticide emission to cropland. Priority scores (PS) of 319 pesticides were simulated with high scores indicating high priority for use in agriculture (relatively high human safety). The simulated results via the LCIA at the production level had strong positive correlations with those via the HHRA at the other three levels, indicating that the LCIA tool was capable of an initial screening of pesticides for use in agriculture. The simulated PS values of 319 pesticides indicated that some pesticides (e.g., chlorpyrifos and fipronil) with low PS values (e.g., < 8) that are currently used in some countries should be further evaluated. For other pesticides with high simulated PS values (e.g., > 15) for use in agriculture, their ecotoxicity impacts and ecological risks should be considered in protecting human health.

Raptor Research in India: Inadequate Data and Species' Status Uncertainty for Many Species

ABSTRACT Despite the recent surge in ornithological research in South Asia, raptors remain poorly studied. Inadequate information on the regional status and ecology of birds of prey hinders development of effective conservation measures. Our meta-analysis that focused on trends of scientific research on diurnal raptors in India found 478 published articles on 78 raptor species. We used the online databases of Google Scholar, Scopus, and the Journal of the Bombay Natural History Society to develop regional research and conservation priority indices (RCPI) for raptors, using the tool originally developed by Buechley et al. (Diversity and Distributions 25:856–869, 2019) for the raptors of the world. Published literature on raptors in India was highly skewed; most were either anecdotal reports about common species, or studies focused on vultures, whose local extirpations received significant attention. Twenty-one raptor species, of which two are near threatened and three vulnerable, were specifically studied in fewer than five publications. Even many common species are similarly poorly studied. The regional raptor RCPI was highest for the Andaman Serpent-Eagle (Spilornis elgini; 0.71) and lowest for Black Kites (Milvus migrans; 0.11). Several species that received high priority scores are vulnerable to extirpation due to factors such as habitat loss, poisoning, electrocutions, and other threats. We conclude that assessment of the species-bias in published studies will help researchers identify and address the knowledge gaps. This will ultimately help conservationists and managers devise effective regional and country-specific management strategies. We recommend further regional contextualization of the RCPI.

Implementation AHP Method in Selection of Outstanding Students at MI Sirojul Athfal 1 Bogor

At the beginning of 2020, precisely in March 2020, the government announced that Indonesia was affected by the Covid-19 outbreak. Since then, Indonesia has also been faced with a pandemic period, where all sectors of life have been affected, including the education sector. The primary school of MI Sirojul Athfal 1 Bogor conducts learning from home, this causes a lack of effective learning between teachers and students, and teachers find it difficult to determine student achievement. The Decision Support System (DSS) is one system that is able to assist researchers in making decisions accurately and in accordance with the objectives in determining outstanding students at the school. The Analytical Hierarchy Process (AHP) is capable of solving complex multi-criteria problems. From the results of this study and calculations carried out using the Expert Choice tool, it was concluded that the highest priority score was obtained by Muamar students with a value of 0.447. From this study, the results of the CR hypothesis for all criteria value are less than 0.1 or less than 10%, therefore the overall hierarchy produces consistent values.

Handling of The Environmental Drainage System In Jembrana District, Bali Province

The rapid growth of the urban population should be followed by the provision of basic infrastructure and facilities inadequate residential areas. One of them is the facilities and infrastructure for the environmental drainage system in residential areas to be free from standing water, especially during the rainy season. In Jembrana Regency, especially in Negara city and its surroundings, there are fourteen inundation points spread over 3 (three) districts. Drainage treatment is carried out by ranking priority scales based on inundation parameters. The parameters are inundation of height, length, frequency, and also the loss parameters due to inundation of economic facilities, public facilities, transportation facilities, housing, and casualties. With limited funds available, detailed planning is carried out on three inundation points with the highest priority score. The analysis shows that three inundation points receive priority for handling, namely Baler Bale Agung village’s environmental drainage system, Dauh Waru village, and environmental drainage Loloan Timur village. The drainage construction system uses an open channel with a U-ditch type and a box culvert with freecast concrete’s quality value of K-350.

Relative Importance of Determinants of Changes in Eating Behavior during the Transition to Parenthood: Priorities for Future Research and Interventions.

Background: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. Methods: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a “priority for research”-score was calculated. Results: During pregnancy, the three highest rated determinants by women were “health concerns”, “physiological changes”, and “fatigue”. Men perceived “health concerns”, “health consciousness”, and “influence of the pregnant partner” as important. Postpartum, the three highest rated determinants by women were “adaptation to rhythm of baby”, “baby becomes priority”, and “practical constraints because of the baby”. Men perceived “adaptation to rhythm of baby”, “fatigue”. and “(lack of) anticipation” as important. According to the experts, “professional influence”, “food knowledge”, and “home food availability” received high priority scores for both sexes and during both periods. Conclusions: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals.

Reducing Energy Losses of Steam Boilers Caused by Blowdown with Using the FMEA Method

ABSTRACT In this study, the boiler blowdown was systematically examined and, the risks that increase the energy loss was determined using the potential Failure Mode and Effects Analysis (FMEA) method. Risk priority numbers (RPN) were calculated for each potential risk. It was revealed that ‘Performing more blowdown than it is necessary’ has the highest priority score. Improvement opportunities were identified by using the tree diagram, which is one of the process improvement techniques. Three suggestions were developed, such as flash steam heat recovery, reduction of water conductivity using the reverse osmosis technique, and the use of both methods. Repayment periods were calculated for each investment. If the flash steam unit and reverse osmosis system are applied together, 113.5 KW/h energy can be saved. It has been demonstrated that the FMEA technique can be used in the investigation and reduction of energy loss.

Conservation Gaps in Traditional Vegetables Native to Europe and Fennoscandia

Vegetables are rich in vitamins and other micronutrients and are important crops for healthy diets and diversification of the food system, and many traditional (also termed underutilized or indigenous) species may play a role. The current study analyzed 35 vegetables with a European region of diversity with the effort to map the conservation status in Fennoscandia and beyond. We mapped georeferenced occurrences and current genebank holdings based on global databases and conducted conservation gaps analysis based on representativeness scores in situ and ex situ. Out of the 35 target species, 19 got at a high priority score for further conservation initiatives, while another 14 species got a medium priority score. We identified a pattern where traditional vegetables are poorly represented in genebank holdings. This corresponds well to a lack of attention in the scientific community measured in number of published papers. Considering the grand challenges ahead in terms of climate change, population growth and demand for sustainability, traditional vegetables deserve greater attention. Our contribution is to provide a basis for conservation priorities among the identified vegetables species native to Fennoscandia.

A system for risk stratification and prioritization of breast cancer surgeries delayed by the COVID-19 pandemic: preparing for re-entry.

PurposeDuring the COVID-19 pandemic, most breast surgery for benign and malignant conditions has been postponed, creating a backlog of patients who will need surgery. A fair and transparent system for assessing the risk of further delaying surgery for individual patients to prioritize surgical scheduling is needed.MethodsFactors related to risk of delaying surgery for breast patients were identified. Scores were assigned to each factor, with higher scores indicating a greater risk from delaying surgery. REDCap and Microsoft Excel tools were designed to track and score delayed patients.ResultsPublished data and multidisciplinary clinical judgement were used to assign risk scores based on patient and tumor factors, length of delay, and tumor response to preoperative therapy. Patients completing neoadjuvant chemotherapy were assigned the highest scores as their options for delaying surgery are most limited. Among patients receiving neoadjuvant endocrine therapy or no medical therapy, higher scores were assigned for low-estrogen receptor or high-genomic risk scores, higher grade, larger tumors, younger age and longer delay. High priority scores were assigned for progression during preoperative therapy. Low scores were assigned for re-excisions, atypical lesions and other benign indications. There was good agreement of the tool’s ranking of sample patients with rankings by experienced clinicians. The tool generates risk-stratified patient lists by surgeon or institution to facilitate assignment of surgery dates.ConclusionsThis tool generates a clinically consistent, risk-stratified priority list of breast surgical procedures delayed by the COVID-19 pandemic. This systematic approach may facilitate surgical scheduling as conditions normalize.

Human factors-based risk analysis to improve the safety of doffing enhanced personal protective equipment.

To systematically assess enhanced personal protective equipment (PPE) doffing safety risks. We employed a 3-part approach to this study: (1) hierarchical task analysis (HTA) of the PPE doffing process; (2) human factors-informed failure modes and effects analysis (FMEA); and (3) focus group sessions with a convenience sample of infection prevention (IP) subject matter experts. A large academic US hospital with a regional Special Pathogens Treatment Center and enhanced PPE doffing protocol experience.ParticipantsEight IP experts. The HTA was conducted jointly by 2 human-factors experts based on the Centers for Disease Control and Prevention PPE guidelines. The findings were used as a guide in 7 focus group sessions with IP experts to assess PPE doffing safety risks. For each HTA task step, IP experts identified failure mode(s), assigned priority risk scores, identified contributing factors and potential consequences, and identified potential risk mitigation strategies. Data were recorded in a tabular format during the sessions. Of 103 identified failure modes, the highest priority scores were associated with team members moving between clean and contaminated areas, glove removal, apron removal, and self-inspection while preparing to doff. Contributing factors related to the individual (eg, technical/ teamwork competency), task (eg, undetected PPE contamination), tools/technology (eg, PPE design characteristics), environment (eg, inadequate space), and organizational aspects (eg, training) were identified. Participants identified 86 types of risk mitigation strategies targeting the failure modes. Despite detailed guidelines, our study revealed 103 enhanced PPE doffing failure modes. Analysis of the failure modes suggests potential mitigation strategies to decrease self-contamination risk during enhanced PPE doffing.

An in silico proteomics screen to predict and prioritize protein-protein interactions dependent on post-translationally modified motifs.

The development of proteomic methods for the characterization of domain/motif interactions has greatly expanded our understanding of signal transduction. However, proteomics-based binding screens have limitations including that the queried tissue or cell type may not harbor all potential interacting partners or post-translational modifications (PTMs) required for the interaction. Therefore, we sought a generalizable, complementary in silico approach to identify potentially novel motif and PTM-dependent binding partners of high priority. We used as an initial example the interaction between the Src homology 2 (SH2) domains of the adaptor proteins CT10 regulator of kinase (CRK) and CRK-like (CRKL) and phosphorylated-YXXP motifs. Employing well-curated, publicly-available resources, we scored and prioritized potential CRK/CRKL-SH2 interactors possessing signature characteristics of known interacting partners. Our approach gave high priority scores to 102 of the >9000 YXXP motif-containing proteins. Within this 102 were 21 of the 25 curated CRK/CRKL-SH2-binding partners showing a more than 80-fold enrichment. Several predicted interactors were validated biochemically. To demonstrate generalized applicability, we used our workflow to predict protein-protein interactions dependent upon motif-specific arginine methylation. Our data demonstrate the applicability of our approach to, conceivably, any modular binding domain that recognizes a specific post-translationally modified motif. Supplementary data are available at Bioinformatics online.

Work facility design for VCO operator using integrated quality function deployment and Analytic Hierarchy Process

The Musculoskeletal disorder (MSDs) is skeletal muscle disorders that lead to damage in nerves, muscles, joints and cartilages. The damage is caused by muscle tension and degeneration. From the preliminary research in virgin coconut oil (VCO) processing industry, Central Java, Indonesia, there are potential risk of MSDs for workers. The majority of operators complaining on the right thigh (score 37) and left thigh (score 35). In addition, 50% of operators is work with moderate risk (rapid entire body assessment scores 4-7) and 50% others at a high risk level (rapid entire body assessment scores 8-10). Therefore, improvement is needed to prevent MSDs through work facility design using an integrated quality function deployment (QFD) method. In QFD, there is a concept screening phase to select some product design concept. To determine the priority, the QFD method can be integrated with analytic hierarchy process (AHP) method. The research shows that attributes of work facility needed by user are ergonomic, portable, durable and aesthetic. Concept design B have the highest priority score 0,32 and selected as the final work facility design. The technical specification are made from mahogany wood with an attractive design, red colour combination and developed based on user's anthropometry data.

Propagating logic-based Benders’ decomposition approaches for distributed operating room scheduling

We develop three novel logic-based Benders’ decomposition (LBBD) approaches and a cut propagation mechanism to solve large-scale location-allocation integer programs (IPs). We show that each LBBD can be implemented in four different possible ways, yielding distinct LBBD variants with completely different computational performances. LBBDs decompose the IP model into an integer location and knapsack-based allocation master problem and multiple packing IP sub-problems. We illustrate the performance of our LBBDs on the distributed operating room (OR) scheduling (DORS) problem, where patients and ORs are collaboratively scheduled across a network of hospitals, and the goal is to select patients with the highest priority scores and schedule them in the current planning horizon, while determining the number of surgical suites and operating rooms required to accommodate the schedule at minimum cost. We quantitatively demonstrate that the new Benders’ cuts, cut propagation, and implementation can individually or collectively yield a computational time impact of at least two orders of magnitude. We also demonstrate that our LBBDs are 10–100x faster than IP+Gurobi and are more successful at finding optimal solutions. Finally, we show that DORS increases the average OR utilization across the network to more than 95%.

Development of an oncology quality metric evaluation and prioritization tool (QMEPT).

260 Background: For reporting purposes and to enable ongoing quality improvement, it is essential that metrics reflective of quality oncology care delivery are tracked and reviewed on an ongoing basis. Collection of performance data and incorporation into a usable dashboard can require significant IT resources, both in personnel time and direct costs. The Tisch Cancer Institute (TCI) identified a myriad of cancer quality metrics that required prioritization in order to best allocate limited IT resources and a standardized process to facilitate comparison across different disease groups. Methods: Quality metrics were identified from various sources: CMS, PQRS, Commission on Cancer, QOPI, AHRQ and others recommended by TCI disease management teams (DMTs). All measures were evaluated with QMEPT according to the following domains: 1) Regulatory (CMS or other certifications), 2) Cost &amp; Feasibility (resource intensiveness of the collection process), 3) Patient Outcomes – (existence of standard benchmarks or known underperformance) and 4) Financial – (influence on payor contracting). All metrics were scored to generate a composite score for each metric and then weighted with 40% for Regulatory, 20% for Cost &amp; Feasibility, 40% for Patient Outcomes. Financial was not weighted but given a yes/no designation. Results: Metrics across all disease sites were scored, weighted and compared. Composite scores ranged from 1.56 to 2.67 (range 1 - 3). Weighted scores ranged from 1.4 to 2.8. In general, metrics related to breast, prostate, colorectal and lung cancers scored higher because of the required reporting and existence of evidence-based standardized benchmarks. Metrics proposed by the DMTs were frequently found to have high resource requirements for data collection. Following the scoring process, information was disseminated to the DMTs, leading to alteration of many of the quality metric requests. Metrics with the highest priority scores were submitted to the IT group for incorporation into the quality dashboard. Conclusions: The QMEPT allowed comparison of quality metrics across disparate oncology disease groups, prioritization for incorporation into a quality dashboard and rational allocation of limited IT resources.

Prioritization of the introduction of new vaccines to the national immunization program in the Republic of Korea

BackgroundThis study was performed to determine the priority of vaccine introduction for five vaccine-preventable diseases (VPDs) caused by Haemophilus influenzae type b (Hib), pneumococcus (Spn), hepatitis A virus (HepA), rotavirus (RV), and human papillomavirus (HPV) to the future Korean National Immunization Program (NIP) and to suggest framework programs to assist decision makers on implementation of the NIP. MethodsFollowing analysis of the disease burden and economics of the five VPDs by the core team and Korean Advisory Committee on Immunization Practices sub-committee members, a Delphi survey was administered to 94 Korean experts using structured questionnaires that provided the reference data. The two evaluation frameworks for NIP prioritization were (1) a disease-related framework and (2) a vaccine-related framework. After analyzing the responses, a meeting of experts was held to build a consensus for determining how to prioritize NIP implementation. ResultsThe average scores for relative importance were 63.29 for the disease-related framework and 36.71 for the vaccine-related framework. Within the disease-related framework, the mortality and case fatality rate was the highest scored factor (8.97), whereas within the vaccine-related framework, efficacy of the vaccine was considered the most important factor (9.56). On average, Spn, Hib, and HepA had the highest priority scores. ConclusionThe Korean experts suggested that the main factors influencing the decision to adopt new vaccines in the Korean NIP should be disease mortality, case fatality, and the efficacy and effectiveness of the vaccine. Among the five selected VPDs, Spn, Hib, and HepA were considered to be of higher priority than RV and HPV.