Importance Of Continuous Quality Improvement Research Articles

Pediatric tonsilitis: modern tactics against an old foe

Abstract Background Pediatric tonsillitis (PT) impacts public health due to its widespread incidence and the prevalent overprescription of antibiotics driven by concerns over Group A β-hemolytic streptococcus (SGA) complications. Rapid antigen diagnostic tests (RADT) serve as vital tools for promptly identifying SGA infections in PT cases. However, despite their widespread availability, healthcare professionals often underutilize RADT, leading to inappropriate antibiotic prescriptions. Clinical audits and feedback to professionals emerge as solutions to this issue. Methods An audit was conducted on clinical cases of PT during 2023 to evaluate the correct usage of RADT and subsequent antibiotic prescription across various primary care practices in Lisbon, Portugal. Afterwards, a pilot practice was selected to assess the feasibility and utility of an online tool designed specifically to report RADT results and create a real-time surveillance system of incidence of SGA with feedback to prescribing clinicians. Following the revision of the reporting tool after the pilot, its implementation was extended to multiple practices across the Lisbon region. Results From the 1050 clinical cases analyzed, 992 had an indication to do a RADT according to the Portuguese guidelines, however only 282 (28.4%) tests were done. Overall, only 19.6% of PT cases were considered fully compliant. During the pilot, the introduction of the online tool led to a 3.259 increase in reporting (from 0.574 RADT/day to 1.872 RADT/day) for the same time period between February and March. Conclusions The implementation of an online reporting tool represents a significant advancement in SGA surveillance efforts, detecting cases promptly for public health interventions. This initiative underscores the importance of continuous quality improvement in diagnostics and shows digital tools’ potential for better disease surveillance in clinical settings. Key messages • Underutilization of RADT in PT cases contributes to inappropriate antibiotic prescriptions, compromising patient care. • Introduction of an online reporting tool significantly enhances RADT usage, aiding prompt SGA detection for improved public health interventions.

APPEAL: a toolkit for attracting people who inject drugs with hepatitis C to healthcare systems

Abstract Aim The “APPEAL” toolkit was developed to address the challenges in diagnosing people who inject drugs (PWID) with hepatitis C (HCV) and engaging them with healthcare systems. It introduces an ecosystemic approach based on health and well-being literacy across awareness, prevention and diagnosis dimensions of the hepatitis C’s care cascade (CC) for PWID. Subject and methods The framework incorporated a scoping review and thematic analysis of 54 studies, alongside contributions from 57 hepatitis C key opinion leaders across seven countries. The toolkit is structured around five main axes: problems, solutions, outputs, outcomes and feedback process, employing a holistic perspective that considers economic, legal and social contexts. Eighteen policy prescriptions (PP) are proposed and supported by selective references to ensure relevance and applicability. Results The APPEAL toolkit facilitates a strategic workflow for policymakers, health authorities and patient advocacy organizations, guiding them through action flowcharts to evaluate and enhance their interventions within the hepatitis C’s CC for PWID. Notably, its implementation demonstrated potential in identifying and attracting PWID to hepatitis C treatment pathways, contributing to increased diagnostics, education on risk behaviours and raising overall disease awareness. The toolkit’s intelligent cycle system supports accountability, enabling continuous data-driven improvement and innovation in addressing hepatitis C. Conclusion The APPEAL toolkit was developed to attract PWID living with HCV to healthcare systems in a proactive manner. By managing information and fostering education on HCV, it aims to amplify awareness, prevention and diagnosis. The toolkit’s design and functionality underscore the importance of continuous quality improvement and the potential for its use in internal or external quality audits of healthcare services related to hepatitis C.

Optimizing Contraceptive Prescription in Smoking Women: A Quality Improvement Study.

Introduction Family planning is fundamental in primary care (PC), and informed counseling helps to guide contraceptive choices. Combined hormonal contraceptives (CHC) pose cardiovascular risks, particularly when combined with smoking. According to the World Health Organization, the recommended global clinical decision is to refrain from employing CHC in female smokers aged 35 or older. This study aimed to improve contraception prescriptionfor female smokers aged 35-54 in PC. Methods This study was conducted in a Portuguese Family Health Unit (FHU) from October 2021 to August 2022, and it followed theStandards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and the Plan-Do-Study-Act approach.Female smokers aged 35-54 were includedand evaluated in three moments: baseline evaluation (October 2021), intermediate evaluation (February 2022), and post-intervention evaluation (August 2022). Interventions involved educating medical staff, creating patient awareness campaigns,and evaluating contraceptive methods. The established quality-defining goal was to decrease the prevalence of female smokers aged 35 or above using CHC to ≤5%. Results CHC prevalence among smoking women aged 35-54 decreased from 16.4% to 8.5% after nine months of the initial intervention. There was an increase in progestogen-only methods usage over time, from 25.7% to 34.0%. Discussion Despite not fully achieving the predefined goal, interventions led to a substantial reduction ofCHC useamong smoking women aged 35-54. Collaborative efforts between healthcare professionals and patients played a pivotal role in optimizing care and reducing cardiovascular risk. This study underscores the importance of continuous quality improvement, collaborative interventions, and knowledge updates in Family Medicine practice. While conducted in a single FHU, the intervention's multidimensional approach holds the potential for broader applicability. Conclusion In the future, healthcare teams should continue to reflect on achieved results, maintain knowledge, and empower patients in contraceptive method choices. The study contributes to improved care quality and highlights the positive impact on medical practice and patient outcomes.

Correlates of Satisfaction among Hospitalized Patients in Kosovo

Background: The aim of our study was to assess selected sociodemographic correlates of satisfaction among hospitalized patients in Kosovo. Methods and Results: A cross-sectional study was conducted in May-June 2022, including a representative sample of 508 hospitalized patients (58.1% women and 41.9% men) aged ≥18 years. A structured 19-item questionnaire about patient satisfaction with hospital services was used for data collection. Each item was measured on a Likert scale ranging from 1 (very satisfied) to 5 (very unsatisfied). A summary score was calculated for all 19 items related to the level of satisfaction among hospitalized patients ranging from 19 (highest level of satisfaction) to 95 (lowest level of satisfaction). Binary logistic regression was used to assess the association of the summary score of satisfaction (19-item instrument, dichotomized in the analysis into “satisfied” vs. “unsatisfied” based on the median value of the summary score) with sociodemographic factors, general health status, and duration of hospitalization. In multivariable-adjusted logistic regression models controlling in a backward stepwise procedure for all sociodemographic factors, health status, and duration of hospitalization, patients’ unsatisfaction was significantly associated with urban residence (OR=1.52, 95%CI: 1.00-2.31), income level (OR[low vs. high income]=2.44, 95%CI: 1.18-5.06) and health status (OR[poor vs. good health]=7.95, 95%CI: 4.43-14.24. Conclusion: Our findings indicate a significantly higher unsatisfaction level among urban and low-income patients. Healthcare providers and policymakers in Kosovo and other similar countries should be aware of the importance of continuous quality improvement of hospital services to increase, among other things, the satisfaction level of hospitalized patients.

Kvalitet i marketing orijentacija u funkciji izgradnje brenda, zadovoljstva korisnika i unapređenja poslovanja

The paper deals with the analysis and role of integrated marketing communications, supported by modern information and communication technologies, in building a brand and improving the business performance of organizations. Marketing orientation enables brand re-cognition on the market, while for consumer loyalty to a given brand, it is necessary to provide the desired level of quality. Correlation analysis determined the existence of the influence of quality on increasing customer satisfaction. In addition, statistically significant relationships were found between marketing communication and brand building, indicating their interdependence. The results of the correlation analysis show that there is an important correlation between quality and marketing communication to improve the business performance of the organization. Regression analysis found that quality has the greatest impact on customer confidence and improving business profitability, with quality management activities that have had the greatest impact are relationship management, people engagement, leadership and fact-based decision making. The results of the regression model pointed out that marketing communication contributes the most to creating brand recognition in the market and achieving greater market share, with the greatest contribution being made by economic propaganda, personal sales and public relations. Variables of quality and marketing communications have been shown to influence the variables of brand building, customer satisfaction and business performance, which are also factors in business improvement. Factor analysis determined the existence of two components, with one component bringing together the factors of brand building and customer satisfaction, while the other component brought together the factors of business performance. A statistically significant association was established between these two components. The aim of this research is to point out the importance of continuous quality improvement as a factor in increasing customer satisfaction, but also the importance of marketing communications in building a brand. Effective brand building in the market and satisfied and loyal customers are a prerequisite for improvement business by improving the business performance of the organization.

Improving outcomes for Colorado's IRT-IRT-DNA cystic fibrosis newborn screening algorithm by implementing floating cutoffs

The Colorado Newborn Screening Program (CO-NBS) screens for cystic fibrosis (CF) by measuring immunoreactive trypsinogen (IRT) from two screens coupled with DNA analysis (IRT/IRT/DNA). The Colorado CF Care Center identified 8 missed CF cases among 358,187 infants screened by the CO-NSP since 2016. Retrospective analysis of CO-NSP IRT data shows that a 96th percentile floating IRT cutoff with a 50 ng/mL fixed cutoff on the first screen, and second screen 50 ng/mL fixed cutoff would have identified 7 of the 8 missed cases. These efforts demonstrate the importance of continuous quality improvement in order to increase sensitivity and reduce missed cases.

Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System

Prompted by null findings from several care transition trials and practice changes for heart failure in recent years, leaders from a large integrated health care system aimed to reassess the outcomes of its 10-year multicomponent transitional care program for heart failure (HF-TCP). To examine the association of the individual HF-TCP components and their bundle with the primary outcome of all-cause 30-day inpatient or observation stay readmissions. This retrospective cohort study included patients enrolled in the HF-TCP during an inpatient encounter for heart failure at 13 Kaiser Permanente Southern California hospitals from January 1, 2013, to October 31, 2018, who were followed up from discharge until 30 days, readmission, or death. Data were analyzed from May 7, 2019, to May 1, 2020, with additional review from September 2 to October 1, 2020. Patients received 1 home health visit or telecare (telephone) visit from a registered nurse within 2 days of hospital discharge, a heart failure care manager call within 7 days, and a clinic visit with a physician or a nurse practitioner within 7 days. Multivariable proportional hazards regression models were used to estimate the probability of 30-day readmission for those who received the individual or bundled HF-TCP components compared with those who did not. A total of 26 128 patients were included; 57.0% were male, and the mean (SD) age was 73 (13) years. The 30-day readmission rate was 18.1%. Both exposure to a home health visit within 2 days of discharge (hazard ratio [HR], 1.03; 95% CI, 0.96-1.10) and a 7-day heart failure case manager call (HR, 1.08; 95% CI, 0.99-1.18) compared with no visit or call were not associated with a lower rate of readmission. Completion of a 7-day clinic visit was associated with a lower readmission rate (HR, 0.88; 95% CI, 0.81-0.94) compared with no clinic visit. There were no synergistic effects of all 3 components compared with clinic visit alone (HR, 1.05; 95% CI, 0.87-1.28). This study found that HF-TCP as a whole was not associated with a reduction in 30-day readmission rates, although a follow-up clinic visit within 7 days of discharge may be helpful. These findings highlight the importance of continuous quality improvement and refinement of existing clinical programs.

Automated Machine-Learning Radiation Therapy Treatment Planning for Pediatric and Adult Brain Tumors

To evaluate the feasibility of using a machine-learning (ML) treatment planning method to automatically generate treatment plans for pediatric and adult brain tumor cases, and compare ML-generated treatment plans with human-generated plans used clinically. The application of a ML radiation treatment planning method [1] was investigated using a training set of adults (n = 25) and pediatric (n = 91) brain tumor patients treated from December 2007 to March 2018 with dose prescription of 54 Gy in 30 fractions using IMRT/VMAT. Our ML model predicts the optimal dose to targets and normal tissues based on learned relationships between image features and dose distributions of anatomically similar patients. Predicted dose plans are converted to clinically deliverable single-arc VMAT plans using optimization algorithms that enforce technical beam delivery constraints. Ten children and three adults with centrally-located primary brain tumors clinically treated with 54 Gy, not previously used for model training, were re-planned with this ML model. Dosimetry to targets and organs-at-risk (OAR) were compared between ML and manual clinical plans. Comparable target coverage was observed in both ML and manual plans. At least 95% of PTV received >51.3 Gy (95% of prescription) in 11 ML vs 12 manual plans. Similar maximum doses to OARs including optic nerves, chiasm and cord were observed. Maximum dose to optic nerves was <54 Gy in all ML and manual plans; maximum chiasm dose was <54 Gy in 12 ML vs 13 manual plans; maximum cord dose was <54 Gy in 12 ML vs 11 manual plans. Maximum brainstem dose was >54 Gy in 11 out of 13 ML (85%) and 7 manual (54%) plans, because 81% of the training cases with centrally located tumors had brainstem doses >54 Gy. The median differences in mean dose to left and right cochleae were 3 Gy and 0.3 Gy higher in ML than manual plans, respectively, whereas mean doses to left and right temporal lobes were 2.5 Gy and 2.8 Gy lower in ML plans than manual plans, respectively. Average time for ML plan generation was 27 minutes (range, 17-34). We demonstrate the feasibility of rapidly generating clinically-deliverable ML plans with consistent plan quality, similar target coverage and OAR sparing as compared to manual clinical plans. A similar proportion of cases with maximum brainstem doses >54 Gy was observed in both ML plans and historical training cases which illustrates the importance of continuous quality improvement in ML models.

The Quality Culture Inventory: a comprehensive approach towards measuring quality culture in higher education

ABSTRACTQuality assurance and quality development represent central challenges of higher education institutions (HEIs). In this context, the term quality culture has gained increasing attention. Quality culture refers to an organizational culture, which emphasizes the importance of continuous quality improvement, shared attitudes, and commitment towards quality. Despite growing discussion of quality culture, sound empirical approaches that capture this key construct have not been developed systematically. Therefore, we developed the ‘Quality Culture Inventory’ (QCI), which represents a comprehensive approach to operationalizing quality culture in HEIs. In a first step, this paper summarizes the development and empirical validation of the QCI, which comprises six dimensions (e.g. quality-oriented commitment, leadership, and communication). In a second step, relationships between the QCI dimensions and several potential outcome measures (e.g. job satisfaction) are reported. The QCI allows HEIs to evaluate their current state of quality culture based on empirical evidence and develop target-oriented recommendations for quality improvement.

Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

The Importance of Continuous Quality Improvement in Peritoneal Dialysis Units.

The Importance of Continuous Quality Improvement in Peritoneal Dialysis Units.

Golden Age of Assessment in Pharmacy Education

Nearly 10 years ago, during a meeting to establish university-wide quantitative learning outcomes and assessment measures, a physics faculty member assured the other committee members that, “If we just drag this out long enough it won’t matter anymore (because) this assessment stuff is going away.” In pharmacy education, “this assessment stuff” is definitely not going away. In fact, pharmacy assessment has reached its golden age. Although for some this golden age may appear to be driven by the Center for the Advancement of Pharmacy Education (CAPE) 2013 Outcomes1 and Accreditation Council for Pharmacy Education (ACPE) 2016 Standards,2 the inverse is true, as this assessment prosperity has been growing and building within the academy over the past decade. Just over 5 years ago, the American Association of Colleges of Pharmacy (AACP) established the Assessment Special Interest Group (SIG) with the goal of facilitating faculty exchange of ideas and innovations regarding curricular and programmatic assessment planning and implementation and outcome management. In that short time, the SIG has grown to the third largest in AACP. Recognizing that most schools and colleges only have one designated assessment person, this growth shows that AACP members whose primary responsibility is not assessment recognize the need to increase their own assessment knowledge and skills. As another means to increase assessment knowledge and skills, academy members are increasingly attending the annual AACP institutes. As far back as the 2007 Assessment Institute at Lansdowne, Virginia, and Snowbird, Utah, institutes have included assessment components regardless of the primary topic. In 2015, AACP Annual Meeting programming included 20 distinct sessions and mini-sessions on assessment topics, doubling from 2009 and representing a quarter of all educational sessions at the meeting.3 Educational programming is not the only area in which assessment’s golden age is noted; governance and initiatives are aiming to establish stronger quality assurance measures through validated tools. The association has worked with its membership to develop and launch curriculum quality surveys that provide national and peer school benchmarks in perceptions of student, faculty, alumni, and preceptors to all member institutions. During the 2015 AACP House of Delegates, the need for stronger assessments and links between licensure and assessment were emphasized through the resolution that AACP lead collaborative efforts to produce evidence-based assessments mapped to current CAPE Outcomes.4 While some perceive that assessment efforts are entirely driven by accreditation, the overall trend toward accountability in higher education, particularly in the health professions, has influenced the revision of the ACPE Standards in 2007 and in 2016, which involves the members of the academy and other stakeholders. These revisions highlight the importance of continuous quality improvement, engagement of all stakeholders, and the transparency and availability of assessment data. Although this is a time of prosperity for assessment, we are far from our pinnacle. What else needs to be done? First and foremost, despite having only one person assigned to assessment at most institutions, it is not a one-person job. Along with ensuring sufficient administrative and staff support, schools need to develop cultures of assessment in which all faculty members appreciate their role in curricular and programmatic assessment. Deans and administrators need to provide leadership in assessment to engage faculty members, staff, students, and stakeholders. Beyond support of an assessment culture, part of this leadership requires administrators to encourage faculty members to validate their assessment instruments to ensure the tools assess what they claim to measure. This leadership also requires that measures beyond student perceptions be used to evaluate achievement of learning outcomes. Collaboration among similar schools also will serve to advance assessment. Many schools have formed consortiums or other collaborative groups, which advance knowledge among members, establish and share practices for meaningful data collection and use, validate assessment tools, and advance scholarly pursuits. Not only is “this assessment stuff” not going away, it is here to stay and flourish. The academy has embraced the culture of continuous quality improvement and accountability to prepare our graduates for entry into practice and provision of patient-centered care as members of a health care team. Now is the time to join the assessment efforts as we move onward and upward during this time of assessment prosperity. Don’t get left behind.

P86 Improving surgical antibiotic prophylaxis: the importance of continuous quality improvement

P86 Improving surgical antibiotic prophylaxis: the importance of continuous quality improvement