Inform Quality Improvement Research Articles

Quantifying the health needs of migrants in vulnerable circumstances registered with a nurse-led primary care service.

As of the end of 2019, at least 79.5 million people worldwide have been forced to flee their homes. Those seeking asylum face adversity before, during and after arrival in the UK, resulting in complex health and social needs. The study setting was a nurse-led asylum seeker service in a dispersal city, commissioned to provide an initial health assessment, immunisations and support to register with a general practitioner. The aim was to quantify the health needs of migrants in vulnerable circumstances registered with a nurse-led primary care service by clinical audit. In June 2018, 80 electronic records were reviewed by seven auditors to analyse documentation of demographics, asylum status, service use, barriers to care, physical and mental health. Where data were available, 86% migrated due to persecution or trafficking, 59% had a chronic physical illness, 51% had a mental health condition and 49% experienced barriers to accessing a mainstream general practitioner. Although a small sample, this survey demonstrated high physical and mental health needs that are often unmet in mainstream services. There was a high level of unknown need, for example of torture rates. These findings informed quality improvement in documentation and health assessments, and further research.

Chinese Neonatal Network: a national protocol for collaborative research and quality improvement in neonatal care

IntroductionThe objective of the Chinese Neonatal Network (CHNN) is to provide a platform for collaborative research, outcomes evaluation and quality improvement for preterm infants with gestational age less than 32...

Development of dynamic health care delivery heatmaps for end-of-life cancer care: a cohort study

ObjectiveMeasures of variation in end-of-life (EOL) care intensity across hospitals are typically summarised using unidimensional measures. These measures do not capture the full dimensionality of complex clinical care trajectories over...

The use of patient experience data for quality improvement in hospitals: A scoping review

In this paper we identified what was reported in the literature on qualitative and quantitative approaches used to capture and improve patient experiences in a hospital setting. For inclusion, articles were required to describe an embedded strategy for capturing patient experiences that was used to inform quality improvement in a hospital setting. Articles also had to be published in English between January 2004 and December 2020. Six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Health and Psychosocial Instruments and Cochrane Library) and grey literature (relevant hospital and government websites) were searched. All articles were screened by two reviewers and any disagreements were resolved through consensus. Data were extracted from the included articles using a study-specific form in Microsoft Excel and synthesized using descriptive qualitative and quantitative approaches. Thirty articles were included in this scoping review. Patient experience data were captured through a variety of methods including surveys, focus groups, patient complaints and informal feedback, with the majority using formal, paper-based surveys. A wide range of quality improvement initiatives were implemented as a result of hospitals’ patient experience data, but there was limited contextual information regarding the hospital settings and population characteristics. Initiatives implemented by a dedicated and multidisciplinary quality improvement team (nurses, administrators, physicians, etc.) generally demonstrated positive outcomes. We conclude that more work is needed to better understand how best to capture and use patient experience data for quality improvement, the contexts in which initiatives are successful and how to integrate patients and families in the ongoing implementation and evaluation processes.

Understanding variation in patient care: A qualitative study of hospital (non-ST elevation myocardial infarction) practices

Background Variation in care is often poorly understood but has a big impact on patients. Non-ST segment elevation myocardial infarction (NSTEMI, also known as non-ST elevation acute coronary syndrome or NSTE-ACS) is the most common form of heart attack. NSTEMI is frequently hard to diagnose, its management pathway poorly defined and there is considerable variation in clinical practice. Methods A qualitative study based on site visits, observation, and interviews with managers, clinicians and patients. The setting was 10 hospitals in England and Wales selected to represent variation in 30-day mortality. 199 hospital staff and 68 patients were observed; 142 staff and 53 patients were interviewed. Analysis was thematic and guided by the principles of grounded theory. We triangulated interviews, observational data and medical records and interpreted these findings with reference to national guidelines. Results While the majority of hospitals in our sample had specialist cardiac roles, variation in their remits, specifically their involvement in close monitoring, significantly affected patient management. Close monitoring was important in the identification and prioritisation of patients. Rapid responses with diagnostic and treatment procedures were facilitated by close monitoring but also heavily dependent on effective and flexible bed and catheter laboratory management. Conclusions Close monitoring was a key area of variation. Guidelines for NSTEMI care specify what to do, but not how to do it. These findings are especially relevant for acute conditions with diagnostic and treatment uncertainty. Detailed examples of variation in care can inform quality improvement and potentially help improve patient outcomes.

“One of the team” patient experience of integrated breast cancer care

PurposeThis paper presents my experience of breast cancer care in which I describe my care as positive and integrated.Design/methodology/approachI have applied an autoethnographical approach to my patient story to analyse my care in order to reflect and share insights. I have applied my knowledge and experience in integrated care through my research, management and practice.FindingsIn my patient story I describe being empowered and feeling like “one of the team.” Vertical and horizontal integration was evident across staff services and agencies. This included integrated working across multi‐disciplinary teams, between primary and secondary care and also between the NHS and a voluntary agency. I identified features that were important to me in my care under the headings of: certainty, communication, contact, compassion, continuity, cohesive, care and collaboration.Practical implicationsI consider the implications of sharing patient stories to inform quality improvement, influence education and training for staff and design support for patients. I consider how patients can be more involved in the evaluation of their care.Originality/valueThis viewpoint has been written from my perspective as a patient and a professional, and was written in order to recognise good practice and share the learning for continual quality improvement. There is every sign that person-centred integrated care is starting to be embedded in some of our services and hopefully this will be recognised, celebrated and sustained.

Adaptation and validation of the patient assessment of chronic illness care in United States community pharmacies

BackgroundRoles for United States (US)-based community pharmacists in caring for persons with chronic conditions have greatly expanded. The Patient Assessment of Chronic Illness Care (PACIC) was developed to assess patients’ perspectives of care received. However, successful application of this instrument in community pharmacies is uncertain. The objective of this study was to adapt the PACIC for use in community pharmacies (CP-PACIC), assess validity of the CP-PACIC and examine CP-PACIC scale score differences relative to patient characteristics.MethodsThis cross-sectional study surveyed chronically ill adults in Indiana, US who receive care from pharmacists in community pharmacies. The modified CP-PACIC scale consisted of 20-items, which were rated on a 5-point Likert scale from 0 (none of the time) to 4 (always). The total possible score ranged from 0 – 80. An exploratory factor analysis (EFA) was conducted to assess performance and dimensionality. CP-PACIC validity, including face validity, construct validity (via exploratory factor analysis) and internal consistency were assessed. Relationships between patient characteristics and scale scores were evaluated using appropriate statistical tests.ResultsFive hundred forty-six respondents’ data were analyzed. EFA revealed a 2-factor solution (termed advanced pharmacy chronic illness care (AP) and traditional pharmacy chronic illness care (TP) subscales) accounting for 64.7% of variance; all 20 items were retained. The total 20-item CP-PACIC scale had a Cronbach’s alpha (internal consistency) of 0.96; with a 12-item AP subscale Cronbach’s alpha of 0.97 and 8-item TP subscale Cronbach’s alpha of 0.89. Median total score was 12.0 [interquartile range = 27.3]. Median CP-PACIC sores varied across many respondent demographics (i.e., survey administration type, age, sex, education, health condition, number of pharmacy services received, community pharmacy type) such as whether respondents participated in one or more pharmacy service or not (29 vs. 10; p < .001).ConclusionsUnlike the original 5-subscale (patient activation, delivery system design, goal setting, problem solving, and follow-up/coordination) PACIC, analysis demonstrated a 2-factor (AP, TP) solution for the CP-PACIC scale with good internal consistency. As there are no standardized evaluation tools that exist, community pharmacies could find great value in using this CP-PACIC tool to benchmark performance and inform quality improvement strategies for patient care delivery.

Strategic flexibility in small firms

ABSTRACT Contrasted with their larger counterparts, small firms are disadvantaged due to their limited resources, economies of scale, and managerial expertise. However, the ability to respond and adapt promptly in today’s rapidly changing environment provides SMEs advantage over larger firms. In this paper, we argue that SMEs need to overcome resource disadvantages, leverage structural advantages, and develop new relational advantages in collaboration with partners to enhance their strategic flexibility for gaining competitive advantage. Specifically, we conjecture that building proactively strategic relationships with suppliers and logistics providers in addition to improving information quality could allow these entities to develop strategic flexibility and improve performance. We use structural equation modeling to assess the proposed model on a sample of 75 small firms located in India.

Marketing platform products for successful customer outcomes: an empirical investigation of project process integration

PurposeCross-functional teams engage in developing platform projects which become the basis of many smaller projects. The purpose of this paper is to examine how project teams engage in front-end plan formulation and backend work implementation. This paper shows the critical linkage role of platform product practices.Design/methodology/approachThis study examines the conceptual framework and research model by using a survey questionnaire for the target respondents of product development managers from the USA and Korea. After refining processes, this study determines the items for each variable for the large-scale survey.FindingsResults suggest that when heavy-manager and customers are jointly or separately involved with a project team for the formation of shared team purpose and mission, then there would be differences in terms of information quality, shared team purpose and mission and the project outcomes. If the primary roles of heavyweight leadership and customer involvement are to improve information quality in terms of reduction of uncertainty and equivocality, then the project team is empowered enough to work on the formation of shared team purpose and mission on their own. Platform product practices are a linkage between front-end planning and back-end work doing which guides more specific projects with shared purpose and performance goals.Research limitations/implicationsAs the data collection was limited to the USA and Korea, generalizability across diverse contexts requires caution. However, the findings provide meaningful insight on how to manage projects in an environment of increasing complexity and ambiguity.Practical implicationsThis study provides interesting insight into how project teams approach platform product development. Based on the empirical test, this study shows how cross-functional teams integrate front-end project plan formulation and back-end project work implementation. This study also presents how heavyweight manager and customer involvement addresses the front-end information challenges and influence platform product practices.Originality/valueThis study empirically tests the role of fuzzy front planning in impacting project team success. In particular, this study highlights the dynamic relationships between heavyweight managers and customer involvement, information quality (i.e. uncertainty and equivocality), and the nature of team purpose and mission which are all crucial for effective cross-functional teamwork.

New horizons in the perioperative care of older adults.

Older adults undergoing surgery have high perioperative morbidity and mortality. Age-related physiological changes and prevalence of geriatric syndromes such as frailty increase the risk of adverse postoperative outcomes. Geriatricians utilise comprehensive geriatric assessment (CGA) and management to identify and manage geriatric syndromes, and deliver patient-centred perioperative care. Perioperative models of CGA are established for older patients undergoing hip fracture surgery. Recent trials support the benefits of perioperative models of CGA for non-orthopaedic surgery, and have influenced current care recommendations for older surgical patients. Areas for further action include addressing the implementation gap between recommended evidence-based perioperative care and routine perioperative care, evaluating the clinical and cost-effectiveness of perioperative models of CGA for patients living with frailty, and embedding routine use of patient-reported outcome measures to inform quality improvement.

Leveraging Information Technology for Enhanced Information Quality and Managerial Performance

This study aims to analyze and understand the contribution of information technology and its impact on information quality and management performance in the digital printing industry. The approach used in this study is causality between variables, while the sampling technique used is a census method, which means that the entire population is a target sample of 52 respondents who are business leaders. To measure the variables in this study, variable indicators consisting of a five-level Likert scale have been used, while the analysis method used to demonstrate the hypothesis is SmartPLS Software. The results of this study find that information technology has a positive contribution to improving information quality and management performance in the digital printing industry. The results show that improving information quality and management performance can be achieved by using new information technology and computer-based telecommunications. It was also found that the quality of information has a positive and significant effect on improving managerial performance. This implies that to improve the management performance of the digital printing industry, information quality support is required so that the decisions taken are effective and relevant to achieving management performance and maintaining business continuity.

Effectiveness of reception class teachers’ pedagogical approaches in delivering pre-primary curriculum – Evidence from practice

Background: This report is part of a study commissioned to provide evidence to inform quality improvements, and the rolling out of the public reception class programme (RCP) to all public primary schools in Botswana by 2020. The study adopted the Discrepancy Evaluation Model (DEM) as a theoretical framework. Aim: One of the specific objectives of the study was to determine the effectiveness of the programme in terms of the RCP curriculum coverage and the teachers’ effectiveness in delivering the curriculum. The aim of the study reported in this article was therefore to determine the reception class teachers’ pedagogical approaches in delivering the RCP curriculum. Setting: The study was conducted in Botswana where early childhood care and education was provided by private providers until 2014 when the government of Botswana introduced the RCP in public primary schools. Methods: The study utilised a multi-method design. Stratified random sampling was used to select 10% of the 539 public primary schools that had implemented the programme since 2014 when it was introduced. An analysis tool based on the revised Bloom’s Taxonomy was used to analyse the content, as well as the level of coverage of important skills within the RCP curriculum. Questionnaires were used to gather information from teachers. Interviews were used to gather information from principal education officers (PEOs) who are part of the inspectorate. Feedback received from these participants was considered as indicating performance, according to the DEM. This performance was then compared with standards (with the RCP curriculum) to determine if any discrepancies existed. Results: Findings indicated that the RCP curriculum was adequate in coverage of skills at various levels of knowledge, understanding and appreciation. However, in some learning areas, certain competencies and performance targets were pitched at higher-order thinking. This resulted in most teachers focusing on achieving performance targets instead of following performance indicators to develop particular skills. As a result, learners demonstrated achievement of performance targets yet their developmental process skills were not fully accomplished. Conclusion: The RCP generally had a sound teaching cadre which would generate a considerable impact on the programme, should their pedagogical approaches not be derailed by the desire to fulfil performance targets at the expense of developmental process skills.

Bull's eye or typhoon eye? Psychological distress and associated factors in Wuhan and surrounding areas during the COVID-19 pandemic.

The COVID-19 pandemic caused significant psychological consequences among the public, especially for people in the epicenter. This study examined the 'bull's eye' model by comparing the level of psychological distress and the effect of different stressors in Wuhan (the original epicenter) with that in the surrounding areas in Hubei Province during the pandemic. Data were obtained from a cross-national survey of 10 478 respondents between the ages of 18 and 80 years in Hubei Province during the peak of the pandemic. Results of the ordinary least squares regression models showed that Wuhan residents experienced more psychological distress than those in the surrounding areas. Social and economic problems caused by the pandemic, risk exposure, perceived discrimination, and information-seeking behaviors were positively associated with distress. Social assistance was negatively associated with distress. Findings were consistent with the bull's eye model by revealing both a higher level of psychological distress and a stronger effect of stressors among the Wuhan residents than with those in low-risk areas. Thus, policymakers and psychological workers should provide adequate psychological services in high-risk areas. Lowering risk exposure, reducing discrimination against people in the epicenter, and improving information quality are essential to alleviate their psychological distress.

Improving information quality in E-Government of Ukraine

Improving information quality in E-Government of Ukraine

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study.

Direct primary care (DPC) is a growing model of care that is suggested as an alternative to traditional fee-for-service healthcare. Patient-reported experiences of DPC can provide unique insight into the impact of joining the model and inform quality improvement. The purpose of this study was to investigate patient perceptions of DPC. Thirty-one participants were initially recruited for the study and completed a survey assessing patient demographics. Of the 31 participants, 10 went on to complete the focus group interviews. Qualitative analysis of focus group transcripts identified common themes and subthemes. Focus group findings were stratified into 4 themes including quality of care, access to care, affordability, physician qualities, and reasons for choosing DPC. The top positive subthemes were good communication, joining DPC due to poor past healthcare experiences, and physician personability. The most common negative subthemes were difficulty referring to specialists outside the practice, poor communication, and poor access to medications. All findings were presented and discussed with the investigated clinic to facilitate improvements in healthcare delivery.

Deep Learning L2 Norm Fusion for Infrared &amp; Visible Images

Fusion is a strategy for collecting data from multiple images in order to improve information quality. Infrared images can recognise objects from their surroundings depending mostly on radiation disparity, which works better in all weather conditions as well as irrespective of whether it is day or night. Visible images can integrate texture information with great visual precision and in detail that matches with human visual system. Integrating the benefits of thermal radiation information with precise visual information from infrared and visible modalities is a good idea. The presented algorithm utilises the <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\ell _{2} $ </tex-math></inline-formula> norm and a combination of residual networks for combining the complementary information from both image modalities. The encoder consist of convolutional layers with selected residual connections in which the output of each layer is associated with each other layer. The <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\ell _{2} $ </tex-math></inline-formula> norm approach is then used to fuse the two featuremaps. At last, decoder recreates the fused image. The large mutual information value of 14.85084 indicates more complementary information retained in the fused image than in the infrared and visible images. The large entropy value of 6.92286 indicates more information content in the fused image and the fused image is equipped with more edge information. The proposed architecture collect more pixel values from both infrared and visible image and the fused image looks more natural as it contain more textual content. The proposed system accomplishes a noteworthy performance with the existing models.

Clinical quality registries: urgent reform is required to enable best practice and best care.

Clinical quality registries (CQRs) systematically collect data on pre-agreed markers of quality of care for a given procedure, that can be reliably and reproducibly defined and collected across multiple sites. Data is then risk adjusted, and comparisons may be used to benchmark performance. These data then inform quality improvement initiatives. CQRs require an overarching independent governance structure and surety of funding. CQRs rely upon whole of population enrolment to minimize the risk of selection bias, and often rely on the secondary use of sensitive health information, meaning that the processes for ethical review and consent to participation are different to clinical trials. Despite several local examples of CQR improving practice in Australia and Aotearoa New Zealand, providing substantial cost-benefit to the community, there remain significant barriers to CQR implementation and functions. These include the difficulty of accurate data capture, lack of a fit for purpose ethical review system, the constraints of existing Qualified Privilege legislations and the need for protected funding. Whilst the Australian Government has released a 10-year strategy for CQR reform, and the Aotearoa New Zealand Government has included registries in the planned Health New Zealand reforms for the public sector, we believe more urgent implementation of strategies to overcome these barriers is needed if CQRs are to have the impact on quality of care our Communities deserve.

Hospital accreditation processes in Saudi Arabia: a thematic analysis of hospital staff experiences

BackgroundHospital accreditation by an international organisation can play an important role in health quality and safety. However, little is known about how managers and front-line employees experience and perceive the...

Short Selling and Information Quality: Evidence from Natural Experiments in an Emerging Market

ABSTRACT Using a comprehensive sample of Chinese-listed firms and the generalized difference-in-differences (DID) approach, we find that information quality significantly improves after an exogenous removal of short selling ban. Treated firms engage less in accruals management and experience fewer restatements. Auditors exert more effort and spend more time in auditing financial statements. We further demonstrate that the improvement of information quality is driven by increased investor attention and media coverage of the treated firms. The results are more pronounced in firms with lower institutional ownership and in non-state-owned firms.

Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes.

Study DesignLiterature review.ObjectiveTo describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time.MethodsLiterature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman’s rho was used to determine the association between the Extreme Quotient (EQ) and year of publication.ResultsWe identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= −.33, P= .09).ConclusionsPractice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.