Mechanisms Of Quality Improvement Research Articles

Creating a Culture of Assessment

Programmatic and curricular assessment, as mechanisms of continuous quality improvement, are essential and require input from multiple stakeholders. Despite its essential nature, there are few resources to help guide the development of a sustainable model of assessment. The aims of this organizational case study are to describe a sustainable model. Data was collected from various stakeholders of the Doctor of Physical Therapy (DPT) program. Results were compared between and within groups to determine level of agreement and yearly trends. These results were discussed at the faculty assessment retreat. The outcomes included data collection timelines that have been operationalized and systematized. Five out of nine faculty participated in a post-survey. All respondents (100%) indicated a favorable impression of the event. Building a culture of assessment requires an intentional and sustainable plan. A retreat was an effective method to communicate the results of the assessment and to build trust and transparency.

High performance drilling of T800 CFRP composites by combining ultrasonic vibration and optimized drill structure

Drilling of high-strength T800 carbon fiber reinforced plastic (CFRP) are widely employed in current aviation industry. Drilling-induced damages frequently occur and affect not only the load carrying capacity of components but also the reliability. As one of effective methods to reduce the drilling-induced damages, advanced tool structures have been widely used. Nevertheless, it is still difficult to realize high machining accuracy and efficiency by this method. This paper compared three different drill bits to evaluate the drilling performance of T800 CFRP composites and the results showed that the dagger drill was a good choice to drill T800 CFRP considering the lowest thrust force and damages. On this basis, ultrasonic vibration was successfully imposed on dagger drill to further improve the drilling performance. The experimental results showed that ultrasonic vibration reduced the thrust force and surface roughness with a maximum decrease of 14.1 % and 62.2 % respectively. Moreover, the maximum hole diameter errors were decreased from 30 μm in CD to 6 μm in UAD. Besides, the mechanisms of force reduction and hole quality improvement by ultrasonic vibration were also revealed. The results suggest that the combination of ultrasonic vibration and dagger drill is a promising strategy for high performance drilling CFRP.

The Mechanisms of AlGaN Device Buffer Layer Growth and Crystalline Quality Improvement: Restraint of Gallium Residues, Mismatch Stress Relief, and Control of Aluminum Atom Migration Length

The mechanisms of AlGaN device buffer layer growth were studied. Gallium residues in the reactor chamber may be harmful to the quality of the AlN strain modulation layer, which eventually worsens the AlGaN buffer layer. By restraining the gallium residues, the crystalline quality of the AlGaN layer is markedly improved. In addition, enhancing stress relief in nucleation and coalescence stages will reduce the edge dislocations induced by strain relaxation in the 2D growth stage. A slower precursor flow rate can promote the stress relief in nucleation and coalescence stages. By comparison, a suitable suppression of Al atoms’ surface migration can decrease surface roughness, which can be realized by increasing the precursor flow rate. Eventually, we obtained a AlGaN buffer layer having both low edge dislocation density and a flat surface using a two-step growth method.

Transcriptomic and Metabolomic Analysis Reveal Possible Molecular Mechanisms Regulating Tea Plant Growth Elicited by Chitosan Oligosaccharide.

Chitosan oligosaccharide (COS) plays an important role in the growth and development of tea plants. However, responses in tea plants trigged by COS have not been thoroughly investigated. In this study, we integrated transcriptomics and metabolomics analysis to understand the mechanisms of chitosan-induced tea quality improvement and growth promotion. The combined analysis revealed an obvious link between the flourishing development of the tea plant and the presence of COS. It obviously regulated the growth and development of the tea and the metabolomic process. The chlorophyll, soluble sugar, and amino acid content in the tea leaves was increased. The phytohormones, carbohydrates, and amino acid levels were zoomed-in in both transcript and metabolomics analyses compared to the control. The expression of the genes related to phytohormones transduction, carbon fixation, and amino acid metabolism during the growth and development of tea plants were significantly upregulated. Our findings indicated that alerted transcriptomic and metabolic responses occurring with the application of COS could cause efficiency in substrates in pivotal pathways and hence, elicited plant growth.

The use of quasi-experimental design methods to evaluate and improve the impact of acute care centers on oncologic emergencies.

e13515 Background: Reducing avoidable hospital and emergency department (ED) use are national priorities in cancer care. Acute care centers (ACCs) that expand access for patients with oncologic emergencies are increasingly implemented as alternatives to inpatient and ED care. The impact of these ACCs is uncertain. Additionally, how to rigorously evaluate these interventions and to iteratively improve their effectiveness remains unclear as infrastructure interventions such as ACCs are not amenable to experimental manipulation. Methods: We are developing a novel quasi-experimental framework for evaluating and improving the effectiveness of an ACC intervention at the Simmons Comprehensive Cancer Center (SCCC) of the University of Texas Southwestern. SCCC covers one of the largest geographic regions of any academic medical center in the country, creating challenges addressing access to care. Drawing on the Andersen model for healthcare utilization we hypothesize that ACC effectiveness is mediated through enabling factors, particularly distance. Our initial evaluation framework draws on an untreated control group design with multiple pretest and post-test samples. The control group is comprised of patients living in zip codes farther away from the ACC. Additional analytic work will assess the feasibility of adding a matching cohort group structure based on factors such as onset of illness and matching individual patient episodes based on risk adjustment parameters. If the ACC is later expanded to other sites, the design can be further developed by adding a switching replications methodology to augment the quasi-experiment. Data collection draws on claims data provided through SCCC’s participation in Medicare’s Oncology Care Model (OCM). Results: Over OCM’s initial four performance periods (each six months long), all-cause risk adjusted hospitalization rates for SCCC patients ranged from 25.2% to 27.2%. All-cause risk adjusted OCM ED use ranged from 28.1 to 29.9%. Seeking to improve performance for both, SCCC leadership initially implemented a temporary urgent care clinic in August 2018. This initial prototype clinic was formalized into an operational ACC in August 2020. Evaluation of the impact of this ACC intervention is ongoing. Conclusions: ACCs represent potentially important means to reduce avoidable hospital and ED use. However, complex infrastructure interventions are not amenable to experimental evaluations assessing their impact, and it remains difficult to gain insights into how to tailor services through these interventions to support patients with oncologic urgencies and emergencies. Quasi-experimental approaches when integrated alongside ACC interventions represent promising mechanisms of evaluation and continuous quality improvement.

Transcriptomic analysis reveals hub genes and subnetworks related to ROS metabolism in Hylocereus undatus through novel superoxide scavenger trypsin treatment during storage

BackgroundIt was demonstrated in our previous research that trypsin scavenges superoxide anions. In this study, the mechanisms of storage quality improvement by trypsin were evaluated in H. undatus.ResultsTrypsin significantly delayed the weight loss and decreased the levels of ROS and membrane lipid peroxidation. Transcriptome profiles of H. undatus treated with trypsin revealed the pathways and regulatory mechanisms of ROS genes that were up- or downregulated following trypsin treatment by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses. The current results showed that through the regulation of the expression of hub redox enzymes, especially thioredoxin-related proteins, trypsin can maintain low levels of endogenous active oxygen species, reduce malondialdehyde content and delay fruit aging. In addition, the results of protein-protein interaction networks suggested that the downregulated NAD(P) H and lignin pathways might be the key regulatory mechanisms governed by trypsin.ConclusionsTrypsin significantly prolonged the storage life of H. undatus through regulatory on the endogenous ROS metabolism. As a new biopreservative, trypsin is highly efficient, safe and economical. Therefore, trypsin possesses technical feasibility for the quality control of fruit storage.Graphical abstract

Characterization of the Effect of Melt Treatments on Melt Quality in Al-7wt %Si-Mg Alloys

The effects of degassing, holding time and melt additions (Sr, Sr + Ti, Ti, B and B + Sr) on the quality of A356 melts were examined. A total of 120 reduced pressure test samples were collected. Pores in these samples were analyzed via digital image processing to determine the number density of pores as well as the statistical distribution of their sizes. Results showed that in all cases, degassing with argon reduced the number of defects regardless of the additions made to the melts. Moreover, all additions were found to degrade melt quality. The lowest number density of pores in all melts was achieved in melts with no additions that were degassed. In both degassed and non-degassed melts, Sr additions degraded the melt quality significantly. The mechanisms of melt quality improvement or degradation with different melt treatments are discussed in the paper.

Home Visiting: A Service Strategy to Reduce Poverty and Mitigate Its Consequences

Home visiting programs are increasingly recognized as an important part of the early childhood system of care in the United States. The objectives of this report are to review the rationale for home visiting; characterize the Federal Home Visiting Program; highlight the evidence of home visiting effectiveness, particularly for low income families; identify opportunities to promote coordination between medical homes and home visiting programs; and explain the critical role of research, evaluation, and quality improvement to strengthen home visiting effectiveness. Home visiting programs offer voluntary home-based services and other supports to meet the needs of vulnerable pregnant women and young families. Home visiting intends to address poverty in 2 ways. First, it promotes economic self-sufficiency directly by building parents' knowledge, skills, and motivation related to employment opportunities and by linking families with community services such as adult education and job training. Second, it mitigates the effects of poverty through direct service and community linkages to enhance parents' capacity for positive parenting and for their own health and family functioning. Home visiting has shown effectiveness in multiple domains, including family economic self-sufficiency, birth outcomes, maternal health, child health and development, and positive parenting practices. Authorized as part of the Affordable Care Act in 2010 and reauthorized in 2015, the Federal Home Visiting Program invests an unprecedented $1.9 billion in the form of grants to states to expand home visiting programs and support rigorous research. As part of the early childhood system of services, home visiting programs must coordinate with other community services and supports. Programs will be most effective when resources are used efficiently, duplication of services is avoided, and alignment and reinforcement of other providers' messages are achieved. The Federal Home Visiting Program has established 4 mechanisms of research, evaluation, and quality improvement to enhance home visiting implementation and effectiveness.

THE QUALITY OF STUDIES: MANAGEMENT ASPECT

In recent years attention to quality of studies is not decreasing. Lots of different level and type articles have been written, books and other literature have been published. On the other hand, over the last few years different national, regional and international science conferences and symposiums took place. Some of them can be mentioned. In November, 2000, “International Conference on Quality Assurance in Higher Education: Standards, Mechanisms and Mutual Recognition” took place in Thailand. One of the main accents in this conference was the question on how to establish new mechanisms of quality assurance and quality improvement (Harman, 2000). In October, 2010, an international conference took place on Quality Assurance in Higher Education in Africa: Setting a Sustainable Agenda for a New Decade (http://www.unesco-bamako.org/conferences/). In February, 2001, 10th International Research Conference on Quality, Innovation & Knowledge Management (http://www.buseco.monash.edu.au/mgt/qik-conference/) took place in Malaysia. There’s no purpose in mentioning all conferences that were held. All of them were significant in their own way. After all, different events on university study quality questions are regularly organised by international organisations such as, for example, European University association (http://www.eua.be/Home.aspx).

Trust, standards and healthcare quality: a case of babies and bathwater?

The last few years have not been too comfortable for the members of many professional groups. Concerns about behaviour, propriety, effectiveness, public safety and, in the case of the public sector, cost have resulted in significant scrutiny of the position and role of professionals. One manifestation of this scrutiny has been a growing tendency to establish and impose external standards of practice embodied in codes of conduct or legislation. This issue has had its most recent airing in the fifth report of the Shipman Inquiry.1 Historically, the majority of professionals have relied on internally derived and self-managed standards of care; witness the concept of a basic set of `ancient virtues' at the heart of a medical ethos.2 The growing trend of externally imposed standards raises the question as to whether the possible resulting disempowerment will lead to professionals relying less on their intrinsic mechanisms of quality improvement—which, it could be argued, are the mainstay to underpinning safe and effective practice. Are we throwing the baby out with the bathwater? From the point of view of the patient their long-term interests are likely to be best served by a timely response from the doctor. An internalized professional ethos to act in the patient's best interests would support this. An over reliance on external mechanisms of quality improvement might see professionally derived internal mechanisms atrophy and cease to influence behaviour. In the example of Box 1, a doctor may fail to respond to a patient's vague history of chest pain simply because there are no external drivers to do so. A timely completion of a routine follow-up appointment might be all that the external standards require. The patient may well be satisfied and unaware of the implications of his vague symptoms being passed off. A weakened professional ethos may no longer be able to guide professional practice in those areas where external standards are absent (and perhaps could never even be applied), and hence the quality of patient care would suffer.

The Unintended Consequences of Publicly Reporting Quality Information

Health care report cards publicly report information about physician, hospital, and health plan quality in an attempt to improve that quality. Reporting quality information publicly is presumed to motivate quality improvement through 2 main mechanisms. First, public quality information allows patients, referring physicians, and health care purchasers to preferentially select high-quality physicians. Second, public report cards may motivate physicians to compete on quality and, by providing feedback and by identifying areas for quality improvement initiatives, help physicians to do so. Despite these plausible mechanisms of quality improvement, the value of publicly reporting quality information is largely undemonstrated and public reporting may have unintended and negative consequences on health care. These unintended consequences include causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve "target rates" for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment. Public reporting of quality information promotes a spirit of openness that may be valuable for enhancing trust of the health professions, but its ability to improve health remains undemonstrated, and public reporting may inadvertently reduce, rather than improve, quality. Given these limitations, it may be necessary to reassess the role of public quality reporting in quality improvement.

Baylor Research Institute: 2003 Update

The research being conducted through Baylor Research Institute (BRI) is one of Dallas' best-kept secrets. Few people know that physicians and scientists in Baylor Health Care System have almost 500 active protocols. The focus is to move advances from the bench to the bedside, with programs in basic science, mechanisms of disease, clinical effectiveness, clinical efficacy, and health care quality improvement. The 2 basic science programs are in immunology-which relates to the clinical areas of cancer, infectious diseases, allergy, transplantation, and autoimmune diseases-and metabolic disease, which relates to the diagnosis and treatment of inherited errors of metabolism. Other major clinical research concentrations include asthma, gastroenterology, diabetes, cardio-vascular disease, orthopaedics, and dermatology. BRI exists to improve the medical care and well-being of our community-nationally and internationally-through innovative, clinically relevant research that is consistent with the mission, vision, and values of Baylor Health Care System. The institute provides administrative support to investigators in areas such as education, finances, and quality assurance and en-sures compliance with federal and state regulations. It has divisions devoted to research quality and safety, sponsored research, research subject protection, clinical trials, financial management, and the BioScience Center (Figure ​(Figure11). In this article, I review BRI's activities in 2002 and outline goals for 2003. Figure 1 Current organizational structure of Baylor Research Institute.

Harmonic imaging in tissue

In the last few years it has become clear that harmonic imaging in tissue (or tissue harmonic imaging) will improve image quality in many ‘‘difficult to image’’ patients. This talk will focus on the practical and clinical aspects of this imaging method which makes use of the nonlinear propagation of ultrasound in tissue. By filtering the received signal around the second harmonic, much of the haze and clutter in the image is reduced. Although there has been much research on the propagation of nonlinear waves in tissue, the exact mechanisms of this image quality improvement are still unclear. One hypothesis is based on the fact that the intensity of the second harmonic signal increases as the signal pass deeper into tissue. As the majority of artifacts arise from structures close to the transducer, the artifacts in the second harmonic signal are significantly lower than those in the fundamental. By imaging the second harmonic signal, much of the haze and clutter in the image can then be reduced. This talk will give a basic description of tissue harmonic imaging illustrated with clinical examples and a hypothesis for the improvements in image quality.

The Oversight of Medical Care: A Proposal for Reform

The oversight of medical care, in the form of peer review, has traditionally been used to ensure that the highest standards of care are maintained. What is relatively new is the external oversight of medical practice carried out by a growing number of independent entities (government, third-party payers, for-profit firms, for example), overseeing care in uncoordinated ways. Tensions arise when reviews of utilization and reviews of quality are conducted by different organizations with conflicting goals. The review instruments are still crude and have neither been adequately tested nor validated. Future attention to developing reliable and valid measures of efficiency and quality is essential. Evidence suggests that the principal process of review, the case-by-case review, may not be cost-effective and may not be conducive to improving quality. It should be replaced by profiles of practice patterns at institutional, regional, or national levels. We propose a model of oversight that emphasizes the appropriate balance between internal mechanisms of quality improvement and external accountability. In this model, internal and external reviews have specific, complementary roles that promote efficiency and quality. Detailed monitoring of quality and problem solving are left to providers who are intimately involved with care. In return, they become accountable to payers and the public through the surveillance of patterns of practice.