New Measure Of Quality Research Articles

Assessing the quality of public services: For-profits, chains, and concentration in the hospital market.

We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk-adjust for hospital characteristics and county demographics. While the overall association between for-profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for-profit relative to non-profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for-profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not-for-profit hospitals.

OFF episode quality of life impact scale (OFFELIA): A new measure of quality of life for off episodes in Parkinson's disease

IntroductionOFF Episodes occur in people with Parkinson's disease when their medication wears off, and motor and/or non-motor symptoms emerge. Existing measures used to assess OFF Episodes focus on the time spent in OFF Episodes through diaries or by identifying symptoms, but they are limited in their ability to capture the severity and functional impact of OFF episodes. The aim of this study was to develop and validate a new instrument, called “OFFELIA,” that measures the impact of OFF episodes on the quality of life of individuals with Parkinson's disease. MethodsParticipants completed a cross-sectional questionnaire, “Impact and Communication on OFF Periods,” while enrolled in the online clinical study Fox Insights. The data collected was used to develop OFFELIA. Psychometric testing was performed on 18 candidate items using classical, exploratory factor analysis, and item response theory methods. Results569 individuals with Parkinson's disease completed the questionnaire. All items were retained for the final measure, with 17 items aggregated into two multi-item scales (functioning and psychological well-being) and one item reported separately as it did not function well with the other items (employment). Known group comparisons based on average duration, frequency and unpredictability of OFF episodes indicated that OFFELIA subscales were more sensitive than existing generic and condition-specific measures. ConclusionInitial evidence supports the validity of OFFELIA, a new instrument that assesses the impact of OFF periods on daily life. This instrument can be used in assessing clinical therapeutic strategies targeting OFF episodes in Parkinson's disease.

Deriving a Preference-Based Measure for People With Duchenne Muscular Dystrophy From the DMD-QoL

ObjectivesThis study generates a preference-based measure for capturing the quality of life of people with Duchenne muscular dystrophy (DMD) from a new measure of quality of life, DMD-QoL. MethodsA health state classification system was derived from the DMD-QoL based on psychometric performance of items, factor analysis, and item response theory analysis. Preferences for health states described by the classification system were elicited using an online discrete choice experiment survey with life years as an additional attribute, from members of the UK general population (n = 1043). Discrete choice experiment data was modeled using a conditional fixed-effects logit model and utility estimates were directly anchored on the 1 to 0 full health-dead scale. ResultsThe health state classification system has 8 dimensions: mobility, difficulty using hands, difficulty breathing, pain, tiredness, worry, participation, and feeling good about yourself. The standard model had mostly statistically significant coefficients and reflected the instrument’s monotonic structure. However, 2 dimensions had inconsistent coefficients (where utility increased as health worsened) and a consistent model was estimated that merged adjacent inconsistent severity levels. The best state defined by the classification system has a value of 1 and the worst state has a value of −0.559. ConclusionThe modeled results enable DMD-QoL-8D utility values to be generated using DMD-QoL or DMD-QoL-8D data to generate QALYs for people with DMD. QALYs can then be used to inform economic models of the cost-effectiveness of interventions in DMD. Future research comparing the psychometric performance of DMD-QoL-8D to existing generic preference-based measures, including EQ-5D-5L, is recommended.

QuaLVAD Instrument: A New Measure of Quality of Life in Patients with a Left Ventricular Assist Device (LVAD)

Background Although the use of LVADs in treating patients with advanced heart failure is growing, no current tool exists that can reliably assess health-related quality of life (HRQL) in this population. The QuaLVAD instrument has been designed to address this need. It incorporates important elements of LVAD-related care such as LVAD-specific complications, routine care of the device and other related clinical, personal and social factors. Methods The QuaLVAD instrument was designed after literature search, expert consultation, and patient discussion. It currently includes a 70-item instrument with scores ranging from 0-100 wherein a higher score signifies better HRQL. We assessed its performance by enrolling 24 patients and co-administered it with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and visual analog scale (VAS) to stable patients implanted with a LVAD. Cronbach's alpha was calculated to measure the internal consistency of the instrument. Spearman correlation coefficients (ρ) and Wilcoxon rank-sum test helped assess for various associations of the QuaLVAD scores. Results The 24 subjects included had a mean age and BMI of 60.0 ± 13.2 years and 32.3 ± 18.2 kg/m2 respectively. The Cronbach's alpha for the entire instrument was 0.95 and >0.75 for all its six domains. Other summary statistics and the Cronbach's alpha for each domain are shown in Table 1. Amongst patient characteristics, the QuaLVAD overall score had the greatest correlation (ρ = -0.60) with the total number of comorbidities and a significant association with outpatient status of the subject (p-value = 0.05). A moderate negative correlation (ρ = -0.37) was observed with the New York Heart Association (NYHA) class. Convergent validity was established with strong correlation scores with the KCCQ and VAS (ρ of 0.84 and 0.67 respectively for overall scores; p-value ≤ 0.001). Subject feedback indicated that 52% considered the QuaLVAD instrument as more relevant in assessing their LVAD-related quality of life than any previously filled questionnaires. Conclusion Our results have demonstrated promising early insights into the internal consistency and validity of the QuaLVAD instrument. To further refine the instrument, we shall focus on item reduction, testing responsiveness to change in HRQL and more widespread application of this novel instrument.

“What’s the Risk?” Assessing and Mitigating Risk in Cardiothoracic Surgery

“What’s the Risk?” Assessing and Mitigating Risk in Cardiothoracic Surgery

Improvements in the distribution of hospital performance for the care of patients with acute myocardial infarction, heart failure, and pneumonia, 2006-2011.

Medicare hospital core process measures have improved over time, but little is known about how the distribution of performance across hospitals has changed, particularly among the lowest performing hospitals. We studied all US hospitals reporting performance measure data on process measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) to the Centers for Medicare & Medicaid Services from 2006 to 2011. We assessed changes in performance across hospital ranks, variability in the distribution of performance rates, and linear trends in the 10th percentile (lowest) of performance over time for both individual measures and a created composite measure for each condition. More than 4000 hospitals submitted measure data each year. There were marked improvements in hospital performance measures (median performance for composite measures: AMI: 96%-99%, HF: 85%-98%, PN: 83%-97%). A greater number of hospitals reached the 100% performance level over time for all individual and composite measures. For the composite measures, the 10th percentile significantly improved (AMI: 90%-98%, P<0.0001 for trend; HF: 70%-92%, P=0.0002; PN: 71%-92%, P=0.0003); the variation (90th percentile rate minus 10th percentile rate) decreased from 9% in 2006 to 2% in 2011 for AMI, 25%-8% for HF, and 20%-7% for PN. From 2006 to 2011, not only did the median performance improve but the distribution of performance narrowed. Focus needs to shift away from processes measures to new measures of quality.

Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC index): A new measure of quality in cardiac surgery

Quality of cardiac surgical care may vary between institutions. Mortality is low and large numbers are required to discriminate between hospitals. Measures other than mortality may provide better comparisons. To develop and assess the Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC) index, a new performance measure for cardiothoracic admissions to intensive care units (ICUs). The Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and Australian and New Zealand Intensive Care Society Adult Patient Database were linked. Logistic regression was used to generate a predicted risk of death first from preoperative data using the previously validated Allprocscore and second on admission to an ICU using Acute Physiology and Chronic Health Evaluation III score. Change in risk as a percentage (ARCTIC) was calculated for each patient. The validity of ARCTIC as a marker of quality was assessed by comparison with intraoperative variables and postoperative morbidity markers. Sixteen thousand six hundred eighty-seven patients at 21 hospitals from 2008 to 2011 were matched. An increase in ARCTIC score was associated with prolonged cardiopulmonary bypass time (P = .001), intraoperative blood product transfusion (P < .001), reoperation (P < .0001), postoperative renal failure (P < .0001), prolonged ventilation (P < .0001), and stroke (P = .001). The ARCTIC index is associated with known markers of perioperative performance and postoperative morbidity. It may be used as an overall marker of quality for cardiac surgery. Further work is required to assess ARCTIC as a method to discriminate between cardiac surgical units.

The Quality Function Measure: reliability and discriminant validity of a new measure of quality of gross motor movement in ambulatory children with cerebral palsy

Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)--a revision of the Gross Motor Performance Measure (GMPM)--evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM. Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation. QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05). The QFM is reliable and valid, making it possible to assess how well young people with CP move and what areas of function to target to enhance quality of motor control.

CLASS–Infant: An Observational Measure for Assessing Teacher–Infant Interactions in Center-Based Child Care

Research Findings: The growing body of literature demonstrating the importance of quality interactions with caregivers to infant development coupled with the increasing number of infants spending time in classroom settings highlights the need for a measure of interpersonal relationships between infants and caregivers. This article introduces a new measure of quality in infant classrooms based on the Classroom Assessment Scoring System (CLASS) framework. This measure focuses on teacher–infant interactions with the goal of understanding how these proximal process features can be assessed in this environment. Results from a small pilot study of 30 infant classrooms indicated that the CLASS–Infant demonstrated adequate variability as well as expected convergent and divergent validity with the most commonly used infant child care quality measure. The dimensions of the measure composed a single construct of classroom quality based on teacher–infant interactions. Practice or Policy: Implications of using this measure as an assessment of center-based infant classroom quality and improving professional development are discussed.

The Eating Disorders Well Being Questionnaire (EDwell): a new measure of quality of life in eating disorders

Eating disorders (EDs) are an important cause of physical morbidity and psychosocial impairment, and eating disordered patients have a worse quality of life than peers. The aim of this study was to develop and validate a new self-report instrument, the Eating Disorders Well Being Questionnaire (EDwell), a measure of eating disorders-related quality of life, which takes into consideration not only the intensity, but also the subjective relevance of physical and psychosocial distress. The questionnaire was administered to 120 eating disordered patients and 60 healthy controls. Patients underwent a psychopathological and clinical evaluation. Test-retest reliability, internal consistency, and psychopathological correlates were evaluated. All patients were also administered the Eating Disorder Examination (EDE12.0D) and the Short Form 36 Health Survey (SF36). A factor analysis was performed to verify the distribution of items into subscales. EDwell showed good test-retest reliability and internal consistency. EDwell scores significantly correlated with EDE12.0D total and subscale scores. A significant correlation was also found between several EDwell and SF36 scores. Factor analysis identified three factors: Perfectionism/Control, Loneliness/Avoidance, Social Functioning. The EDwell questionnaire is a feasible and reliable measure of the specific impact of Eating Disorders psychopathology on quality of life.

The ‘Global Outcomes Score’: A Quality Measure, Based On Health Outcomes, That Compares Current Care To A Target Level Of Care

The quality of health care is measured today using performance measures that calculate the percentage of people whose health conditions are managed according to specified processes or who meet specified treatment goals. This approach has several limitations. For instance, each measure looks at a particular process, risk factor, or biomarker one by one, and each uses sharp thresholds for defining "success" versus "failure." We describe a new measure of quality called the Global Outcomes Score (GO Score), which represents the proportion of adverse outcomes expected to be prevented in a population under current levels of care compared to a target level of care, such as 100 percent performance on certain clinical guidelines. We illustrate the use of the GO Score to measure blood pressure and cholesterol care in a longitudinal study of people at risk of atherosclerotic diseases, or hardening of the arteries. In that population the baseline GO Score was 40 percent, which indicates that the care being delivered was 40 percent as effective in preventing myocardial infarctions and strokes as our target level of care. The GO Score can be used to assess the potential effectiveness of different interventions such as prevention activities, tests, and treatments.

Surprising results on phylogenetic tree building methods based on molecular sequences.

BackgroundWe analyze phylogenetic tree building methods from molecular sequences (PTMS). These are methods which base their construction solely on sequences, coding DNA or amino acids.ResultsOur first result is a statistically significant evaluation of 176 PTMSs done by comparing trees derived from 193138 orthologous groups of proteins using a new measure of quality between trees. This new measure, called the Intra measure, is very consistent between different groups of species and strong in the sense that it separates the methods with high confidence.The second result is the comparison of the trees against trees derived from accepted taxonomies, the Taxon measure. We consider the NCBI taxonomic classification and their derived topologies as the most accepted biological consensus on phylogenies, which are also available in electronic form. The correlation between the two measures is remarkably high, which supports both measures simultaneously.ConclusionsThe big surprise of the evaluation is that the maximum likelihood methods do not score well, minimal evolution distance methods over MSA-induced alignments score consistently better. This comparison also allows us to rank different components of the tree building methods, like MSAs, substitution matrices, ML tree builders, distance methods, etc. It is also clear that there is a difference between Metazoa and the rest, which points out to evolution leaving different molecular traces. We also think that these measures of quality of trees will motivate the design of new PTMSs as it is now easier to evaluate them with certainty.

Opportunities for systematic change in the academic research library: elements of the post-digital library

This paper, based on a talk delivered at the University of Leeds on 19 April 2011, seeks to outline a series of important trends that are influencing the roles and responsibilities of the academic research library, and a program of radical collaboration that would enable deeper integration of resources and a more systemic approach to the critical collection and service challenges. The academic research library must sustain its core responsibilities, albeit in an increasingly digitized, networked and mobile condition, enrich fundamental relationships with its user communities, and assume powerful new roles in support of learning and scholarship. New measures of quality, impact, productivity, innovation and leadership must be advanced. The paper suggests that the evolution of the academic library will focus more on an evolving period of polygamy, parabiosis and particularism, as we think beyond the transition to electronic and more about a post-digital context.

The Psychometric Properties of the Older People's Quality of Life Questionnaire, Compared with the CASP-19 and the WHOQOL-OLD.

Purpose. To present the psychometric properties of a new measure of quality of life in older age, the Older People's Quality of Life (OPQOL) Questionnaire, compared with the CAPSE-19 and the WHOQOL-OLD. Design and Methods. The vehicle was three national population surveys of older people living at home in Britain, including a survey of ethnically diverse older people. Results. The OPQOL had acceptable levels of reliability and validity in British population samples of older people, but more modest in the ethnically diverse population sample. The CASP-19 and WHOQOL-OLD had acceptable levels of reliability and validity in the British population sample, but not in the ethnically diverse sample. Implications. The OPQOL has potential for use as a multidimensional population surveillance instrument for use with older populations, or as an outcome measure of multisector policy. Its strengths are that its development was embedded firmly in the perspectives of older people, integrated with theory.

Field Testing, Refinement, and Psychometric Evaluation of a New Measure of Quality of Care for Assisted Living

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, generalizability theory, and exploratory factor analysis. The 34-item scale has a coherent six-factor structure that conceptually describes the multidimensional concept of care quality in assisted living. The six factors can be logically clustered into process (Homelike and Caring, 21 items) and structure (Access and Choice; Lighting; Plants and Pets; Outdoor Spaces) subscales and for a total quality score. Classical test theory results indicate most subscales and the total quality score from the OIQ-AL have acceptable interrater, test-retest, and strong internal consistency reliabilities. Generalizability theory analyses reveal that dependability of scores from the instrument are strong, particularly by including a second observer who conducts a site visit and independently completes an instrument, or by a single observer conducting two site visits and completing instruments during each visit. Scoring guidelines based on the total sample of observations (N = 358) help guide those who want to use the measure to interpret both subscale and total scores. Content validity was supported by two expert panels of people experienced in the assisted-living field, and a content validity index calculated for the first version of the scale is high (3.43 on a four-point scale). The OIQ-AL gives reliable and valid scores for researchers, and may be useful for consumers, providers, and others interested in measuring quality of care in assisted-living facilities.

The Feasibility and Value of New Measures Showing Patterns of Quality for Patients With 3 Chronic Conditions

The aim of this study was to create new measures of quality that combine individual service measures. Using an all-or-none approach, we identify 5 levels of care reflecting the extent to which optimal patterns of service were obtained by patients with asthma, diabetes, and heart failure. We also assess the feasibility of these levels-of-care measures and their potential value in quality improvement efforts. The study was designed to analyze claims data to reflect patterns of services used in a single metropolitan market of about 1 million residents in the northeastern United States. More than 80,000 patients insured over 4 years (1994-1997) had claims with 1 or more of 3 chronic conditions. The analysis showed that the measures discriminated effectively among groups of patients with the 3 chronic conditions and highlighted areas to target quality improvement efforts. Although the numbers vary by year, for two of the diagnoses, most patients were in the lowest categories (59%-75%), and for the third, 40% were in these categories. Few were in the highest category. Most patients were in the same category from one year to the next. The levels-of-care approach to quality measurement can help caregivers and policy makers find methods for avoiding unnecessary utilization and expenditures while raising--not lowering--the probability that utilization patterns will conform to condition-specific recommended care.

Surgical specimen identification errors: A new measure of quality in surgical care

Surgical specimen identification errors: A new measure of quality in surgical care

Understanding and Measuring Patients' Assessment of the Quality of Nursing Care

Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement. To develop the Patient's Assessment of Quality Scale--Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive. Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later. After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance. Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.

Surgical specimen identification errors: A new measure of quality in surgical care

Communication errors are the primary factor contributing to all types of sentinel events including those involving surgical patients. One type of communication error is mislabeled specimens. The extent to which these errors occur is poorly quantified. We designed a study to measure the incidence and type of specimen identification errors in the surgical patient population. We performed a prospective cohort study that included all patients who underwent surgery in an outpatient clinic or hospital operating room and for whom a pathology specimen was sent to the laboratory. The study took place during a 6-month period (October 2004 to April 2005) at an urban, academic medical center. The study's main end-points were the incidence and type of specimen labeling errors in the hospital operating room and the outpatient clinic. The specimen was the unit of analysis. All specimens were screened for "identification errors," which, for the purposes of this study, were defined as any discrepancy between information on the specimen requisition form and the accompanying labeled specimen received in the laboratory. Errors were stratified by the type of identification error, source, location, and type of procedure. A total of 21,351 surgical specimens were included in the analysis. There were 91 (4.3/1000) surgical specimen identification errors (18, specimen not labeled; 16, empty container; 16, laterality incorrect; 14, incorrect tissue site; 11, incorrect patient; 9, no patient name; and 7, no tissue site). Identification errors occurred in 0.512% of specimens originating from an outpatient clinic (53/10,354 specimens) and 0.346% of specimens originating from an operating room (38/10,997 specimens). Procedures involving the breast were the most common type to involve an identification error (breast = 11, skin = 10, colon = 8); in addition, 59.3% (54/91) of errors were associated with a biopsy procedure. Follow-up was complete in all cases found to have an identification error. Surgical specimen identification errors are common and pose important risks to all patients. In our study, these events occurred in 4.3 per 1000 surgical specimens or an annualized rate of occurrence of 182 mislabeled specimens per year. Given the frequency with which these errors occur and their potential effect on patients, the rate of surgical specimen identification errors may be an important measure of patient safety. Strategies to reduce the rate of these errors should be a research priority.

The development of a new measure of quality of life in the management of gastro-oesophageal reflux disease: the Reflux questionnaire

This paper reports on the development of a new measure of health-related quality of life for use among patients with gastro-oesophageal reflux disease (GORD), funded as part of the REFLUX trial. This is a large UK multi centre trial that aims to compare the clinical and cost effectiveness of minimal access surgery with best medical treatment for patients with GORD within the NHS. Potential items were identified via a series of interviews and focus groups carried out with patients who were receiving/had received medical or surgical treatment for GORD. The final measure consisted of 31 items covering 7 categories (Heartburn; Acid reflux; Wind; Eating and swallowing; Bowel movements; Sleep; Work, physical and social activities). The measure produced two outputs: a quality of life score (RQLS) and five Reflux symptom scores. Reliability (internal consistency), criterion validity with the SF-36 and, sensitivity to change in terms of relationship with reported change in prescribed medication were assessed amongst a sample of 794 patients recruited into the trial. The measure was shown to be internally consistent, to show criterion validity with the SF-36 and sensitive to changes in patients use of prescribed medication at baseline and 3 month follow-up. The Reflux questionnaire is a new self-administered questionnaire for use amongst patients with GORD. Initial findings suggest that the new measure is valid, reliable, acceptable to respondents and simple to administer in both a clinical and research context.