Ongoing Quality Research Articles

Developing a Quality Improvement Framework to Enhance the Health System User Experience for Individuals Living With Type 1 Diabetes: The Reshape T1D Study.

User experience design aims to create products and services that are accessible, usable, and enjoyable. The Reshape T1D study aims to apply these principles to understand how individuals living with T1D interact with and experience healthcare to inform T1D clinical quality improvement. Using a community-based participatory research design, we involved four patients and four clinicians as co-researchers throughout the research. A questionnaire and virtual semi-structured interview were applied across a purposeful sample of 41 adults living with T1D across Alberta, Canada, between September 2021 and May 2022. Audio recordings were transcribed verbatim and de-identified before coding. Thematic analysis was conducted on coded participant discourse through multiple coders. Participants indicated the need for a centralized hub that provides consistent, reliable, and up-to-date T1D education and resources and an emphasis on access to mental health resources within T1D care settings. Providing greater flexibility for appointment types (ie. in-person, virtual, etc.) and after-hours access contributed to better self-management and prevented emergency room visits. Participants desired a choice as to who comprises their T1D care team and for teams to address patient needs specific to their reality. We identified that medical trauma had long-term impacts on perceptions of healthcare and contributed to a reluctance to seek future care. Women expressed challenges in discussing reproductive health with their clinicians. Diabetes online communities provide an adjunct to clinical care through peer support. Cost and access to the latest technology are ongoing barriers for many participants, especially concerning publicly funded programmes that use advanced insulin pump therapy, continuous glucose monitoring, and automated insulin delivery systems. A quality improvement framework emerged through data analysis, and findings were synthesized into actionable recommendations for ongoing clinical quality improvement. Our findings highlight how important health system user suggestions are for more equitable, accessible, and empathetic healthcare for individuals living with T1D. Further work is needed to explore health system user experiences with clinicians and healthcare administrators to effectively carry out T1D clinical quality improvement.

Intravascular Imaging as a Performance Measure for Percutaneous Coronary Intervention.

Intravascular imaging (IVI) is widely recognized to improve outcomes after percutaneous coronary intervention (PCI). However, IVI is underutilized and is not yet established as a performance measure for quality PCI. We examined temporal trends of IVI use for all PCIs performed at Veterans Affairs hospitals in the United States from 2010 to 2022 using retrospective observational cohorts. IVI was defined as intravascular ultrasound or optical coherence tomography. A contemporary subset of PCIs from 2020 to 2022 was used to examine clinical characteristics associated with IVI use and test the reliability of IVI as a pass/fail performance measure. We then used a generalized linear mixed model to estimate the proportion of IVI use variability attributable to the hospital, physician, and patient level. Cox proportional hazard models were used to assess the association of IVI with clinical outcomes at 1 year. IVI use increased from 12.3% in 2010 to 43.1% in 2022 in 136 071 PCIs included in the study. Among 22 918 PCIs in the contemporary cohort, IVI was more frequent with nonemergent presentations, chronic total occlusions, and left main lesions but usage variability was primarily attributable to hospital (54%) and physician (33%) levels. As a pass/fail performance measure, reliability was high (>0.96) at hospital and physician levels. However, IVI use was not associated with statistically significant differences in mortality or major adverse cardiovascular events in this cohort. IVI use for PCI is increasing rapidly at Veterans Affairs hospitals in the United States but with marked variation at the hospital and physician levels. IVI meets established criteria for an effective performance measure and should be measured and reported by local and national organizations to encourage further uptake. Ongoing training and quality improvement may be required to maximize the benefit of IVI as it is more widely utilized.

Perceived effectiveness and recommendations from a childbirth quality assurance and improvement programme in India’s private sector: a qualitative evaluation using the RE-AIM framework

IntroductionPrevious studies have revealed inconsistent quality of care in India’s private sector, where nearly one in three facility births take place. Manyata is a quality assurance and improvement programme launched...

Nutritional intelligence in the food system: Combining food, health, data and AI expertise.

Transformative change is needed across the food system to improve health and environmental outcomes. As food, nutrition, environmental and health data are generated beyond human scale, there is an opportunity for technological tools to support multifactorial, integrated, scalable approaches to address the complexities of dietary behaviour change. Responsible technology could act as a mechanistic conduit between research, policy, industry and society, enabling timely, informed decision making and action by all stakeholders across the food system. Domain expertise in food, nutrition and health should always be integrated into both the development and continuous deployment of AI-powered nutritional intelligence (NI) to ensure it is responsible, accurate, safe, useable and effective. Dietary behaviours are complex and improving diet-related health outcomes requires socio-cultural-demographic considerations within the design and deployment of NI tools. This article describes existing examples of NI within the food system and future opportunities. Human-in-the-loop approaches with food, health and nutrition experts involved at all stages including data acquisition, processing, output validation and ongoing quality assurance are essential to ensure evidence-based practice. The same ethical considerations should apply in this domain as in any other (e.g. privacy, inclusivity, robustness, transparency and accountability) and responsible practice must encompass rigorous standards and alignment with regulatory frameworks. Critical today and in the future is accessibility to appropriate high-quality food compositional data sets, which include up-to-date information on commercially available products that reflect the constantly evolving food landscape to realise the potential of responsible AI to help address the existing food system challenges.

Development, Implementation and Initial Evaluation of the Blueprint for MBBS Theory Exams in a Private Medical College of Pakistan

Objective: This study aimed to enhance the validity of the exam bank at Liaquat National Medical College (LNMC), Karachi, through the development and evaluation of the exam blueprinting process as part of an ongoing quality assurance initiative. Study design and setting: This study was conducted at Liaquat National Medical College (LNMC), Karachi. Participants included key stakeholders i. faculty members, ii-officials from the examination department (involved in the development of the fourth-year MBBS neuroscience exam blueprint), and iii-students. Methodology: Ethical approval for this study was taken by the LNMC Ethics Review Committee. For the ease of understanding, this article was divided into two sections: In first section, the stepwise approach of blueprint development was discussed whereas the second section dealt with feedback from 105 Year 4 MBBS students, feedback from faculty involved in this process and lastly, the experiences of examination unit personnel were explored. Results: Following the Calgary model by Coderre et al., blueprint for undergraduate MBBS theory exam was developed. Students (85%) agreed that the exam accurately assessed the taught content. Faculty expressed satisfaction with the blueprinting process, noting improvements in exam quality, topic representation, and the elimination of redundant questions. Examination unit personnel reported better time management and improved alignment with curricular objectives. Initial challenges, such as faculty’s lack of training and resistance were also identified. Conclusion: The blueprinting process significantly enhanced alignment of theory exam with educational objectives thereby ensuring the content validity. Continued training and institutional support are vital to overcoming initial challenges

Assessing the Effectiveness of Interdisciplinary Education in Healthcare

Introduction: This study focused on innovative health leadership models that can improve the quality of life in post-acute care settings. It answered the need to address leadership strategy in improving patient experience and operational strategy.Methods: The researcher used a mixed-methods approach, incorporating quantitative surveys and qualitative interviews with healthcare professionals in different types of post-acute care settings. The researchers examined data from 150 participants to assess how various leadership models affected the quality of care and staff satisfaction. These included transformational, transactional, and servant leadership models.Results: The data showed that transformational leadership models are associated with significantly better quality of life for patients in post-acute care settings. Those facilities using this model had higher patient satisfaction scores and better overall health outcomes than those using transactional and servant leadership models. Staff in transformational leadership environments also reported greater job satisfaction and less burnout.Conclusions: The study found that transformational leadership is the most effective model for post-acute care settings because it promotes a favorable climate for patients and staff. Transformational leadership elements such as empathy, communication, and empowerment can improve patient care and the job satisfaction of healthcare workers. The study suggested implementing transformational leadership training programs for healthcare leaders who were being nurtured and educated in transformational leadership skills as a desirable format to improve the future and ongoing quality of life in post-acute care settings.

Air quality levels in the industrial city of Jubail, Saudi Arabia

Ambient air quality remains a significant health and environmental challenge in developing cities, primarily due to increasing gas emissions from fossil fuel use. Harmful outdoor air pollutants constitute a critical environmental and public health concern, as poor air quality directly impacts human health, leading to respiratory and cardiovascular diseases. This study aimed to assess ambient gaseous air pollutants—specifically sulfur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), and non-methane hydrocarbons (NMHC)—in Jubail Industrial City, Saudi Arabia. Hourly fixed-site air quality monitoring data were collected from three monitoring stations distributed throughout Jubail, covering the period from January 2020 to December 2022, alongside recorded hourly meteorological conditions. Standard monitoring equipment was employed to measure pollutant concentrations at all three locations. Notably, the highest emissions of CO, SO2, and NMHC occurred in 2021, while the highest emissions of NO, NO2, and NOx were recorded in 2022, with 2022 generally exhibiting the highest gas emissions and 2020 the lowest. Variations in gaseous contaminants were observed, influenced by changes in meteorological conditions and human activities. However, the levels of gaseous emissions remained within acceptable limits according to the air quality index. Consequently, policies implemented during and after the COVID-19 lockdown effectively reduced the accumulation of gaseous emissions to below harmful levels. Maintaining these measures is crucial for ensuring ongoing air quality improvements.

A comparison of scalable routine clinical materials and observer ratings to assess CBT fidelity

Decades of research have demonstrated the efficacy of cognitive behavioral therapies (CBTs) for a wide variety of psychiatric diagnoses, resulting in the inclusion of CBT as a first-line evidence-based practice (EBP) in treatment guidelines for mood and anxiety disorders. However, some research suggests that many providers do not implement EBPs as intended. Ongoing quality monitoring is needed to support EBP implementation and sustainability, but “gold standard” fidelity monitoring (e.g. observer ratings) is time-consuming, requires extensive training, and may feel intrusive to providers and clients. In the current study, we aimed to develop a scalable method of assessing CBT fidelity that leverages information generated in routine clinical care (e.g. session worksheets and clinician checklists). Ratings of adherence based on worksheets were not correlated with ratings of adherence based on observer ratings. However, ratings of competence based on worksheets were significantly correlated with observer ratings of competence. Ratings of adherence based on clinician checklist ratings were also significantly correlated with observer-rated adherence. Results did not indicate a strong relationship between adherence or competence measured by worksheet ratings or observer and symptom change. However, adherence as measured by clinician checklists were associated with subsequent depression symptom change. Findings have a strong potential to impact fidelity monitoring strategies for a variety of CBTs. Given the limited resources and time to do full audio review in routine care settings, findings suggest that using routine materials generated in session to assess therapist competence may be a feasible alternative to the “gold standard” audio review. The trial is registered at ClinicalTrials.gov, number NCT03479398.

Implementation of a Preoperative Frailty Screening and Optimization Pathway for Vascular Surgery Patients is Associated with Decreased 30-Day Readmission

Frailty is characterized by decreased physiological reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for patients undergoing vascular surgery and assessed its impact on postoperative outcomes. As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI). Baseline data were collected from May to July 2022. Frail patients (RAI score of ≥37) were referred to an anesthesia optimization clinic, nutrition consultation, and case management evaluation in the intervention phase (August 2022 to July 2023). Primary outcomes were postoperative hospital length of stay, 30-day readmission, and 30-day mortality. Secondary outcomes included intensive care unit (ICU) admission, ICU length of stay, discharge disposition, and nonhome discharge. Two-way analyses compared frail vs nonfrail patients and preintervention vs postintervention groups using the Student t test or Wilcoxon rank-sum test for continuous variables and the χ2 or Fisher's exact test for categorical outcomes. Of all patients scheduled for elective inpatient vascular surgery procedures at a single institution (n= 225), 216 completed frailty screening (mean age, 72years; 68.5% male; 54.6% White; mean RAI 28.9; 18.5% frail). Of these, 15 had surgeries cancelled, and 201 ultimately underwent surgery with 36 (17.9%) identified as frail. Overall, frail patients had significantly longer ICU (median, 4.0 days [intertquretil range (IQR), 2.5-13.5 days] vs median, 2.0 days [IQR, 1-4 days]; P=.001) and hospital length of stay (median, 2.45 days [IQR, 1.51-5.67 days] vs median, 1.23 days [IQR, 1.0-2.1 days]; P= .001), higher nonhome discharge (30.6% vs 4.2%; P< .0001), and higher 30-day readmission (22.2% vs 6.7%; P= .009) compared with nonfrail patients. Comparing preintervention and postintervention groups, the 30-day readmission rates for the overall cohort decreased significantly (from 22.2% to 7.5%; P= .03). Among frail patients, there was a trend toward a reduced hospital length of stay (from 4.73 to 2.14days), nonhome discharge (from 57.1% to 24.1%), and 30-day readmission (from 42.9% to 17.2%); however, these differences did not reach statistical significance. Overall, the 30-day mortality rates was 1.5% with all three deaths (two frail, one nonfrail) occurring after the intervention (0% before vs 1.7% after; P= 1.0). Successful implementation of a preoperative frailty screening and optimization pathway for patients undergoing elective vascular surgery led to a significant decrease in overall 30-day readmission and a trend toward reduced hospital length of stay, nonhome discharge, and 30-day readmission for frail patients. Further expansion to all surgical clinics has the potential to improve quality metrics for the health care system.

Source-specific acute cardio-respiratory effects of ambient coarse particulate matter exposure in California’s Salton Sea region

Abstract Windblown dust is an ongoing air quality and public health concern among residents living around California’s Salton Sea. As particles emitted from different surface types can differ greatly in terms of composition and other properties, variability in the resulting health impacts of windblown particulates may likewise be source dependent. Here we use observed coarse particulate matter (PMc) concentrations and modeled atmospheric back trajectories along with land surface data to estimate individual source region contributions to particulates observed in the Salton Sea region. We then apply these data products to an analysis of source-specific acute cardio-respiratory impacts using a time-stratified case crossover design with conditional logistic regression based on 171,465 hospitalizations cases recorded from 2008 to 2019. Using a remote sensing chlorophyll-a data product, we further investigate the possible influence of periodic bloom events on those hospitalizations. Results suggest that a 10 g/m3 increase in coarse PM coming from over the Salton Sea is associated with a 8.6% (Risk Ratio, RR = 1.086, 95% CI: 1.028 - 1.147) increased risk of respiratory hospitalizations; increases that are greater than those for dust likely originating from other surface types. Furthermore, we find even higher RR values for dust associated with Salton Sea back trajectories during bloom events: a 24.9% (RR = 1.249 95% CI: 1.031 – 1.514) increased risk in respiratory hospitalization. Our findings suggest that exposure to aerosols potentially originating from the Salton Sea or surrounding surfaces is associated with increased respiratory, especially during observed bloom events. Further research is needed to determine the underlying mechanisms responsible for these health impacts, as well as possible primary or secondary preventive strategies.&amp;#xD; &amp;#xD;&amp;#xD;

Multilevel Facilitators and Barriers to Healthcare Organization and Delivery Among Childhood Cancer Survivors.

Childhood cancer survivors (CCS) are at risk for medical and psychosocial late effects of their disease and its treatment and are recommended to receive annual follow-ups. Yet, rates of follow-up adherence are suboptimal and may be influenced by the organization and delivery of their healthcare. This research aimed to examine experts' perceptions of facilitators and barriers to healthcare organization and delivery to CCS. Thirty-one clinicians and administrators in a comprehensive cancer center's research consortium were interviewed about system-level factors that may promote or deter annual follow-ups among CCS. Interview transcripts were coded and inductively analyzed using a study-specific scheme. Three main themes were identified: (1) healthcare system influences (59%); (2) social determinants of health (25%); and (3) intra/interpersonal factors (16%). Prominent subthemes included age-related changes in the transition of healthcare responsibility that disrupt ongoing CCS care (28.1%), the breadth and quality of psychosocial support available to navigate CCS to follow-up (13.5%), and transportation challenges (24.6%; especially in low-resource areas). In contrast, community trust facilitated follow-up (17.3%). The system of healthcare was prominent in receipt of follow-up by CCS, and further influenced by social determinants of health and intra/interpersonal factors. Easing transitions of responsibility (from parents to CCS, and acute care to survivorship teams) may be beneficial, especially when social determinants of health obstacles are present. Psychosocial wrap-around care is essential, along with promoting staff awareness of obstacles that CCS encounter in low-resource communities.

Meeting the accreditation standard through implementation of a multiprogram residency advisory committee and ongoing quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To describe the process utilized by a large multiprogram residency site to expand preceptor engagement and establish ongoing quality improvement efforts in order to meet the program's needs in response to evolving ASHP accreditation standards. A multiprogram residency advisory committee (RAC) primarily composed of residency program leadership was formed to focus on aspects of program management and accreditation compliance that were not being addressed at the monthly all-preceptor meeting. The ASHP standard and a recent residency accreditation survey guided the RAC agenda, which led to the creation of a combined manual for the institution's 5 residency programs and a preceptor manual. Preceptor engagement was improved through the establishment of local preceptor requirements, inclusion of preceptor representatives on the RAC, expansion of subcommittee opportunities, addition of a preceptor midpoint retreat, and optimization of the end-of-year preceptor retreat. Communication with residents and identification of continual improvement opportunities were improved through roundtables with residents, residency program directors, and the RAC chair; a monthly meeting with the rotating chief resident and RAC chair; and face-to-face exit interviews with the department's chief of pharmacy. The RAC chair has been a key figure in coordinating program change to meet the ASHP standard as well as leading planning for subsequent ASHP surveys. Through the establishment of a multiprogram RAC and a RAC chair, our program has been able to engage a large preceptor group that is dedicated to continual improvement and provides the ability to dynamically respond to ASHP's progressing guidance for pharmacy residency programs.

Feasibility and Safety of a Paramedic-Directed Prehospital Buprenorphine Initiation Protocol for Acute Opioid Withdrawal

Objectives The epidemic of opioid use disorder (OUD) remains pervasive in the United States. In an effort to increase the availability and timeliness of medications for opioid use disorder (MOUD), several agencies in the United States (US) offer buprenorphine by prehospital providers to selected patients, though published data remains limited. We describe the preliminary safety and feasibility of training all paramedics within a single agency to administer buprenorphine in the field without online medical control to simultaneously treat opioid withdrawal and initiate MOUD. Methods Using data from an ongoing quality assurance (QA) database, cases were retrospectively reviewed. Inclusion criteria included administration of buprenorphine by paramedics; cases were excluded if administered prior to EMS arrival on scene (i.e., the patient was given buprenorphine by a bystander or took their own). Data were entered into a REDCap database as part of the ongoing QA process. The primary reported outcome was administration of buprenorphine without complications. Complications were defined as any adverse effects from the administration of medication, including but not limited to new or worsening opioid withdrawal symptoms. Results In total, 121 patients met inclusion criteria, 82 were treated for naloxone-induced withdrawal and 39 for withdrawal due to opioid cessation. There were no cases of precipitated withdrawal or worsening of patient condition observed. Adverse effects were limited to three cases of nausea and vomiting post-administration, all of which were present prior to buprenorphine administration. No patients met the primary outcome of adverse effects from medication administration. Conclusions In a single prehospital system, the use of buprenorphine appears to be a feasible and safe strategy for treating patients experiencing acute opioid withdrawal.

Re-excision rates after breast-conserving surgery for invasive breast cancer: an Albertan perspective.

Re-operation after breast-conserving surgery for invasive breast cancer is variable among centres and individual surgeons. In this study, we aimed to characterize the current landscape of practice regarding re-operation for invasive breast cancer in the province of Alberta. This study was a retrospective review of the Synoptec database for patients undergoing primary breast-conserving surgery for invasive breast cancer or reoperation in the province of Alberta in the year 2020. We extracted data on demographic and tumour characteristics, use of intraoperative margin-assessment strategies, and surgical facility. We conducted univariate and multivariate logistic model analyses. We included 1391 breast surgeries in the study. A total of 158 patients underwent re-operation during the study period. The median time to first reoperation was 34 days. The overall re-operation rate was 11.4% (range 5.4%-18.5%) among surgical facilities. The completion mastectomy rate was 5.2%, and 1.5% of patients underwent multiple revisional surgeries. Tumour multifocality was associated with increased revisional surgery rates on multivariate analysis (odds ratio 2.80). The results of this study are consistent with the published literature. We have identified heterogeneity among sites in Alberta for revisional surgery after breast-conserving surgery for invasive breast cancer. This highlights an opportunity for ongoing education and quality improvement in breast cancer care in the province of Alberta.

Quality measure for screening for adult obstructive sleep apnea by primary care providers: 2024 update after measure maintenance.

Lloyd RM, Crawford T, Donald R, etal. Quality measure for screening for adult obstructive sleep apnea by primary care providers: 2024 update after measure maintenance. J Clin Sleep Med. 2024;20(11):1819-1822.

Association between caseload volume and outcomes in left ventricular assist device implantations-a EUROMACS analysis.

This EUROMACS study was conducted with the primary aim of investigating the association between a centre's annual caseload and postoperative outcomes among patients undergoing left ventricular assist device (LVAD) implantation. A total of 4802 patients identified between 2011 and 2020 from 35 participating centres were dichotomized based on the annual caseload of the treating centre at the time of device implant (≤30 vs. >30 LVAD implantations/year). The primary endpoint was 1-year survival. Secondary outcomes included overall survival analysis, device-related adverse events and readmissions. Cumulative follow-up was 10 003 patient-years, with a median follow-up of 1.54 years (interquartile range 0.52-3.15). Patients from higher volume centres more frequently presented in INTERMACS levels 1 and 2, suffered from right heart dysfunction and needed inotropic support. No difference was observed in adjusted 1-year survival. Adjusted overall survival probability was lower in higher volume centres (p = 0.002). In the subgroup analysis of HeartMate 3 devices only, higher volume centres were associated with decreased odds of 1-year survival (adjusted odds ratio 0.43, 95% confidence interval 0.20-0.97, p = 0.041). Similar findings were observed in the cumulative (i.e. learning curve) caseload analyses. In patients undergoing LVAD implantation, centre volume was not associated with 1-year survival, but was related to device-related adverse events. Patient profiles differed with respect to centre size. These findings underscore the necessity for ongoing quality improvement initiatives in all centres, regardless of their annual caseload. Efforts are needed to standardize patient selection and preconditioning to further improve patient outcome.

Integrating an AI-powered symptom assessment application (SAA) in a hospital network in Portugal

Abstract Introduction Patients often struggle to understand medical information and healthcare worker shortage strains health systems. Integrating SAAs that guide patients and provide diagnostic decision support (DDS) to doctors can help. This study evaluates the impact of the SAA ‘Ada’, a class IIa medical device, after its integration into the patient portal of a Portuguese hospital network, CUF, on clinical workflow and patient health. Methods This on-going post-market quality improvement study, started in Nov 2023 and has enrolled 664 participants. Participating doctors complete a baseline survey. Consenting patients conduct symptom assessments and answer survey questions within the app. The patient’s symptom report is shared with their physician, who then completes a post-consultation survey. Results After using Ada, 86% of patients could enter all their symptoms, 79% felt more prepared for their consultation, and 39% felt less health anxiety (N = 664). In the baseline survey, most doctors utilize online resources (96%) in the absence of a symptom checker, followed by discussions with colleagues (65%) for challenging cases (N = 26). In the post-consultation survey, 95% of doctors found Ada’s condition suggestions reasonable, with only 10% disagreeing with its triage classification. Doctors reported time saving and increased consultation efficiency (64%), and 59% felt more confidence in their diagnosis. A majority said that Ada provided them with additional information about patients (77%). Ada also improved consultation efficiency (74%), preparation (78%), patient engagement (82%), and health knowledge (77%; N = 22). Conclusions By providing personalized health information, Ada prepares patients for their consultation, resulting in improved patient engagement and facilitation of clinical conversation. Incorporating a SAA into routine patient care enhances quality of consultation, reduces consultation time, increases efficiency, and provides DDS to doctors. Key messages • Digital health enhances patient engagement, clinical efficiency, and diagnostic decision support for doctors in healthcare settings. • Ada’s personalized health information empowers patients, improves consultations, and reduces health-related anxiety.

Exploring Longitudinal Physiological Monitoring: Insights From Utilizing a Commercial Wearable Device Among Older Adults With Mild Cognitive Impairment

Commercial wearable technologies are becoming increasingly prevalent and offer the potential for monitoring physiological changes over time, particularly in older adults with Mild Cognitive Impairment (MCI). While literature suggests the utility of such devices, little evidence exists of their successful deployment among people with MCI. This feasibility study aimed to establish research guidelines, optimize participant training, and identify data collection challenges when collecting longitudinal physiological data using the Oura Ring. Our results indicated that adequate researcher support was crucial for study success and participant engagement. This involves including care partners of participants with MCI and providing appropriate technological training to participants. Care partner support reduced device troubleshooting instances and emotionally encouraged participants with MCI. Lastly, maintaining regular researcher-participant communication fostered rapport and ensured ongoing participant consent and data quality. This research lays the groundwork for future health monitoring studies by emphasizing the importance of tailored support, communication, and researcher involvement.

Recruitment and retention of new doctors in remote and Aboriginal medical services through the Remote Vocational Training Scheme's Targeted Recruitment Strategy: a focus group study.

To explore the results of a targeted recruitment strategy designed to attract and retain new doctors in remote and Aboriginal medical services where they can access Remote Vocational Training Scheme (RVTS) training and support to qualify as general practitioners. Two 2-hour purposeful online focus groups on the RVTS' Targeted Recruitment Strategy. Five participants and nine stakeholders with knowledge and experience of the strategy. Data were transcribed and deductively and inductively coded for themes including insights from separate project reference and stakeholder advisory groups. Perspectives of the strategy. The overarching theme was that the strategy is useful for attracting and retaining new general practitioners in areas of high need and is potentially scalable. Since 2018, 20 new doctors were recruited via the Targeted Recruitment Strategy and six of them completed the RVTS program. The strategy could better differentiate target locations because increasing communities are experiencing major general practice workforce shortages. The package of employment and training could also be more clearly defined for participants, nationally marketed and collaboratively implemented. Further, more site accreditation and ongoing risk and quality review is needed, along with intense early supports for participants who are new to both the community and general practice work. The Targeted Recruitment Strategy is still maturing but the early results suggest it is a unique and proactive model for attracting and improving access to general practitioners in places with high needs. It could be strengthened through formal agreements between communities and agencies, ensuring coordinated implementation, clarifying roles and responsibilities, and developing clear pathways for risk and quality management.

Evolution of overall survival (OS) after curative-intent lung cancer surgery in a population-based Mississippi Delta cohort.

278 Background: Surgical resection is the most important curative modality for patients with lung cancer, with long-term OS influenced by both surgical quality and cancer biology. We compared surgical care and outcomes over 4 eras in the population-based Mid-South Quality of Surgical Resection (MS-QSR) cohort, an ongoing regional surgical and pathologic quality improvement (QI) dissemination and implementation project. Methods: We implemented a surgical lymph node collection kit and a novel pathology gross dissection method across 12 hospitals encompassing &gt;95% of lung cancer resections in 5 contiguous Dartmouth Hospital Referral Regions. We analyzed the MS-QSR cohort at 5-year intervals characterized by stepped-wedge implementation of specific QI interventions: Era 1 (2004-2008; baseline, no QI), Era 2 (2009-2013; quality feedback, surgical QI pilot), Era 3 (2014-2018; surgical QI implementation), and Era 4 (2019-2023; combined surgical QI and pathology QI implementation). We used standard statistical methods to compare surgical quality; Kaplan-Meier plot, log-rank test, and Cox proportional hazards model with Era 1 as reference to compare OS across eras. Results: Of 7240 resections, 14%, 31%, 29%, and 26% were performed in Eras 1-4, respectively (Table). Attainment of the stringent International Association for the Study of Lung Cancer (IASLC) definition of complete resection increased from 0% in Era 1 to 32% in Era 4; attainment of the American College of Surgeons Operative Standard 5.8 (ACS_OS 5.8), the current US definition of surgical quality, improved from 4% in Era 1 to 67% in Era 4; 120-day mortality rate decreased from 10% to 4% (p&lt;0.0001 for all comparisons). With median follow-up of 4.7, 5.5, 5.6, and 2 years for Eras 1-4, 3-year OS rates were 60%, 64%, 70%, and 79%; 5-year OS rates were 48%, 52%, 58%, and 70%, respectively (p&lt;0.0001). The Hazard Ratio (HR) for mortality decreased from 0.91 (95% CI: 0.8-0.99) in Era 2 to 0.49 (95% CI: 0.43-0.56) in Era 4. Conclusions: Surgical quality and OS sequentially improved in this diverse, high-risk population-based Mississippi Delta surgical resection cohort. We are evaluating the full range of factors associated with this striking OS improvement. Ongoing work is exploring biologic correlates to this improvement. Variable Era 1 N= 988 Era 2 N=2235 Era 3 N=2107 Era 4 N=1910 Median age (Q1, Q3) 68 (62, 74) 68 (62, 74) 68 (61, 74) 68 (61, 74) Male sex (%) 514 (52%) 1234 (55%) 1082 (51%) 977 (51%) Black race 221 (22%) 416 (19%) 450 (21%) 451 (24%) Attained ACS_OS 5.8 40 (4%) 533 (24%) 1050 (50%) 1272 (67%) IASLC complete resectionUncertain completeness 0 (0%)930 (94%) 194 (9%)1932 (86%) 435 (21%)1594 (76%) 606 (32%)1227 (64%) 120-day mortality 100 (10%) 197 (9%) 139 (7%) 72 (4%) 5-year OS 48 (45-51) 52 (50-55) 58 (56-60) 70 (66-74) HR (95% CI) Reference 0.91 (0.83-0.99) 0.75 (0.69-0.83) 0.49 (0.43-0.56)