Potential Quality Measures Research Articles

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

BackgroundHospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised...

Quality measures in primary care skin cancer management: a qualitative study of the views of key informants

ObjectivesThis study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.DesignSemistructured interviews and qualitative proforma surveys were...

1666. Sources and Preventability of Hospital-onset Bacteremia and Fungemia in the United States: Evaluation of a Potential Healthcare Quality Measure

Abstract Background Hospital-onset bacteremia and fungemia (HOB) is being proposed as a potential healthcare quality measure due to its clinical significance, objectivity, and ease of detection. However, information is lacking on sources of HOB and the proportion and types of cases considered preventable. Methods We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture >= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1-6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable. Results We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture >= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1–6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable. Conclusion Gastrointestinal and endovascular sources account for a large majority of noncommensal HOB cases. A high proportion of noncommensal HOB cases are likely not preventable. The presence of non-preventable events should be considered when using HOB as a quality measure. Approaches to identifying the subset of preventable noncommensal HOB events should be explored. Disclosures Scott Fridkin, MD, Pfizer: Grant/Research Support Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics (ISAPP): travel and lodging to attend international meeting to deliver a presentation, June 2022 Aaron Milstone, MD, Merck: Grant/Research Support Rajeshwari Nair, MBBS, PhD, Vertex Pharmaceuticals: Salary.

Endogenous quality investments in the U.S. hospital market

High and increasing hospital prices could reflect market imperfections, including provider concentration. Yet high prices could also reflect increased willingness to pay by privately insured consumers for clinical and non-clinical quality. In this paper, we explore strategic quality choices where hospitals make quality investments to increase private revenue. We then measure the relationship between potential prices and numerous quality measures including patient satisfaction, hospital processes, risk-adjusted mortality, the revealed preferences of current Medicare patients, technology adoption, physician quality, and ED wait times. We show that across a range of measures quality is correlated with the profitability of the payer mix: hospitals with more potential privately insured patients are of higher quality.

AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia With Helicobacter pylori

AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia With Helicobacter pylori

Quality Measures for Pediatric Orthopaedic Surgery: A Systematic Review.

Quality measures provide a way to assess health care delivery and to identify areas for improvement that can inform patient care delivery. When operationalized by a hospital or a payer, quality measures can also be tied to physician or hospital reimbursement. Prior work on quality measures in orthopaedic surgery have identified substantial gaps in measurement portfolios and have highlighted areas for future measure development. This study aims to identify the portfolio of quality measures in pediatric orthopaedic surgery. We used methodology of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and reviewed PubMed/ MEDLINE and EMBASE, the American Academy of Orthopaedic Surgery (AAOS), National Quality Forum (NQF), and the Agency for Healthcare Research and Quality (AHRQ), for quality measures and candidate quality measures. Quality measure and candidate quality measures were categorized as structure, process, or outcome. Measures were also classified into 1 of the 6 National Quality Strategy priorities (safety, effective, patient centered, timely, efficient, and equitable). A review of PubMed/EMBASE returned 1640 potential quality measures and articles. A review of AAOS, NQF, and AHRQ databases found 80 potential quality measures. After screening we found a total of 18 quality measures and candidate quality measures specifically for pediatric orthopaedic surgery. Quality measures addressed conditions such as supracondylar humerus fractures, developmental dysplasia of the hip, and osteochondritis dissecans. There were 10 process measures, 8 outcome measure, and 0 structure measures. When we categorized by National Quality Strategy priorities and found 50% (9/18) were effective clinical care, 44% (8/18) were person and care-giver centered experience and outcomes, 6% (1/18) were efficient use of resources. There are few quality measures and candidate quality measures to assess pediatric orthopaedic surgery. Of the quality measure available, process measures are relatively over-represented. Pediatric orthopaedic surgeons can lead the development of outcome (eg, patient-reported outcomes after surgery) and structure measures (eg, subspecialty training certification) to assess quality of care in pediatric orthopaedic surgery. Level II-systematic review.

Gender Diversity among Defined Contribution Plan Administrators and the Potential Impact on Retirement Outcomes

This article explores how gender representation has varied among defined contribution plan administrators from 2000 to 2017 and the relation between gender and some potential measures of plan quality. We find that there has been a significant increase in gender diversity among defined contribution plan administrators, where approximately 30% of plan administrators were female in 2000, increasing to approximately 50% in 2017. We also find that plans run by female administrators have attributes that would widely be considered “better” than those run by male administrators, because they were more likely to exhibit better plan governance attributes, more likely to automatically enroll participants, and more likely to offer target-date funds.

How can tobacco policy models quality be assessed: a systematic review

Abstract Policy simulation models (PSMs) have been used extensively, both to shape health policies before real-world implementation and to evaluate post-implementation impact. However, an accepted quality assessment framework for simulation models is lacking. This systematic review aimed to develop a novel quality assessment framework for tobacco control PSMs. We searched five databases to identify peer-reviewed tobacco control PSMs that projected tobacco-use and tobacco-related outcomes from smoking policy scenarios. We extracted information on modelling inputs, structure and outputs. Using our proposed quality assessment framework, we scored models on nine dimensions: representativeness of population, policy effectiveness evidence, simulated smoking histories, simulated smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. We then compared the model score with the number of cited papers using each model. The results were narratively presented. After screening 5046 candidate papers; 145 papers were included and categorised into 25 PSMs. After scoring the models using our proposed framework, we observed that seven models were given seven and more points. The higher-scored models were generally those with a higher number of publications. While all included models had been subject to sensitivity analysis, other best practices were often lacking. Nine models did not explicitly consider smoking-related diseases. Smoking histories were commonly collapsed into crude smoking status categories rather than reflecting smoking intensity or quitting history. Furthermore, only four models estimated policy equity impact. Our systematic review revealed a variety of modelling techniques used in tobacco control. Our novel quality assessment framework offers a potential quality measure for tobacco control policy simulation models. It may guide health decision modellers and inform health policymaking. Key messages All nine framework dimensions were observed in two tobacco control PSM, suggesting the framework relevance and feasibility. However, few models achieved high scores in all dimensions. This novel quality assessment framework aims to support the development and sharing of good modelling practice and thus promote better health policy decision-making.

American Gastroenterological Association Institute and College of American Pathologists Quality Measure Development for Detection of Mismatch Repair Deficiency and Lynch Syndrome Management

American Gastroenterological Association Institute and College of American Pathologists Quality Measure Development for Detection of Mismatch Repair Deficiency and Lynch Syndrome Management

Quality measures for end-of-life care for children with cancer: A modified Delphi approach.

The quality of adult end-of-life (EOL) cancer care has benefited from quality measures, but corresponding pediatric measures are lacking. Therefore, the authors used a validated expert panel method to recommend EOL quality measures for pediatric oncology. The authors used the modified Delphi method to assess potential quality measures. Panelists were selected on the basis of professional organization nominations and expert qualifications. Pediatric and adult oncology, pediatric palliative care, social work, nursing, and hospice were represented. The authors provided the panel with a literature review on 20 proposed measures derived from adult measures and bereaved family interviews. The panel first scored the importance of each measure on a 9-point scale and then discussed the measures via a conference call. The panel then rescored the measures. According to a priori standards, measures with median scores ≥ 7 with at least 7 of 9 experts ranking it as ≥4 were endorsed. The 16 endorsed measures included measures related to avoidance of medically intense care (eg, intensive care unit death and intubation in the last 14 days of life), death location (eg, death in the preferred location), hospital policies/programs (eg, the removal of visitor restrictions at EOL and the presence of a bereavement program), and supportive care services (eg, pediatric palliative care involvement and sibling needs assessment). Unendorsed measures included avoidance of chemotherapy at EOL and home death. Expert panel-endorsed quality measures have been developed for EOL care in pediatric oncology. The measures need validation with bereaved families and further refinement before they are ready for real-world application as a tool for standardizing EOL care in pediatric oncology. Quality measures for end-of-life care for children with cancer lag behind adult quality measures. Therefore, the authors have conducted an expert panel to develop an endorsed list of quality measures for end-of-life care for children with cancer. The 16 endorsed measures include measures related to avoidance of medically intense care (eg, intensive care unit death and intubation in the last 14 days of life), location of death (eg, death in the preferred location), hospital policies/programs (eg, the removal of visitor restrictions at the end of life and the presence of a bereavement program), and supportive care services (eg, pediatric palliative care involvement and sibling needs assessment).

Conceptual approach to developing quality measures for transgender patients

BackgroundValid and reliable quality measures can help catalyze improvements in health care. The care of transgender patients is ripe for quality measurement, as there is increasing awareness of the increasing prevalence of this population and the urgency of improving the health care they receive. While best practices may not exist for some aspects of transgender health care, other aspects are characterized by well-developed and highly evidence-based recommendations. Our objective was to create a list of potential quality measures for transgender care.Methods and resultsIn consultation with our advisory panel, which consisted of clinical and academic experts in transgender medicine, we selected eight prominent clinical practice guidelines of transgender health care for review. Our four team investigators carefully reviewed all eight clinical practice guidelines. Through the course of multiple consensus-building meetings, we iteratively refined items until we had agreed upon a list of forty potential quality measures, all of which met the criteria for quality measures set forth in the Center for Medicare and Medicaid Services Blueprint for developing quality measures.ConclusionsThis manuscript explains the origin of the quality measures we developed, and also provides a useful roadmap to any group hoping to develop quality measures for a field that has not previously had any.

Exploring the Complexities of Quality Measurement in Assisted Living in Washington State

In Assisted Living (AL) choice and quality of life are highly valued by residents. Prior research has found many interrelated components contribute to AL residents’ experiences of quality. There are 543 licensed AL facilities in Washington state, with 33,830 licensed beds; in 2019, resident cost per year ranged from $44,000 to $78,000. In 2018, the Washington Legislature identified a need for consumer access to unbiased information on AL quality and directed the Department of Social and Health Services (DSHS) to form a workgroup on quality measures. The workgroup consists of representatives from state agencies, AL provider associations, advocacy organizations, AL providers and AL residents. To inform the workgroup, DSHS conducted a study of AL quality measures. Five statewide programs were identified and analyzed in 10 categories. The WA workgroup then assessed a series of measures across six domains: community participation and quality of life; consumer satisfaction; equity, diversity and inclusivity; informed choice and decision making; person-centered planning; and, resident safety. The workgroup assessed and chose to adopt CoreQ, a satisfaction measure developed by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and endorsed by the National Quality Forum (NQF). In evaluating potential measures of quality, workgroup members weighed regulatory, industry, provider, consumer and family perspectives. Outcomes of this process include assessment of AL quality measurement in other states, selected measures for Washington and key insights into relative prioritization of quality domains by different stakeholder types.

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure

2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure

Complications and Failure to Rescue After Inpatient Pediatric Surgery.

To describe the frequency and patterns of postoperative complications and FTR after inpatient pediatric surgical procedures and to evaluate the association between number of complications and FTR. FTR, or a postoperative death after a complication, is currently a nationally endorsed quality measure for adults. Although it is a contributing factor to variation in mortality, relatively little is known about FTR after pediatric surgery. Cohort study of 200,554 patients within the National Surgical Quality Improvement Program-Pediatric database (2012-2016) who underwent a high (≥ 1%) or low (< 1%) mortality risk inpatient surgical procedures. Patients were stratified based on number of postoperative complications (0, 1, 2, or ≥3) and further categorized as having undergone either a low- or high-risk procedure. The association between the number of postoperative complications and FTR was evaluated with multivariable logistic regression. Among patients who underwent a low- (89.4%) or high-risk (10.6%) procedures, 14.0% and 12.5% had at least 1 postoperative complication, respectively. FTR rates after low- and high-risk procedures demonstrated step-wise increases as the number of complications accrued (eg, low-risk- 9.2% in patients with ≥3 complications; high-risk-36.9% in patients with ≥ 3 complications). Relative to patients who had no complications, there was a dose-response relationship between mortality and the number of complications after low-risk [1 complication - odds ratio (OR) 3.34 (95% CI 2.62-4.27); 2 - OR 10.15 (95% CI 7.40-13.92); ≥3-27.48 (95% CI 19.06-39.62)] and high-risk operations [1 - OR 3.29 (2.61-4.16); 2-7.24 (5.14-10.19); ≥3-20.73 (12.62-34.04)]. There is a dose-response relationship between the number of postoperative complications after inpatient surgery and FTR, ever after common, "minor" surgical procedures. These findings suggest FTR may be a potential quality measure for pediatric surgical care.

Development and Evaluation of a Structured Tool to Assess the Preventability of Hospital-Onset Bacteremia and Fungemia

Background: Hospital-onset bacteremia and fungemia (HOB) may be a preventable hospital-acquired condition and a potential healthcare quality measure. We developed and evaluated a tool to assess the preventability of HOB and compared it to a more traditional consensus panel approach. Methods: A 10-member healthcare epidemiology expert panel independently rated the preventability of 82 hypothetical HOB case scenarios using a 6-point Likert scale (range, 1= “Definitively or Almost Certainly Preventable” to 6= “Definitely or Almost Certainly Not Preventable”). Ratings on the 6-point scale were collapsed into 3 categories: Preventable (1–2), Uncertain (3–4), or Not preventable (5–6). Consensus was defined as concurrence on the same category among ≥70% expert raters. Cases without consensus were deliberated via teleconference, web-based discussion, and a second round of rating. The proportion meeting consensus, overall and by predefined HOB source attribution, was calculated. A structured HOB preventability rating tool was developed to explicitly account for patient intrinsic and extrinsic healthcare-related risks (Fig. 1). Two additional physician reviewers independently applied this tool to adjudicate the same 82 case scenarios. The tool was iteratively revised based on reviewer feedback followed by repeat independent tool-based adjudication. Interrater reliability was evaluated using the Kappa statistic. Proportion of cases where tool-based preventability category matched expert consensus was calculated. Results: After expert panel round 1, consensus criteria were met for 29 cases (35%), which increased to 52 (63%) after round 2. Expert consensus was achieved more frequently for respiratory or surgical site infections than urinary tract and central-line–associated bloodstream infections (Fig. 2a). Most likely to be rated preventable were vascular catheter infections (64%) and contaminants (100%). For tool-based adjudication, following 2 rounds of rating with interim tool revisions, agreement between the 2 reviewers was 84% for cases overall (κ, 0.76; 95% CI, 0.64–0.88]), and 87% for the 52 cases with expert consensus (κ, 0.79; 95% CI, 0.65–0.94). Among cases with expert consensus, tool-based rating matched expert consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewer 1 and reviewer 2, respectively. The proportion of cases rated “uncertain“ was lower among tool-based adjudicated cases with reviewer agreement (15 of 69) than among cases with expert consensus (23 of 52) (Fig. 2b). Conclusions: Healthcare epidemiology experts hold varying perspectives on HOB preventability. Structured tool-based preventability rating had high interreviewer reliability, matched expert consensus in most cases, and rated fewer cases with uncertain preventability compared to expert consensus. This tool is a step toward standardized assessment of preventability in future HOB evaluations.Funding: NoneDisclosures: None

Abstract 13: Patient-reported Health Status Changes are Associated With Subsequent Clinical Outcomes After Transcatheter Valve Therapies: Insights From the Sts/tvt Registry

Background: The goals of TAVR and transcatheter mitral valve repair (TMVr) are to prolong survival, reduce heart failure (HF) hospitalizations, and improve health status. Most patients report large improvements in health status within 30 days of these procedures. While this is an important patient-centered outcome on its own, if these changes were also associated with subsequent clinical outcomes, this would further support using short-term health status as a quality metric for valve procedures. Methods: Among patients who underwent transfemoral TAVR or TMVr, had KCCQ data at baseline and 30 days, and could be linked to CMS for 1-year outcomes; we constructed sequential models examining the association of KCCQ with death and HF hospitalization from 30 days to 1 year: 1) baseline KCCQ, 2) 30-day KCCQ, 3) baseline and 30-day KCCQ, 4) change in KCCQ from baseline to 30 days. In each model, we tested the interaction between procedure type and KCCQ, examined the linearity of the association of KCCQ with outcomes using restricted cubic splines, and adjusted for patient factors (Figure footnote). Results: Our cohort included 73,699 patients who underwent TAVR or TMVr from 2011-18 (median age 83 [IQR 77-87], 53% men, 92% TAVR). There were no significant interactions between procedure type and KCCQ, so all analyses used the combined cohort. Higher baseline KCCQ (model 1) and 30-day KCCQ (model 2) were both strongly associated with lower risk of death and HF hospitalization (Figure). When both were included in the model (model 3), each assessment was independently associated with subsequent outcomes, with the 30-day being most predictive. Change from baseline to 30 days was nonlinearly associated with outcomes (model 4), with increases up to 25 points associated with lower risk of death or HF hospitalization but no further risk reduction beyond 25 points. There were no meaningful changes in the associations after adjusting for patient factors. Conclusion: Short-term improvements in patient-reported health status after TAVR or TMVr were strongly associated with lower risk of death or HF hospitalization, with the 30-day assessment having a stronger association than baseline. These results support the routine use of 30-day KCCQ as a potential measure of quality after TVTs and to identify those at higher risk for adverse outcomes.

Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial

IntroductionType 2 diabetes (T2D) is associated with an increased fracture risk despite normal-to-increased bone mineral density, suggesting reduced bone quality. Exercise may be effective in reducing fracture risk by ameliorating...

Assessment of black carbon concentration as a potential measure of air quality at multi-purpose facilities

Despite its potential adverse health effects, black carbon (BC) has not received much attention from the perspective of managing indoor air quality at multi-purpose facilities. In this scenario, real-time measurements of indoor BC were performed in a classroom, in parking lots, and in airplane cabins. Results showed that the average typical indoor BC concentration in a classroom is approximately 1 μg/m³, which is comparable to a typical ambient BC concentration. The indoor and ambient BC concentrations were simultaneously measured using two microAeth AE51s. The indoor BC concentrations varied during the experiments depending on the ambient BC concentrations, suggesting that both indoor and ambient concentrations show site- and/or source-specific correlative responses. The highest BC concentration was observed in parking lots, and it instantaneously reached 39 μg/m3. Our approach has important advantages for certain tasks such as the identification of hotspots and the monitoring of variations in BC concentrations as a supplementary tool.

Time to response and patient visibility during tonic–clonic seizures in the epilepsy monitoring unit

ObjectiveThere is a high cost associated with recording quality video and electroencephalography (EEG) data in National Association of Epilepsy Center (NAEC) level IV epilepsy monitoring units (EMU). This study considers potential quality measures in EMUs for generalized tonic–clonic (GTC) seizures: types of safety signals, response time, and visibility of patient's limbs for semiology. These quality measures have been summarized across 12 EMUs to estimate response times to GTC seizures and the quality of video data that is captured during admissions. MethodsVideo electroencephalographies (vEEGs) from two prospective regulatory studies for the Brain Sentinel device were reviewed. A total of 232 subjects with a history of GTC seizures underwent routine clinical EMU stays. Fifty-four of the study subjects had 96 GTC seizures. The vEEG of events were reviewed for safety signal used, response time, and visibility of patient's limbs. ResultsThe average response time from members of the hospital team was 22 s from electrographic generalization (minimum −37 s, maximum 111 s, two no response). For caregivers, average response was 11 s (minimum −15 s, maximum 33 s, 45 not present/no response). In 73% of events, the patient visibility was limited at seizure onset. In 55% of events with limited limb visibility, the visibility was improved (by removing sheets or improving camera angle) >30 s after start of the event. The primary safety signals were as follows: an alert from outside the patient room (54%), button press (23%), hospital team present at seizure start (14%), caregiver vocal alert (6%), and no response (2%). SignificanceThe average response time of caregivers was twice as fast as the hospital team, underscoring the importance of having a person in the room during onset of a GTC seizure. Diagnostic yield could be improved with more timely removal of patient coverings. It was observed that when patients experienced a GTC seizure, 40% were fully or partially obscured for more than 30 s during the event, compromising the ability of epileptologists to evaluate semiology during seizure onset. Automated seizure alarms may help staff get to patients more quickly and improve diagnostic characterization.