Quality Improvement Priorities Research Articles

ANALISIS TINGKAT KEPENTINGAN DAN KINERJA (IMPORTANCE-PERFORMANCE ANALYSIS) NILAI KEGUNAAN APLIKASI M-COMMERCE

Good application quality can bring user satisfaction to form user’s loyalty and trust in the company. The level of user satisfaction is different between Gojek and Grab even though each them has similarities in application features. Gojek and Grab are trying to make position as the most popular by the community in getting people's needs quickly and efficiently with huge competitive. This study aims to analyze and compare the usability qualities of Gojek and Grab based on the User Experience Questionnaire (UEQ) approach on the dimensions of attractiveness, perception, efficiency, dependability, stimulation and novelty. Measurements are made using Importance-Performance Analysis to graphically measure customer satisfaction so that service quality improvement priorities can be established. The data was collected by questionnaire to 32 selected respondents who accessed the Gojek and Grab applications in the Greater Jakarta area in August-December 2022. Based on the results of the study, the position of the usability quality attributes in Gojek and Grab was visually almost the same for each IPA quadrant. The Gojek application is superior in 5 dimensions to Grab, in terms of attractiveness, perception, dependability, stimulation, and novelty. Grab has one dimension that is superior to Gojek, in terms efficiency.

Evaluation of Home Product Quality Using the Importance-Performance Analysis Method at PT. Galaxy Alam Semesta

Government support for the property sector through incentive policies, such as the Ministry of Finance Regulation on Government-Borne Value Added Tax (VAT-GOV) on properties, was reintroduced in 2024 to boost economic growth, focusing on the delivery of new landed houses and new apartment units. In this context, property and real estate companies are required to maintain customer satisfaction, which is the key to the company's success. Customer satisfaction not only reflects product quality but also influences the company's brand image. To understand customer satisfaction with product quality, particularly landed houses, PT. Galaxy Alam Semesta conducts periodic surveys of its customers. However, survey results from the first semester of 2023 indicated that customer satisfaction with the quality of houses was still below the company's standards. Therefore, this research aims to evaluate the quality of PT. Galaxy Alam Semesta's houses using the Importance-Performance Analysis method. This research will identify attributes that need quality improvement priority, with the hope of enhancing customer satisfaction and the company's image, as well as utilizing the House of Quality to determine the priority of these improvement proposals. The analysis results indicate that the attributes requiring quality improvement priority are even and non-streaky paint, straight wall corners, even wall and ceiling surfaces, smoothly and easily operable doors and windows, neat and even paint and sealant, even tile installation, and precise and neat installation of door and window accessories. From the analysis of the proposed improvement, five main priorities were identified: increasing the frequency of supervision and inspection to ensure compliance with quality standards, setting limits on the number of units overseen by building supervisors, using higher quality paint, evaluating the quality of door accessories and tile materials, and conducting regular evaluations and selections of contractors.

Prevention and Enhancement of Housing Quality and Slum Settlements of Biawu-Biawao, Gorontalo City By IJISRT

This study aims to identify the slum conditions, develop a model of prevention, and improve the housing quality and the slum areas of Gorontalo City. The field survey with a proportional sampling of the Biwau and Biawao river banks was used as the slum identification area, prevention and improvement of housing quality and slum areas. Non-economic vitality criteria, economic vitality, land legality, location strategic value, population, condition of facilities and infrastructure, local government commitment, priority of prevention and quality improvement are used to analyse quantitative and qualitative descriptions. The results of the physical building planning strategies include building arrangements, density, and technical requirements. Facilities and infrastructure planning strategies include improving environmental roads, drinking water supply, environmental drainage, wastewater management, waste management and providing fire protection.

Evaluation of E-Government Implementation in Managing Public Service Complaints Using E-GovQual and Importance Performance Analysis (Case Study: CRM - Cepat Respon Masyarakat – of the Jakarta Provincial Government)

The improvement of public service quality is an effort to enhance the quality and innovation of public services within each government agency periodically, according to the needs and expectations of the society. One of the efforts to enhance the quality of service by public service providers, in order to improve the well-being of the community, is to use public complaints as a basis for making improvements in public services. According to data from the Central Bureau of Statistics in 2022, the population of DKI Jakarta is 10,679,000. The Provincial Government of DKI Jakarta has an integrated complaint system called "Cepat Respon Masyarakat" (CRM), which serves as a platform for the public to report issues within the DKI Jakarta area. The assessment of the "Cepat Respon Masyarakat" system is necessary to ensure that the services provided through the system can be utilized by the public and to obtain feedback regarding aspects that need improvement by the DKI Jakarta Provincial Government, which serves as the service provider. The purpose of this research is to determine the quality of the "Cepat Respon Masyarakat" complaint system using the e-GovQual method and identify attributes that require priority for service quality improvement using Importance Performance Analysis. In this study, 6 dimensions and 21 e-GovQual attributes are used to assess service quality with a sample of 118 respondents. The analysis results indicate a level of conformity of 98.39% (<100%) for the 6 dimensions, meaning that the public service provided through the "Cepat Respon Masyarakat" system still falls short of user expectations. The average gap (GAP) between expectations and performance is -0.03 or < 0, suggesting that, based on public perceptions, the quality of complaint service performance through the CRM system is still not up to par with expectations. The attributes that require improvement are those located in Quadrant A (1 attribute) and Quadrant C (7 attributes). Recommendations are provided based on literature/theory for attributes that need improvement to enhance the quality of complaint services in DKI Jakarta.

Actioning the findings of hard endpoint clinical trials as they emerge in the realm of chronic kidney disease care: a review and a call to action.

Fewer than half of patients treated with hemodialysis survive 5 years. Multiple therapeutics are used to address the complications of advanced chronic kidney disease but most have not been found to improve clinical outcomes. Clinical trials of treatment innovations for chronic kidney diseases and dialysis care have been suboptimal in number and quality. Recent trials are changing this trend. Practice and policy change when new evidence emerges remains frequently impeded by resource and organizational constraints and accordingly, clinical practice guidelines are updated years or decades after definitive evidence is produced. Ultimately, practice change in health systems is slow, leading to impaired uptake of effective medical interventions and lower value healthcare, although innovations in rapid guideline production are emerging. What can be done to ensure that conclusive evidence is taken up in practice, policy and healthcare funding? We use the example of the recently published hard endpoint study "Comparison of high-dose HDF with high-flux HD" (CONVINCE) (hemodiafiltration versus hemodialysis), to explain how a new trial can impact on medical knowledge and change in practices. We (i) assess how the trial can be placed in the context of the totality of the evidence, (ii) define whether or not further trials of convective dialysis therapies are still needed and (iii) examine whether the evidence for convective therapies is now ready to inform practice, policy and funding change. When looking at CONVINCE in the context of the totality of evidence, we show that it addresses dialysis quality improvement priorities and is consistent with other trials evaluating convective dialysis therapies, and that the evidence for convective dialysis therapies is now definitive. Once updated evidence for cost-effectiveness in specific healthcare settings and patient-reported outcomes become available, we should therefore determine whether or not clinical practice guidelines should recommend uptake of convective dialysis therapies routinely, and move on to evaluating other treatments.

Psychosocial Experiences in an Australian Rural Cancer Service: Mixed-Method Insights into Psychological Distress and Psychosocial Service Barriers

Purpose. To examine psychosocial and well-being concerns throughout the cancer experience, from prediagnosis to survivorship. Whilst most oncology research focuses on patients, the role and experiences of families and caregivers are increasingly recognised as a core component of health service delivery. Moreover, research suggests that geography is an important consideration, with evidence of rural inequities in health service provision and access. Aims. (i) To examine the unique patient and caregiver experiences of rural people in three rural cancer treatment centres in New South Wales (NSW) and (ii) to examine the barriers to rural patients and caregivers accessing psycho-oncological support in NSW. Methods. A convergent parallel mixed-method evaluation of the psychosocial experiences of rural patients and caregivers accessing cancer services through three health services in rural NSW was undertaken (N = 125). Measures of psychological distress as well as quantitative and qualitative barriers data were collected. Results. Approximately, one-third of the participants reported moderate to severe distress. Patients and caregivers reported systemic, intrapersonal, interpersonal, and pandemic-specific barriers in accessing quality psychosocial healthcare. Conclusions. These results suggest that cancer patients and caregivers in rural NSW may experience elevated levels of psychological distress and barriers in accessing psychosocial care. The combination of high psychological need for patients and caregivers with reduced availability of psychosocial support services has substantial implications for psychological wellbeing and service provision. Underdetection of psychosocial need and a lack of support services pose a significant challenge for rural people with cancer and for those who care for them; this must be an urgent priority for quality improvement and equitable healthcare provision.

SIN-BARRSS – Developing a mnemonic to support nurses’ participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement

ObjectivesTo develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. Research methodology/designAppreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. SettingLarge (44 beds) critical care unit in the United Kingdom. Main outcome measuresInterprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses’ contributions to ward round discussions (frequency and focus). Result/findingsInterprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. ConclusionsThe implementation of a mnemonic supported bedside nurses’ contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. Implications for clinical practiceA mnemonic can provide a structure which supports bedside nurses’ contributions in ways that make good use of bedside nurses’ professional expertise and most up to date knowledge of patients’ clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses’ confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.

Enhance understandings of Online Food Delivery's service quality with online reviews

This research presents an integrative approach, leveraging large-scale user-generated content (online reviews) to decipher consumers' quality perceptions in the burgeoning Online Food Delivery (OFD) sector. Utilizing the advanced BERTopic machine learning algorithm, we first qualitatively identify key service topics (qualities) pertaining to consumers’ OFD experience. Different from prior studies that overlook the synergies between cutting-edge machine learning and traditional methods, our findings are reflected against current scales established with traditional methods such as interviews and surveys. This practice allows us to highlight several topics overlooked by existing framework, such as corporate social responsibility, and identify low-importance service dimensions like personalization experience. Following the narrative analysis, an importance-performance analysis is undertaken to discern the priority of quality improvement for OFD platforms. Collectively, our insights offer pivotal theoretical and practical implications for practitioners and researchers in the OFD domain. Besides, our integrative approach balances theoretical development and practical applicability and can be readily extended to wider service scenarios.

Understanding post-COVID-19 hierarchy of public transit needs: Exploring relationship between service attributes, satisfaction, and loyalty

Introduction and objectiveCOVID-19 transforms travel behavior and undermines public transit (PT) operations even though the disease is under control. PT recovery partly requires instruments to prioritize service quality and satisfaction improvement based on travelers' transit needs. However, there is limited understanding of psychological needs for post-COVID-19 transit use and how the needs affect satisfaction and loyalty. Thus, this study explored the influences of post-COVID-19 psychological needs for bus service attributes on satisfaction and loyalty and thereby built a bus need hierarchy for riders in different use stages to distinguish critical service attributes from basic and excitement ones by applying Maslow's need hierarchy theory. MethodsA face-to-face questionnaire survey with systematic sampling collected data from 204 bus riders in Kaohsiung, which is a transit-developing city of Taiwan and whose PT ridership and service levels had drastically reduced because of the pandemic. Factor analysis was used to construct bus service attributes, and structural equation modeling was applied to analyze the influence of bus service attributes on overall satisfaction with and loyalty to bus services. ResultsResults indicated that (1) riders included epidemic prevention needs in transit safety assessment and (2) pursued the needs for safety, reliability, and comfort to increase overall satisfaction and thereby form loyalty; and (3) safety and reliability were respectively critical needs of riders in the beginning and intermediate use stages, whereas comfort persisted in critical needs throughout all use stages. ConclusionsThe findings implied the necessity of satisfying the needs for safety with epidemic prevention for initiating post-COVID-19 transit use and service quality improvement priorities for different PT use and system contexts. The implications can also be applied to future public health emergency management for PT administrators.

Stakeholder Engagement and Determination of Priority Strategies in Quality Improvement in Higher Education

Stakeholder management is vital to the project's success because the strategies, plans, methods and processes for stakeholders determine the success of implementing sustainable construction. This study aims to analyze the quality improvement of tertiary institutions in optimizing stakeholder involvement and determining quality improvement priority strategies. The research method used is qualitative, with the NVivo 12 application analysis. This research was conducted at the Pacific University (UNIPAS) Morotai. The study results show that through stakeholder involvement, Pacific University Morotai is committed to developing the potential of Morotai's human resources for the development and progress of the Morotai Island Regency area. As well as the proposed quality improvement priority strategy is also inseparable from the proposed derivative strategy in quality improvement within the Pacific University of Morotai itself. This derivative strategy can be effective, assuming the priority strategy can be implemented effectively.

Analisis Persepsi Pelanggan terhadap Kualitas Jasa dengan Metode Importance Performance Analysis dan Potential Gain Customer Value

Purpose: The objectives of the study are first, to know how customers perceive the service quality of Hotel Santika Gresik with an Importance Performance Analysis (IPA) method and second to determine the priority of service quality improvement at Hotel Santika Gresik with the Potential Gain Customer Value (PGCV) method.
 Methodology: The population in this study is who have used the services at Hotel Santika Gresik and the sample in this study are customers who have used the services at Hotel Santika Gresik in the period November 2020 – April 2022. Determination of the number of samples will be determined with a 95% level of confidence and a margin of error of 10%, the number of samples obtained is 96 respondents. The researcher's decision to increase the sample to 98 respondents so that the sample is better at representing the population and the results are better generalized. The sampling technique used in this study is based on the Non Probabilistic Sampling method using a purposive sampling.
 Results: The results show that (1) the level of conformity between the interests (importance) of customers and the company's performance on the quality of services provided by Hotel Santika Gresik has an average level of conformity below 100%, which is 95.41%, which means Hotel Santika Gresik still lacking or not fulfilling what is considered important by customers and the service is not fully satisfactory; (2) the priority of improvement on the service quality of Hotel Santika Gresik according to the Importance Performance Analysis (IPA) method is that Hotel Santika Gresik employees serve customers quickly, the behavior of Hotel Santika Gresik employees is able to grow customer trust in them, Hotel Santika Gresik always strives to store proprietary data the customer properly and without error, the equipment owned by Hotel Santika Gresik is complete; (3) the priority of improvement on the service quality of Hotel Santika Gresik with the Potential Gain Customer Value (PGCV) method is that Hotel Santika Gresik employees give individual attention to customers with the highest number of 3.86 and the lobby room at Hotel Santika Gresik is clean and comfortable to get the lowest value is 2.77.

Developing a statewide infection prevention program assessment service for dialysis settings using a six-sigma framework

Background: Due to the need for recurrent and direct access to the bloodstream, patients who require hemodialysis are at higher risk of developing healthcare-associated infections. Failure to assess gaps in systems and processes impedes the implementation of quality and performance improvement initiatives. In Michigan, there is no consultative service offered to dialysis units to assist with infection prevention practices, and no statewide dialysis data are being utilized. The Michigan Department of Health and Human Services developed a consultative, nonregulatory service dedicated to providing a comprehensive assessment of dialysis-based infection prevention programs. Methods: A multidisciplinary team created an infection prevention dialysis evaluation program using the six-sigma define–measure–analyze–design–verify model. These elements included content within the dialysis-specific Infection Control Assessment and Response (ICAR) Tool from the CDC with supporting program assessment items. From August 2021 through August 2022, the team completed 17 inpatient dialysis assessments within our cohort’s 17 hospitals. Data were analyzed using descriptive statistical analysis, and the final analysis included 1,086 observations from the developed assessment tool. Observations were grouped into 7 infection prevention categories: appropriate use of single and multiuse devices and supplies, aseptic technique, bloodborne pathogen prevention, cleaning and disinfection, hand hygiene, personal protection equipment (PPE) use, and storage of devices and supplies. Detailed summary reports were provided to the participating facilities after each site visit that included identified gaps, recommendations for improvement, and evidence-based resources. Results: Deficiencies were grouped into 7 major infection prevention categories among the 17 assessments, including cleaning and disinfection (n = 17, 100%), hand hygiene (n = 9, 53%), PPE use (n = 9, 53%), appropriate use of single and multiuse devices and supplies (n = 6, 35%), bloodborne pathogen prevention measures (n = 6, 35%), aseptic technique (n = 5, 29%), and storage of devices and supplies (n = 4, 24%). Conclusions: Our program’s prototype has been successful at detecting gaps in dialysis-based IP programs. By conducting data analyses of assessment findings, we have been able to assist the organization in establishing priorities for quality and performance improvement. Based on the results, comprehensive and robust systems to assess infection prevention programs, including those in dialysis settings, are necessary to enhance infection prevention operations across the continuum of care.Disclosures: None

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth.

Telehealth (TH) broadly encompasses remote activities of clinical care (telemedicine), provider and patient education, and general health services. The use of synchronous video for TH first occurred in 1964 and then catapulted to the forefront in 2020 during the COVID-19 Public Health Emergency (PHE). Due to the sudden need for increased TH utilization by nearly all health care providers at that time, TH became essential to clinical practice. However, its sustainable future is unclear in part given that best practices for telehealth in pediatric gastroenterology (GI), hepatology, and nutrition remain undefined and non-standardized. Key areas for review include historical perspective, general and subspeciality usage, health care disparities, quality of care and the provider-patient interaction, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement priorities, and future use of telehealth in pediatric GI with a call for advocacy. This position paper from the Telehealth Special Interest Group of NASPGHAN provides recommendations for pediatric GI-focused telehealth best practices, reviews areas for research and quality improvement growth, and presents advocacy opportunities.

Persistent barriers to achieving quality neonatal care in low-resource settings: perspectives from a unique panel of frontline neonatal health experts

Background Despite increasing rates of facility-based deliveries, neonatal mortality rates remain persistently high in low-resource settings (LRS). This has catalysed international focus on understanding and enabling quality newborn care. We aimed to understand persistent barriers to Quality of Care (QoC) and to identify quality improvement priorities from the perspective of a panel of neonatal experts with first-hand experience of delivering newborn care in low-resource settings (LRS). Methods We conducted 13 semi-structured interviews with neonatal health experts via Skype. All interviews were recorded and transcribed verbatim. We adopted an inductive thematic analytical approach. Ethical approvals were not required. Results Twenty-two experts were invited to participate, of whom 16 responded and 13 agreed to take part (five neonatologists, six paediatricians and two advanced neonatal nurse practitioners). Participants had a mean of 13 (±7 SD) years working in LRS. Lack of physical resources including basic equipment and infrastructure such as running water, combined with limited human resources, education and specialist neonatal training were cited as key barriers to delivering quality care. In addition, weak leadership at the community, local and national level were thought to hinder progress. Poor communication within clinical teams, limited documentation and lack of standardised and locally appropriate guidelines were also identified as challenges. Digital technologies were perceived to have potential for data capture and enabling standardised care. However, some highlighted that unreliable internet access and possible stigma may hinder implementation. Conclusions With less than 10 years to reach the Sustainable Development Goals (SDGs), it is critical to ensure access to quality care for all sick and vulnerable newborns admitted to health facilities. Clinical leaders in low resource settings need to be empowered to define local agendas and advocate for critical resources in order to close the gap between local and global quality of care priorities.

National Cancer Diagnosis Audits for England 2018 versus 2014: a comparative analysis.

Timely diagnosis of cancer in patients who present with symptoms in primary care is a quality-improvement priority. To examine possible changes to aspects of the diagnostic process, and its timeliness, before and after publication of the National Institute for Health and Care Excellence's (2015) guidance on the referral of suspected cancer in primary care. Comparison of findings from population-based clinical audits of cancer diagnosis in general practices in England for patients diagnosed in 2018 or 2014. GPs in 1878 (2018) and 439 (2014) practices collected primary care information on the diagnostic pathway of cancer patients. Key measures including patient characteristics, place of presentation, number of pre-referral consultations, use of primary care investigations, and referral type were compared between the two audits by descriptive analysis and regression models. Among 64 489 (2018) and 17 042 (2014) records of a new cancer diagnosis, the percentage of patients with same-day referral (denoted by a primary care interval of 0 days) was higher in 2018 (42.7% versus 37.7%) than in 2014, with similar improvements in median diagnostic interval (36 days versus 40 days). Compared with 2014, in 2018: fewer patients had ≥3 pre-referral consultations (18.8% versus 26.2%); use of primary care investigations increased (47.9% versus 45.4%); urgent cancer referrals increased (54.8% versus 51.8%); emergency referrals decreased (13.4% versus 16.5%); and recorded use of safety netting decreased (40.0% versus 44.4%). In the 5-year period, including the year when national guidelines were updated (that is, 2015), there were substantial improvements to the diagnostic process of patients who present to general practice in England with symptoms of a subsequently diagnosed cancer.

ANALISIS PERSEPSI PELANGGAN TERHADAP KUALITAS JASA DENGAN METODE IMPORTANCE PERFORMANCE ANALYSIS (IPA) DAN POTENTIAL GAIN CUSTOMER VALUE (PGCV)

The objectives of the study are first, to know how customers perceive the service quality of Hotel Santika Gresik with an Importance Performance Analysis (IPA) method and second to determine the priority of service quality improvement at Hotel Santika Gresik with the Potential Gain Customer Value (PGCV) method. The population in this study is who have used the services at Hotel Santika Gresik and the sample in this study are customers who have used the services at Hotel Santika Gresik in the period November 2020 – April 2022. Determination of the number of samples will be determined with a 95% level of confidence and a margin of error of 10%, the number of samples obtained is 96 respondents. The researcher's decision to increase the sample to 98 respondents so that the sample is better at representing the population and the results are better generalized. The sampling technique used in this study is based on the Non Probabilistic Sampling method using a purposive sampling. The results show that (1) the level of conformity between the interests (importance) of customers and the company's performance on the quality of services provided by Hotel Santika Gresik has an average level of conformity below 100%, which is 95.41%, which means Hotel Santika Gresik still lacking or not fulfilling what is considered important by customers and the service is not fully satisfactory; (2) the priority of improvement on the service quality of Hotel Santika Gresik according to the Importance Performance Analysis (IPA) method is that Hotel Santika Gresik employees serve customers quickly, the behavior of Hotel Santika Gresik employees is able to grow customer trust in them, Hotel Santika Gresik always strives to store proprietary data the customer properly and without error, the equipment owned by Hotel Santika Gresik is complete; (3) the priority of improvement on the service quality of Hotel Santika Gresik with the Potential Gain Customer Value (PGCV) method is that Hotel Santika Gresik employees give individual attention to customers with the highest number of 3.86 and the lobby room at Hotel Santika Gresik is clean and comfortable to get the lowest value is 2.77.

Merenje zadovoljstva korisnika kompanije za e-trgovinu zasnovano na postupku opinionmining-a pomoću SVM algoritma, CSI i IPA

This study was carried out to examine the perceived service quality of an e-commerce company app users and the measures that may be taken to improve customer satisfaction. The analysis techniques used were opinion mining to analyse reviews on the Google Play Store, e-SERVQUAL and Customer Satisfaction Index (CSI) to assess customer satisfaction, and Importance Performance Analysis (IPA) to identify elements that require improvement. According to the findings of opinion mining, 65.86% of e-commerce company application users were satisfied, while 34.14% were dissatisfied. Customer satisfaction levels were classified as satisfied for the dimensions of efficiency and reliability, and fairly satisfied for the dimensions of fulfilment, compensation, and responsiveness, based on questionnaire distribution. The Importance Performance Analysis method was used to determine the priority for service quality improvement. Findings showed that delivery time, product suitability, refund and return policy, and service time were the top priorities for service improvement.

After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies

ABSTRACT Objective Youth psychiatric emergencies have increased at alarming rates, and disproportionately so for youth of color. Outpatient follow-up care is critical for positive youth outcomes, but rates of follow-up remain low, especially for racial/ethnic minoritized youth. Mobile crisis response can initiate care connection. The current study (1) describes the population who received mobile crisis response (MCR) within the nation’s largest county public mental health system, (2) assesses rates of follow-up outpatient services after MCR, and (3) examines racial/ethnic disparities in outpatient services and correlates of receipt of therapy dose (≥8 sessions). Method Administrative claims for MCR and outpatient services for youth ages 0 to 18 were abstracted from the Los Angeles County Department of Mental Health. Results From October 2016–2019, 20,782 youth received a MCR, 52.5% of youth were female, and youth mean age was 13.41 years. The majority of youth (91.8%) received some outpatient services after their first MCR. However, only 56.7% of youth received ≥1 therapy session. In a logistic regression, youth age, gender, race/ethnicity, primary language, primary diagnosis, insurance status, MCR call location, and MCR disposition significantly predicted receipt of ≥8 therapy sessions. Conclusions Findings highlight disparities in therapy receipt for Asian American Pacific Islander, Black, and White youth (relative to Latinx youth), older youth, youth whose MCR was initiated from a police station call, and youth whose MCR did not result in hospitalization. We discuss priorities for quality improvement for MCR processes and strategies to promote linkage to care to achieve mental health equity.

Assessment of quality improvement priorities to improve care delivery for patients with ovarian cancer.

307 Background: In the US, more than 12,000 people die from ovarian cancer annually. Although new treatments have recently become available, ovarian cancer care delivery remains suboptimal. The Association of Community Cancer Centers (ACCC) developed a series of initiatives to improve the quality of care for patients with ovarian cancer. In Phase I, ACCC evaluated the needs of cancer programs, conducted 3 quality improvement (QI) workshops, and developed expert-driven Quality of Care recommendations to aid cancer programs in self-assessment and quality improvement. In Phase II, ACCC invited programs to self-assess their level of care using the Quality of Care recommendations. Methods: In 2022, ACCC surveyed 7 ovarian cancer programs across the US. Developed by a multidisciplinary expert steering committee, the 26-question survey assessed the patient populations served, services provided, diagnostic evaluations performed, access to molecular testing, and a self-assessment of quality care delivery and interest in conducting QI projects related to self-identified needs. The survey was administered in Qualtrics and summarized using descriptive statistics. Results: Surveys were completed by 1 community, 2 comprehensive community, 2 hospital-associated, 1 academic comprehensive, and 1 NCI-designated comprehensive cancer programs. The median annual ovarian cases was 40 [range: 2 to 68]. The 7 programs serve diverse racial/ethnic distribution of patients with ovarian cancer ranging from 55% Black to 60% Asian and 30% Pacific Islander. Five programs have a multidisciplinary team for ovarian cancer. All 5 multidisciplinary teams included gynecologic oncology and pathology; 3 teams also included medical oncology and or radiology colleague(s). Sites assessed their level of care for 7 domains of quality care from 1 (lowest) to 5 (highest). The average score was 4.0 for Care Coordination and Patient Education, Treatment Planning, and Disease Surveillance. Diagnosis and Initial Management scored on average 3.8, Equity in Care 3.25, Prevention and Screening 3.25, and Quality of Life 3.2. Sites ranked areas of interest for future QI projects (1 = area of most interest, 7 = area of least interest). The highest ranked domains were Care Coordination and Patient Education as well as Diagnosis and Initial management (average rankings 2.8). These were followed by Quality of Life (average 3.0), Prevention and Screening (Average 3.8), Treatment Planning (Average 4.4), Equity in Care (Average 5.0), and Disease Surveillance (Average 6.2). Conclusions: This assessment will be used to identify 4 additional sites for Phase II QI workshops. Findings from these projects will be combined, summarized, and disseminated to inform future education opportunities and QI initiatives. This initiative aims to help organize and standardize the care of patients with ovarian cancer and improve patient care coordination.

Establishing national stakeholder priorities for quality improvement in pediatric trauma care: Consensus results using a modified Delphi process.

Quality improvement efforts within pediatric trauma centers (PTCs) are robust, but the majority of children do not receive initial postinjury care at PTCs. Disparities in access to quality trauma care remain, particularly for children who initially access the trauma system outside of a PTC. The purpose of this project was to identify unmet needs for injured children within the pediatric emergency care system and to determine national priorities for quality improvement across the continuum of pediatric trauma care. A panel of delegates representing patients and families, prehospital providers, federal funding partners, nurses, and physicians was recruited from 10 national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes and then ranked by the panel using a modified Delphi approach to determine consensus priorities. Items not achieving >35% prioritization on a given iteration were dropped from subsequent iterations. Consensus was defined as 75% of members designating an item as a top-four priority. Nineteen themes were identified as potential targets for QI initiatives. Four iterations of panel ranking were used to achieve consensus, with four priorities identified: (1) creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care; (2) development of minimum standards for pediatric trauma resuscitation and stabilization capability in nonpediatric centers; (3) facilitating creation of local nursing and physician champions for pediatric trauma; and (4) development and dissemination of best-practice guidelines to improve imaging practices for injured children. System-level quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions. Therapeutic/Care Management; Level IV.