Continuous Quality Improvement Program Research Articles

Better health-related quality of life is associated with prolonged survival and reduced hospitalization risk among dialysis-dependent chronic kidney disease patients: a historical cohort study

Rationale & objectiveEnd-stage kidney disease (ESKD) negatively affects patients’ physical, emotional, and social functioning. Furthermore, adjustment to dialysis require substantial lifestyle changes that may further impact on patients physical and emotional well-being. However, the relationship between Health-Related Quality of life impairment with future adverse outcomes in dialysis is not well characterized. Our study aims to investigate the relationship between Health-Related Quality of Life (HRQoL) and patients’ survival and hospitalization rates within a large European dialysis network.MethodsA historical cohort study was conducted to evaluate association of HRQoL with hospitalization and mortality rates over a 12-month follow-up period. Patients responded to a self-administered survey as part of a Continuous Quality Improvement Program implemented in clinics affiliated with the Spanish FMC-Nephrocare organization. Health-Related Quality of Life (HRQoL) was measured with the KDQOL-36. Potential confounders included socio-demographic characteristics, comorbidities, biochemical parameters, dialysis treatment. We used Cox’s Proportional Hazard regression to assess the hazard of death and Logistic Regression to assess the likelihood of hospital admissions during 12-month follow-up period.ResultsA total of 2280 (51.5%) completed the self-administrated survey, and 1838 patients met the inclusion/exclusion criteria of the study. Higher HRQoL scores were associated with significantly lower mortality and hospitalization risk. Risk estimates were robust to adjustment for potential confounders.ConclusionsSeveral dimensions of HRQoL are associated with patient-centered outcomes (i.e., mortality and hospitalizations at 1 year). Patient-Reported Outcomes contribute unique pieces of information characterizing patients’ health. Residual confounding cannot be fully ruled out; moreover, the high attrition rate could result in selection bias, which may limit the generalizability of the findings to a broader population.

From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture.

Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.

Analysis of program outcomes attainment for diploma in civil engineering at Universiti Teknologi MARA Pahang

Analysis of program outcomes involves the assessment of the learning objectives based on cognitive, psychomotor, and affective domains and their attainment is measured using both direct and indirect approaches. This study aims to assess the program outcomes attainment for the civil engineering diploma program at Universiti Teknologi MARA Pahang. The program outcomes attainment in this study was obtained from two categories of students based on cohort 20174 using the Plan ID 6541, namely i) 257 graduated on-time students and ii) 365 overall students including extended students. The attainments were analyzed quantitatively using key performance indicators for each program outcome and program performance indicators for the overall attainment of program outcomes. Based on the key performance indicator, the results reveal that nine program outcomes are indicated as excellent while three program outcomes are indicated as good. Meanwhile, based on the program performance indicator, this cohort is indicated as well performed where 9 out of 12 program outcomes recorded above 70% average attainment. Various effective continuous quality improvement (CQI) program can be identified by the school’s committee based on these findings to further enhance the program outcomes attainment.

Feasibility of a Hospital Peer Review Continuous Quality Improvement Program for Pharmacists' Documentation: A Mixed-Methods Study.

Peer review to assess the quality of documentation is essential, as it provides a framework for constructive feedback, using evaluators with similar qualifications to increase acceptability. To determine the feasibility of implementing a peer review continuous quality improvement program for pharmacists' documentation at the Montreal Children's Hospital. A prospective, single-centre mixed-methods feasibility study was conducted (from January to June 2021) to evaluate the practicality and acceptability of a peer review program (PRP) for assessing the quality of pharmacists' documentation. A peer review committee of 5 pharmacists evaluated their peers' clinical notes using a standardized assessment tool. Practicality was determined through the time required for administrative and evaluative tasks and the resources needed for each evaluation cycle. Acceptability was determined through pooled quantitative data related to pharmacists' perceived relevance of the PRP, confidence in their peers, and satisfaction with the evaluation process. Qualitative data collected through surveys, a focus group, and semistructured individual interviews helped to further explain the results. A total of 37.4 hours was required to complete both administrative and evaluative tasks in one peer review cycle, which respected the budgeted cut-off for practicality. Acceptability was also achieved, given that more than 80% of survey respondents found the PRP relevant to their practice, were confident in their peers, and were satisfied with the PRP. Qualitative results showed that participants found the PRP to be instructive and that qualitative feedback was preferred over a grade issued as a percentage. This study showed that it is feasible to implement a PRP to assess the quality of pharmacists' documentation. To ensure success, it is key that documentation objectives and department resources be predefined.

Development and evaluation of a continuous quality improvement programme for antimicrobial stewardship in six hospitals in Uganda

BackgroundAppropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.MethodsSix Ugandan hospitals implemented...

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Analisis Pengurangan Defect pada Produksi Wide Flange (H-Beam) dengan Metode DMAIC

Abstract&#x0D; &#x0D; With changes in technology and the increasing internationalization of manufacturing, production has become the main approach for benefiting from globalization and being able to bridge income gaps with the industrial world. In making Wide Flange (H-beam) at PT. X found several product defects such as dimensions not according to shop drawings, holes not centered during assembly, number of holes not according to drawings, undercuts, and porosity. To improve the quality of the Wide Flange (H-Beam) product at PT X, it is necessary to take corrective steps for product defects that occur. One of the continuous quality improvement programs to overcome product defects that occur with the DMAIC stages. Based on the research results, it can be concluded that the sigma level and DPMO value of the company is 50.331 with a possible damage of 47,893 pieces. After analyzing using a Pareto diagram, it was found that the type of defect, the number of holes that do not match the drawing with a percentage of 29% and holes not centered during assembly with a percentage of 32%, is the most common. And based on the results of the FMEA analysis, one of the causes of defects in the hole not being a flashlight during assembly is improper installation with an RPN value of 144 and the cause of the defect in the number of holes not conforming to the drawing is not following the drawing with an RPN value of 140.&#x0D; &#x0D; Keyword : DMAIC, DPMO, FMEA, RPN, Wide Flange (H-Beam)

Effectiveness of adenosine triphosphate to monitor manual cleaning and disinfection efficacy of flexible endoscopes in Hong Kong.

Adenosine triphosphate (ATP) bioluminescence assay is widely adopted in the West to allow rapid evaluation of endoscopes for bacteriologic/biologic residue, but this practice is rarely adopted in Asia. In this continuous quality improvement program, we evaluated the utility of ATP in bacteriologic surveillance on endoscope reprocessing. A total of 456 samples (304 ATP samples and 152 culture samples) of 38 flexible endoscopes were assessed after routine clinical use in a private hospital in Hong Kong. Endoscopes were assessed with an ATP system and bacterial cultures at different time points during the reprocessing. After pre-cleaning, the ATP values ranged from 228 to 65 163 relative light units (RLU) through all endoscope types. After manual cleaning, ATP values were decreased to 7-81 RLU (median, 19 RLU) for endoscope surface and 3-671 RLU (median, 12 RLU) for channel rinsate. There was a significant reduction in ATP levels between pre-cleaning and after manual cleaning. One of the 38 (2.6%) endoscopes (a duodenoscope) had an ATP value of 671 RLU from channel rinsate, which exceeded the benchmark for cleanliness of >200 RLU, and was sent back for re-cleaning. All endoscopes cultured no bacteria after high-level disinfection (HLD) by automated endoscope reprocessor (AER) and storage up to 24 h. ATP values were <200 RLU for all endoscopes after HLD and storage. Adenosine triphosphate bioluminescence assay offers a rapid, practical, and cost-effective alternative for detection of endoscope microbial residue as well as a routine monitoring tool for endoscope cleanliness in the clinical setting.

CIPP 평가모형 기반 의과대학 CQI 프로그램 개선 연구

Purpose: The purpose of this study was to verify the effectiveness of a medical school Continuous Quality Improvement (CQI) program and to explore ways for improvement. Methods: To achieve the purpose of this study, a survey was conducted with seventy-two professors who participated in the 2020 CQI program for developing a CIPP evaluation model-based survey tool. Data analysis was conducted by t-test, One-Way ANOVA, and the Importance-Performance Analysis (IPA) using SPSS. Results: First, in the context evaluation stage, the purpose of the CQI program was fully recognized but the conditions for participation in the program and the support system needed to be improved. Second, in the input evaluation stage, the support facilities for the operation of the CQI program were satisfactory, but the level of participation and data provision of the program were found to need improvement. Third, in the process evaluation stage, it was found that maintaining and managing the status quo was sufficient for the CQI program operation plan and schedule. Fourth, in the product evaluation stage, it was found that the CQI program was helpful in strengthening student education and medical education competency. However, it was found that improvement was needed to help research activities. Conclusion: Following combining these results, a way to improve the CQI program was suggested in terms of goal setting, operation plan and execution, performance evaluation, and feedback.

Current status of cytopathology practice in Korea: impact of the coronavirus pandemic on cytopathology practice.

The Continuous Quality Improvement program for cytopathology in 2020 was completed during the coronavirus pandemic. In this study, we report the result of the quality improvement program. Data related to cytopathology practice from each institute were collected and processed at the web-based portal. The proficiency test was conducted using glass slides and whole-slide images (WSIs). Evaluation of the adequacy of gynecology (GYN) slides from each institution and submission of case glass slides and WSIs for the next quality improvement program were performed. A total of 214 institutions participated in the annual cytopathology survey in 2020. The number of entire cytopathology specimens was 8,220,650, a reduction of 19.0% from the 10,111,755 specimens evaluated in 2019. Notably, the number of respiratory cytopathology specimens, including sputum and bronchial washing/ brushing significantly decreased by 86.9% from 2019, which could be attributed to the global pandemic of coronavirus disease. The ratio of cases with atypical squamous cells to squamous intraepithelial lesions was 4.10. All participating institutions passed the proficiency test and the evaluation of adequacy of GYN slides. Through the Continuous Quality Improvement program, the effect of coronavirus disease 2019 pandemic, manifesting with a reduction in the number of cytologic examinations, especially in respiratory-related specimen has been identified. The Continuous Quality Improvement Program of the Korean Society for Cytopathology can serve as the gold standard to evaluate the current status of cytopathology practice in Korea.

Barriers and Facilitators to the Implementation and Adoption of a Continuous Quality Improvement Program in Surgery: A Case Study.

As postoperative adverse events (AEs) drive worsened patient experience, longer length of stay, and increased costs of care, surgeons have long sought to engage in innovative approaches aimed at reducing AEs to improve the quality and safety of surgical care. While data-driven AE performance measurement and feedback (PMF) as a form of continuing professional development (CPD) has been presented as a possible approach to continuous quality improvement (CQI), little is known about the barriers and facilitators that influence surgeons' engagement and uptake of these CPD programs. The purpose of this knowledge translation informed CPD study was to examine surgeons' perspectives of the challenges and facilitators to participating in surgical CQI with the broader objective of enhancing future improvements of such CPD interventions. Using Everett Rogers diffusion of innovations framework as a sampling frame, the participants were recruited across five surgical divisions. An exploratory case study approach, including in-depth semistructured interviews, was employed. Interview transcripts were analyzed and directly coded using the Theoretical Domains Framework. Directed coding yielded a total of 527 coded barriers and facilitators to behavior change pertaining to the implementation and adoption of PMF with the majority of barriers and facilitators coded in four key theoretical domains environmental context and resources, social influences, knowledge, and beliefs about consequences. A key barrier was the lack of support from the hospital necessitating surgeons' self-funding their own PMF programs. Facilitators included having a champion to drive CQI and using seminars to facilitate discussions around CQI principles and practices. This study identified multiple barriers and facilitators to surgeons' engagement and uptake of a data-driven PMF system in surgery. A key finding of the study was the identification of the influential role of positive deviance seminars as a quality improvement and patient safety mechanism that encourages surgeon engagement in PMF systems.

Professional Master of Pharmacy Education in China

Abstract: Background: The Professional Master of Pharmacy (M. Pharm.) education program in China has undergone 10 years of development and has rapidly achieved great progress. The aim of this study was to summarize and introduce the development of M. Pharm. education in China. Materials and Methods: The data related to M. Pharm. education in China was obtained from literature retrieval, the Ministry of Education of the People’s Republic of China (MOE), and related university websites. Some data was obtained from the Chinese National Steering Committee for the Professional Degree of Pharmacy Graduate Education (NSCPDP). The NSCPDP data was a result of questionnaires sent to 113 training institutions in 2021 and from a survey of recent graduates of China Pharmaceutical University (CPU) in 2019. Results: The main findings are that the training goals, degree education, qualifications and admission standards of institutions, training fields, curriculum setting, teaching methods, professional practice, faculty teams, quality assurances and evaluations, degree awarding and employment direction in the M. Pharm. education system are relatively well developed, and that M. Pharm. education has become an important part of pharmacy education in China. Conclusion: M. Pharm. education in China not only draws lessons from foreign advanced experience in the administration of schools and universities, but also has formed its own Chinese characteristics and emphasis. M. Pharm. education in China has a bright future through a program of continuous quality improvement. Keywords: Professional master of Pharmacy, Education Program,Cultivation Model, Present and Future, China.

Epidemiology of peritoneal dialysis outcomes.

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

Impact of a continuous quality improvement program on contrast-induced nephropathy in outpatients with chronic kidney disease: an interrupted time-series study.

Contrast-induced nephropathy (CIN) caused by exposure to radioactive contrast media can cause acute kidney injury in patients with chronic kidney disease (CKD). We developed a multifaceted approach in a CIN-quality improvement (QI) program based on a shorter saline hydration protocol for the prevention of CIN in outpatients and assessed the effect of our CIN-QI program on decreasing both the incidence rate of CIN and overall use of contrast agents in patients undergoing contrast-enhanced computed tomography (CT). We conducted a multi-center prospective interrupted time-series study from 2006 to 2018 investigating the efficacy of a CIN-QI program in preventing CIN among outpatients with CKD. An automatic medical record system alert was implemented to instruct physicians to consult a nephrologist and administer prophylactic hydration and follow-up when ordering contrast-enhanced imaging in patients with an estimated glomerular filtration rate (eGFR) <45mL/min/1.73 m2. The primary outcomes were the rates of prophylactic hydration and follow-up kidney function assessment, and the incidence of CIN for eligible patients. The usage rate of contrast-enhanced CT was also examined. A total of 95594 patients who underwent contrast-enhanced CT were included in the study. The annual prophylactic hydration rate before the CIN-QI program ranged from 2.0% to 23.2% but increased to 59.2%-75.2% during the CIN-QI program (P<.001). The annual rate of follow-up kidney function testing also improved from 18.6%-25.8% to 34.1%-42.5% after implementation of the CIN-QI program (P<.001). The rate of CIN significantly declined in level by 10.0% at the start of the CIN-QI program (P=.002) and in trend by 2.9%/year (P<.001). The number of contrast-enhanced CT orders showed a positive level change in patients with advanced CKD, who were the CIN-QI program target group of patients with eGFR <45mL/min/1.73 m2, at the start of the implementation of the CIN-QI program. After implementing the CIN-QI program, the number of contrast-enhanced CT orders showed a negative trend change across all patients, which decreased from -1.4%/year to -10.0%/year for patients with advanced CKD. The multifaceted approach in the CIN-QI program may be associated with the decreased incidence of CIN and increased rates of prophylactic hydration and follow-up kidney function testing.

EQIP's First Year: A Step Closer to Higher Quality in Surgical Education

To describe the first year of the Educational Quality Improvement Program (EQIP) DESIGN: The Educational Quality Improvement Program (EQIP) was formed by the Association of Program Directors in Surgery (APDS) in 2018 as a continuous educational quality improvement program. Over 18 months, thirteen discrete goals for the establishment of EQIP were refined and executed through a collaborative effort involving leaders in surgical education. Alpha and beta pilots were conducted to refine the data queries and collection processes. A highly-secure, doubly-deidentified database was created for the ingestion of resident and program data. 36 surgical training programs with 1264 trainees and 1500 faculty members were included in the dataset. 51,516 ERAS applications to programs were also included. Uni- and multi-variable analysis was then conducted. EQIP was successfully deployed within the timeline described in 2020. Data from the ACGME, ABS, and ERAS were merged with manually entered data by programs and successfully ingested into the EQIP database. Interactive dashboards have been constructed for use by programs to compare to the national cohort. Risk-adjusted multivariable analysis suggests that increased time in a technical skills lab was associated with increased success on the ABS's Qualifying Examination, alone. Increased time in a technical skills lab and the presence of a formal teaching curriculum were associated with increased success on both the ABS's Qualifying and Certifying Examination. Program type may be of some consequence in predicting success on the Qualifying Examination. The APDS has proved the concept that a highly secure database for the purpose of continuous risk-adjusted quality improvement in surgical education can be successfully deployed. EQIP will continue to improve and hopes to include an increasing number of programs as the barriers to participation are overcome.

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

BackgroundIschemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers.MethodsWe conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes.ResultsBarriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging).ConclusionSimplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021.

MO867: Confirmatory Factor Analysis and Computer Adaptive Testing System Prototype Based on Multidimensional Item Response Theory of KDQOL-36 Among a Large Sample of Spanish Dialysis Patients

Abstract BACKGROUND AND AIMS The Kidney Disease Quality of Life (KDQOL™-36) is widely used to assess the quality of life of dialysis patients worldwide. It combines disease-specific and generic scales capturing unique facets of patients’ adaptation to the physical and mental burden of renal disease and dialysis treatment. the KDQOL™-36 psychometric properties and cross-national validation have been subject to intense review in latest years suggesting mixed replicability in different populations. Furthermore, its length may hamper its wider use in clinical practice as respondent burden may be substantial if used longitudinally within continuous quality improvement programs. Therefore, we sought to evaluate its measurement properties and develop an item response theory model enabling personalized survey administration while maximizing measurement efficiency. METHOD This is a retrospective, observational analysis of Patient-Reported Outcomes Measures (PROM) collected in Spanish NephroCare clinics during 2019 as part of a continuous quality improvement program launched by the country medical director of Spain. We used Multidimensional Item Response Theory (MIRT) models to confirm the theoretical factor structure underlying the measurement model of KDQOL™-36. MIRT extends classical IRT in that it allows complex factor structures in the multifactorial space. A critical advantage of scoring systems based on MIRT models over classical test theory models is the ability to personalize survey administration based on patient's characteristics and previous responses, reduction of measurement error, objective calibration, evaluation of test and item bias, greater accuracy in the assessment of change due to therapeutic intervention, and evaluation of model and person fit. We specified 4 competitive theoretical models for the SF-12 and the disease-specific KDQOL items (Figure 1). First, we fitted a unidimensional model, to exclude that one single factor could explain the response pattern of the questionnaire. Second, we tested a two-factor (or three-factor) orthogonal model for the SF-12 (and disease-specific KDQOL) to account for the standard scoring structure of the KDQOL™-36 questionnaire. Third, we tested the hypothesis of correlated two-factor (or three-factor) structure. Fourth, we tested a bifactor model structure, which accounts for a general HRQOL latent construct as well as lower order dimensions tapping specific dimensions of health. We expect the bifactor model would capture the pleiotropic effect of ESKD on patients’ life adjustment. We compared model fit with RMSEA, CFI and TLI statistics. For illustrative purposes, we simulated MIRT-based adaptive testing using different Delta Thetas as stopping rules to assesses measurement efficiency for the SF-12 component of the questionnaire. RESULTS Among patients completing the survey in the 2019 ePROM Spanish wave, 1838 (80.6%) dialysis prevalent patients met the inclusion criteria for the present analysis. Mean age was 68.8 ± 14.4, 60% were men, 65% had an arteriovenous fistula, and 66% were on HDF. For both generic and disease-specific KDQOL-36 components, the bifactor model significantly improved empirical fit (Figure 1). Despite slightly inferior compared with the bifactor model solutions, a simpler correlated second-order factor solution showed acceptable model fit. CAT simulation of the SF-12 showed reduction in the amount of administered item while preserving measurement reliability (Figure 2). CONCLUSION As previously reported, a correlated two factor structure and three-factor structure for the SF-12 and disease-specific KDQOL, respectively, showed acceptable fit to the observed response pattern. However, a bifactor model structure improved model fit. CAT simulation based on delta theta rules for the SF-12 questionnaire demonstrated promising results as an item selection strategy.

MO196: Moderate-To-Severe CKD-Associated Pruritus (CKD-AP) is Independently Associated with Worse Health-Related Quality of Life (HRQOL) Among Dialysis Patients

Abstract BACKGROUND AND AIMS Chronic kidney disease–associated pruritus (CKD-aP) is common, yet underrecognized condition among end-stage kidney disease patients. We sought to evaluate the prevalence of CKD-aP and its impact on health-related quality of life (HRQOL) among dialysis patients across five European countries. METHOD This is a retrospective, observational analysis of data abstracted from the EuCliD® database (European Clinical database), the clinical information system adopted in Fresenius Medical Care (FMC) outpatient dialysis facilities in several European countries. Patient-Reported Outcomes Measures (PROM) were collected as part of a continuous quality improvement program launched for the first time in all centres belonging to the Nephrocare network in France, Italy, Spain, United Kingdom and Ireland. The presence and severity of CKD-aP were documented based on information captured by both the Kidney Disease Quality of Life (KDQOL™-36) and the 5-D Itch questionnaires. HRQOL was assessed with KDQOL™-36. Clinical and demographic data have been extracted from EuCliD®. The relationship between CKD-aP and HRQOL was evaluated with generalized linear models. RESULTS The ePROM campaign attained a large participation rate with very low attrition. Among 9974 who were actively treated in the clinics and were able to fill in a self-reported questionnaire, 8157 responded to the survey and only 1033 (11.2%) refused to participate. We enrolled 6221 patients in the present secondary analysis. The study flowchart is reported in Figure 1. Slightly more than half of patients (52%) reported no CKD-aP, 25% mild, whereas roughly 23% reported moderate-to-severe CKD-aP. Patients reporting more severe CKD-aP had shorter dialysis vintage, higher phosphate and parathormone, and more frequently diabetes. Average KDQOL-36 scores are reported in Figure 2a. We observed a strong, graded relationship between CKD-aP severity and KDQOL-36 scores (Figure 2b). The association was robust to adjustment for potential confounders. The quality of life penalty associated with more severe pruritus was clinically significant based on distribution based minimal clinically important difference threshold for the KDQOL-36 scales. CONCLUSION CKD-aP was common in a large, representative sample of the dialysis population in five European countries. We observed a large, clinically important, quality of life penalty associated with CKD-aP even after adjusting for potential confounders.

Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach

BackgroundHand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.ObjectiveTo determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019.MethodsA CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts.ResultsHand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time.ConclusionTraining and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.

The influence of Continuous Quality Improvement on healthcare quality: A mixed-methods study from Zimbabwe

In an effort to improve the poor quality of maternal, newborn, and child health services, the Zimbabwe Ministry of Health and Child Care implemented a Continuous Quality Improvement (CQI) pilot in 2016. Health workers and district managers were trained and supported to implement cycles of quality target setting, developing and implementing action plans, and tracking outcomes. The pilot was implemented in district hospitals and primary health centers in five districts as an arm of the performance-based health financing (PBF) program. This study uses mixed methods to estimate the effect of the CQI model on quality of care for various services and to identify factors that enabled or impeded quality improvements. We assessed changes in quality of care for seven services over a two-year implementation period and compared these changes against other PBF districts. We also conducted focus group discussions and in-depth interviews with district and facility-level health workers and managers after implementation to explore enabling and impeding factors affecting program performance. Among the seven services assessed, CQI was associated with quality improvement in primary health centers for two: postnatal care and maternal delivery care. Enabling factors included strengthened leadership, teamwork and joint decision-making at facilities; and supportive supervision. Impeding factors included fragmentation of quality assurance policies; staff shortages and turnover; and gaps in the CQI training. Improvements were limited when considering the full breadth of potential outcomes but arise in certain areas of core focus of the CQI program. In order to see large scale improvement in the quality of healthcare in Zimbabwe, CQI should be seen as one potential tool in a broader health systems quality improvement strategy.