Progressive Improvement In Quality Research Articles

INTERNAL QUALITY ASSURANCE PRACTICES IN HIGHER EDUCATION: EVIDENCE FROM A GHANAIAN UNIVERSITY

<p>Providing quality education has become a policy priority in higher education systems around the world in recent years. This study investigated internal quality assurance practices in higher education in a Ghanaian university. The study was a descriptive survey that aimed to assess the adequateness and effectiveness of the internal quality assurance (IQA) structures and practices in place at the university. It examined the extent to which institutional quality assurance arrangements, guidelines, and strategies were introduced by the university to ensure the quality of its educational provisions. The study population consisted of the teaching staff (senior members) and third and fourth-year students from eight faculties and three schools of the University, including the Director of the Academic Planning and Quality Assurance Directorate. A purposive sampling approach was applied to choose the six representative faculties and two representative schools. From each faculty and school, two departments were randomly selected. A systematic random sampling technique was employed to select six lecturers and 20 students from each academic department. In total, a sample of 416 respondents was involved in the study. Two sets of questionnaires were adapted and used for the study, one for students and the other for teaching staff. The findings revealed that quality assurance systems and practices are at work at the university and that they improve the quality of internal processes that influence teaching and student learning. It was, therefore, suggested that the university take concrete steps to establish and document clear policy guidelines and related procedures that will consolidate the progress made in assuring the quality and standards of its programmes and awards. The university needs to consider making an explicit commitment to developing a culture and awareness of quality. It is also important for the university to design and implement progressive quality improvement strategies that will perpetuate a quality culture.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0333/a.php" alt="Hit counter" /></p>

A fast stream transaction system for real-time IoT applications

Due to the recent prevalence of IoT (Internet of Things) technologies, various IoT devices connect to the Internet and continuously send their generated data to remote processing computers such as video data or sensor data. The transaction rate is one of the main factors to improve the performance of some IoT applications. For instance, in surveillance systems, the probability to catch a thief increases as the processing computer analyzes the video with a higher transaction rate. To improve the transaction rate, some methods reduce the transaction time between a processing computer and stream data sources under a static transaction interval. However, the transaction rate can be further improved by changing the transaction interval dynamically depending on the transaction time. In this paper, we propose a method to improve the transaction rate by changing the transaction interval dynamically. In our proposed method, a processing computer sometimes changes the transaction interval to be the same length as the average transaction time. Moreover, our proposed method adopts a progressive quality improvement (PQI) approach to reduce the transaction time. We measured the transaction rate of our proposed method by both a simulator and an implemented system. We confirmed that our proposed method can improve the transaction rate by 4.4 times and the transaction time by 21% at least compared with the conventional method. Moreover, we confirmed that the average frame rate increases 22% compared with a simple method in a real situation.

Quality Improvement of Magnetic Resonance Imaging for Musculoskeletal Infection in Children Results in Decreased Scan Duration and Decreased Contrast Use.

Magnetic resonance imaging (MRI) is a heavily utilized resource to evaluate children suspected to have a musculoskeletal infection. Complex interdisciplinary workflows are involved with decision-making with regard to indications, anesthesia, contrast use, and procedural timing relative to the scan. This study assesses the impact of a quality improvement endeavor on MRI workflows at a tertiary pediatric medical center. A registry of consecutively enrolled children for a multidisciplinary musculoskeletal infection program identified those evaluated with MRI from 2012 to 2018. Annual MRI process improvement feedback was provided to the key stakeholders. Demographic characteristics, laboratory parameters, MRI indications, anesthesia use, MRI findings, final diagnoses, scan duration, imaging protocol, surgical intervention following MRI, and length of stay were retrospectively compared between the 3 cohorts (initial, middle, and final) representing 2-year increments to assess the impact of the initiative. There were 526 original MRI scans performed to evaluate 1,845 children with suspected musculoskeletal infection. Anesthesia was used in 401 children (76.2%). When comparing the initial, middle, and final study period cohorts, significant improvement was demonstrated for the number of sequences per scan (7.5 sequences for the initial cohort, 5.8 sequences for the middle cohort, and 4.6 sequences for the final cohort; p < 0.00001), scan duration (73.6 minutes for the initial cohort, 52.1 minutes for the middle cohort, and 34.9 minutes for the final cohort; p < 0.00001), anesthesia duration (94.1 minutes for the initial cohort, 68.9 minutes for the middle cohort, and 53.2 minutes for the final cohort; p < 0.00001), and the rate of contrast use (87.6% for the initial cohort, 67.7% for the middle cohort, and 26.3% for the final cohort; p < 0.00001). There was also a trend toward a higher rate of procedures under continued anesthesia immediately following the MRI (70.2% in the initial cohort, 77.8% in the middle cohort, and 84.6% in the final cohort). During the final 6-month period, the mean scan duration was 24.4 minutes, anesthesia duration was 40.9 minutes, and the rate of contrast administration was 8.5%. Progressive quality improvement through collaborative interdisciplinary communication and workflow redesign led to improved utilization of MRI and minimized contrast use for suspected musculoskeletal infection. There was a high rate of procedural intervention under continued anesthesia for children with confirmed musculoskeletal infection. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of patient centredness on health service experience: Mediation of patient satisfaction

Background: Hospitals are looking for progressive improvement in quality by refocusing healthcare delivery and organisational policies towards the patient. Patients should receive high quality care whenever it is needed, healthcare staff need to respect and respond to patient choices, needs and values and partnerships need to be formed between the provider, patients, their family and care givers with the core concept of patient centred care. Apart from the quality of care, reduction of cost and many other issues, healthcare executives give more priority to patient experience and satisfaction. Aim: The aim of the study is to assess the mediating effect of patient satisfaction between patient centred care and health service experience and to find the effect of patient centred care on health service experience. Method: Through a structured questionnaire 454 patients who have visited the leading eye hospitals in South India were selected for the study. Structural equation modeling was used to test the constructs. Results: The result suggested that the patient centred care and health service experience has a direct relationship, while patient satisfaction was found to be a partial mediator of patient centred care and experience. Moreover, coordination among the employees will help to deliver centred care for the patient along with a good experience and can result in satisfaction for the patient. Implication for management: Managers should emphasise on communication, providing health services in time without any delay and attention to the needs and wants of patients and offer them good reception and treatment.

Ensuring evidence-based cancer medicine by influencing prescribing behavior.

212 Background: Oncology Analytics, Inc. (OA) promotes evidence-based, guidelines-compliant cancer therapeutic decision-making on behalf of healthcare payers. The OA web-based 1,300 protocol treatment request system screens several hundred applications each month. Evidence-based requests are automatically approvable within seconds (Auto); those needing medical director (MD) review, within hours (Non-Auto). Some 10% of all requests require real-time consultation between OA board-certified medical oncologists/hematologists and the prescribing cancer specialist. Three-quarters of these non-compliant residual requests are rescinded by the treating oncologist. The remainder are either approved because of additional information while about 1% are recommended for an adverse determination. Methods: We hypothesize that OA’s presence in a cancer market gradually improves the likelihood of evidence-based oncologist prescribing behavior. We tested this over 44 consecutive months of rapid growth, from May 2009 through December 2012, within a single southeastern US market. Since Auto requests are evidence- and guidelines-based, and Non-Auto requests are either not supported by evidence or have evidence support but with less toxic or less costly alternatives available, we reasoned that any sustained directional change in the ratio of Auto to Non-Auto represents a characteristic change in cancer specialist behavior over that span. The monthly ratios of Auto to Non-Auto were analyzed for trends by least squares and the slopes of each were contrasted by ANCOVA. Results: During the first six months, Auto-processed requests approximately equaled Non-Auto-processed request numbers, for a baseline ratio of one. Over the next 38 months, this ratio rose to approximately 1.4, meaning that 40% more requests were eventually approved automatically each month than those requiring MD review. The slopes of this relationship between Auto and Non-Auto approvals are statistically distinct (F = 43.34; p&lt;0.001). Conclusions: This progressive quality improvement reflects malleability of cancer doctor prescribing behavior, results in substantial savings, occurs quickly, persists and grows over time.

Pay for Performance Raises Anxiety Level at AMA

Back to table of contents Previous article Next article Professional NewsFull AccessPay for Performance Raises Anxiety Level at AMAMark MoranMark MoranSearch for more papers by this authorPublished Online:2 Dec 2005https://doi.org/10.1176/pn.40.23.0008The AMA reiterated its opposition to pay-for-performance proposals that do not meet five broad principles and guidelines for quality during last month's Interim Meeting of the AMA House of Delegates.The five AMA principles for fair and ethical pay-for-performance programs approved at the June annual meeting of the AMA House of Delegates, state that these programs must:ensure quality of care,foster the patient-physician relationship,offer voluntary physician participation,use accurate data and fair reporting,and provide fair and equitable program incentives.As public and private payers alike move toward the concept of pay for performance (P4P), delegates at the Interim Meeting in Dallas reiterated those principles. The AMA's stance effectively says “no” to an impending P4P pilot project by the Centers for Medicare and Medicaid Services (CMS) that begins in January 2006, as well as to the Medicare Value Based Purchasing Act of 2005 (S 1356), which would establish pay for performance as the basis for reimbursement throughout the Medicare program.P4P and a related voluntary data-reporting project floated by CMS just days prior to the AMA meeting were the focus of debate last month (see Original article: page 1), with delegates expressing cynicism about the government's moves toward “value-based purchasing” of health care services.Central to the AMA's opposition to P4P in the Medicare program is the organization's longstanding insistence that the government first reform the physician-payment formula, especially the component known as the Sustainable Growth Rate (SGR). The Value Based Purchasing Act, sponsored by Sen. Charles Grassley (R-Iowa), links P4P to a temporary 1 percent update in physician payment, but the AMA insists on a permanent fix to the payment formula.Debate at the AMA meeting centered on the dilemma of how much latitude to give AMA lobbyists in negotiations around programs and policies that—like P4P—may have taken on a momentum of their own. By“ drawing a line in the sand,” does the AMA forfeit an opportunity to influence programs that may not be perfectly in keeping with its principles?But so great was the accumulated frustration with the government's Medicare policies that the overriding sentiment of the house was one of “enough is enough.”“If we don't stand for our principles, we don't stand for anything,” said Chester Danehower, M.D., expressing the sense of the house. “The integrity of this organization is at stake.”The principles that delegates voted to reiterate were approved at the June House of Delegates meeting:Ensuring quality of care: Fair and ethical P4P programs are committed to improved patient care as their most important mission. Evidence-based quality of care measures, created by physicians across appropriate specialties, are the measures used in the programs. Variations in an individual patient-care regimen are permitted based on a physician's sound clinical judgment and should not adversely affect P4P program rewards.Fostering the patient/physician relationship: Fair and ethical P4P programs support the patient/physician relationship and overcome obstacles to physicians treating patients, regardless of patients' health conditions, ethnicity, economic circumstances, demographics, or treatment compliance patterns.Offering voluntary physician participation: Fair and ethical P4P programs offer voluntary physician participation and do not undermine the economic viability of nonparticipating physician practices. These programs support participation by physicians in all practice settings by minimizing potential financial and technological barriers.Using accurate data and fair reporting: Fair and ethical P4P programs use accurate data and scientifically valid analytical methods. Physicians are allowed to review, comment, and appeal results prior to the use of the results for programmatic reasons and any type of reporting.Providing fair and equitable program incentives: Fair and ethical P4P programs provide new funds for positive incentives to physicians for their participation, progressive quality improvement, or attainment of goals within the program. The eligibility criteria for the incentives are fully explained to participating physicians. These programs support the goal of quality improvement across all participating physicians.In addition, delegates at the June meeting also approved much lengthier and detailed “guidelines” to govern the mechanisms of how P4P programs might work. Broad categories covered by the guidelines include quality of care, physician-patient relationship, physician participation, physician data and reporting, and program rewards (Psychiatric News, July 15).And last month, in addition to reiterating the five principles, delegates resolved to continue advocating for repeal of the SGR component and urged the AMA to “develop public-education materials to teach patients and other stakeholders about the potential risks and liabilities of pay-for-performance programs” that are not consistent with AMA principles.“Until we establish a practice environment where payment matches costs, it is not conceivable that pay for performance is going to work,” said AMA Trustee John Armstrong, M.D., during a press conference following the house meeting. “There is no point talking about value-based purchasing without fixing the payment formula.” ▪ ISSUES NewArchived

Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia.

Severe idiopathic constipation with rectal inertia represents a challenging medical problem that, in extremis, might warrant surgery. We studied a group of patients who have undergone proctocolectomy and ileal pouch-anal anastomosis for this problem. The purpose was to assess the functional success of this procedure and its impact on the social function of the patients. Patients with functional, intractable constipation have one motion or less per week and are laxative-dependent. The indication for surgery was based on failure of long-term medical therapy. The selection criteria were normal colonoscopy, normal anal manometry and pudendal nerve latency test, and abnormal transit study and abnormal video proctography. The functional outcome after surgery was assessed by anal manometry and stool frequency. Quality of life was analyzed using the Rand health survey 1.0 consisting of a comprehensive questionnaire used preoperatively and postoperatively with emphasis on physical function, role limitation because of functional/emotional problems, social function, pain, and general health. Fifteen patients (14 females) underwent ileal pouch-anal anastomosis over a seven-year period (1993-1999). The mean age was 41 (range, 25-47) years. All had a temporary defunctioning loop ileostomy fashioned, and there were no anastomotic leaks. Two patients required pouch excision within 18 months because of intractable pelvic pain. The mean stool frequency was eight (range, 3-12) per day at the first follow-up. At the second follow-up, this had improved to five (range, 2-6) per day. The mean resting and squeeze anal pressures preoperatively were 82 cm H2O and 104 mmHg, respectively, and were unchanged after surgery. Significant improvement in lifestyle scores were recorded in the categories of physical function, social function, and pain at the first follow-up and in all categories at the second follow-up (P < 0.05). Restorative proctocolectomy is an option in selected patients and leads to progressive improvement in quality of life.

Managed care: Strengthening the consumer voice in managed care: II. Moving NCQA standards from rights to empowerment.

Managed care: Strengthening the consumer voice in managed care: II. Moving NCQA standards from rights to empowerment.

QUALITY CONTROL IN COTTON SPINNING AND WEAVING. SOME PRACTICAL RESULTS

In this communication the results obtained during the introduction of statistical quality control techniques into six mills with more than 100,000 cotton spinning spindles, and 1,500 looms are described. A brief description of the control methods employed, and the particular manufacturing processes used in each mill are given. The improvements obtained by the application of quality control are studied, in particular, the progressive improvement in quality as expressed by the deviation of the yarn count obtained from that required by the specification, the quality as expressed by percentage mean range (P.M.R.), and the coefficient of variation between selected yarn lengths. The study includes the complete sequence of processes from pickers and lap machines, through carding, drawing, roving to spinning. The results are compared and discussed together with the suitabilities of the several spinning processes used for the materials employed—cotton, staple rayon and mixtures. In the application of control techniques to weaving, the methods adopted for the control of fabric weight with the consequent improvements are described. Finally, a new statistical control technique is suggested to deal with defects and a commercial control that is now applied to the manufacture of cotton velveteens and fabrics for military use is described.