Program Quality Assurance Research Articles

CT Colonography Reporting and Data System (C-RADS): Benchmark Values From a Clinical Screening Program

The CT Colonography Reporting and Data System (C-RADS) is a well-recognized standard for reporting findings at CT colonography (CTC). However, few data on benchmark values for clinical performance have been published to date, especially for screening. The purpose of this study was to establish baseline C-RADS values for CTC screening. From 2005 to 2011, 6769 asymptomatic adults (3110 men and 3659 women) 50-79 years old (mean [± SD] age, 56.7 ± 6.1 years) were enrolled for first-time CTC screening at a single center. CTC results were prospectively classified according to C-RADS for both colorectal and extracolonic findings. C-RADS classification rates and outcomes for positive patients were analyzed. C-RADS classification rates for colorectal evaluation were C0 (0.7%), C1 (85.0%), C2 (8.6%), C3 (5.2%), and C4 (0.6%). Overall, 14.3% of subjects were positive (C2-C4), and positive findings were more frequent among men (17.5%) than women (11.6%; p < 0.0001). Positivity also increased with age, from 13.4% of patients 50-64 years old to 21.8% of patients 65-79 years old (p < 0.0001). Regarding extracolonic evaluation, 86.6% of patients were either negative for extracolonic findings or had unimportant extracolonic findings (E1 or E2). Likely unimportant but indeterminate extracolonic findings where further workup might be indicated (E3) were found in 11.3% of patients, whereas 2.1% had likely important extracolonic findings (E4). Overall, E3 and E4 rates were increased for older (p < 0.0001) and female (p = 0.008) cohorts. C-RADS results from our initial experience with CTC screening may serve as an initial benchmark for program comparison and quality assurance measures.

Building a practice research network: Obstacles faced and lessons learned at the Center for Collegiate Mental Health

Objective: The Center for Collegiate Mental Health (CCMH) was created through a grass-roots initiative among university and college counseling centers to standardize assessment procedures, conduct empirical studies, and advocate clinical services. Method: At present, CCMH has over 240 college counseling center members and oversees a research infrastructure based on these centers' routine services, describing approximately 90,000 individual clients annually. These data are used to provide clinical tools, which can be useful for ongoing clinical services as well as program evaluation, quality assurance, and advocacy on behalf of the counseling centers and clients. Results: There have been substantial obstacles to overcome, and there remain numerous challenges in day-to-day operations. This article provides a brief overview of the challenges and current solutions. Conclusions: Large-scale collaborations between researchers and practitioners are possible, and some recommendations can be made based on the experience of CCMH.

Cervical cancer screening: the big step from morphology to molecular biology

The achievement of cervical cancer screening by pap smear screening is highly remarkable and has resulted in a significant reduction in cervical cancer morbidity and mortality in western countries. This decline could be seen in countries which performed an opportunistic screening every year or an organized screening in 3to 5-year interval which is not free of opportunistic screening either. The Nobel Prize winner Harald zur Hausen and his coworkers mainly were responsible for the ignition of two big changes in the prevention of cervical cancer: the slow step from morphology-based screening to molecular biologyoriented screening and triaging in secondary prevention, and a quick and very effective step towards HPV vaccination as primary prevention. Despite the success in secondary prevention by diagnosing and treating precancerous disease, the gynaecologic surgeon is still faced with quite a number of early and advanced stage invasive cervical cancers and has to employ his skills to reduce the negative impact of existing disease or at least disease-related complications (tertiary prevention). In his review about the prevention of human papilloma virus-associated neoplasia, C.A. Liberani takes the reader onto a revolutionary journey about cervical cancer prevention. Though large observational studies had documented that HPV-based strategies seem to be more sensitive but less specific than cytology, only the results of large randomized clinical trials conducted over one or more screening episodes have led to new guidelines in the US that recommend in women older than 30 years, a tremendous prolongation in the USscreening interval from 1 year previously up to either every 3 years by cytology or even every 5 years by cytology plus HPV cotesting. However, as C.A. Liberani points out in his article, HPV-based strategies may have the disadvantage of more colposcopies needed to detect a case of CIN 3 or greater. Because of limited number of cervical cancers in screened populations, a balance between improved reduction of invasive cases and the morbidity associated with potential overtreatment plus the impact on costs is necessary (C.A. Liberani, The four steps in the prevention of human papilloma virus–associated neoplasia. Archives of Gynecology and Obstetrics 2013). Interestingly, the Canadian taskforce on preventive healthcare held it premature to make a recommendation on the use of HPV testing in screening, but will revisit this issue as new date become available (Canadian recommendations on screening for cervical cancer, 2013 CMAJ). Other countries such as Australia or Germany are currently in the process of developing its new national guidelines. Based on the ‘‘Nationale Krebsplan’’, German legislation has issued a new law about cervical cancer prevention and registration (KFRG) for the implementation of an organized, population-based and quality-assured screening program—a challenging step for Germany.

Towards Quality Assurance in Business Education in Nigeria: Constraints and Control

This study x-rays the concept of quality assurance in business education programs in Nigeria with particular reference to its constraints and control measures. The importance of quality business education in nation building cannot be overemphasized. The whole essence of quality assurance in business education is to enhance and improve the effectiveness and efficiency of the system towards achieving the set standards. However, in recent times, evidences abound that the education system in Nigeria (business education inclusive) is performing below expectations. Although, quality assurance of business education program in Nigeria may have been jeopardized by several factors such as poor evaluation program, inadequate funding, poor supervision, attitudinal failure among others but the situation can be reversed and revamped for quality to be guaranteed. Hence, there has been a concerted effort targeted at ameliorating this deplorable situation. It was based on this therefore, that this study suggested some control measures that could help to enhance the quality of business education in Nigeria. Consequently, the paper drew a conclusion for the subject matter and it was recommended among others that there should be a positive attitudinal change, internal integrity and commitment by all stakeholders to the whole issues of education for quality to be assured in business education in Nigeria.

Externe Qualitätssicherung in Einrichtungen der stationären Vorsorge und Rehabilitation für Mütter und Väter einschließlich Mutter-/Vater-Kind-Einrichtungen: Einrichtungsvergleichende Analysen im Bereich Ergebnisqualität

To date, there are no programs for external quality assurance for inpatient prevention and rehabilitation programs for mothers, fathers and children. Instruments for outcome quality assessment were evaluated with the goal of determining their ability to document differences between prevention/rehabilitation centers in quality-relevant outcome parameters. Referring to the ICF, relevant outcome variables were specified and operationalized using established questionnaires. Data from 45 inpatient prevention and rehabilitation centers for mothers, fathers and children were analyzed using multilevel modeling with risk adjustment. Intra-class correlations were computed to determine in which parameters differences between institutions could be found. The percentage of variability accounted for by patient vs. institution characteristics was computed while statistically controlling for relevant confounders. For prevention centers, substantial variation on the institutional level was found in 9 out of 15 parameters. Almost all institutions did not deviate significantly from the grand mean of the respective parameter. For rehabilitation centers, significant variability was found in 2 out of 10 parameters. The differences between most institutions remained within a range of expectable variability. The results imply that comparative analyses across hospitals are better suited to identify institutions with low quality rather than establish quality-based rankings of institutions.

Quality Assurance and Performance Improvement in Intraoperative Neurophysiologic Monitoring Programs

ABSTRACT.Quality assurance (QA) as it relates to intraoperative neurophysiological monitoring (IONM) can be defined as the systematic monitoring, evaluation, and modification of the IONM service to insure that desired standards of quality are being met. In practice, that definition is usually extended to include the concept that the quality of the IONM service will be improved wherever possible and, although there are some differences in the two terms, in this article the term QA will be understood to include quality improvement (QI) processes as well. The measurement and documentation of quality is becoming increasingly important to healthcare providers. This trend is being driven by pressures from accrediting agencies, payers, and patients. The essential elements of a QA program are described. A real-life example of QA techniques and management relevant to IONM providers is presented and discussed.

Utilizing community health worker data for program management and evaluation: Systems for data quality assessments and baseline results from Rwanda

Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through these programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). In this paper, we describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May–June 2011. We discuss considerations for other programs interested in adopting such systems. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.

Introduction from the president.

It is with great pride that I write this introductory comment for our new United European Gastroenterology Journal. The Journal represents the confidence the UEG Council has for its future. It is a bold adventure but we are convinced and committed to its success. We are encouraged by the enthusiasm the professionalism and the experience of our publisher SAGE. We are delighted that our editor Jan Tack who has proven editorial skills and is one of the leading European researchers has taken up the challenge. He has chosen bright distinguished rising stars as associate editors Arthur Kaser, Oliver Pech and Tim Greten. The Council has promised unequivocal support for their journal. There is a crowded market but there is room for this publication as it will be a show piece of our organisation. UEG is the voice of gastroenterology in Europe and beyond. We have a voice that must be heard but we also must listen to others particularly patients. Only a handful of countries in Europe have a population based quality assured screening program for colorectal cancer even though the Council of Europe declared that this was a right of every European citizen over the age of 50 as far back as 2003. It is a shame that patients with inflammatory bowel disease have to wait for up to five years before a diagnosis is made and that many patients with the condition have to seek help through accident and emergency departments. There have been significant improvements in the treatment of inflammatory bowel disease in the last few years but over 50% of patients fail to respond to treatment. Helicobacter pylori infection accounts for over a million deaths globally a year. Three quarters of a million die from gastric cancer and a quarter of a million from complications of peptic ulcer disease. The world health organisation declared that H.pylori is a class one carcinogen but yet there is no public health study to look at the effect of screening on early detection and on mortality from gastric cancer in Europe. There are guidelines on who, how and when to treat this infection but these are not always put into practice. I am convinced that the way out of the current economic difficulties is to invest into research and innovation. The funds allocated to health research needs to be increased both from national governments and the European Commission. It is important to mobilise support from politicians and patient groups to have our voice heard and listened to. The advent of our journal is a milestone in our development and shows we have come of age in our twenty first year since we were founded. Professor Colm O’Morain President

Quality Assurance in Psychology Programmes across Europe: Survey and Reflections

The present article examines how different institutions that offer psychology study cycles across Europe have adopted quality principles and have taken up particular quality assurance initiatives to raise standards and enhance quality. Thirty-eight different institutions from 32 countries who were members of a European psychology network responded to a survey about quality issues. Results are presented regarding (a) policy and procedures for quality assurance, (b) approval, monitoring and periodic review of programmes and awards, (c) assessment of students, and (d) quality assurance of teaching staff. Implications for the quality assurance of psychology programmes and for further studies are discussed.

Experiences with Establishing the First Self-Care Hemodialysis Program in a Hospital in Mainland China

There has never been a home hemodialysis (HHD) program or self-care hemodialysis (SC-HD) program in Mainland China, and it may be plausible starting from an SC-HD program. This study describes the systems for, and the initial results of, starting an SC-HD program. A program for SC-HD was instituted at the Peking University Third Hospital. A working group had designed the patient education program and water quality assurance. The patient’s education program was established, which consisted of a handbook and a video for training. In May 2009, two patients were recruited and trained for HD. They were adequately dialyzed with satisfactory Kt/V, both the patients could perform all of the self-care procedures after training for 12 weeks. More difficult procedures, such as the self-cannulation, were successfully handled. Significant improvement was found in six of the eight short form (SF)-36 health scales after 6 months for SC-HD treatment. For the past year, there were no severe complications resulting from SC-HD. In summary, our first SC-HD program in Mainland China is feasible and safe. It promotes rehabilitation, increases self-esteem, and improves health-related quality of life. It is also a first attempt for starting an HHD program.

The Long-Term Career Outcome Study (LTCOS): What Have We Learned From 40 Years of Military Medical Education and Where Should We Go?

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large.

Preventing diabetes: will NICE guidance do what it says on the tin?

The goal of the programme was to achieve a 7% reduc-tion in body weight and physical activity of moderateintensity for at least 150 minutes per week. The cumula-tive incidence of diabetes was 4.8, 7.8 and 11.0 cases per100 person-years in the lifestyle, metformin and controlgroups, respectively. This reduction in incidence equatedto one case of diabetes prevented for every seven peoplewith IGT treated for three years in the lifestyle interven-tion group, compared with 14 for the metformin group. In addition, a review has also indicated that the numbersneeded to treat (NNT) to prevent one case of type 2 dia-betes with lifestyle intervention in people at risk of diabetesis dramatically low at 6.4 (over 1.8 to 4.6 years).

Accreditation and standards-driven program evaluation: implications for program quality assurance and stakeholder professional development

This study evaluates a language education program and assesses the influence of this program evaluation on program performance and stakeholder professional development. The research design makes use of mixed paradigms and methods. Positivism is followed to verify the extent to which the program meets predetermined quality standards through quantitative evaluation research, questionnaires and document and record analysis. In contrast, the qualitative paradigm is followed to uncover program evaluation impact on program components and stakeholders through qualitative evaluation and interviews. The study concludes the program maintains satisfactory overall performance with some components performing better than others. Likewise, evaluation of program evaluation improves program elements and faculty and program administration professional skills. The study therefore recommends program evaluation as an effective program improvement strategy. Program evaluation is also an effective professional development strategy that provides program administration, staff and faculty members with onsite opportunities to develop their professional skills. Moreover, evaluation of program evaluation should be an integral part of program evaluation to help program stakeholders not only do but also use evaluation alongside decreasing resistance to imposed review and reform.

Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study

AimFirstly, to detail the experiences of one UK training region in establishing an emergency ultrasound (EU) training programme and secondly, to report the initial 30 months of EU scanning experience.MethodsProspective...

Quality Assurance in Gerontological and Geriatric Training Programs: The European Case

Quality assurance (QA) in gerontological and geriatric education programs is regarded as essential to maintain standards, strengthen accountability, improve readability of qualifications, and facilitate professional mobility. In this article the authors present a summary of international developments in QA and elaborate four international trends, including the pros and cons of QA. Furthermore, the authors focus on accreditation and credit transfer opportunities in vocational and academic education programs for primary care practitioners, including nurses, home care workers, social workers, physiotherapists, and family doctors involved in the care of older people in nine European countries and highlight changes that have occurred over the last decade. Vocational education and professional training in elderly care at the basic and postgraduate specialization level remains extremely diversified, reflecting the lack of standardization for programs outside the higher education sector. The situation is ripe for the implementation of the European Qualifications Framework, which is intended to promote transparency, comparability and portability of qualifications at different levels and the introduction of a credit transfer system for vocational education to be established in 2012.

Quality Assurance in Postgraduate Medical Education: Implications for Dermatology Residency Training Programs

In the past few years, quality assurance has become an increasingly important part of medical education for both Canadian and American training programs. Since this emphasis on quality assurance in residency programs is recent, most faculty members involved in teaching residents in dermatology training programs would not themselves have had experience with quality assurance. As a result, satisfying this requirement may be a challenge. In this article, we review published reports in which various residency training programs have satisfied this requirement and propose projects in which dermatology residency training programs may satisfy quality assurance requirements. Using the key words residency, training, project, quality, assurance, improvement, medical errors, and safety, a literature search was conducted of English-language articles published after January 1990. There are many innovative and effective ways program directors in dermatology training programs should be able to develop projects that improve patient care, enhance resident education, and fulfill accreditation requirements.

Benefits of the quality assured double and arbitration reading of mammograms in the early diagnosis of breast cancer in symptomatic women

To address the benefits of double and arbitration reading regarding tumour detection rates, percentage of in situ tumours, and number (of patients) needed to send for expert reading (number needed to treat; NNT) for one additional tumour finding. QuaMaDi is a quality assured breast cancer diagnosis programme; with two-view mammography (craniocaudal, mediolateral oblique) and, in case of breast density ACR 3 or 4, routine ultrasound imaging; and with independent double reading of all images. A consecutive sample of symptomatic women, i.e. women at risk for breast cancer, women aged 70 and above, and/or women with preceding BI-RADS III findings, was analysed. 28,558 mammograms were performed (mean age of women: 57.3 [standard deviation: 12.3] years). Discordant findings were present in 3,837 double readings and were sent for arbitration reading. After histopathological assessment, 52 carcinomas were found (thereof 32% in situ). These carcinomas accounted for 1.8 tumours per 1,000 examinations in the total cohort and increased the tumour detection rate up to 16.4/1,000. The NNT in discordant cases was 74. Double and arbitration reading appears to be a useful tool to ensure the quality of early detection of breast lesions in symptomatic women during indication-based, standardised mammography. • Quality assured breast cancer diagnosis is feasible outside organised screening structures. • Double and arbitration reading is beneficial for populations ineligible for screening. • Double and arbitration reading increases the tumour detection rate. • Double and arbitration reading increases the percentage of in situ cancers.

Next Generation Cancer Protection: The Bivalent HPV Vaccine for Females.

Nearly a half a million women throughout the world develop cervical cancer every year Parkin and Bray (“Chapter 2. The burden of HPVrelated cancers,” Vaccine, vol. 24, no. 3, pp. S11–S25, 2006); 80% of these women are in countries without a quality-assured cytology screening program. It is in this setting that Cervarix could reduce the incidence of cervical cancer to about 9.5/100,000 women. New evidence indicates that this might be able to be accomplished with a single dose of Cervarix, a great advantage to public health implementation programs Kreimer et al. (“Proof-of-principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 vaccine, The Journal of the National Cancer Institute, vol. 103, no. 19, pp. 1444–1451, 2011). In countries with screening programs, adenocarcinoma is the most difficult to detect and treat with later-stage presentation and higher mortality Smith et al. (“The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—a 24-year population-based study,” Gynecologic Oncology, vol. 78, no. 2, pp. 97–105, 2000) and Gunnell et al. (“A longitudinal Swedish study on screening for squamous cell carcinoma and adenocarcinoma: evidence of effectiveness and overtreatment,” Cancer Epidemiology Biomarkers and Prevention, vol. 16, no. 12, pp. 2641–2648, 2007). With additional cross-protection to HPV 31, 33, and 45 and protection against HPV 16 and 18 lasting at least 9.4 years, Cervarix may reduce adenocarcinomas in screened populations by more than 90%. This paper will detail the evidence about the efficacy, immunogenicity, and safety of Cervarix in the studied populations contrasting public health goals with individual health options.

Nutrition Program Quality Assurance through a Formalized Process of On-site Program Review

A protocol for a systematic onsite review of the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program–Education was developed to support quality programming and ensure compliance with state guidelines and federal regulations. Onsite review of local nutrition program operations is one strategy to meet this goal. Observation and interaction with staff allow a comprehensive understanding of strengths, weaknesses, and emerging issues. This information provides managers with timely feedback to strengthen and improve all aspects of nutrition programming.

Accuracy of administrative claims data for polypectomy

The frequency of polypectomy is an important indicator of quality assurance for population-based colorectal cancer screening programs. Although administrative databases of physician claims provide population-level data on the performance of polypectomy, the accuracy of the procedure codes has not been examined. We determined the level of agreement between physician claims for polypectomy and documentation of the procedure in endoscopy reports. We conducted a retrospective cohort study involving patients aged 50-80 years who underwent colonoscopy at seven study sites in Montréal, Que., between January and March 2007. We obtained data on physician claims for polypectomy from the Régie de l'Assurance Maladie du Québec (RAMQ) database. We evaluated the accuracy of the RAMQ data against information in the endoscopy reports. We collected data on 689 patients who underwent colonoscopy during the study period. The sensitivity of physician claims for polypectomy in the administrative database was 84.7% (95% confidence interval [CI] 78.6%-89.4%), the specificity was 99.0% (95% CI 97.5%-99.6%), concordance was 95.1% (95% CI 93.1%-96.5%), and the kappa value was 0.87 (95% CI 0.83-0.91). Despite providing a reasonably accurate estimate of the frequency of polypectomy, physician claims underestimated the number of procedures performed by more than 15%. Such differences could affect conclusions regarding quality assurance if used to evaluate population-based screening programs for colorectal cancer. Even when a high level of accuracy is anticipated, validating physician claims data from administrative databases is recommended.