Health Quality Improvement Research Articles

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Management of children and young people (CYP) with asthma: a clinical audit report

An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented—a National Asthma Audit; however, this hasn’t reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016. This was funded as a Local Incentive Scheme (LIS) aimed at improving quality health care delivery. Two years after the publication of the NRAD report it is surprising that risks for future attacks were not recognized, that few patients were assessed objectively during attacks and only 10% of attacks were followed up within 2 days. However, it is encouraging that CYP hospital admissions following the audit were reduced by 16%, with clear benefit for patients, their families and the local health economy. This audit has provided an example of how clinicians can focus learning on patients who have had asthma attacks and utilize these events as a catalyst for active reflection in particular on modifiable risk factors. Through identification of these risks and active optimization of management, preventable asthma attacks could become ‘never events’.

Accelerating Momentum: The Impact of CDC and RWJF Investments in Support of Public Health Accreditation and Quality Improvement.

Accelerating Momentum: The Impact of CDC and RWJF Investments in Support of Public Health Accreditation and Quality Improvement.

Pegagan and cinnamon bark flours as a feed supplement for quail growth rate (Coturnix coturnix)

Quail (Coturnix coturnix) is one of the poultry that developed continuously to meet the needs of animal protein as well as to improve the quality of public health. Aside from meat, quail also produces egg productively. Meanwhile, excessive consumption of quail eggs is known to cause the health problem. Cinnamon (Cinnamomum sp) and (Centella asiatica) are believed to improve health quality but has not known their impact on quail especially on its growth rate. The objective of this research is to determine the effect of cinnamon bark flour and Pegagan leaf to the growth rate of Australia quail. This study used experimental design consisted of 8 treatments with 4 replications, i.e., controls, feeds supplemented with cinnamon bark flour 5%, 10%, pegagan 5%, 10%, cinnamon bark flour: pegagan leaf powder, among others 5 %: 5%, 5%: 10%, and 10%: 5%. The results showed that the combination of cinnamon bark flour: pegagan flour: 5%: 10% produced the highest growth rate of quail. To conclude, the combination of cinnamon bark flour: pegagan with concentration 5%: 10% could increase the growth rate of quail.

Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia

BackgroundYoung people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes.MethodsIn-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011–2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components.ResultsOf the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs.ConclusionsAcross all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044. Registered 6/05/2010. Prospectively Registered.

Evaluation of Early Detection Program of Bronchial Asthma in Primary Health Centers of Al-Nasiriyah City/ 2016

One of the main important public health objectives is the prevention of childhood asthma. Evaluating the effectiveness of early detection of childhood asthmatic symptoms, followed by a counseling intervention at preventive child health centers is the corn stone of this study. Early detection and counseling is expected to reduce the prevalence of asthma symptoms and improve health quality in general. This study aimed to evaluate the early detection program of asthma through structure or preconditions of early detection program of asthma, process to be carried out to deliver this program, outcome (Intermediate and ultimate indicators) and lastly opinion of consumers and providers. Evaluation type of study had been conducted all over the 2016. Nine health care centers were involved since the 1st week of January 2016, where an early detection tool had been applied at age groups 1, 2-5, 6 and more than 6 years at the intervention centers. Children who met the intervention criteria received counseling intervention (personal advice to parents to prevent the child from exposure to smoking, and/or referral to the general practitioner or asthma nurse). The primary outcome was asthma diagnosis at age 6 years. Secondary outcomes included frequency and severity of asthma symptoms, health-related quality of life at age 6 years. Analysis was done according to the intention-to-treat principle. Data collection was completed at the 1st of November 2016. Evaluation of the present input, process of PHC for early detection program resulted in: Providing most of the human resources in terms of laboratory assistants and coordinators of the program. Providing most of the material resources such as pressure gauges, medical handset and scales and tape measure height and waist needed to work in the laboratory with the availability of a suitable place for the work program staff to do their job and appliances. The percentage for input was 60% for all PHCs. While regarding consumer satisfaction: Most of consumer are highly satisfied 149 (80.1%) while not satisfied only 8 (4.3%) and high numbers gave the reason due to good services 97 (52.5%) and no comments 71 (38.2%). Regarding the proportion of the detected cases for different non communicable diseases was 44.1% of the whole population that have alarming sign and symptoms of NCD. The lack of doctors of all spatiality (GP, graduted doctors and specialist), lack of some essential tools, following wrong guidelines for this program by general health department by abolishment many ministerial guidelines, human mistakes and lack of training of staff of program, there no feedback mechanism for referral patient from hospital to PHC, lack of some treatment and investigations and some services not free.

Call to action: Better care, better health, and greater value in college health

ABSTRACTIt is time for action by leaders across higher education to strengthen quality improvement (QI) in college health, in pursuit of better care, better health, and increased value – goals closely linked to students' learning and success. The size and importance of the college student population; the connections between wellbeing, and therefore QI, and student success; the need for improved standards and greater accountability; and the positive contributions of QI to employee satisfaction and professionalism all warrant a widespread commitment to building greater capacity and capability for QI in college health. This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring QI to the forefront of college health practice – and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.

Mental health quality improvement goes global.

Mental health quality improvement goes global.

Measuring and improving the quality of mental health care: a global perspective.

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

Posyandu Roles as Mothers and Child Health Information Center

This research studied on The Posyandu Roles as Mothers and Children Health Information Center in Narawita Village Cicalengka County Bandung Regency. With objectives to find out community perceptions toward the Posyandu (center of integrated health services) Programs, its roles in improving health quality of mothers and children, and the Posyandu as an information center for communities, this study used qualitative method and data are gathered through interviews, observations, focus group discussion, and a literature study. The respondents are Posyandu cadres, the Village PKK (family welfare program) cadres, medical practitioners, and the posyandu members. The results show that the communities perceptions toward Posyandu Programs are adequately positive, Posyandu has important roles in improving the health of mothers and children through health service processes, and Posyandu has became as a community health information center.

Effect of distance learning on (health worker) behvarz knowledge level in comparison with other health teams of Kashan, health care systems in the field of PHC (Primary Health Care) 2014

Background: Health education is the first and most important step in health care. Then, it is necessary to pay attention to personnel training. Methods: The research population is all employees of Kashan University of Medical Sciences who were selected through the census. Educational pamphlets were sent to the centers and the first test was held. After 2 months, the test was resumed. Data were analyzed using SPSS software and paired t-test. Results: The highest percentage of correct responses by groups of community health workers, technicians, and experts struggles with illness, family health expert technicians, and midwives-related topic drugs are estimated to be in the home health. The lowest percentage of correct answers was to issues related to physical activity pyramid, pyramid charts, and knowledge of physical activity. The findings of this study showed that there was no significant difference between the study groups with community health workers' knowledge of aging issues, depression, health, miracle foods, drugs, home health assessment, and cough natural asthma in children, bandages and dressings, child abuse, thalassemia research on home health care, quality improvement, empowerment, injection safety, physical activity, and oral health pyramid (in 80% of paired comparisons between groups of the worker). Conclusion: Due to the lack of significant differences between knowledge community health workers and other health team members in most comparisons of educational programs in primary health care for health professionals, it seems that university education should be done with higher qualifications for high academic degrees and if we learn more to community health workers, we can expect high performance from them.

Promotion of Human Rights in Mental Health – Youth’s Perspective

There exists a global human rights emergency in mental health. The stigma, myths and misconceptions associated with mental disorders negatively affect the lives of people with mental disorders leading to denial of even the most basic human rights. Worldwide, people with mental disabilities experience an ambit of human rights violations. They are denied access to basic mental health care and treatment. They are not only discriminated against and stigmatized but are also subjected to abuse in both mental health facilities and the community. Several violations in community-based mental health care go unreported. Victims of discrimination are particularly vulnerable to restrictions in economic, social and cultural rights that make it difficult to be integrated into mainstream society. A sense of alienation can affect a person’s dignity and self-esteem, which is detrimental to one’s well-being. A qualitative approach was employed to understand the role of youth in promoting and protecting human rights in mental health. A Focus Group Discussion was done on a sample of 10 respondents who willing first BA students of Psychology – 2 males and 8 females aged 18–20 years. Results were analyzed using narratives. The objectives were to understand the threats to dignity in mental health care and ways to promote it. It was expressed that mental health inequalities lie even outside the health sector and thus inter-sectoral action is required to redress the issue. It was advocated to raise mental health issues on the agenda of political, religious and community arenas. Health facilities ought to be person-centred, privacy maintained, equitable and equal. The study has implications for mental health professionals to be more humane and ethical in practice and improve quality health care. Besides, mental health literacy should be imparted at various levels of education.

Milk from transgenic goat expressing human lysozyme for recovery and treatment of gastrointestinal pathogens

Lysozyme is an important non-specific immune protein in human milk, modulating the immune response against bacterial infections. The aim of this study was to characterize the milk of a transgenic goat expressing a recombinant human lysozyme (rhLZ) in the milk, also testing the in vitro antibacterial activity of the rhLZ milk against pathogens of the gastrointestinal tract. Milk samples collected from Tg and non-transgenic goats (nTg) from the 3rd to the 11th week of lactation were submitted to physicochemical analyses, rhLZ semi-quantification, and to rhLZ antimicrobial activity against Micrococcus luteus, Shiguella sonnei and Enterococcus faecalis. Viability and cell migration were studied in ileum epithelial cells (IEC-18) in absence or presence of E. faecalis, Staphylococcus aureus, Escherichia coli (EPEC) and S. sonnei. The expression of ZO-1 and IL-6 genes was evaluated in IEC-18 to evaluate the effect of rhLZ milk on intestinal barrier function and intestinal inflammation. Physicochemical parameters between goat Tg and nTg milk were similar and within normal values for human consumption, with hLZ concentrations being similar between Tg (224μg/mL) and human (226μg/mL) milk. The Tg milk had bactericidal activity against M. luteus, no bactericidal effect on S. sonnei, and relative to discrete sensitivity against E. feacalis than controls. Better migrating parameters were observed in cells in culture with nTg and Tg than controls. In the presence of pathogens, the Tg milk promoted improved migrating parameters than controls, except for S. sonnei, with lower cell numbers in the presence of nTg samples and E. faecalis and S. sonnei. No differences in ZO-1 relative expression patterns were observed in cultured cells, with increased expression in IL-6 in cells exposed to nTg milk than controls, with the Tg group being similar to all groups. In conclusion, goat milk containing rhLZ demonstrated valid evidence for its potential use as a nutraceutical for improvement of health and nutrition quality in humans.

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research

BackgroundThe Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women’s Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women’s Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans’ engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health.Methods/DesignThe three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women’s health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans’ mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design.DiscussionEMPOWER represents a coherent program of women’s health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans’ engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women’s Health, to disseminate and spread the programs nationally.Trial registrationThe two implementation research studies described in this protocol have been registered as required:Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534, registered 9 December 2016.Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961, registered 21 October 2016.

How Kabarole Hospital in western Uganda saved mothers’ lives through team-based problem-solving

Globally, the maternal mortality ratio (MMR) has declined in recent years, with 99% of maternal deaths occurring in developing countries. Most (75%) maternal deaths are due to severe bleeding, infections, pre-eclampsia and eclampsia, complications of obstructed and prolonged labour, and unsafe abortions.1 In 2013 in Uganda, the MMR was 360 per 100 000 live births compared with 210 per 100 000 live births globally.2 3 Kabarole Hospital, a private, not-for-profit general hospital in Kabarole District, was among the high-volume facilities prioritised by the United States Agency for International Development Applying Science to Strengthen and Improve Systems Project for a maternal, neonatal and child health (MNCH) quality improvement (QI) initiative in four districts of Western Uganda. The aim of the initiative was to contribute to a reduction of maternal and newborn mortality and morbidity by 50% in four districts of western Uganda including Kabarole Hospital. In May 2013, maternity staff at Kabarole Hospital were trained in QI methods applied to maternal and newborn care. In June 2013, a QI team of 10 members was formed, composed of the head of nursing (responsible for resource allocation), the medical officer assigned to the MNCH Department (provided technical oversight), the head of the MNCH Department (leader of the MNCH QI team), five midwives (provided MNCH services), the records officer (conducted data analysis and reporting), the laboratory technician (conducted laboratory investigations) and the storekeeper responsible for ordering allocation of drugs and supplies. This team started analysing their processes of care using data summarised from the maternity and antenatal registers and client charts onto a weekly summary sheet developed by the improvement team. The summary sheet contained variables such as number of clients seen per week, number of clients with obstetric complications, management of these complications and the outcome of each obstetric complication. The team recognised …

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3–6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program’s inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.

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OBJECTIVES/SPECIFIC AIMS: The primary objective of this effort is to develop and distribute an easy to use i2b2 component that is capable of evaluating diverse complex relationships for a wide variety of exposures and outcomes over time. In this manner we are able to leverage the unique design of the i2b2 database to support health services research, comparative effectiveness, and quality improvement using a single tool. Furthermore, our novel database redesign has the potential to provide user-friendly access to individual and group CHC data for CER. METHODS/STUDY POPULATION: For this project we used software experts, clinical informatics specialists, and the existing i2b2 open-source software to convert our legacy HOME Cell into a web-client version. The tool will be used to study health outcomes within a network of Boston based Community Health Centers and the largest safety-net hospital in New England, Boston Medical Center. RESULTS/ANTICIPATED RESULTS: The new web-client HOME Cell will allow i2b2 users to model virtually any exposure (including therapeutic interventions such as medications or tests) in i2b2 against any outcome accounting for complex temporal relationships and other factors. In addition we plan to use our new Community Health Center views to enhance our community engagement activities by allowing direct access to their data for our partners. DISCUSSION/SIGNIFICANCE OF IMPACT: Our project addresses multiple national priorities related to data sharing, clinical research informatics, and comparative effectiveness. The web-client version of the HOME Cell substantially improves our community’s access to HOME Cell functionality and is a novel, sharable resource for use within the CTSA/NCATS community. Our approach provides a new way to perform large-scale collaborative research without the need to actually move patient-level data and has demonstrated that CER, health services research, and quality measurement can share a common framework. In addition, and as demonstrated in our earlier pilot work, the HOME Cell also has the potential to support large-scale multivariate analyses in a distributed manner that does not require sharing of patient-level data. We believe our approach has great promise for supporting the reuse of clinical data for rapid, transparent, health outcome assessments on a national scale. Our efforts support multiple strategic goals including: (1) support for building national clinical and translational research capacity by enhancing a broadly adopted informatics tool (i2b2); (2) enhanced consortium-wide collaborations by offering a tool that can be easily shared within the CTSA network to support multi-institutional collaboration; and (3) improving the health of our communities by offering a tool that has the potential to provide new insights into health care processes and outcomes that could drive innovation and improvement activities.

Information governance laws and principles.

The Health Quality Improvement Partnership has launched a guide on how information governance laws and principles apply to the use of personal data in local or regional multi-agency healthcare quality improvement studies, such as clinical audits, productivity reviews, intervention testing and service evaluation.

Provider Perspectives on Behavioral Health Navigation Program for Adolescents

Background: This research evaluation is for an adolescent behavioral health (BH) quality improvement project within a multispecialty health care delivery system. Approximately 20% of U.S. adolescents have a mental health condition, thus underscoring the BH needs of this population. Best practices call for early detection of conditions by primary care providers (PCPs) and coordinated care aimed at managing conditions. Results from baseline PCP surveys and interviews showed that while confident about identifying adolescent BH needs, PCPs face challenges in providing necessary and appropriate treatment for their patients. In an effort to support PCPs and provide improved quality of BH care in primary care, a navigation program was developed to facilitate referrals from PCPs to BH specialists for adolescents. We asked PCPs about their experience with the program.

Improvements in health-related quality of life, cardio-metabolic health, and fitness in postmenopausal women after a supervised, multicomponent, adapted exercise program in a suited health promotion intervention: a multigroup study.

This study explored the multidimensional outcomes that resulted from the adherence to regular exercise among previously sedentary postmenopausal women. The exercise was managed through a supervised, multicomponent, adapted approximately 20-week program in a suited health promotion intervention. A multigroup, mixed-design study with between-group (intervention, sedentary, and active women) and within-subject measures (baseline, postintervention, and 3- and 12-month follow-ups) was conducted using intention-to-treat methodology. The Cervantes Scale assessed health-related quality of life (HRQoL), and several indicators of cardio-metabolic status and fitness were also assessed. After the intervention, the participants experienced positive changes in short and long-term physical and mental health, with significant enhancements in several HRQoL dimensions, particularly mental well-being and menopause-related health and subdomains. Improvements were maintained or continued (eg, mental well-being) throughout the period, leading up to the 12-month follow-up. These outcomes were accompanied by significant improvements in cardio-metabolic status and fitness, including weight, body mass index, cardio-respiratory fitness, and flexibility. Our findings parallel previous empirical evidence showing the benefits associated with regular exercise, and add evidence to the association of positive outcomes in HRQoL with improvements in cardio-metabolic health and fitness status after the adoption of an active lifestyle.