Set Of Quality Indicators Research Articles

Developing an initial set of quality indicators for chiropractic care: a scoping review

BackgroundQuality indicators are standardized, evidence-based measures of health care quality. Currently, there is no basic set of quality indicators for chiropractic care published in peer-reviewed literature. The goal of this research is to develop a preliminary set of quality indicators, measurable with administrative data.MethodsWe conducted a scoping review searching PubMed/MEDLINE, CINAHL, and Index to Chiropractic Literature databases. Eligible articles were published after 2011, in English, developing/reporting best practices and clinical guidelines specifically developed for, or directly applicable to, chiropractic care. Eligible non-peer-reviewed sources such as quality measures published by the Centers for Medicare and Medicaid Services and the Royal College of Chiropractors quality standards were also included. Following a stepwise eligibility determination process, data abstraction identified specific statements from included sources that can conceivably be measured with administrative data. Once identified, statements were transformed into potential indicators by: 1) Generating a brief title and description; 2) Documenting a source; 3) Developing a metric; and 4) Assigning a Donabedian category (structure, process, outcome). Draft indicators then traversed a 5-step assessment: 1) Describes a narrowly defined structure, process, or outcome; 2) Quantitative data can conceivably be available; 3) Performance is achievable; 4) Metric is relevant; 5) Data are obtainable within reasonable time limits. Indicators meeting all criteria were included in the final set.ResultsLiterature searching revealed 2562 articles. After removing duplicates and conducting eligibility determination, 18 remained. Most were clinical guidelines (n = 10) and best practice recommendations (n = 6), with 1 consensus and 1 clinical standards development study. Data abstraction and transformation produced 204 draft quality indicators. Of those, 57 did not meet 1 or more assessment criteria. After removing duplicates, 70 distinct indicators remained. Most indicators matched the Donabedian category of process (n = 35), with 31 structure and 4 outcome indicators. No sources were identified to support indicator development from patient perspectives.ConclusionsThis article proposes a preliminary set of 70 quality indicators for chiropractic care, theoretically measurable with administrative data and largely obtained from electronic health records. Future research should assess feasibility, achieve stakeholder consensus, develop additional indicators including those considering patient perspectives, and study relationships with clinical outcomes.Trial registrationOpen Science Framework, https://osf.io/t7kgm

Quality criteria of nature-based interventions in healthcare facilities: a scoping review.

Implementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement. After filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed. When designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.

Development of person-centred quality indicators for aged care assessment services in Australia: A mixed methods study.

This study developed a proposed set of person-centred quality indicators (PC-QIs) for services that assess older adults' care and support needs to determine their eligibility to receive government-funded aged care services in Australia. Individual proposed PC-QIs amenability for change within current organizational structures were explored. Barriers and opportunities to adapt service elements of the aged care assessment service to better align with the intent of the proposed PC-QIs were identified. A mixed methods study was conducted over five phases. A scoping review identified domains of quality for aged care services as perceived by older adults. Service elements of an aged care assessment service were mapped alongside quality domains informing key attributes of each quality domain. Self-determination theory was used to formulate each proposed PC-QI to align with key attributes and quality domains. Consultation with a consumer group enabled revision of the proposed PC-QIs. A focus group with clinicians evaluated the amenability of each proposed PC-QI for change and identified barriers and opportunities to better align service elements with older adults' perceptions of quality. Results were informed by qualitative and quantitative data from a structured focus group. Focus group discussions were audio recorded and subsequently transcribed verbatim. Qualitative data were analyzed using a deductive thematic approach by two independent researchers. Twenty-four proposed PC-QIs were developed. Refinement to descriptors of the proposed PC-QIs were made by the consumer group (n = 18) and all were affirmed as being amenable to change by aged care assessors. Barriers in meeting the intent of the proposed PC-QIs were identified across five domains including: health care staff knowledge (18.7%; n = 3); clear communication (31%; n = 5); person-centred approach (18.7%; n = 3); respect for client (18.7%; n = 3); and collaborative partnership with client (12%; n = 2). Participants made 21 recommendations. Of the five service elements in delivering an aged care assessment service, barriers in meeting the intent of the proposed PC-QIs were identified at the intake and booking of an assessment and during the assessment. Recommendations identified provide assessment services guidance on ways to adapt service elements to better align with older adults' perceptions of quality. Patients and carers were involved as collaborators in this project at the protocol stage which included participating in discussions regarding the refining and modification of the protocol, refinement of the proposed PC-QIs, data collection forms and supplementary information for participants.

The method of multi-criteria selection of the optimal variant of the information protection system for the information and communication system of the enterprise

The development of any complex technical system is usually associated with solving an optimization problem. In the case of designing an information protection system for an information and communication system of an enterprise, it is a search for the optimal variant of a set of protection means from the entire set of possible ones. Like any complex system, the information protection system of the information and communication system of the enterprise is characterized by a set of performance indicators that characterize the protection system from the point of view of countermeasures: the intrusion of intruders into the system; threats to confidentiality, integrity and availability of information; malicious software, etc. The article considers the method of multi-criteria selection of the optimal version of the information protection system for the information and communication system of the enterprise. 5 approaches to choosing the architecture of a complex system are offered. The approaches under consideration are illustrated on a model example of choosing one of the four options for the information protection system of the information and communication system of the enterprise. A simple and fairly visual method of choosing the optimal variant of the information protection system for the information and communication system of the enterprise from a set of possible options is proposed. This method allows you to solve the problem directly on the set of quality indicators without collapsing the criteria into a complex indicator. The prospects for the development of the proposed method are its improvement in order to realize the possibility of giving preference to certain criteria.

How patients define success for integrated care: How the University Health Network identifies iterative improvement priorities

Background: While many standardized surveys exist to measure patient experience, they are not designed to assess unique features of integrated care (IC) programs including transitions from hospital to community, satisfaction with homecare, or resources and supports provided post-discharge. The aim was to have patients lead efforts to develop a set of quality indicators for routine monitoring of patient experience in the University Health Network (UHN) integrated models of care in Toronto, Ontario, Canada. The output would be used to evaluate efforts and prioritize ongoing improvement to continue to meet patient needs.
 Population: We invited 29 stakeholders to participate in this study between April-July 2022. Twenty-three (79%) were female, 14% identified as a person with a disability, and 28% identified as a person of colour. Nearly half of all participants were patients or caregivers (42%), followed by administration/clinicians (58%).
 Engagement: This work was carried out in partnership with patients and caregivers. We worked collaboratively with the UHN Patient Experience Team to ensure materials and processes were effectively designed for engagement. 
 Methods: We used the RAND-modified Delphi method, an approach combining scientific literature and expertise of stakeholders, to reach consensus on an agreed-upon set of indicators to measure patient experience. The study consisted of two surveys and a virtual meeting. In survey #1, participants answered demographic questions and rated 45 patient-reported experience measures (PREMs) on whether they felt the indicator was reliable, necessary, and actionable, and also provided written feedback on each. We averaged responses and feedback to rank indicators; those with above-average ratings were included in survey #2 where respondents identified if each indicator should be included as a key performance metric. All results were shared and discussed at the virtual meeting.
 Results: Among the 29 stakeholders surveyed, 27(93%), 25(86%) participated in survey #1 and #2, respectively. The average rating for indicators in survey #1 was 79%, resulting in 23 indicators proceeding to survey #2. In 71.1% of indicators from survey #1 there was full agreement, meaning that both patients/caregivers and administration/clinicians rated above or below 79% (i.e., there was agreement to keep or remove the indicator). The remaining 29% of indicators had half agreement between patients/caregivers and administration/clinicians. Divergence of opinion mostly occurred for indicators that assessed the patient’s emotional well-being (e.g., addressing anxieties, fears, worries). The final set of indicators covers pre-hospital admission through the post-discharge period and assesses domains such as informational continuity, person-centered care, timeliness of care, effectiveness of resources and supports, and efficacy of knowledge translation.
 Conclusions: After 2 survey rounds and a virtual meeting participants reached consensus on 13 indicators to measure patient experience. This is the first set of PREMs co-designed by patients and caregivers with a focus on IC applications in Canada. 
 Lessons Learned: Patients and caregivers rated indicators that measure domains of emotional support and reassurance higher than administration/clinicians, highlighting the importance of sub-group analysis in designing patient experience measures. 
 Next Steps: Following a successful pilot in the Division of Orthopedics, these indicators will be implemented in all UHN IC programs.

Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review.

e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems.

Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND – modified Delphi procedure

ABSTRACT Introduction Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. Objectives The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. Methods A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. Results A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. Conclusion Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Recomendaciones y criterios de calidad para mejorar el diagnóstico precoz de la colangitis biliar primaria

ObjectiveThe study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. Patients and methodsIt was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. ResultsSeven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient's quality of life. Consider their point of view and agree on recommendations and care» and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually», respectively. ConclusionsThe implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

Selection of Quality Indicators to Evaluate Quality of Care for Patients with Esophageal Atresia Using a Delphi Method.

Survival of neonates with esophageal atresia (EA) is relatively high and stable, resulting in increased attention to optimizing care and longer-term morbidity. This study aimed to reach consensus on a quality indicator set for benchmarking EA care between hospitals, regions, or countries in a European clinical audit. Using an online Delphi method, a panel of EA health care professionals and patient representatives rated potential outcome, structure, and process indicators for EA care identified through systematic literature and guideline review on a nine-point Likert scale in three questionnaires. Items were included based on predefined criteria. In rounds 2 and 3, participants were asked to select the five to ten most essential of the included indicators. An international panel of 14 patient representatives and 71 multidisciplinary health care professionals representing 41 European hospitals completed all questionnaires (response rate: 81%), eventually including 22 baseline characteristics and 32 indicators. After ranking, 10 indicators were prioritized by both stakeholder groups. In addition, each stakeholder group highly prioritized one additional indicator. Following an additional online vote by the other group, these were both added to the final set. This study established a core indicator set of twenty-two baseline characteristics, eight outcome indicators, one structure indicator, and three process indicators for evaluating (quality of) EA care in Europe. These indicators, covering various aspects of EA care, will be implemented in the European Pediatric Surgical Audit to enable recognition of practice variation and focus EA care improvement initiatives.

Toward a Model to Evaluate Machine-Processing Quality in Scientific Documentation and Its Impact on Information Retrieval

The lack of quality in scientific documents affects how documents can be retrieved depending on a user query. Existing search tools for scientific documentation usually retrieve a vast number of documents, of which only a small fraction proves relevant to the user’s query. However, these documents do not always appear at the top of the retrieval process output. This is mainly due to the substantial volume of continuously generated information, which complicates the search and access not properly considering all metadata and content. Regarding document content, the way in which the author structures it and the way the user formulates the query can lead to linguistic differences, potentially resulting in issues of ambiguity between the vocabulary employed by authors and users. In this context, our research aims to address the challenge of evaluating the machine-processing quality of scientific documentation and measure its influence on the processes of indexing and information retrieval. To achieve this objective, we propose a set of indicators and metrics for the construction of the evaluation model. This set of quality indicators have been grouped into three main areas based on the principles of Open Science: accessibility, content, and reproducibility. In this sense, quality is defined as the value that determines whether a document meets the requirements to be retrieved successfully. To prioritize the different indicators, a hierarchical analysis process (AHP) has been carried out with the participation of three referees, obtaining as a result a set of nine weighted indicators. Furthermore, a method to implement the quality model has been designed to support the automatic evaluation of quality and perform the indexing and retrieval process. The impact of quality in the retrieval process has been validated through a case study comprising 120 scientific documents from the field of the computer science discipline and 25 queries, obtaining as a result 21% high, 39% low, and 40% moderate quality.

Development of a Fundamental Set of Quality Indicators for Evaluating HIV and AIDS Clinical Care: A Systematic Review

Development of a Fundamental Set of Quality Indicators for Evaluating HIV and AIDS Clinical Care: A Systematic Review

“We don’t trust all data coming from all facilities”: factors influencing the quality of care network data quality in Ethiopia

ABSTRACT Background Good quality data are a key to quality health care. In 2017, WHO has launched the Quality of Care Network (QCN) to reduce maternal, newborn and stillbirth mortality via learning and sharing networks. Guided by the principle of equity and dignity, the network members agreed to implement the programme in 2017–2021. Objective This paper seeks to explore how QCN has contributed to improving data quality and to identify factors influencing quality of data in Ethiopia. Methods We conducted a qualitative study in selected QCN facilities in Ethiopia using key informant interview and observation methods. We interviewed 40 people at national, sub-national and facility levels. Non-participant observations were carried out in four purposively selected health facilities; we accessed monthly reports from 41 QCN learning facilities. A codebook was prepared following a deductive and inductive analytical approach, coded using Nvivo 12 and thematically analysed. Results There was a general perception that QCN had improved health data documentation and use in the learning facilities, achieved through coaching, learning and building from pre-existing initiatives. QCN also enhanced the data elements available by introducing a broader set of quality indicators. However, the perception of poor data quality persisted. Factors negatively affecting data quality included a lack of integration of QCN data within routine health system activities, the perception that QCN was a pilot, plus a lack of inclusive engagement at different levels. Both individual and system capabilities needed to be strengthened. Conclusion There is evidence of QCN’s contribution to improving data awareness. But a lack of inclusive engagement of actors, alignment and limited skill for data collection and analysis continued to affect data quality and use. In the absence of new resources, integration of new data activities within existing routine health information systems emerged as the most important potential action for positive change.

Measuring quality of care in autologous breast reconstruction: a Delphi consensus

Measuring and benchmarking quality of care in surgical oncology has been gaining popularity. In autologous breast reconstruction (ABR), a standardized set of indicators to assess quality of care is lacking. In this study, we defined a set of evidence-based quality indicators for autologous breast reconstruction.First, we performed a systematic review to identify factors related to quality of care in ABR. Variables were categorized depending on their function: indicators related to outcome, indicators related to process and case-mix variables. The review was followed by a 3-round Delphi Consensus to determine which indicators and case-mix-variables were considered relevant and feasible for inclusion in an ABR standard set of indicators.932 unique articles were identified, of which 110 papers were included in the study. Indicators were categorized by function: outcome, process and case-mix variables. In total, 8 process indicators and 41 outcome indicators were extracted. 30 case-mix-variables were included. Following 3 rounds of questioning in the Delphi Consensus, all respondents agreed on type of ABR, oncological outcomes and patient satisfaction for the standard set. Indicators related to complications were consistently ranked highly. Most process indicators were not chosen after 3 rounds of questioning. 11 case-mix-variables were included in the final set.Following the Delphi Consensus, it was possible to identify 33 process and outcome indicators and 11 case-mix-variables for inclusion for a standard set of quality indicators. With the inclusion of both objective and patient-reported outcome measures, this set of indicators provides a multidimensional measurement tool for quality assessment for ABR.

Development of a set of quality indicators in paediatric and perinatal care in Japan with a modified Delphi method

BackgroundsFew paediatric and perinatal quality indicators (QIs) have been developed in the Japanese setting, and the quality of care is not assured or validated. The aim of this study was...

Development of care quality indicators for palliative care in China: A modified Delphi method study

ObjectiveWhile there are limited studies addressing palliative care quality in China, the availability of an effective set of care quality indicators is scarce. This study aimed to develop a comprehensive set of quality indicators for palliative care in China. MethodsConducting a systematic literature search across databases and guideline websites from inception to December 2020, combined with qualitative interviews, we established a preliminary pool of indicators. Subsequently, two rounds of Delphi expert consultation surveys were administered to 19 multidisciplinary experts (specializing in clinical nursing/medicine, nursing/medicine management, and health care administration, as well as those engaged in teaching and research) from 12 provinces in Mainland China (three each from North, East, and South China, and four from Central China) via email from March to June 2021. The analytic hierarchy process was employed to determine indicator weights. ResultsBoth rounds of expert consultation yielded a 100% positive coefficient, with expert authority coefficient values of 0.91 and 0.93, respectively. Kendall coefficient of concordance values for the two rounds were 0.148 and 0.253 (P < 0.001), indicating consensus among experts. Consequently, 71 quality indicators deemed important in the Chinese palliative care setting were identified, comprising 22 structure indicators, 35 process indicators, and 14 outcome indicators. ConclusionsThis study established an evidence-based set of quality indicators, addressing previously unmet needs and providing a novel approach to assessing and monitoring palliative care quality. Furthermore, ongoing refinement and integration with the evolving social context are warranted.

Development of quality indicators of transfer and transition in adolescents and young adults with congenital heart disease

BackgroundQuality indicators are crucial in evaluating and comparing the quality of healthcare services. In the case of congenital heart disease, transition programmes for adolescents have been recommended to ensure uninterrupted healthcare and lifelong care. It is necessary to establish quality indicators in order to facilitate the evaluation of programme quality and to allow comparison between different centres. The objective of this study is therefore to develop a set of quality indicators for the transition of adolescents with congenital heart disease.MethodsThe RAND/UCLA appropriateness method was employed in a four-step process to develop a set of quality indicators. First, a literature search was conducted on the dimensions of transitional care, based on which a preliminary set of quality indicators was developed. Second, experts were contacted, and an expert panel was established. Third, the panel members were asked to rate the appropriateness of the quality indicators in a two-round process. Finally, in the fourth step, we evaluated the data by measuring the median and Disagreement Index.ResultsThe expert panel consisted of 16 members, congenital cardiologists, nurses, transition experts, patients and research experts. The preliminary set of quality indicators comprised 16 items, categorized in process and structure criteria. Based on the panel’s feedback, the set was refined to 12 quality indicators, which were rated as relevant and feasible.ConclusionsThis study represents the first attempt to develop quality indicators for transitional care services for adolescents with congenital heart disease. The set of 12 quality indicators was developed based on existing evidence and expert opinion. Further testing is needed to assess the feasibility of these quality indicators in daily practice. If successfully implemented, these quality indicators could allow comparison and facilitate benchmarking of transitional care services for adolescents with congenital heart disease.

The development ofindicators to measure the quality ofcare ingeriatric rehabilitation.

Quality of care is an essential aspect of geriatric rehabilitation. Usually, there are national standards for the quality of care or indicators to measure the quality of care. However, this is not the case for geriatric rehabilitation. Therefore, the aim of this study was to develop structure, process, and outcome indicators to measure the quality of geriatric rehabilitation. To develop quality indicators for geriatric rehabilitation, a literature search was performed to identify indicators for all types of rehabilitation that can also be suitable for geriatric rehabilitation. Thereafter, in the qualitative phase, different stakeholders were inte. Indicators from the literature and indicators developed based on the interviews were merged and processed in a questionnaire. Through this questionnaire, elderly care physicians and managers of geriatric rehabilitation facilities were asked to rate the indicators on relevance and feasibility. Indicators that were considered relevant and feasible by the respondents were included in the final quality indicator set for geriatric rehabilitation. Thirty-six indicators suitable for geriatric rehabilitation were identified from the literature. Additionally, 55 quality indicators were developed based on the interviews. Merging the indicators and omitting duplicates resulted in 69 quality indicators. Analysis of the data from the questionnaires resulted in a final set of 27 quality indicators for geriatric rehabilitation that consists of 17 structure, 8 process, and 2 outcome indicators. This study contributes to the quality of geriatric rehabilitation by providing a first set of quality indicators ready to use in practice. Follow-up research is recommended and may include an assessment of the applicability, reliability, and validity of the developed indicator set.

A scoping review of heart failure transitional care quality indicators and outcomes for use in clinical care and research.

There are no accepted quality indicators for transitional care following hospitalization for heart failure (HF). Current quality measures focus on 30-day readmissions without accounting for competing risks such as death. In this scoping review of clinical trials, we aimed to develop a set of HF transitional care quality indicators for clinical or research applications following hospitalization for HF. We performed a scoping review using MEDLINE, Embase, CINAHL, HealthSTAR, reference lists and grey literature from January 1990 to November 2022. We included randomized controlled trials (RCTs) of adults hospitalized for HF who received a healthcare service or strategy intervention that aimed to improve patient-reported or clinical outcomes. We independently extracted data and performed a qualitative synthesis of the results. We generated a list of process, structure, patient-reported, and clinical measures that could be used as quality indicators. We highlighted process indicators that were associated with improved clinical outcomes and patient-reported outcomes that had high adherence to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and United States Federal Drug Administration (FDA) standards. From 42 RCTs included in the study, we identified a set of process, structure, patient-reported, and clinical indicators that could be used as transitional care measures in clinical or research settings. In this scoping review, we developed a list of quality indicators that could guide clinical efforts or serve as research endpoints in transitional care in HF. Clinicians, researchers, institutions, and policymakers can use the indicators to guide management, design research, allocate resources, and fund services that improve clinical outcomes.

Multivariate Exploratory Analysis of the Bulgarian Soil Quality Monitoring Network.

The goal of the present study is to assess the soil quality in Bulgaria using (i) an appropriate set of soil quality indicators, namely primary nutrients (C, N, P), acidity (pH), physical clay content and potentially toxic elements (PTEs: Cu, Zn, Cd, Pb, Ni, Cr, As, Hg) and (ii) respective data mining and modeling using chemometrical and geostatistical methods. It has been shown that five latent factors are responsible for the explanation of nearly 70% of the total variance of the data set available (principal components analysis) and each factor is identified in terms of its contribution to the formation of the overall soil quality-the mountain soil factor, the geogenic factor, the ore deposit factor, the low nutrition factor, and the mercury-specific factor. The obtained soil quality patterns were additionally confirmed via hierarchical cluster analysis. The spatial distribution of the patterns throughout the whole Bulgarian territory was visualized via the mapping of the factor scores for all identified latent factors. The mapping of identified soil quality patterns was used to outline regions where additional measures for the monitoring of the phytoavailability of PTEs were required. The suggested regions are located near to thermoelectric power plants and mining and metal production facilities and are characterized by intensive agricultural activity.

Stepwise development of a quality assessment instrument for the medicines’ pathway in nursing homes

BackgroundQuality of care in nursing homes (NHs), and especially the quality of the medicines’ pathway, remains a concern. ObjectivesTo develop a quality assessment instrument to support NHs to evaluate the quality of their medicines’ pathway, and to formulate recommendations for its implementation. MethodsA stepwise approach was used. First, a performance questionnaire for coordinating physicians, pharmacists and head nurses was developed, alongside a set of quality indicators (QIs). Next, a feasibility study regarding the QIs was performed in 4 NHs, followed by two pilot studies to optimize the instrument (in 14 and 9 NHs, respectively). Focus groups were held to formulate recommendations for instrument implementation. ResultsThe QI feasibility and first pilot study showed that the clarity and feasibility of QIs was insufficient. All QIs were therefore integrated in the performance questionnaire. The first pilot study also showed low response rates for certain questions in the performance questionnaire and resulted in a revision of questions with the aim to target the right type of healthcare professional, including quality coordinators and general practitioners. The final instrument targets all involved healthcare professionals (i.e. coordinating physicians, pharmacists, head nurses, general practitioners, and quality coordinators), and applies a sequential approach: a quick scan to set priorities, followed by a detailed scan to detect specific working points. The second pilot study showed appreciation for this approach. Last, five recommendations were made to promote the instrument's implementation. ConclusionsA series of feasibility and pilot studies allowed the stepwise optimization of a quality assessment instrument for the medicines' pathway in NHs and resulted in modifications to improve its clarity and feasibility. Participants’ recommendations will promote the successful implementation of the quality assessment instrument.