Quality Measures Research Articles

Conceptual and methodological recommendations for assessing the empirical validity of process measures of health care quality.

Conceptual and methodological recommendations for assessing the empirical validity of process measures of health care quality.

Pharmaceuticalization and Care Coordination in New York City Outpatient Mental Health.

US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD.

Clinical practice guidelines for patients with chronic kidney disease (CKD) recommend regular monitoring and management of kidney function and CKD risk factors. However, the majority of patients with stage 3 CKD lack a diagnosis code, and data on the implementation of these recommendations in the real world are limited. To assess the implementation of guideline-directed monitoring and management practices in the real world in patients with stage 3 CKD without a recorded diagnosis code. REVEAL-CKD (NCT04847531) is a multinational, observational study of patients with stage 3 CKD. Eligible patients had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements indicative of stage 3 CKD recorded >90 and ≤730 days apart, lacked an International Classification of Diseases 9/10 diagnosis code corresponding to CKD any time before and up to 6 months after the second eGFR measurement. Testing of key measures of care quality were assessed. The study included 435,971 patients from 9 countries. In all countries, the prevalence of urinary albumin-creatinine ratio and albuminuria testing was low. Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker and statin prescriptions were highly variable, and sodium-glucose cotransporter-2 inhibitor prescriptions remained below 21%. Blood pressure measurements were recorded in 20.2%-89.9% of patients. Overall, a large proportion of patients with evidence of stage 3 CKD did not receive recommended, guideline-directed monitoring and management. The variability in standard of care among countries demonstrates a clear opportunity to improve monitoring and management of these patients, most likely improving long-term outcomes.

The Assessment of Sperm DNA Integrity: Implications for Assisted Reproductive Technology Fertility Outcomes across Livestock Species

Sperm DNA integrity is increasingly considered a useful measure of semen quality in mammalian reproduction. However, the definition of DNA integrity, the ideal means by which it should be measured, and its predictive value for fertility remain a topic of much discussion. With an emphasis on livestock species, this review discusses the assays that have been developed to measure DNA integrity as well as their correlation with in vitro and in vivo fertility.

Developing Quality Measures for Improving Pre-Liver Transplant Care.

Developing Quality Measures for Improving Pre-Liver Transplant Care.

The value added of short-cycle higher education programs to student outcomes: Evidence from Colombia

We estimate the value added of short-cycle higher education programs (two or three years long) to student academic and labor market outcomes. We exploit administrative data from Colombia to control for a rich set of student, peer, and local choice set characteristics. We find that program value added accounts for 60–70 percent of the variation in graduation and labor market outcomes and varies greatly across programs, across and especially within fields of study. Value-added estimates are strongly correlated with the corresponding outcomes but not with other commonly used quality measures. Value-added to labor market outcomes is positively associated with program duration and age, the degree of the provider's specialization, and the size of the city where the program is taught. We caution against the use of program rankings, which appear highly sensitive to the underlying outcome or value-added metric.

EFFECT OF MICRONIZED PURIFIED FLAVONOID FRACTION ON VENOUS HAEMODYNAMICS EVALUATED USING DIGITAL PHOTOPLETHYSMOGRAPHY IN PATIENTS WITH CHRONIC VENOUS DISEASE

Micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available for the treatment of chronic venous disease (CVD). Photoplethysmography (PPG) is used to quantitatively measure venous haemodynamics and provide information about the overall function of the venous system. The aim of this study was to use digital PPG to evaluate the effects of MPFF on venous haemodynamics in patients with CVD. Patients diagnosed with CVD at an outpatient clinic in Bursa, Turkey between February 2018 and July 2020 were assessed for inclusion in this retrospective analysis. Patients who complied with the advised treatment strategy (MPFF 1000 mg tablets taken orally once daily and compression garments) and attended follow-up visits were included in the analysis. Digital PPG was used to measure venous refilling time (VRT) and venous pumping capacity (VPC) at diagnosis and 6 months of follow-up. The Venous Clinical Severity Score (VCSS) was also obtained at these visits, and patients completed the 20-item Chronic Venous Insufficiency Quality of life Questionnaire (CIVIQ-20). In total, 721 patients (mean age 52 years) with C0-C4 CVD were included in the study. PPG showed that VRT and VPC increased significantly from 19.0 sec and 2.0%, respectively, at diagnosis to 27.4 and 4.9%, respectively, at 6 months (both p<0.05). Mean VCSS improved significantly from 7.9 at diagnosis to 3.1 at 6 months (p<0.05). Mean CIVIQ-20 score also improved significantly at the 6-month follow up (20.1 vs 38.6 at diagnosis; p<0.01). In patients with C0-C4 CVD, 6 months of MPFF treatment plus the wearing of compression garments was associated with statistically significant improvements in venous haemodynamic parameters measured by PPG, as well as measures of clinical severity and quality of life.

The Post-Internationalization Evolution of the Price Discovery Pattern in China’s Iron Ore Markets

Previous literature provided evidence of a negative impact of internationalization on the quality of China’s iron ore futures market within a 6-month window (i.e. June 1, 2018 to November 31, 2018), but little is known on the long-term impact. Using a longer, 4-year-7-month window from June 1, 2018 to December 30, 2022, we examine the market’s price discovery function, an important measure of market quality. We find significant structural break in China’s iron ore data series in August 2021, which largely coincide with a period of rising commodity prices to all-time high. Before the breaks, the price discovery function of China’s iron ore futures appears quite weak, with the spot market leading the futures market, which is consistent with the findings of Fan et al. During the post-break period, however, the futures market demonstrates a stronger price discovery function and takes over the leading role. The day-of-the-week effects in iron ore futures also seem to weaken post-break as well. Our GARCH model results exhibit significant bi-directional volatility spillover between the futures and spot markets.

Evaluating the quality of radiomics-based studies for endometrial cancer using RQS and METRICS tools.

To assess the methodological quality of radiomics-based models in endometrial cancer using the radiomics quality score (RQS) and METhodological radiomICs score (METRICS). We systematically reviewed studies published by October 30th, 2023. Inclusion criteria were original radiomics studies on endometrial cancer using CT, MRI, PET, or ultrasound. Articles underwent a quality assessment by novice and expert radiologists using RQS and METRICS. The inter-rater reliability for RQS and METRICS among radiologists with varying expertise was determined. Subgroup analyses were performed to assess whether scores varied according to study topic, imaging technique, publication year, and journal quartile. Sixty-eight studies were analysed, with a median RQS of 11 (IQR, 9-14) and METRICS score of 67.6% (IQR, 58.8-76.0); two different articles reached maximum RQS of 19 and METRICS of 90.7%, respectively. Most studies utilised MRI (82.3%) and machine learning methods (88.2%). Characterisation and recurrence risk stratification were the most explored outcomes, featured in 35.3% and 19.1% of articles, respectively. High inter-rater reliability was observed for both RQS (ICC: 0.897; 95% CI: 0.821, 0.946) and METRICS (ICC: 0.959; 95% CI: 0.928, 0.979). Methodological limitations such as lack of external validation suggest areas for improvement. At subgroup analyses, no statistically significant difference was noted. Whilst using RQS, the quality of endometrial cancer radiomics research was apparently unsatisfactory, METRICS depicts a good overall quality. Our study highlights the need for strict compliance with quality metrics. Adhering to these quality measures can increase the consistency of radiomics towards clinical application in the pre-operative management of endometrial cancer. Both the RQS and METRICS can function as instrumental tools for identifying different methodological deficiencies in endometrial cancer radiomics research. However, METRICS also reflected a focus on the practical applicability and clarity of documentation. The topic of radiomics currently lacks standardisation, limiting clinical implementation. METRICS scores were generally higher than the RQS, reflecting differences in the development process and methodological content. A positive trend in METRICS score may suggest growing attention to methodological aspects in radiomics research.

Sacral nerve stimulation leads to long-term improvement in fecal incontinence and quality of life for children with functional and organic defecation disorders.

Our objective was to evaluate long-term outcomes of sacral nerve stimulation (SNS) for children with functional and organic defecation disorders. We performed a prospective study of children <21 years of age who started SNS treatment between 2012 and 2018. We recorded demographics, medical history, and diagnostic testing. We obtained measures of symptom severity and quality of life at baseline and follow up at 1, 6, 12, 24, 36, 48, and ≥60 months. Successful response was defined as bowel movements >2 times/week and fecal incontinence (FI) <1 time/week. Families were contacted to administer the Glasgow Children's Benefit Inventory and to evaluate patient satisfaction. We included 65 patients (59% female, median age at SNS 14 years, range 9-21) with median follow-up of 32 months. Thirty patients had functional constipation (FC), 15 had non-retentive FI (NRFI), and 16 had an anorectal malformation (ARM). The percentage with FI <1 time/week improved from 30% at baseline to 64% at 1 year (p < 0.001) and 77% at most recent follow-up (p < 0.001). Patients with FC, NRFI, and ARM had sustained improvement in FI (p = 0.02, p < 0.001, p = 0.02). Patients also reported fewer hard stools (p = 0.001). Bowel movement frequency did not improve after SNS. At most recent follow-up, 77% of patients with a functional disorder and 50% with an organic disorder had responded (p = 0.03). Nearly all families reported benefit. SNS led to sustained improvement in FI regardless of underlying etiology, but children with functional disorders were more likely to respond than those with organic disorders.

Tax revenue instability in Sub‐Saharan Africa: Does institutional quality matter?

AbstractSub‐Saharan African (SSA) nations face a dual fiscal challenge: the need to increase tax revenue mobilization and to manage revenue instability. This paper examines the causal impact of institutional quality on tax revenue stability in SSA from 2000 to 2020. Using UNU‐WIDER data and the System GMM technique, the study finds that institutional quality reduces tax revenue instability, with a stronger effect on indirect tax revenues than on direct taxes. This result is robust to changes in the measure of tax revenue instability, the measure of quality of institutions, the sample, and the time horizon. The effect is particularly pronounced in resource‐rich countries and in countries experiencing economic growth. The article's results are relevant to tax policy, specifically the necessary adjustments to improve tax revenue stability through institutional quality.

Cross Country Study of Human Capital Formation and USFDI Inflows

Purpose: The neo-classical theory of economic growth features the positive impact of the human capital of an economy on its growth. The inflow of foreign direct investment is one of the main components to carry forward the growth effect, this study investigates the impact of country-specific institutional quality and human capital on the cross-country variations of US-Foreign Direct Investment (FDI) inflows. Our core hypothesis is that Countries with better Human capital will attract more FDI if they have good quality institutions in terms of less risk in investment opportunities. Method: Using a set of panel data of US-Foreign Direct Investment (FDI) inflows for both developed and developing countries over the period 1984-2021. Result: The country-specific quality of institutions reinforces the impact of human capital on the inflow of US foreign direct investment in this study. Using two-dimensional panel data we find strong support for our hypothesis using a two-way fixed effects model. Our results are robust to the alternative measures of institutional quality. Implications: The strength of our approach is that in contrast to the previous works (1) we have used the USFDI inflow across countries that have been widely neglected in the related literature and (2) emphasis has been given to the conditional or joint impact of human capital and country-specific institutional quality in determining the cross-country variations in USFDI inflows.

Factors Determining Quality of Drug Information by Hospital Pharmacies—Results from Five-Year Annual Quality Assessment

Drug information (DI) provided by hospital pharmacies aims to promote rational and safe drug therapy. While quality assessment for this task is recommended, more knowledge on the factors determining the quality is needed. We aimed to evaluate the impacts of different factors on the quality of DI provided by hospital pharmacies to healthcare professionals. Retrospectively, answers on fictitious enquiries about annual DI tests for German hospital pharmacies over five years were evaluated for content-related and structural requirements. Multivariate analysis was performed for the impact of the enquiry complexity, DI organization (specialized DI center; pharmacist responsible per day; DI on top of other routine tasks), and quality measures (second look; experience of answering pharmacist in DI/on ward; use of documentation database). In 2017–2021, 45, 71, 79, 118, and 122 hospital pharmacies participated. The enquiry complexity had a statistically significant impact on the content-related quality, with poor results for a higher complexity (years 2018/2021, OR 0.25/0.04, p &lt; 0.01). The DI centers achieved better results regarding content-related quality than for a pharmacist responsible per day (OR 0.76/p = 0.65) or DI on top of routine tasks (OR 0.35/p = 0.02). The DI centers scored better in structural quality. The second look showed an overall trend of a better content-related and structural quality. In conclusion, specialized DI centers and second looks are recommended as quality-improving measures. Training for answering complex enquiries should be intensified.

Biodegradability index (BDI) as an indicator for effluents quality measurement; a case study based on different industry sectors in Matara District, Sri Lanka

ABSTRACT This study addresses the crucial need for appropriate indicators to characterize aquatic pollution, given the challenges posed by unrestricted effluent discharge globally. Focusing on wastewater from hotel and tourism industries and vehicle service stations in Matara District, Sri Lanka, we explored the relationship between biological oxygen demand (BOD) and chemical oxygen demand (COD) through the biodegradability index (BDI). Monthly water samples were collected from January 2019 to December 2022, analyzed using standard methods, and statistically evaluated. Results revealed a significant spatial variation in BDI among industry sites, with a modest temporal change. The BOD:COD ratio exhibited a slight increasing trend over time, suggesting factors beyond temporal influence. BDI correlated significantly with temperature, alkalinity, and total suspended solids (TSS), emphasizing its potential as an indicator. The study underscores the importance of complementing the BOD:COD ratio with other indicators for a comprehensive assessment of industrial effluent quality. This research contributes valuable insights into understanding wastewater characteristics, facilitating informed pollution reduction and control strategies in aquatic systems.

Quality measures in primary care skin cancer management: a qualitative study of the views of key informants

ObjectivesThis study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.DesignSemistructured interviews and qualitative proforma surveys were...

Under pressure: symptomatic pulmonary hypertension is a predictor of poor outcome following hip fracture.

Pulmonary hypertension (PHTN) is associated with increased morbidity and mortality in noncardiac surgery and elective surgery. This population of patients has a low physiological reserve and is prone to cardiac arrest as a result. This study aims to identify the impact that PHTN has on outcomes among geriatric hip fracture patients. A 3:1 propensity-score-matched retrospective case (PHTN)-control (no PHTN [N]) study of hip fracture patients from 2014 to 2022 was performed. Patients were matched utilizing propensity score matching of a validated geriatric trauma risk assessment tool (STTGMA). All patients were reviewed for hospital quality measures and outcomes. Comparative univariable and multivariable analyses were conducted between the two matched cohorts. A sub-analysis compared patients across PHTN severity levels (mild, moderate, severe) based on pulmonary artery systolic pressures (PASP) as measured by transthoracic echocardiogram. PHTN patients (n = 67) experienced a higher rate of inpatient, 30-day, and 1-year mortality, major complications, and 90-day readmissions as compared to the N cohort (n = 201). PHTN patients with a PASP > 60 experienced a significantly higher rate of major complications, need for ICU, longer admission length, and worse 1-year functional outcomes. Pulmonary hypertension was found to be independently associated with a 3.5 × higher rate of 30-day mortality (p = 0.016), 2.7 × higher rate of 1-year mortality (p = 0.008), 2.5 × higher rate of a major inpatient complication (p = 0.028), and 1.2 × higher rate of 90-day readmission (p = 0.044). Patients who had a prior diagnosis of pulmonary hypertension before sustaining their hip fracture experienced significantly worse inpatient and post-discharge outcomes. Those with a PASP > 60mmHg had worse outcomes within the PHTN cohort. Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly. III.

The Big 4 effect for new audit services: The case of the Danish COVID‐19 fixed‐cost business‐support scheme

This study investigates the Big 4 effect for a new‐to‐the‐world audit service. Based on unique data from the Danish COVID‐19 fixed cost support scheme we analyse differences in audit fees and two measures of audit quality across Big 4 and non‐Big 4 engagements. Our findings suggest that firms engaging with Big 4 auditors experience more successful outcomes in the application process and are willing to pay a Big 4 premium for comparable assurance services. Clients of Big 4 auditors are, on average, more likely to receive full compensation, and experience fewer rejections during the application process than clients of non‐Big 4 auditors. This research has implications for policymakers and companies.

Understanding epitaxial growth of two-dimensional materials and their homostructures.

The exceptional physical properties of two-dimensional (2D) van der Waals (vdW) materials have been extensively researched, driving advances in material synthesis. Epitaxial growth, a prominent synthesis strategy, enables the production of large-area, high-quality 2D films compatible with advanced integrated circuits. Typical 2D single crystals, such as graphene, transition metal dichalcogenides and hexagonal boron nitride, have been epitaxially grown at a wafer scale. A systematic summary is required to offer strategic guidance for the epitaxy of emerging 2D materials. Here we focus on the epitaxy methodologies for 2D vdW materials in two directions: the growth of in-plane single-crystal monolayers and the fabrication of out-of-plane homostructures. We first discuss nucleation control of a single domain and orientation control over multiple domains to achieve large-scale single-crystal monolayers. We analyse the defect levels and measures of crystalline quality of typical 2D vdW materials with various epitaxial growth techniques. We then outline technical routes for the growth of homogeneous multilayers and twisted homostructures. We further summarize the current strategies to guide future efforts in optimizing on-demand fabrication of 2D vdW materials, as well as subsequent device manufacturing for their industrial applications.

Data annotation quality in smart farming industry

ABSTRACT Data has become paramount in modern agriculture industry, empowering precision farming practices, optimizing resource utilization, facilitating predictive analytics, and driving automation. However, the quality of data influences the usefulness of smart farming systems. Poor data quality specifically in annotations include mislabeling, inaccuracy, incompleteness, irrelevance, inconsistency, duplication, and overlap. These limitations often emerge from specific constraints, or the small scale of the problem/limited number of stakeholders, making it challenging to overcome the obstacles. This paper presents a comprehensive framework to address data annotation quality challenges. Beginning with raw, non-curated data, we integrate three strategic methodologies: active learning, enhanced annotations, and transfer learning to elevate the data quality resulting in a curated data model that achieves superior data quality refining decision-support. Leveraging a curated set of KPI, we demonstrate that integrating data quality measures leads to enhanced accuracy, reliability, and performance. Transfer learning is the most promising approach, demonstrating superior performance.