Quality Measures Research Articles

Frailty training among healthcare professionals

As the population ages worldwide, frailty becomes more prevalent, leading to a higher risk of poor outcomes. Therefore, there is an increased need to educate healthcare providers in the areas of frailty screening, assessment, and treatment. In our review of the current state of frailty education worldwide we showed that, with the exception of a few European countries, education of clinicians on frailty screening, assessment, and treatment is inadequate.Interprofessional team competencies, quality measures and clinical guidelines that require screening, assessment and management of frailty are needed to propel frailty education forward. It is evident that there is much-needed collaboration between high-, mid-, and low-income countries to reach consensus and create worldwide recommendations for frailty education

Spatial domain noise removal filtering for low-resolution digital images

<p>n this research work, six different filters are applied on a low resolution 8 b/pixel gray-scale images, which operate on small sub-images (windows of 3×3 to 11×11 pixels). The enhanced images are used to compare the efficiency of the different six filters using the peak signal to noise ratio (PSNR) image quality measure. Noise peak elimination filter (PSNR)=36.63) outperforms others, such as median filter (PSNR=36.61), while corruption estimation (PSNR=36.03) significantly cuts processing time by only processing the corrupted pixels while maintaining image details. Mean filter (PSNR=34.05) is sensitive to outliers, which cause the image's sharpness and fine features to be lost. By avoiding averaging across edges, bimodal-averaging filter (PSNR=35.30), which improves on the mean filter, chooses the mean of the biggest population. The median-mean filtering (PSNR=36.32), which combines median and mean filters and determines the output pixel by averaging the median and some nearby pixels, is another improvement above averaging.</p>

Privacy-preserving, communication-efficient, and target-flexible hospital quality measurement

Privacy-preserving, communication-efficient, and target-flexible hospital quality measurement

Do mid‐level providers enhance hospital cost per discharge or triple aim performance efficiency? An exploratory analysis

AbstractHospital administrators are shifting care delivery models toward an approach that uses more caregivers in the form of mid‐level providers (MLPs), such as nurse practitioners, physician assistants, and clinical nurse specialists. To date, however, healthcare operations management (OM) literature remains ambiguous about longitudinal empirical associations between mid‐level providers and hospital costs, quality, and other performance measures. We analyze how the extent of MLP employment used by a hospital is associated with hospital operational outcomes, as reflected by hospital cost per discharge and Triple Aim Performance (TAP) efficiency metrics. Our findings indicate percent MLP usage is positively associated with efficiency metrics for hospital clinical quality, technical efficiency, and patient experience, but not associated with hospital costs. We also find percent MLP usage is associated with the likelihood that hospitals excel on all TAP metrics simultaneously. Post‐hoc exploratory analyses suggest the associations exhibit differential outcomes across hospital efficiency quantiles, while sub‐sample analyses motivate boundary conditions for some hypothesized MLP associations. We contribute to healthcare OM research by providing one of the first panel data analyses of MLPs, improving insights relative to extant work. By giving key stakeholders useful findings about outcomes associated with hospital staffing trends, our managerial contribution helps hospital administrators understand empirical consequences of the increasing use of MLPs.

A role for Local Impedance in CF guided PVI: initial results from the LOCALIZE CF Trial

Abstract Background Contact force catheters (CF) in combination with high-resolution 3D mapping are the gold standard for treatment of complex arrhythmias. Stable CF and catheter position increase both the safety and effectiveness of energy delivery. To date, local impedance (LI) is the only established parameter for real-time measure of lesion quality. Other methods tend to use surrogate parameters. Catheter ablation may be further improved by combining CF and LI. Purpose LOCALIZE CF assessed the utility of LI in addition to CF in predicting lesion durability during RF PVI procedures for paroxysmal atrial fibrillation (PAF). Methods LOCALIZE CF is an international, multicenter non-randomized trial consisting of an index PVI and invasive redo mapping procedure at 3 months. Patients (pts) with PAF underwent de novo PVI using a combined CF/LI catheter and 3D mapping system. Operators could use CF but were blinded to LI. Power settings and ablation duration were at operator discretion. PVI was performed with point-by-point circumferential ablation. The procedural endpoint was confirmation of entry block for all pulmonary veins (PV) after a 20-minute wait. Secondary endpoints included: safety events, procedural characteristics, and the correlation between LI-values and gaps. Gaps at 3-month remap were analysed by anatomical segment (8/ipsilateral PVI circle, 16/pt). Results This study enrolled 60 pts across 4 European centers, 54 pts completed 3-month remap. On average, pts (25% female) were 61 years of age, BMI 27kg/m2, LVEF 64%, LA diameter 38mm, and CHA2DS2-VASc score 1. High-power (40-45W) short duration was used by 3 of 4 sites (32 patients), with standard power (<40W) in the remainder. First pass isolation, assessed after 20min wait, was achieved in 73% of pts. Acute isolation of all PVs was achieved in all pts. At the 3-month re-map procedure, 92 of 845 segments were found to be reconnected. 3,980 point-to-point index ablations were analysed with respect to gap vs blocked segments. The median CF in gap segments was 11g compared to 13.9g in blocked segments (p<0.0001). Gap segments had significantly lower median LI drop (13Ω) than blocked segments (19Ω; p<0.001). In multivariate analysis, lesion spacing, CF and LI drop all independently predicted block. In ROC curve analysis (>9.5g CF, >20Ω LI), a model including all 3 factors had a significantly greater area under the curve than spacing and CF alone (p<0.0001). Conclusions Real-time measurements such as LI and CF are important for improving the quality and durability of ablations. While CF represents the stability of the catheter, LI reflects real-time lesion formation. The combination of both is important and may improve ablation and avoid gaps. This study suggests that CF >9.5g and LI drop >20Ω are predictors of durable lesion. Thus, LI, when used alongside CF, potentially offers a distinctive measure of ablation effectiveness, complementing the data provided by CF.

Developing a novel phantom for image quality evaluation in digital radiography

Evaluation of image quality in digital radiography is important to ensure accurate diagnosis. However, to perform image quality tests accurately and effectively, complex techniques and numerous phantoms are required. The aim of the study was to develop a novel phantom to allow a comprehensive evaluation of image quality in digital radiography. High-Density Polyethylene (HDPE) was used as the main material for the phantom. Physical image quality parameters such as effective Modulation Transfer Function (eMTF), effective Normalized Noise Power Spectra (eNNPS), effective Detective Quantum Efficiency (eDQE), as well as contrast and signal-to-noise ratio (SNR) evaluations can be conducted using the phantom. Preliminary preparation work was carried out through Monte Carlo simulations. The validation of the phantom was performed by comparing with standard phantom results. Physical image quality measurements were performed using an indirect digital radiography system. It was observed that there was a good agreement between the image quality measurement results performed with the standard phantom and the developed phantom. A strong correlation was determined between integrated effective DQE (IeDQE) results (R ≥ 0.97) obtained with HDPE and PMMA phantom. Simulation results regarding the transmission factor showed that HDPE could be an alternative to Polymethyl Methacrylate (PMMA) as a phantom material.

Implementation of nurse administered propofol sedation for same-day discharge pulsed field ablation of atrial fibrillation is safe and has excellent patient reviews

Abstract Background In June 2022, we introduced Pulsed Field Ablation (PFA) for de novo pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Simultaneously, deep sedation with propofol undertaken by trained nurses from the cath lab was introduced. Purpose To evaluate feasibility, safety and patient reported experience for same-day discharge AF ablations performed with PFA on propofol sedation. Methods Patients with an ASA physical status classification of 1 or 2 referred for de novo AF ablation were planned for PFA in propofol sedation. Three nurses with previous experience from the intensive care unit planned and undertook the sedation. In addition, two nurses were trained locally. The initial 200 consecutive patients were included in the observational cohort study after signing consent to participate in follow-up after the procedure. Study data were collected and managed using REDCap electronic data capture tools. In addition to procedure related data, patient-reported quality measures were acquired 30 days after the procedure by an internet based questionnaire including scaling and open questions. Results 96% of the procedures were successfully completed using only propofol while 4% were scheduled for general anesthesia, mainly because of sleep apnea and high BMI. The average procedure time for the first 100 procedures was 57 min (95% CI, 54.1-62.9) and 45 min (95% CI, 42.6-47.4) for the following 100 procedures. Acute PVI was achieved during all procedures. No sedation related adverse effects were observed. One patient experienced pericardial tamponade requiring prolonged hospitalization. 87% were discharged on the same day as planned while 12% remained hospitalized one additional day for reassurance and social reasons. 93% (186/200) completed the questionnaire. 56% of patient only responded "very little" or "not at all" to all questions about adverse symptoms during and after the procedure. For each specific symptom, 80 to 95 % were only experienced "very little" or "not at all" (Fig 1). In general, patients felt safe about the preparation for and handling of the sedation (Fig 2). Conclusions Nurse administered deep sedation with propofol, provides excellent pain relief for PFA procedures, facilitates an efficient workflow and can safely be implemented and administered by nurses from the cath lab. Propofol sedation constitutes an important alternative to general anesthesia that is not widely available.Figure 1Figure 2

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

BackgroundHospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised...

#1008 Prognostic impact of low skeletal muscle quality on 3-year mortality in initial-dialysis patients

Abstract Background and Aims Myosteatosis represents the infiltration of fat into the skeletal muscle in the early stages of sarcopenia, and has been suggested to be associated with adverse outcomes in patients undergoing dialysis. Skeletal muscle density (SMD) determined by computed tomography (CT) is commonly used to assess myosteatosis, but SMD is affected by contrast resulting in inaccurate measurements. Recently, indices for muscle quality measurements determined by muscle area have been developed. Thus, We aimed to investigate the relationship between a novel muscle area index and mortality in initial-dialysis patients and analyse variables related to myosteatosis using the cutoff values. Method This 3-year multicentric retrospective study enrolled a total of 782 initial-dialysis patients from four centres between 2014 and 2019 in China. SMD skeletal muscular area (SMA) normal attenuation muscle area (NAMA) intermuscular adipose tissue area (IMAT) was measured and skeletal muscle index (SMI) total attenuation muscle area (TAMA) NAMA/TAMA index was calculated on CT images at the level of the first lumbar vertebra. The relationship between NAMA/TAMA index and all-cause and cardiac death outcomes was analyzed. And the sex-specific optimal cut-off values of L1-NAMA/TAMA index were determined in relation to all-cause mortality. Univariate and multivariate Cox regression models were applied to evaluate potential risk factors for death. Results A total of 782 patients were enrolled. The optimal cut-off values of NAMA/TAMA index were 48.76 for males and 58.02 for females. Pearson's correlation coefficient between L1-NAMA/TAMA index and L1 SMD was 0.589 (P < 0.001), no significant association between L1-NAMA/TAMA index and L1 SMI was observed (P > 0.05), similarly, no significant association between L1 SMD and L1 SMI (P > 0.05). Multivariate regression analysis revealed that the low L1-NAMA/TAMA index group had lower risks of all-cause death (hazard ratio 0.988; 95% confidence interval 0.977–0.999, P = 0.041) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007). Conclusion Our findings demonstrate that L1-NAMA/TAMA index acquired via CT scan is of great prognostic value on all-cause and cardiac death in patients undergoing initial-dialysis.

Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures

BackgroundTranslational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to “do no harm”, we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.MethodsWe used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.ResultsThe initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.ConclusionsThe initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.

Pathways to Sustainability in Sub-Sahara Africa: Are Institutional Quality Levels Subservient in Achieving Green GDP Growth?

AbstractThere is a growing need for a transition to green economic growth (GGDP) given that the current economic system is largely environmentally unsustainable. This study thus addresses GGDP enhancement in less developed countries using the case of Sub-Sahara Africa (SSA) countries where institutional deficiencies are typically at the root of most resource depletion and environmental degradation issues. Six institutional quality measures were used namely corruption control, government effectiveness, political stability, regulatory quality, rule of law, and voice of accountability while controlling for other factors like industrialization, energy use, and population growth in the region. The study applied a battery of second-generation panel econometric techniques in the empirical analysis after which both Bootstrap Quantile regression (BQR) technique and panel ordinary least squares (OLS) estimation approaches were applied to observe the variables' roles on GGDP advancement in SSA. From the findings, corruption control and government (policy) effectiveness favorably impact Green GDP in SSA. However, both rule of law and regulatory quality performed poorly as they were insignificant to GGDP enhancement. Furthermore, all control variables promote GGDP except for population growth. Thus, the findings buttress the need to strengthen institutions for effective governance and quality environmental regulations to enhance GGDP growth towards actualizing sustainable development goals (SDGs) in the SSA region.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary Management of Osteoarthritis of the Hip.

The Management of Osteoarthritis (OA) of the Hip Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies examining the treatment of OA of the hip in adults (aged 18 years and older). Based on the best current available evidence, this guideline contains eight recommendations and nine options to assist orthopaedic surgeons and all qualified physicians managing patients who have been diagnosed by a trained healthcare provider with OA of the hip and are currently undergoing treatment. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

'Who can tell me what potable water means?' The assessment of water quality in debates over hydraulic infrastructure in nineteenth-century Italy.

How water is perceived and represented has an impact on the relationships between a given society and its water infrastructure. Historians have identified a shift in the perception of water during the nineteenth century, which was connected to the development of chemistry. From an understanding based in Hippocratic medicine and natural history that treated it as an infinite variety of substances, water eventually became understood as a simple compound consisting of oxygen and hydrogen. This resulted in the abstraction of water from its social and environmental contexts, with consequences for the way water was managed. This article aims to demonstrate that such a view gives a mistaken intellectual coherence to a fragmented and conflicted process, which involved continuities, an adaptation of old frameworks to new social priorities, and fine changes in scientific thinking and practices. This paper examines the scientific and political debates concerning water infrastructure, surveys and analyses on water quality, medical reports and political measures in nineteenth-century Italy. Ultimately, the reduction of 'waters' to 'water' in Italy was more about determining who had the authority to assess water quality in the process of creating and stabilizing new power relations between the public and the private spheres than about the abstraction of water from its social and environmental contexts.

Associations between Intake of Dietary Sugars and Diet Quality: A Systematic Review of Recent Literature

Understanding the relationship between the intake of sugars and diet quality can inform public health recommendations. This systematic review synthesized recent literature on associations between sugar intake and diet quality in generally healthy populations aged 2 years or older. We searched databases from 2010 to 2022 for studies of any design examining associations between quantified sugar intake in the daily diet and dietary indexes (DIs) or micronutrient intakes. Different sugar types and diet quality measures were analyzed separately. We converted DI results to Pearson’s r correlations and grouped indexes with or without a free or added sugar component to facilitate cross-study comparisons. Meta-analysis was deemed inappropriate. From 13,869 screened records, we included 27 cross-sectional studies. NUQUEST risk of bias ratings were neutral (n = 18 studies) or poor (n = 9), and strength of evidence by the GRADE approach was very low due to study design. Most studies reported negative associations for added and free sugars with diet quality indexes (r ranging from −0.13 to −0.42) and nutrients of public health concern (fiber, vitamin D, calcium, potassium), while associations with total sugars were mixed. Due to cross-sectional study designs, the clinical relevance of these findings is unclear. Prospective studies are needed to minimize confounding and inform causal relationships.

Quality 4.0: Learning quality control, the evolution of SQC/SPC

This article marks a significant advancement in the field of quality management, specifically focusing on the evolution from traditional Statistical Quality Control (SQC) and Statistical Process Control (SPC) methods to a more advanced Learning Quality Control (LQC) approach. The research introduces Quality 4.0 (Q4.0) as a novel paradigm that fuses the technologies of the fourth industrial revolution, Manufacturing Big Data (MBD), Industrial Internet of Things (IIoT), Cloud Storage and Computing (CSC) and Artificial Intelligence (AI), with traditional quality management practices. The central theme of this study is exploring the limitations inherent in conventional quality control methods when faced with the complexities of modern manufacturing environments. The authors propose LQC systems as a solution, employing binary classification algorithms to predict and detect defects in manufacturing processes. This represents a shift from reactive to proactive quality measures enabled by AI’s real-time data processing capabilities. The document delves into the evolution of manufacturing data across industrial revolutions, highlighting the exponential growth of unstructured data and its challenges. Through case studies, the authors illustrate the practical applications of LQC systems, demonstrating their ability to learn complex patterns in hyperdimensional spaces and automate tasks traditionally performed visually.

Community Quality Evaluation for Socially Sustainable Regeneration: A Study Using Multi-Sourced Geospatial Data and AI-Based Image Semantic Segmentation

The Chinese urban regeneration movement underscores a “people-oriented” paradigm, aimed at addressing urban challenges stemming from rapid prior urbanization, while striving for high-quality and sustainable urban development. At the community level, fostering quality through a socially sustainable perspective (SSP) is a pivotal strategy for people-oriented urban regeneration. Nonetheless, explorations of community quality assessments grounded in an SSP have been notably scarce in recent scholarly discourse. This study pioneers a multidimensional quantitative model (MQM) for gauging community quality, leveraging diverse geospatial data sources from the SSP framework. The MQM introduces an evaluative framework with “Patency, Convenience, Comfort, and Safety” as primary indicators, integrating multi-sourced data encompassing the area of interest (AOI), Point of Interest (POI), Weibo check-ins, and Dianping data. The model’s efficacy is demonstrated through a case study in the Gusu district, Suzhou. Furthermore, semantic analysis of the Gusu district’s street view photos validates the MQM results. Our findings reveal the following: (1) AI-based semantic analysis accurately verifies the validity of MQM-generated community quality measurements, establishing its robust applicability with multi-sourced geospatial data; (2) the community quality distribution in Gusu district is notably correlated with the urban fabric, exhibiting lower quality within the ancient town area and higher quality outside it; and (3) communities of varying quality coexist spatially, with high- and low-quality communities overlapping in the same regions. This research pioneers a systematic, holistic methodology for quantitatively measuring community quality, laying the groundwork for informed urban regeneration policies, planning, and place making. The MQM, fortified by multi-sourced geospatial data and AI-based semantic analysis, offers a rigorous foundation for assessing community quality, thereby guiding socially sustainable regeneration initiatives and decision making at the community scale.

Measuring global monetary damages from particulate matter and carbon dioxide emissions to track sustainable growth

An integrated framework that tracks global stocks and flows of natural capital is needed to assess sustainable economic growth. Here, we develop a set of globally comprehensive monetary damages from particulate matter air pollution and greenhouse gas emissions in 165 countries from 1998 to 2018. Our results show that pollution intensity began to rise after a decade during which the global economy became less pollution-intensive from the late 1990s until the Great Recession. Larger economic production shares and higher pollution intensity in China and India drove this change. Deducting pollution damage from output from the late 1990s until the Great Recession yields higher growth estimates. After the Great Recession, this adjustment for pollution damage attenuated growth. We show that modeling monetary damages instead of physical measures of environmental quality affects inferences about sustainable development. Further, the monetary damages from exposure to particulate emissions peak earlier in the development path than damages due to carbon dioxide emissions. Monetary damages peak later than physical measures of both pollutants. For carbon dioxide, per capita emissions maximize at just over 60,000 dollars while monetary damages peak at nearly 80,000 dollars. In 2018, all but two countries were below this income level. Our results suggest that the global economy is likely to exhibit rising damages from particulates and carbon dioxide emissions in the years to come as nations grow and develop.

A Reference Process for Assessing the Reliability of Predictive Analytics Results

Organizations employ data mining to discover patterns in historic data in order to learn predictive models. Depending on the predictive model the predictions may be more or less accurate, raising the question about the reliability of individual predictions. This paper proposes a reference process aligned with the CRISP-DM to enable the assessment of reliability of individual predictions obtained from a predictive model. The reference process describes activities along the different stages of the development process required to establish a reliability assessment approach for a predictive model. The paper then presents in more detail two specific approaches for reliability assessment: perturbation of input cases and local quality measures. Furthermore, this paper describes elements of a knowledge graph to capture important metadata about the development process and training data. The knowledge graph serves to properly configure and employ the reliability assessment approaches.

Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.

In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the "High Value Framework (HVF)" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.

Feasibility and acceptability of a home-based virtual group exercise program in global Asian adult population: Baseline characteristics of a cohort study.

To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population. We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires. The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program. This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program.