Recommendations For Quality Improvement Research Articles

Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study

ObjectivePresenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and...

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

ObjectiveTo assess the implementation and first results of a term perinatal internal audit by a standardised method.DesignPopulation-based cohort study.SettingAll 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of...

Forensic mental health assessment in France: Recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called “experts” in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

Challenges and Opportunities: Improving the Perioperative Experience for Patients Receiving Palliative Care (FR415)

1. Identify your ED/PC ‘‘Champions.’’ Specific case examples highlighting unmet palliative care needs in the ED are described, as well as the identification of clinical and administrative staff best suited to foster lasting changes. 2. Review the existing literature. By incorporating important emergency medicine policy statements, major review articles, and consensus reports, we provide essential information to support the initiation of collaborative work with the ED. 3. Identify ED resources. Recommendations are offered to actively engage the interdisciplinary ED team (physicians, nurses, social workers, chaplaincy, aides, and administrators) in the use of key PC resources. 4. Develop a plan to complete a needs assessment. We provide a sample self-assessment tool to catalog strengths and limitations of the existing ED services and their interface with outpatient, pre-hospital, and hospital-based services. The session will conclude with specific quality improvement recommendations to engage stakeholders and to measure outcomes.

보건교육의 국내 연구동향

Objectives: The purpose of this study was to identify the domestic research trends in health education published in journals and dissertations, and to provide recommendations for quality improvement. Methods: 277 papers published from 1960 to 2009 were reviewed using criteria of analysis. The results were displayed as frequencies and percentages. Results: The contents of the health education were very poor compared with the Health Promotion Act. In health education program developing and evaluation process, papers on the assessment stage occupied the largest portion. In research methodology; the survey study, school field, the questionnaire research tool and inferential statistics were the most applied. Master theses were the largest number. Conclusions: This review suggests that the published papers, in some instances, have been poorly done. However, this study may provide future guidelines for health education research, and it is hoped that higher level research can be accomplished.

Viszerale Organexplantation

The blatant problem of organ shortage leads to an increasing acceptance of organs from extended criteria donors. This increases the importance of the process of organ donation and retrieval. A working group of representatives of Bavarian retrieval surgeons and the procurement organization German Foundation of Organ Transplantation (DSO) was initiated to develop consensus-based recommendations for quality improvements in the field of organ retrieval on the basis of regional data. The main aim was to professionalize retrieval teams by specified training standards and to define objective qualifications for retrieval surgeons. Initial measures of the working group included agreement on standardized retrieval techniques and improvement of documentation in terms of quality forms and the return rate of the forms. Quality data are being analyzed prospectively with a new categorization of complications. Communication among centers and teams and complication reporting has already been improved and initial structural changes have been set up.

A Medical Mission to Guatemala as an Advanced Pharmacy Practice Experience

To describe the development and outcomes of an advanced pharmacy practice experience (APPE) for a medical mission trip to Guatemala. Pre-mission preparation and post-mission reflection activities were combined with in-country activities to create a 5-week APPE. During the 10-day medical mission trip, pharmacy students dispensed medications, counseled patients, conducted quality improvement assessments, and presented their findings and experiences as part of an interdisciplinary health care team. The students who completed the mission trip met the objectives of the APPE and reported substantial learning in the areas of interdisciplinary teamwork and cultural competency. All students' scores on the Inventory for Assessing the Process of Cultural Competence-Student Version (IAPCC-SV) increased. The majority (81%) of student-generated quality improvement recommendations were implemented by the mission team. The medical mission APPE provided a rich learning environment for pharmacy students and resulted in modifications to the medical mission operation. This type of APPE could be implemented in other colleges of pharmacy via formation of partnerships with established medical mission teams as this one was.

139 Multiple Interventions Reduce Post-Dural Puncture Headache Rates

Background: Lumbar puncture is a common emergency department (ED) procedure with widely variable complication rates reported between 0.98-19% in various experimental protocol driven settings. In the current emergency medicine environment of ABEM required performance improvement, Flexner report recommendations for quality improvement and CMS non-pay for complications, it is vital that robust performance improvement data be reported that reflect actual practice experience, without the artificiality of experimentally controlled conditions.

Greek and English linguistic identities in the EU

Translated and original texts have been claimed to differ with respect to their linguistic make-up. Parallel versions of texts seem to reflect aspects of the identities represented by the respective languages. The study exploits this potential, in the EU context, with a view to raising awareness of linguistic and cultural differences between English and Greek. A descriptive approach to parallel English and Greek EU material reveals aspects of linguistic preference across languages, with reference to the five dimensions of cultural values in Hofstede and Hofstede’s model of cultural relativism (2005). Translation practice can provide evidence of the linguistic manifestation of socially preferred patterns of behavior which determine linguistic action. Aspects of linguistic preference traced in the EU English-Greek translation context are shown against a background of linguistic preference manifested in other genres. Raising awareness of identities across languages is expected to ultimately provide recommendations for quality improvement in the EU translation practice, or how to achieve near-native command in language acquisition, while foregrounding the significance of the experienced socio-cultural realities in the study of meaning making.

World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative*

According to World Health Organization estimates, sepsis accounts for 60%-80% of lost lives per year in childhood. Measures appropriate for resource-scarce and resource-abundant settings alike can reduce sepsis deaths. In this regard, the World Federation of Pediatric Intensive Care and Critical Care Societies Board of Directors announces the Global Pediatric Sepsis Initiative, a quality improvement program designed to improve quality of care for children with sepsis. To announce the global sepsis initiative; to justify some of the bundles that are included; and to show some preliminary data and encourage participation. The Global Pediatric Sepsis Initiative is developed as a Web-based education, demonstration, and pyramid bundles/checklist tool (http://www.pediatricsepsis.org or http://www.wfpiccs.org). Four health resource categories are included. Category A involves a nonindustrialized setting with mortality rate <5 yrs and >30 of 1,000 children. Category B involves a nonindustrialized setting with mortality rate <5 yrs and <30 of 1,000 children. Category C involves a developing industrialized nation. In category D, developed industrialized nation are determined and separate accompanying administrative and clinical parameters bundles or checklist quality improvement recommendations are provided, requiring greater resources and tasks as resource allocation increased from groups A to D, respectively. In the vanguard phase, data for 361 children (category A, n = 34; category B, n = 12; category C, n = 84; category D, n = 231) were successfully entered, and quality-assurance reports were sent to the 23 participating international centers. Analysis of bundles for categories C and D showed that reduction in mortality was associated with compliance with the resuscitation (odds ratio, 0.369; 95% confidence interval, 0.188-0.724; p < .0004) and intensive care unit management (odds ratio, 0.277; 95% confidence interval, 0.096-0.80) bundles. The World Federation of Pediatric Intensive Care and Critical Care Societies Global Pediatric Sepsis Initiative is online. Success in reducing pediatric mortality and morbidity, evaluated yearly as a measure of global child health care quality improvement, requires ongoing active recruitment of international participant centers. Please join us at http://www.pediatricsepsis.org or http://www.wfpiccs.org.

Quality of Research Data, an Operational Approach

This article reports on a study, commissioned by SURFfoundation, investigating the operational aspects of the concept of quality for the various phases in the life cycle of research data: production, management, and use/re-use. Potential recommendations for quality improvement were derived from interviews and a study of the literature. These recommendations were tested via a national academic survey of three disciplinary domains as designated by the European Science Foundation: Physical Sciences and Engineering, Social Sciences and Humanities, and Life Sciences. The popularity of each recommendation was determined by comparing its perceived importance against the objections to it. On this basis, it was possible to draw up generic and discipline-specific recommendations for both the dos and the don'ts.

Suicide registration in eight European countries: A qualitative analysis of procedures and practices

Objective To compare suicide registration in eight European countries and provide recommendations for quality improvement. Method Qualitative data were collected from country experts using a structured questionnaire. Results Suicide registration was based on the medico-legal system in six countries and the coronial system in two. Differences not only between, but also within these two systems emerged. Several elements crucial to the consistency of suicide registration were identified. Conclusion A precise model for recording suicides should include: an accurate legal inquiry and clarification of suicidal intent; obligatory forensic autopsy for injury deaths; reciprocal communication among authorities; electronic data transmission; final decision-makers’ access to information; trained coders.

Dietary compliance and life style of children with coeliac disease

Coeliac disease (CD) is common and requires a permanent strict gluten-free diet (GFD). However, data concerning how the situation is experienced by children are limited. The present study aimed to investigate the compliance with a GFD and the impact of CD and GFD on the lifestyle of patients and their families, together with proposed recommendations for improvement of quality of life. Children with biopsy confirmed CD were recruited consecutively from the outpatient gastroenterology clinic. Participants were evaluated by a special questionnaire for compliance with the GFD, patients' knowledge about CD, and the well-being and lifestyle of children and their families. Comparisons between discrete variables were performed by a chi-square test. Seventy-three children of median age 9.4 (interquartile range = 5-14.5) years were evaluated. Compliance to diet was reported by 58%. Reasons for noncompliance were: poor palatability (32%), dining outside home (17%), poor availability of products (11%), and asymptomatic disease diagnosed by screening (11%). The acceptance of the GFD was reported as good in 65%, whereas avoidance of travelling and restaurants was stated by 17% and 46% of families, respectively. Most families experienced difficulties detecting gluten from the food label. Proposed factors for improvement of quality of life were: better labelling of gluten-containing ingredients (76%) and more gluten-free (GF) foods in supermarkets (58%) and restaurants (42%). Children with CD have low compliance with the GFD. Better education about the disease, the availability of GF products, and appropriate food labelling could improve compliance and quality of life.

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.

Microbiological Quality Assessment of Laboratory Mice in Korea and Recommendations for Quality Improvement

Regular monitoring of commercial laboratory rodents and institutional research animal residents is essential for microbiological quality control programs. The objective of our study was to investigate the recent prevalence of infectious pathogens in laboratory mice from eight experimental animal vendors and 56 institutional animal facilities in Korea. Our investigation was conducted in 2006-2007. Specific Pathogen Free (SPF) mice from four commercial breeders were clean according to serological, bacteriological, parasitological, and histopathological examination results. However, mice from one intermediate vendor that distributed SPF animals from main commercial vendors to local districts had Syphacia obvelata and Mycoptes musculinus infections. Additionally, mice from conventional animal breeders were highly contaminated. Among the 56 institutional animal facilities, mouse hepatitis virus (MHV), Sendai virus and Mycoplasma pulmonis positive results were obtained in 23.2, 8.9, and 1.8% of animals tested, respectively. These results indicate that quarantine and eradication efforts of infectious pathogens in these facilities are sub-optimal and need to be improved. The use of commercial conventional mice for research should be eliminated and appropriate vendor selection as well as thorough quarantine before releasing animals into a facility are needed. Finally we suggest qualified veterinary experts are needed at each animal facility to ensure an adequate health surveillance program.

Assessing the Quality of Randomized Controlled Trials Examining Psychological Interventions for Pediatric Procedural Pain: Recommendations for Quality Improvement

Systematic reviews of randomized controlled trials (RCTs) support the efficacy of psychological interventions for procedural pain management. However, methodological limitations (e.g., inadequate randomization) have affected the quality of this research, thereby weakening RCT findings. Detailed quality coding was conducted on 28 RCTs included in a systematic review of psychological interventions for pediatric procedural pain. The majority of RCTs were of poor to low quality (criteria reported in <50% of RCTs). Commonly reported criteria addressed study background, conditions, statistical analyses, and interpretation of results. Commonly nonreported criteria included treatment administration, evaluation of treatment efficacy (effect sizes, summary statistics, intention-to-treat analyses), caregiver demographics, follow-up, and participant flow. Quality was greater in more recent trials, and did not vary by journal type (psychology vs. medical). Despite poor quality ratings, quality reporting in psychological RCTs for pediatric procedural pain has improved over time. Recommendations for quality enhancement are provided.

RESEARCH ON THE QUALITY OF PASSENGER TRANSPORTATION BY RAILWAY

The transportation of passengers by railroads is a dynamic process because setting, wherein the process takes place, undergoes continuous changes observed at technical, technological and transportation process planning levels. Every passenger has different needs and aims and can afford different possibilities. Therefore, the conception of quality differs in each individual case. In order to be able to plan a railway trip process in a proper manner, it is important to become familiarized with passenger needs and preferences and eliminate any existing deficiencies. To this end, it is reasonable to conduct passenger surveys. The paper provides an affinity diagram of railway transportation quality factors, the elements whereof correspond to the structure of the survey questionnaire. For determining the level of the quantitative significance (weight) of indicators, there was applied the method of Analytic Hierarchy Process (AHP) developed and introduced by the American scientist T. Saaty. The scope of research work carried out by the authors covered the determination of the highest eigenvalue, the compatibility ratio, the concordance correlation coefficient, the estimated and critical value of chi‐square values (the examples of estimations are presented in the paper) as well as the classification and processing of the surveyed data on passenger questionnaire and the analysis of respondents’ opinion. The closing part of the paper presents conclusions drawn based on the findings of the survey and respective recommendations for quality improvements in passenger transportation by Lithuanian railways.

School assessment in Thailand: roles and achievement of ONESQA

The 1999 National Education Act emphasizes the importance of quality assurance and national education standards. The main principle of educational provision of high standard lies in recognition of the importance of assessment for enhancing educational quality and raising the standard. Such recognition has led to establishment in Thailand of the Office for National Education Standards and Quality Assessment (ONESQA). The office is an independent body set up to develop the criteria, methods for external assessment and assessment of educational institutions at each level of education as stipulated in the national education law. The ONESQA became operational in November 2000 and it must appraise every school at least once every 5-year cycle. In this paper, the unique and the roles of the ONESQA will be described. The achievement of the ONESQA concerning the first round assessment of 35,134 schools at the basic education level will be reported and recommendations for quality improvements and lessons learned for the second round assessment will be explored.

Addressing pain on compression: women and radiographers working together

Pain on compression is a major source of complaints to screening programmes. Fear of pain may affect women's participation and thus limit a programme's potential to reduce mortality. This poster describes a quality improvement project on pain in which radiographers and women worked in partnership. BreastScreen Victoria screens over 200,000 women each year. Our Screening and Assessment Services audit complaints and provide a forum for consumer advisory groups to discuss these complaints and offer recommendations for quality improvement. A Radiography 'Q' Group is responsible for monitoring and reviewing state-wide service quality and safety. A strategy to manage pain on compression was developed at BreastScreen Victoria's Bendigo service. The service monitored complaints about pain, consulted its Consumer Advisory Group, and devised an information-based strategy that successfully reduced complaints and improved women's experience. The Radiography Q Group has further developed the strategy and is currently overseeing its implementation at all screening sites. The success of the Pain on Compression project confirms the value of a radiographer-specific quality group working with women to achieve improvements in our screening programme.

Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialists

To evaluate the impact of facilitation by management consultants on implementing recommendations from external quality assessment (visitatie). Data collection through a postal survey amongst 205 medical specialists, representing 50 hospital-based specialist groups in the Netherlands. Under the auspices of the specialty societies of surgeons, paediatricians and gynaecologists, 25 groups were offered approximately 20 h of management consulting to support the implementation of recommendations for quality improvement and were compared to 25 specialist groups not receiving the support. The Quality Consultation (QC) took a site-specific multifaceted implementation approach. Self-reported degree of implementation of recommendations, specialists' judgement of implementation result and process; experienced obstructing factors in implementing recommendations. The response rate was 54% (n = 110). The supported specialist groups were more successful in partially or fully implementing the recommendations from external peer assessment: 66.1% vs. 53.8%. The implementation result and process were also rated significantly higher for the supported groups. The supported groups reported significantly less (P < 0.005) obstructing factors; in particular for the barriers 'expectation of implementation advantages', 'acceptance of the recommendations' and 'assessed self-efficacy'. The experienced obstructing factors are strongly related with the degree of implementation (spearman rho 0.57-32.5%). This study suggests QC is a powerful implementation strategy. It also shows the limitations of merely quantitatively analysing multifaceted strategies: it does not offer any insight into the 'black box' of the QC. It is recommended that these limitations are met by also exploring multifaceted strategies qualitatively.