Standardized Quality Indicators Research Articles

Towards Efficient Value-Based Healthcare Measurement Across Hospital Care Pathways - A Scoping Review.

Hospitals widely employ value-based healthcare (VBHC) to effectively manage healthcare quality. VBHC aims to maximize patient outcomes while minimizing costs by using quality measurements. The Dutch Erasmus Medical Centre experiences challenges with the time-consuming efforts to collect, evaluate, and present value-based quality measurements. Using similar VBHC measurement indicators across multiple care pathways could reduce these efforts. This study aims to identify such generic indicators for evaluating and monitoring VBHC across care pathways. A scoping review resulted in 33 articles from which indicators for VBHC measurement were extracted, aggregated and categorized using Donabedian's Structure-Process-Outcome model. The results of this study can inform researchers and VBHC practitioners on generic quality measurement indicators for VBHC management and guide future system development to facilitate the inclusion of standardized quality indicators in healthcare information systems.

ФОРМИРОВАНИЕ КАЧЕСТВЕННЫХ ХАРАКТЕРИСТИК ПИВНЫХ НАПИТКОВ С ПЛОДОВО-ЯГОДНЫМ СЫРЬЕМ

Beer drinks are gaining more and more popularity, they are distinguished by original taste and aroma characteristics. Consumer interest in beer drinks with the use of fruit and berry raw materials is noted. The objective of the study is to develop a technology for beer drinks using fruit and berry raw materials and to form their quality characteristics. Tasks: to determine the dosage of juices (cherry, currant, raspberry) in the recipe for a beer drink based on light unfiltered beer Prazhskoye by studying the standardized quality indicators and identifying the best sample by overall characteristics; establishing the shelf life of beer drinks with the addition of juices by analyzing safety indicators in accordance with TR CU 021/2011; ma-king adjustments to the technological process to extend the shelf life of beer drinks. The objects of the study were beer drinks based on light unfiltered beer Prazhskoye with the addition of clarified cherry, currant and raspberry juice, produced according to GOST 32102-2013 Group H54 "Canned goods. Juice products. Concentrated fruit juices. General specifications" in quantities of 10, 20, 30 % of beer wort. In the work, generally accepted methods of analysis of organoleptic, physicochemical and microbiological quality indicators were used. The technology of beer drinks was developed, the quantitative dosage of juices was selected: cherry – 20 %, currant – 10, raspberry – 30 % of beer wort. A comprehensive assessment of the quality of the developed drinks was carried out according to organoleptic, physicochemical, microbiological quality indicators. The shelf life of beer drinks was determined – 30 days. The obtained results allow the enterprise to expand the range of beer products and satisfy consumer demand for high-quality domestic drinks with fruit and berry raw materials.

A-062 Development of Quality Control Indicators in the Pre-analytical Phase and a Survey on the Current Status of Clinical Laboratories in Korea

Abstract Background Pre-analytical errors, which account for 50%–75% of all laboratory errors, include various processes handled by various occupations such as prescription, data input, sample collection, sample transport, and sample reception, making it difficult to present standardized quality indicators. Internationally, efforts are being made to present pre-analytical quality indicators and standardize/harmonize them, but in Korea, the status of pre-analytical errors in laboratories has not been identified. Therefore, this study attempted to contribute to improving the quality of domestic clinical laboratories by presenting pre-analytical quality indicators that can be easily applied and effectively managed in domestic clinical laboratories. Methods Domestic and foreign programs for pre-analytical quality indicators were investigated, and a pre-analytical quality indicator survey was conducted for domestic clinical laboratories. The survey results were analyzed to identify the current status and problems of quality management in the pre-analytical stage of the domestic clinical laboratories, and the appropriateness of the pre-analytical quality indicators in the application of the domestic clinical laboratories was reviewed. Results We prepared 22 pre-analytical quality indicators by referring to the “Quality indicators of the Pre-analytical phase” presented by the International Federation of Clinical Chemistry Working Group (2017) and “Development of an external quality control program in the pre-analytical stage for reliable laboratory implementation” presented by the Korean Association of External Quality Assessment (2021). A survey was conducted on 90 institutions nationwide, including tertiary hospitals, secondary hospitals, and professional consignment laboratories. As a result of the survey, 42 institutions (47%) responded, of which 64% were tertiary hospitals, 22% were secondary hospitals, and 14% were professional consignment laboratories. Among the quality indicators, the rate of complete blood counts accompanied by blood clots (93%) and the insufficient sample volume rate (90%) showed the highest response rate. On the other hand, the sample recollection rate (17% in the out of laboratory, 21% in the laboratory), the ratio of samples carried at nonconforming temperatures (24%), and the ratio of delayed samples (24%) showed the lowest response rate, respectively. The median value of the clinical laboratory error rate for all quality indicators of pre-analytical phase was generally very good with a sigma value of 5 or higher. Conclusion In this study, 22 pre-analytical quality indicators applicable to domestic clinical laboratories were prepared. Using this, the status of quality management in the pre-analytical phase of the domestic clinical laboratory was identified, and the appropriateness of quality indicators was reviewed. This is an important cornerstone for the standardization of quality management in the pre-analytical phase, and it is expected that it will greatly contribute to improving the quality of clinical laboratories in Korea by establishing a pre-analytical quality management system in the future.

Development of technical regulation for cement composite mats

Introduction. Currently, such an innovative material as composite cement mats (concrete cloth) is widely used in construction. Due to the novelty of this material, there are currently no approved regulatory and technical documents regulating the general technical conditions of the concrete cloth (including a list and normalized values of indicators that determine the quality of the material), as well as test methods for its normalized indicators.The aim of the research was to study and systematize the currently available information about cement composite mats, as well as to form approaches for the development of a number of relevant regulatory and technical documents.Materials and methods. A review, systematization and analysis of domestic and foreign research and practical works, as well as aspects of technical regulation for cement composite mats, has been carried out.Results. The characteristic of the current status of technical regulation for cement composite mats is given, approaches for its development are indicated. The areas of application of cement composite mats are summarized; material quality indicators recommended for rationing and test methods for their determination; recommendations for the development of standard test methods are given.Conclusions. To improve cement mats quality and accessibility, as well as to increase the share of their use in the construction industry, it is necessary to develop regulatory documents that establish technical requirements for the material, its standardized quality indicators and test methods for their control. When developing them, it is rational to use the accumulated experience of practical application and research of cement composite mats, which is summarized in this article and reflects the main trends in the development of the regulatory framework for this material.

Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach.

Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. Without standardized quality indicators (QIs), it is difficult to characterize and compare the abilities of institutions to achieve excellence. The aim of this study is to reach a consensus among glaucoma specialists concerning the development of a set of QIs to assess the performance of glaucoma care units. A two-round Delphi technique was performed among glaucoma specialists in Portugal, using a 7-point Likert scale. Fifty-three initial statements (comprising process, structure, and outcome indicators) were evaluated and participants had to agree on which ones would be part of the final set of QIs. By the end of both rounds, 28 glaucoma specialists reached consensus on 30/53 (57%) statements, including 19 (63%) process indicators (mainly relating to the proper implementation of complementary exams and the setting of follow-up intervals), 6 (20%) structure indicators, and 5 (17%) outcome indicators. Of the indicators that were part of the final list, functional and structural aspects of glaucoma progression and the availability of surgical/laser procedures were the most prevalent. A set of 30 QIs for measuring the performance of glaucoma units was developed using a consensus methodology involving experts in the field. Their use as measurement standards would provide important information about unit operations and allow further implementation of quality improvements.

Review of approaches to determining the viscosity-penetration dependence of bituminous binders

Abstract. Problem. The constant growth of load tension and traffic intensity on highways requires an increase in the quality and durability of asphalt concrete coatings. At present, conventional indicators for evaluating the quality of bituminous binders, such as penetration, softening temperature and brittleness, are still used in the vast majority of countries around the world. It is impossible to determine with the help of these indicators the characteristics necessary for the design of road clothing. Taking this into account, at the beginning of the last century, some researchers took steps to establish the relationship between standardized quality indicators (penetration, softening temperature, brittleness temperature according to Fraas) with fundamental ones, in particular, toughness. Goal. The purpose of the work is to consider, based on literature data, approaches to determining the viscosity-penetration dependences of bituminous binders, which have been developed for almost a century. Methodology. In order to achieve the set goal, a search was made for literary sources devoted to the issues of viscosity calculation, a critical review of them was performed, and the criteria for their application were established. Results. In 1933, Saal R.N.J. and Koens J. were the first to propose a formula that made it possible to calculate viscosity based on the value of a standard indicator - penetration. This gave impetus to an almost age-old study in which scientists from different countries of the world participated. The purpose of this study was to develop a numerical method for determining viscosity based on the value of penetration. Due to the fact that the quality of bitumen significantly depends on the raw materials from which they are made, manufacturing technology, group composition, structural and rheological type, for almost 90 years it was not possible to develop a dependence that would link the fundamental indicator with high accuracy (viscosity ) with standardized conditional (penetration). Despite this, the formulas proposed by various researchers formed the basis of two widespread road bitumen classification systems and the nomogram for determining bitumen hardness, which was used by designers of various countries of the world for 40 years. The analysis of these literary sources shows the persistent interest of researchers and manufacturers in the possibility of determining the viscosity values of bituminous binders by the calculation method, based on experimentally determined values of penetration. Practical value. It has been established that currently the task of calculating the viscosity based on the penetration value is becoming particularly relevant due to the fact that in modern conditions unmodified bitumens are being replaced by bitumens modified with various additives, for which the previously established dependencies are not valid.

Quality of Sarcoma Care: Longitudinal Real-Time Assessment and Evidence Analytics of Quality Indicators.

Sarcomas represent a large group of rare to very rare diseases, requiring complex management with a transdisciplinary approach. Overall progress has been hampered because of discipline, institution and network fragmentation, and there is no global data harmonization or quality standards. To report on and improve quality, a common definition of quality indicators (QIs) of sarcoma care as well as the capacity to assess longitudinal real-time data is required. An international advisory board of world-renowned sarcoma experts defined six categories of QIs, totaling more than 80 quality indicators. An interoperable (web-based) digital platform was then created combining the management of the weekly sarcoma board meeting with the sarcoma registry and incorporating patient-reported outcome measures (PROMs) into the routine follow-up care to assess the entire care cycle of the patient. The QIs were then programmed into the digital platform for real-time analysis and visualization. The definition of standardized QIs covering all physician- (diagnostics and therapeutics), patient- (PROMS/PREMS), and cost-based aspects in combination with their real-time assessment over the entire sarcoma care cycle can be realized. Standardized QIs as well as their real-time assessment and data visualization are critical to improving the quality of sarcoma care. By enabling predictive modelling and introducing VBHC, precision health care for a complex disease is on the horizon.

ENVIRONMENTALLY FRIENDLY BLEACHING OF DISSOLVING CHEMICAL SULPHITE WOOD PULP AND CHARACTERIZATION OF WASTE WATER

The aim of the work is the environmental assessment for bleaching and alkali treatment of dissolving chemical pulp. Samples of the original unbleached pulp: industrial hard bisulfite pulp with a high mass fraction of lignin, traditionally used for the production of paper, and soft sulfite pulp with a low content of lignin, usually used to produce dissolving chemical pulp. In order to reduce the environmental impact, bleaching and alkali treatment were carried out according to the original technologies developed by the authors: bisulfite pulp - according to the ECF technology using two oxidizing bleaching reagents by scheme Pa-E-Ch1-HE-Ch2-A; sulfite pulp - according to the TCF-technology using one oxidizing bleaching agent by scheme Pa-E-HE-P-A in just 4 stages. Produced samples of pulp according to the standardized quality indicators, meet the requirements of the norms for wood sulphite pulp CA grade P (for nitration). The environmental characteristics of wastewater from bleaching and alkali treatment of both samples using the developed ECF and TCF technologies after biological treatment in terms of the main indicators (COD, BOD, AOX) comply with EU standards.

Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru.

Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.

Разработка и оценка качества майонезного соуса с использованием масла амаранта

We determined the possibility of using amaranth oil (Amaranthus) in mayonnaise sauces while maintaining regulated quality indicators. The properties of four mayonnaise sauce samples, in which a part of sunflower oil was partially replaced by amaranth oil (5, 10, 15, and 20%), are studied. The characteristic features of production were found in terms of organoleptic and physicochemical indicators. Measurement methods were used to analyze pH and acidity, mass fraction of moisture, mass fraction of fat, and emulsion stability in accordance with regulated requirements, as well as squalene content. It has been established that an increase in the proportion of amaranth oil in the formulation by 15% is significantly higher than the viscosity and stability of the emulsion of the finished product, while its taste and flavor deteriorate. The viscosity value with an increase in the proportion of amaranth oil to 20% decreases by 5%, the stability of the non-destructive emulsion is 96%; acidity, pH, and mass fraction of moisture practically do not change. It is shown that mayonnaise sample with the replacement of sunflower oil with amaranth oil in the amount of 10% have the best quality indicators, which allows to obtain a product with standardized quality indicators. The shelf life of mayonnaise sauce with amaranth oil has been established (30 days). In addition to standardized physicochemical indicators, the content of squalene has been introduced as a new organoleptic indicator. Its value has been estimated to be from 0.04 to 0.06 g per 100 g of the product. The nutritional value of the developed sauce is presented. It is shown that using 30 g of the sauce per day corresponds to 10% of dietary reference intake for squalene. The use of amaranth oil is an innovation that allows increasing the biological value of the product and enriching it with squalene.

AB037. Quality measurement of specialty care in Pacific Rim countries: an analysis of five models

Background: Due to its complexity, specialty care is more concentrated in urban areas, and less subject to being measured by standardized quality indicators. A quality measurement program can inform resource allocation and patient care-seeking. Particularly for specialty care, rural residents might need to travel to unfamiliar urban facilities. This analysis surveys existing initiatives to inform stakeholders of the diverse ways to develop such a program.

Application of the alveograph device for the development of requirements for the quality of flour for the production of a wafer sheet

Due to the constantly growing demand for flour confectionery and culinary products, it became necessary to develop specialized requirements for the quality of wheat flour as a raw material. To date, there are no such requirements in our country, and for the production of these products, bakery flour obtained according to the traditional wheat grind scheme was used, the quality of which had to be leveled depending on the range of confectionery products. One way to solve this problem is to differentiate the properties of wheat flour according to its intended purpose and their rationing. The purpose of the study is to develop quality requirements for Russian wheat flour for the production of wafer sheets according to objectively and reliably determined indicators of the dough rheological properties using an alveograph device to create, in the future, a system for classifying wheat flour by its intended purpose. Flour quality assessment was carried out using domestic devices and laboratory equipment (MOK system, Falling-number value, etc.); the dough rheological properties were evaluated by an alveograph device (company Chopin, France), wafer sheets were baked and evaluated using methods previously developed by the authors. The analysis of the interdependence of standardized quality indicators, as well as newly developed ones, was conducted to identify indicators that differentiate the quality of wheat flour by its intended purpose, i.e. by finished products. For this, methods of mathematical statistics were applied.

Design quality assessment of campus facilities through post occupancy evaluation

PurposeThis study aims to present the design quality assessment of facilities on a university campus in Saudi Arabia.Design/methodology/approachForty-nine standardized design quality indicators (DQIs) have been adopted for the study. These were classified into relevant categories including: “Indoor Environment, Safety and Maintenance,” “Furniture, Utilities and Spaces” and “Privacy, Appearance and Surrounding Areas.” A web-based survey was used to obtain responses from 207 respondents. The survey was designed based on a Likert scale of satisfaction and was analyzed to obtain the satisfaction indices (SI) as well as Design Quality Scores (DQS).FindingsOccupants were dissatisfied the “level of noise generated from within the space,” “amount of natural light from daylighting systems” and “ease of control of air ventilation systems” among others. The DQS revealed that residential buildings had the highest design quality in terms of “Indoor Environment, Safety, and Maintenance” and “Privacy, Appearance and Surrounding Areas.” Administrative buildings had the best design quality in terms of “furniture, utilities and spaces.” Academic buildings had the lowest design quality in terms of “Indoor Environment, Safety and Maintenance” and “Privacy, Appearance and Surrounding Areas.”Originality/valueUltimately, the study demonstrated how the adoption of a standard set of DQIs could facilitate the standardization of design quality evaluation in the property sector as well as identify best practices through comparison and benchmarking.

What should be measured to assess the quality of community-based palliative care? Results from a collaborative expert workshop.

The need for palliative care (PC) will continue to increase in Canada with population aging. Many older adults prefer to "age in place" and receive care in their own homes. Currently, there is a lack of standardized quality indicators (QIs) for PC delivered in the community in Canada. A one-day workshop collected expert opinions on what should be measured to capture quality PC. Three brainstorming sessions were focused on addressing the following questions: (1) what is important to measure to support quality PC, regardless of setting? (2) Of the identified measures, are any of special importance to care provided in the home? (3) What are the challenges, barriers, and opportunities for creating these measures? The National Consensus Project (NCP) for Quality Palliative Care framework was used as a guide to group together important comments into key themes. The experts identified four themes that are important for measuring quality, regardless of care setting, including access to care in the community by a multidisciplinary team, care for the individual with PC needs, support for the informal caregiver (e.g., family, friends), and symptom management for individuals with PC needs. Two additional themes were of special importance to measuring quality PC in the home, including spiritual care for individuals with PC needs and home as the preferred place of death. The challenges, barriers, and potential opportunities to these quality issues were also discussed. PC experts, through this collaborative process, made a substantial contribution to the creation of a standardized set of QIs for community-based PC. Having a standardized set of QIs will enable health care professionals and decision makers to target areas for improvement, implement interventions to improve the quality of care, and ultimately, optimize the health and well-being of individuals with a serious illness.

Estimating the Steam Quality in Power-Generating Boilers from Electrical Conductivity and pH Measurements

The quality of steam produced by boilers is strictly standardized and must be maintained whatever the quality of makeup water and whatever the composition of the boiler unit’s thermal cycle equipment. Under the conditions of constantly improved instruments for chemical monitoring, it becomes possible to develop measurement systems using which the main standardized and diagnostic steam quality indicators can be monitored by measuring the electric conductivity and pH of cooled samples. Unlike boilers operating at a pressure of 13.8 MPa and higher, steam boilers for steam pressures equal to 9.8 and 3.9 MPa—and also industrial heat recovery steam generators—operate with steam that has a higher content of salts and carbon dioxide; in addition, it contains ammonia, which enters into steam from boiler water. Steam quality is often estimated using the two-quadrant nomographic chart of Mostofin, who proposed it more than 50 years ago. In using certain computation algorithms, it is possible to calculate the standardized and diagnostic steam quality indicators, such as concentrations of sodium, chlorides, ammonia, carbon dioxide, and salt content. The article presents an algorithm for estimating the concentrations of the above-mentioned impurities for cooled live steam samples of power-generating boilers operating at pressures below 10.0 MPa, and boilers for superhigh and supercritical pressures, and industrial heat recovery steam generators, including the combined-cycle power plant units. Examples of using the calculation procedure for analyzing the steam quality in industrial boilers are given.

A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma.

There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care. QIs are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available QIs, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process QIs in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them. We performed a scoping review of 4 electronic bibliographic databases for studies reporting on process QIs in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator. We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intraocular pressure. Indicators regarding the quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned. There are notable variations among process QIs in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.

Experiencia de reconversión de un servicio clínico anestésico-quirúrgico en unidad de pacientes críticos COVID-19 en un hospital universitario

Introduction: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical-anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. Objectives: Describe the unit’s restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. Matherial and Methods: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an institutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. Results: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. Discussion: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health. © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.

Peptides from Animal Origin: A Systematic Review on Biological Sources and Effects on Skin Wounds.

Background Skin wounds are closely correlated with opportunistic infections and sepsis risk. Due to the need of more efficient healing drugs, animal peptides are emerging as new molecular platforms to accelerate skin wound closure and to prevent and control bacterial infection. Aim The aim of this study was to evaluate the preclinical evidence on the impact of animal peptides on skin wound healing. In addition, we carried out a critical analysis of the studies' methodological quality. Main Methods. This systematic review was performed according to the PRISMA guidelines, using a structured search on the PubMed-Medline, Scopus, and Web of Science platforms to retrieve studies published until August 25, 2020 at 3 : 00 pm. The studies included were limited to those that used animal models, investigated the effect of animal peptides with no association with other compounds on wound healing, and that were published in English. Bias analysis and methodological quality assessments were examined through the SYRCLE's RoB tool. Results Thirty studies were identified using the PRISMA workflow. In general, animal peptides were effective in accelerating skin wound healing, especially by increasing cellular proliferation, neoangiogenesis, colagenogenesis, and reepithelialization. Considering standardized methodological quality indicators, we identified a marked heterogeneity in research protocols and a high risk of bias associated with limited characterization of the experimental designs. Conclusion Animal peptides show a remarkable healing potential with biotechnological relevance for regenerative medicine. However, rigorous experimental approaches are still required to clearly delimit the mechanisms underlying the healing effects and the risk-benefit ratio attributed to peptide-based treatments.

Quality of care of acute ischemic stroke in Germany 2018

In this overview the current quality of acute in-hospital care of stroke patients in Germany in 2018 is described based on standardized and evidence-based quality indicators. For this purpose the reports of the regional quality assurance projects for stroke care, which collaborated within the German-speaking Stroke Registers Study Group (ADSR) were analyzed. Overall, more than 280,000 acute admissions of stroke patients were documented in the included quality assurance projects. The results regarding the defined 16 quality indicators comprising diagnostics, acute treatment, rehabilitation and secondary prevention showed ahigh level of acute inpatient treatment of stroke in Germany. Only a few quality indicators, such as early transfer for thrombectomy indicated a great necessity for process optimization.

A Multidisciplinary Process to Improve Quality Indicators in a Veterans Affairs Community Living Center

Quality Indicators (QIs) are an important part of Long-Term Care Quality improvement initiatives and 1 of 3 domains of the overall star rating developed by Centers for Medicare/Medicaid (CMS). At the Corporal Michael J Cresencz Veterans Affairs Community Living Center (CLC), a 120-bed Long-Term Care institution in Philadelphia, PA, we were scored a 1-star facility on CMS standardized quality indicators. The administrative and clinical teams felt we were better than this and undertook an initiative to study and hopefully improve the indicators.