Standardized Quality Indicators Research Articles

QS ENDO Real - A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland.

Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

Использование альвеографа при разработке требований к качеству муки для производства вафельного листа

Objectively and reliably determined indicators of rheological properties of the dough were identified using the alveograph device to create a system of classifications of wheat and flour from it for the intended purpose in the future. The analysis of the relationship of standardized quality indicators, as well as newly developed indicators for identifying them, differentiating the quality of wheat flour for the intended purpose, i.e. for finished products. To do this, we use mathematical statistics methods.

Development of universal method for determining specific mass or thickness of scale crust on the surface of wire rod after continuous cooling

Problem statement. The production of various metal products using hot plastic deformation or heat treatment is inevitably linked to the processes of oxidation of steel because of its interaction with the air or atmosphere of the furnace. At the same time, changes occur in the chemical composition of the surface metal layer, the formation of oxides (scale), the transformation of their phase composition during the processing, which, in turn, depends on the temperature, speed and method of cooling the metal.The most widespread type of metal products, for which the scale is standardized not only by the requirements of the relevant standards, but also has a significant impact on the process of subsequent processing, is wire rod. The carbon steel scale, formed at high temperatures, consists of three oxides (FeO, Fe3O4 and Fe2O3), the actual content of which affects the formation of various density, and, consequently, different specific mass of scale with the same thickness of its layer on the rolled surface. In view of the fact that the known methods for determining the specific mass of the scale are rather laborious and require appropriate qualifications of technical personnel, there is a need to develop a universal method for qualitative and quantitative assessment of oxides formed on the surface of carbon steel, depending on changes in the technological parameters of production. Purpose. Development of a method for determining the specific mass or thickness of the scale layer formed on the surface of a wire rod of various diameters, with its actual chemical composition. Results. Based on the known chemical and physical patterns of processes occurring during high-temperature interaction of the surface of carbon steels and atmospheric air, a universal mathematical model has been developed that allows to elaborate one of the standardized quality indicators and it can be recommended as an alternative method for determining the specific mass or thickness of the scale on the surface wire rod in the research laboratories of metallurgical enterprises.

Assessment of Avoidable Readmissions in a Visceral Surgery Department with an Algorithm: Methodology, Analysis and Measures for Improvement.

Standardized quality indicators assessing avoidable readmission become increasingly important in health care. They can identify improvements area and contribute to enhance the care delivered. However, the way of using them in practice was rarely described. Retrospective study uses prospective inpatients' information. Thirty-day readmissions were deemed potentially avoidable or non-avoidable by a computerized algorithm, and annual rate was reported between 2010 and 2014. Observed rate was compared to expected rate, and medical record review of potentially avoidable readmissions was conducted on data between January and June 2014. During a period of ten semesters, 11,011 stays were screened by the algorithm and a potentially avoidable readmission rate (PAR) of 7% was measured. Despite stable expected rate of 5 ± 0.5%, an increase was noted concerning the observed rate since 2012, with a highest value of 9.4% during the first semester 2014. Medical chart review assessed the 109 patients screened positive for PAR during this period and measured a real rate of 7.8%. The delta was in part due to an underestimated case mix owing to sub-coded comorbidities and not to health care issue. The present study suggests a methodology for practical use of data, allowing a validated quality of care indicator. The trend of the observed PAR rate showed a clear increase, while the expected PAR rate was stable. The analysis emphasized the importance of adequate "coding chain" when such an algorithm is applied. Moreover, additional medical chart review is needed when results deviate from the norm.

Impact of quality improvement in tuberculosis laboratories in low- and lower-middle-income countries: a systematic review.

The effect of quality improvement measures on the performance of diagnostic tuberculosis (TB) laboratories in low- and lower-middle-income countries is not known, and is the subject of this review. Three databases were searched for quality improvement studies presenting data on performance parameters before and after the implementation of quality improvement interventions. Twenty-one studies were included in this review. Quality improvement measures were most frequently implemented by an external organization; settings targeted ranged from microscopy centers, hospitals, districts, regional and national reference laboratories. Quality improvement interventions and outcome measurements were highly heterogeneous. Most studies investigated interventions aimed at improving smear microscopy (n = 17). Two studies evaluated comprehensive quality improvement measures (n = 2) and another three studies focused on mycobacterial culture and drug susceptibility testing. Most studies showed an improvement in outcomes measured on before-after or time trend analysis. Quality improvement measures implemented in TB laboratories showed a positive impact on various outcomes. Due to the high heterogeneity of outcome reporting and interventions and the low quality of the studies, the effect size was not clear. Identification of standardized quality indicators and their link to the quality of patient care would improve knowledge in this field.

A Dutch Nationwide Bariatric Quality Registry: DATO

IntroductionIn the Netherlands, the number of bariatric procedures increased exponentially in the 90s. To ensure and improve the quality of bariatric surgery, the nationwide Dutch Audit for Treatment of Obesity (DATO) was established in 2014. The audit was coordinated by the Dutch Institute for Clinical Auditing (DICA). This article provides a review of the aforementioned process in establishing a nationwide registry in the Netherlands.Materials and MethodsIn collaboration with the DATO’s scientific committee and other stakeholders, an annual list of several external quality indicators was formulated. This list consists of volume, process, and outcome indicators.In addition to the annual external indicators, the database permits individual hospitals to analyze their own data. The dashboard provides several standardized reports and detailed quality indicators, which are updated on a weekly base.ResultsSince the start, all 18 Dutch bariatric centers participated in the nationwide audit. A total of 21,941 cases were registered between 2015 and 2016. By 2016, the required variables were registered in 94.3% of all cases. A severe complicated course was seen in 2.87%, and mortality in 0.05% in 2016. The first-year follow-up shows a > 20% TWL in 86.1% of the registered cases.DiscussionThe DATO has become rapidly a mature registry. The well-organized structure of the national audit institution DICA and governmental funding were essential. However, most important were the bariatric teams themselves. The authors believe reporting the results from the registry has already contributed to more knowledge and acceptance by other health care providers.

A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan

BackgroundImproving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems.MethodsWe used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources.ResultsBoth Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety.ConclusionStudy findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

Errors in the Extra-Analytical Phases of Clinical Chemistry Laboratory Testing.

The total testing process consists of various phases from the pre-preanalytical to the post-postanalytical phase, the so-called brain-to-brain loop. With improvements in analytical techniques and efficient quality control programmes, most laboratory errors now occur in the extra-analytical phases. There has been recent interest in these errors with numerous publications highlighting their effect on service delivery, patient care and cost. This interest has led to the formation of various working groups whose mission is to develop standardized quality indicators which can be used to measure the performance of service of these phases. This will eventually lead to the development of external quality assessment schemes to monitor these phases in agreement with ISO15189:2012 recommendations. This review focuses on potential errors in the extra-analytical phases of clinical chemistry laboratory testing, some of the studies performed to assess the severity and impact of these errors and processes that are in place to address these errors. The aim of this review is to highlight the importance of these errors for the requesting clinician.

The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative.

Acute flaccid paralysis (AFP) surveillance is a key strategy used by the Global Polio Eradication Initiative (GPEI) to measure progress towards reaching the global eradication goal. Supported by a global polio laboratory network, AFP surveillance is conducted in 179 of 194 WHO member states. Active surveillance visits to priority health facilities are used to assure all children <15 years with AFP are detected, followed by stool specimen collection and testing for poliovirus in WHO-accredited polio laboratories. The quality of AFP surveillance is regularly monitored with standardized surveillance quality indicators. In highest risk countries and areas, the sensitivity of AFP surveillance is enhanced by environmental surveillance (testing of sewage samples). Genetic sequencing of detected poliovirus isolates yields programmatically important information on polio transmission pathways. AFP surveillance is one of the most valuable assets of the GPEI, with the potential to serve as a platform to build integrated disease surveillance systems. Continued support to maintain AFP surveillance systems will be essential, to reliably monitor the completion of global polio eradication, and to assure that a key resource for building surveillance capacity is transitioned post-eradication to support other health priorities.

Розробка моделі факторів впливу на експлуатаційні показники пластикових карток

In recent years, plastic cards have become a standard attribute of life in economically developed countries, and are increasingly spreading in Ukraine. Thanks to the reliability and ease of use, plastic cards are used in many areas of business. Plastic cards as a new product type require a comparison of the technical capabilities of processes and equipment, the selection of materials, the setting of exactly those parameters of technological regimes that can provide a standardized quality indicators of products.The article deals with the problems arising during the operation of plastic cards and their solutions. The methods of system and matrix analysis, graph theory are proposed to use to achieve the objectives — to highlight the presentation and formalization of relations between the factors of influence on the performance characteristics of plastic cards. The use of the analysis of factors influencing the operating performance of plastic cards, allowed to build a structured hierarchy model with the identification of priority of their impact on the manufacturing process.Among the factors that influence the performance of plastic cards, in the process of interviewing respondents were highlighted: the printing method; materials for manufacturing; magnetic stripe; microchip installation; scratch coating; bar code; embossing; microtext; strip (panel) for signature; varnishing, laminating; methods of processing the surface of plastic materials.The resulting model shows that the most important factor is the materials that are used for the manufacture of plastic cards. Type of material influences the manufacturing and handling processes, and it ensures the quality and durability of plastic cards. No less important are: printing methods and handling processes of plastic cards, because all subsequent processes depends on them.

Impact of endoscopic ultrasound quality assessment on improving endoscopic ultrasound reports and procedures.

To evaluate the impact of endoscopic ultrasonography (EUS) quality assessment on EUS procedures by comparing the most recent 2013-2014 local EUS procedural reports against relevant corresponding data from a 2009 survey of EUS using standardized quality indicators (QIs). Per EUS exam, 27 QIs were assessed individually and by grouping pre-, intra-, and post-procedural parameters. The recorded QI frequencies from 200 reports (2013-2014) were compared to corresponding data of 100 reports from the quality control study of EUS in 2009. Data for QIs added after 2009 to professional guidelines (added after 2010) were also tabulated. Significant differences (P-value < 0.05) were found for 13 of 20 of the relevant QIs examined. 4 of 5 pre-procedural QIs, 6 of 10 intra-procedural QIs, and 3 of 5 post-procedural QIs all demonstrated significant upgrading with a P-value < 0.05. Significant improvements were demonstrated in QI adherence and thus EUS reporting and delivery quality when the 2013-2014 reports were compared to 2009 results. QI implementation facilitates effective high-quality EUS exams by ensuring comprehensive documentation while limiting error.

Quality Assurance in German Mental Healthcare

Introduction One of the priorities in the German mental healthcare system pertains to the development and implementation of evidence-based quality assurance initiatives with the goal to measure quality and optimize the structures, processes and outcomes of mental healthcare services. To optimize the quality of mental healthcare by developing quality assurance tools including clinical practice guidelines and quality indicators. To describe quality assurance initiatives in German mental healthcare. Review of quality assurance initiatives and their current status. In national and regional initiatives, evidence- and consensus-based clinical practice guidelines and quality indicators are being developed. As examples, the cross-sectoral quality indicators of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the update process of the German clinical practice and disease management guideline on schizophrenia will be described. A discussion of the critical issues in psychiatric quality indicator and guideline development and implementation will be included. Evidence- and consensus-based approaches are crucial to the development of relevant and valid instruments for quality assurance. One of the main challenges is the implementation of clinical practice guidelines and their evaluation by means of quality indicators as well as the establishment of a common framework of standardized quality indicators that address relevant quality aspects in mental healthcare.

Temporal Changes in the Quality of Acute Stroke Care in Five National Audits across Europe.

Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care.

Assessment of life quality factors by breast cancer patients

The aim of the article is to present the results of a sociological investigation with the aim to analyze the research data on subjective and objective life quality factors for breast cancer patients and to discover the key factors influencing quality of life the most at the start of treatment. To achieve this goal a survey of 300 breast cancer patients recently having undergone a mastectomy was conducted at the Pauls Stradins Clinical University hospital. The questionnaire covered an array of social factors and a set of standardized life quality indicators. The quantitative data was supplemented with qualitative material from 14 in-depth interviews. The results showed that breast cancer patients, at the beginning of treatment, evaluated their quality of life mainly average or good. The primary factors negatively influencing quality of life were insubstantial finances, inadequate social and emotional support at the first weeks after diagnosis.

Best Practices for Developing Cardiovascular Quality Indicators

The Canadian Heart Health Strategy and Action Plan recommended that the Canadian Cardiovascular Society (CCS) lead the development of pan-Canadian data definitions and quality indicators (QIs) for evaluating cardiovascular care in Canada. In response to this recommendation, the CCS developed and adopted a standardized QI development methodology. This report provides a brief overview of the CCS “Best Practices” for developing pan-Canadian cardiovascular QIs. A more detailed description is available in Supplemental Material. The CCS Best Practices QI development methodology consists of 3 phases: phase I, plan and organize the QI development initiative; phase II, develop and select QIs; and phase III, operationalize the QIs. Phase I includes identifying the cardiovascular focus or content area, determining the objective and/or purpose of the initiative, the target users of, and the target population for, the QIs, and selection of a QI working group. Phase II involves formulating the QIs including generating a preliminary set of QIs and draft definitions, followed by an indicator rating and ranking process based on the CCS QI rating criteria. Phase III involves finalizing technical specifications and pilot testing the QIs. It also describes the CCS QI approval process and addresses knowledge translation. Adoption of a standardized methodology for QI development will improve the quality, completeness, acceptability, and usability of pan-Canadian cardiovascular QIs developed by the CCS. Public release of the QI definitions and related performance data might help improve patient care quality and outcomes.

A qualitative analysis of a consensus process to develop quality indicators of injury care

BackgroundConsensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators.MethodsWe performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes.ResultsWe identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection.ConclusionOur study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.

Pan-Canadian Cardiovascular Data Definitions and Quality Indicators: A Status Update

After the 2009 publication of Building a Heart Healthy Canada, the Canadian Cardiovascular Society was commissioned to address a long-standing information gap related to the compatibility and comparability of data on the quality of cardiovascular care in Canada. Through collaboration between the Canadian Institute for Health Information, the Institute for Clinical Evaluative Sciences, the Public Health Agency of Canada, and 5 regional cardiovascular registries, 2 committees were tasked with developing standardized cardiovascular data definitions and quality indicators. The work culminated in national consensus on the definitions of 55 patient, disease, and therapeutic variables (core and optional) to facilitate cardiovascular care comparisons within and across Canada. Supplemental data definition chapters were then developed on acute coronary syndrome and coronary angiography/revascularization, with chapters on heart failure and atrial fibrillation electrophysiology to follow. This foundational work led to a critical appraisal of cardiac quality indicator development initiatives via the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Quality Indicator tool, followed by the development of quality indicator catalogues on heart failure and atrial fibrillation. These indicators will be embedded within the clinical practice guidelines of the Canadian Cardiovascular Society, facilitating national comparisons across Canada on cardiovascular disease incidence, prevalence, patterns and quality of care, and clinical outcomes. This methodology—achieving national stakeholder consensus on a standardized process for the development and selection of cardiovascular quality indicators—illustrates the capacity to reach agreement by drawing on expertise and research across diverse organizational mandates and agendas, potentially contributing to improved cardiovascular care and outcomes for patients.

Validating the Selection of Quality Indicators for Venipuncture Procedures Performed in a Radiation Therapy Department

Purpose An extensive literature review was completed to validate the selection of quality indicators for venipuncture procedures performed in a radiation therapy department. Methods A retrospective quantitative study (2007-2010) was conducted at the Tom Baker Cancer Center (TBCC) to review the data captured on a quality control log/statistical template for 900 venipuncture procedures performed in the radiation treatment program (RTP). The quality indicators for the venipuncture program had previously been identified to include the collection and monitoring of: the frequency/occurrence of adverse events, identifying the type of adverse events, and the number of attempts required to obtain venous access. There were no patient identifiers recorded on the department log/statistical template. Results Data extracted from the TBCC RTP quality control log in 2007-2010 revealed an incidence of five extravasations events and one air embolism event. Comparison of the published adverse events and rates in the literature to the TBCC RTP venipuncture program rates show that its recorded quality control log/statistical template is targeting the appropriate categories. The literature reported, on average, rates for extravasations to be between 0.04% and 1.3% compared with the TBCC RT department’s 0.56%. The occurrence of air embolism rates in the literature was reported to be between 11.7% and 23% compared with 0.11% occurrence in the TBCC RTP department. Based on the evidence reported in the literature, other quality control indicators have been incorporated into the TBCC RTP venipuncture program. The TBCC RTP expanded the venipuncture program quality control log/statistical template to collect and monitor the occurrence rates of phlebitis, hematoma/bruising, nerve, tendon and/or ligament damage, and infection. Conclusion The creation of standardized quality indicators for radiation treatment programs performing venipuncture in all health care facilities performing venipuncture would 1) be a step in maximizing patient safety and improving quality of care and 2) provide an opportunity for institutions to gauge and compare the quality of care provided using the same quality indicators for health care institutes performing venipuncture procedures. Collaboration with other facilities to identify, monitor, and report the data collected from standardized quality indicators would result in an increase of knowledge concerning the occurrence of rates of adverse events during and after venipuncture procedures performed in a radiation therapy department. Such efforts can only lead to increased quality of care provided across the health care system.

Aplicación del Modelo Europeo de Calidad en Oncología

To assess a Medical Oncology Service using a healthcare setting version of the European Foundation for Quality Management (EFQM). To use this tool as training, an opportunity for participation and the base for checking the strategic planning. We use the EFQM Model adapted to healthcare centers EFQM as the evaluation instrument. It maintains scores and weights, only modifying vocabulary and simplifying that not relevant to the healthcare setting. Exercise was done with the "proform" system. Its advantage is that it uses standard formulas combined with open areas for discussion and presentation of ideas. It uses group sessions for agreement. 2001 Management. Evaluation was performed in the second term of 2002. 58 strengths and 37 areas of improvement were identified. These elements were used to create a strategic document, which served as the basis for future improvement. The score reached was used as an internal reference to monitor service quality evolution. The EFQM model is applicable in a Medical Oncology Service, although it would be desirable to have standardized quality indicators that permit a more objective and specific evaluation.