Use Of Quality Indicators Research Articles

Role of the cardiology pharmacist in improving quality of care for patients with acute myocardial infarction based on ESC-ACCA quality indicators

Abstract Background The European Society of Cardiology-Acute Cardiovascular Care Association (ESC-ACCA) suggested the use of quality indicators (QIs) to improve quality of care for patients with acute myocardial infarction (AMI). Among these QIs are prescribing of angiotensin-converting enzyme inhibitor (ACEi) and beta blocker (BB) if left ventricular ejection fraction (LVEF) was ≤40%, and prescribing high intensity statin and dual antiplatelet therapy (DAPT) before discharging patients from the coronary care unit (CCU). Purpose To identify the role of cardiology clinical pharmacy specialist in improving quality of care for patients with AMI based on ESC-ACCA QIs. Methods A cross-sectional study was conducted at a single CCU in Iraq between January 2021 and August 2023. Patients with AMI with or without LVEF ≤40% were included in the study. Patients' profiles were reviewed to collect data about suggestions by the cardiology clinical pharmacy specialist to initiate high intensity statin, addition of a second antiplatelet therapy to keep patients on DAPT, or addition of ACEi and/or BB if LVEF ≤40%. Results Total number of patients included was 326 of whom 119 (37%) patients had LVEF ≤40%. Drug interventions by the cardiology clinical pharmacy specialist with the initiation of statin and addition of a second antiplatelet therapy to optimize DAPT for patients with AMI and initiation of ACEi and/or BB for patients with AMI and LVEF ≤40% are shown in table 1 and figure 1. Drug interventions were based on the updated ESC guidelines and agreed by the interventional cardiologists. Conclusions Role of the cardiology clinical pharmacy specialist was important in bridging gaps in the medical therapy and improving quality of care for patients with AMI and/or LVEF ≤40% by optimizing patients medications particularly for the initiation of ACEi. ACEi was initiated in about one-quarter of the patients with AMI and LVEF ≤40% based on the suggestion of the cardiology clinical pharmacy specialist and approved by the interventional cardiologists.

Quality indicators for occupational therapy: a scoping review

BackgroundOccupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.MethodsWe conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.ResultsThe screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients’ subjective view and their experience with occupational therapy interventions.ConclusionsAll identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.

INDICADORES DE QUALIDADE EM TERAPIA NUTRICIONAL (IQTN) NA AVALIAÇÃO DO CUIDADO NUTRICIONAL EM UNIDADES HOSPITALARES DO BRASIL: UMA REVISÃO DE LITERATURA

Malnutrition is understood as an imbalance caused by low nutrient intake or increased nutritional needs, in the hospital environment, malnutrition has a direct influence on the clinical course of the patient and is often neglected, resulting in complications such as: infections, delayed healing and prolonged duration of treatment. Hospitalization time. In these cases, nutritional therapy (NT) is used and, along with the implementation, adverse events may prevent the effective implementation of nt. in this context, the use of quality indicators in nutritional therapy (IQTN) are applied, aiming to ensure the effectiveness of daily routines associated with nutritional management. Thus, this work aims to verify the use of the iqtn tool in the evaluation of nutritional care in hospital units in Brazil. the present study is a bibliographical review of the literature, built from scientific articles in the medline database (pubmed), portal periódicos capes and latin american literature in health sciences (lilacs) using the descriptors “Protein-Energy Malnutrition”, “Quality Indicators in Health Care”, “Nutritional Therapy”. Articles that did not correspond to the topic of interest and those published in the last 11 years were excluded. After cataloging, 08 articles were added that demonstrated the implementation of IQTN in the evaluation of nutritional care in services provided in hospitals in Brazil. most studies present indicators in accordance with the proposed goals, but it is worth mentioning that there is a significant prevalence of malnutrition in all the studies selected in this research, however those that have greater adequacy in indices related to nutritional assessment and prescription x calorie and protein infusion has a better prognosis for hospitalized patients. Therefore, the implementation of the IQTN tool becomes necessary in hospital units, as through this method it is possible to assess the compliance of nutritional care in order to minimize risks and intercurrences.

Attention to STEMI patients in our region: what is the adherence to the quality indicators from a population perspective?

Abstract Funding Acknowledgements None. Introduction The use of quality indicators (QI) proposed by the Association for Acute Cardiovascular Care (ACVC) for processes carried out in cardiology services represents an excellent internal quality control of their operation. Purpose The aim is to assess adherence to the main QI in the care of acute ST-elevation myocardial infarction (STEMI) in our region, according to data from the population-based registry of myocardial infarction in that area. Methods Evaluation of adherence to the main QI proposed by the ESC Association for ACVC, by retrospective analysis (data from in-hospital and out-of-hospital care) of patients with STEMI from our regional Infarction Registry attended between 2017 and 2020, in both tertiary and secondary hospitals of the public and private care network, providing data with a population-based character. Results QI were analysed in 1355 patients categorised as STEMI in our regional Infarction Registry between 2017 and 2020. 71% of patients were male. The number of STEMI per year ranged from 358 in 2019 to 316 in 2020. Primary percutaneous coronary intervention (PCI) was performed in 87% of patients. In 53% the first medical contact occurs in out-of-hospital care, while 25% occur in emergency departments (ED) of PCI capable hospitals and 12% in emergency departments of non-PCI hospitals. Forty-two percent of patients firstly attended out-of-hospital or in non-PCI centres achieve revascularisation in less than 90 minutes, but less than 30% of patients seen in PCI centres achieve revascularisation in less than 60 minutes. Radial access was used in 92% of cases. LVEF was assessed during admission in 98% and LDL-cholesterol was determined in 87%. Ninety-one per cent of patients were discharged on dual antiplatelet therapy, 96% on statins and a large proportion of patients with left ventricular dysfunction received angiotensin-converting enzyme inhibitors (78%) and beta-blockers (88%). Conclusion There is good overall adherence to major QI related to care of patients with STEMI in our region. However, there are indicators that could be optimised, particularly those related to timely primary reperfusion. Networked care thanks to the local Infarction Code means a significant reduction in reperfusion times, avoiding unnecessary referrals to Emergency Departments.

Assessing quality of hepato-pancreato-biliary surgery: nationwide benchmarking.

Clinical auditing is a powerful tool to evaluate and improve healthcare. Deviations from the expected quality of care are identified by benchmarking the results of individual hospitals using national averages. This study aimed to evaluate the use of quality indicators for benchmarking hepato-pancreato-biliary (HPB) surgery and when outlier hospitals could be identified. A population-based study used data from two nationwide Dutch HPB audits (DHBA and DPCA) from 2014 to 2021. Sample size calculations determined the threshold (in percentage points) to identify centres as statistical outliers, based on current volume requirements (annual minimum of 20 resections) on a two-year period (2020-2021), covering mortality rate, failure to rescue (FTR), major morbidity rate and textbook/ideal outcome (TO) for minor liver resection (LR), major LR, pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). In total, 10 963 and 7365 patients who underwent liver and pancreatic resection respectively were included. Benchmark and corresponding range of mortality rates were 0.6% (0 -3.2%) and 3.3% (0-16.7%) for minor and major LR, and 2.7% (0-7.0%) and 0.6% (0-4.2%) for PD and DP respectively. FTR rates were 5.4% (0-33.3%), 14.2% (0-100%), 7.5% (1.6%-28.5%) and 3.1% (0-14.9%). For major morbidity rate, corresponding rates were 9.8% (0-20.5%), 28.1% (0-47.1%), 36% (15.8%-58.3%) and 22.3% (5.2%-46.1%). For TO, corresponding rates were 73.6% (61.3%-94.4%), 54.1% (35.3-100), 46.8% (25.3%-59.4%) and 63.3% (30.7%-84.6%). Mortality rate thresholds indicating a significant outlier were 8.6% and 15.4% for minor and major LR and 14.2% and 8.6% for PD and DP. For FTR, these thresholds were 17.9%, 31.6%, 22.9% and 15.0%. For major morbidity rate, these thresholds were 26.1%, 49.7%, 57.9% and 52.9% respectively. For TO, lower thresholds were 52.5%, 32.5%, 25.8% and 41.4% respectively. Higher hospital volumes decrease thresholds to detect outliers. Current event rates and minimum volume requirements per hospital are too low to detect any meaningful between hospital differences in mortality rate and FTR. Major morbidity rate and TO are better candidates to use for benchmarking.

Development of consensus quality indicators for cancer supportive care: a Delphi study and pilot testing

BackgroundHigh quality supportive care is fundamental to achieve optimal health outcomes for people affected by cancer. Use of quality indicators provides comparative information for monitoring, management, and improvement of care within and across healthcare systems. The aim of this Australian study was to develop and test a minimum viable set of cancer supportive care quality indicators that would be feasible to implement and generate usable data for policy and practice.MethodsA two-round, modified reactive Delphi process was employed firstto develop the proposed indicators. Participants with expertise in cancer control in Australia, the United Kingdom, and Canada rated their level of agreement on a 7-point Likert scale against criteria assessing the importance, feasibility, and usability of proposed indicators. Relative response frequencies were assessed against pre-specified consensus criteria and a ranking exercise, which delivered the list of proposed indicators. Draft indicators were then presented to a purposive sample of clinicial and health management staff via qualitative interviews at two acute care settings in Melbourne, Australia for feedback regarding feasibility. Desktop audits of online published health service policy and practice descriptions were also conducted at participating acute care settings to confirm health service data availability and feasibility of collection to report against proposed indicators.ResultsSixteen quality indicators associated with the delivery of quality cancer supportive care in Australian acute healthcare settings met pre-specified criteria for inclusion. Indicators deemed ‘necessary’ were mapped and ranked across five key categories: Screening, Referrals, Data Management, Communication and Training, and Culturally Safe and Accessible Care. Testing confirmed indicators were viewed as feasible by clinical and health management staff, and desktop audits could provide a fast and reasonably effective method to assess general adherence and performance.ConclusionsThe development of quality indicators specific to cancer supportive care provides a strong framework for measurement and monitoring, service improvement, and practice change with the potential to improve health outcomes for people affected by cancer. Evaluation of implementation feasibility of these expert consensus generated quality indicators is recommended.

A REVIEW ON HEALTHCARE QUALITY INDICATORS AND UNEXPECTED EVENTS APPROACHES IN GERMANY AND TURKEY

Evaluation of quality studies in order to ensure patient safety is possible by measuring quality. "Quality Indicators" are used for this. In order to determine indicators and for realistic measurements, detecting and reporting unexpected events that have arisen on the basis of these indicators reveal invaluable results for the development of health systems.Germany, which is a developed country and a member of the European Union, and Turkey, which is a developing country on the way to the European Union, were compared in the focus of quality indicators and unexpected events in focus of “Quality Practices in Healthcare” in study.It is aimed to recognize the Quality of Health Care as a result of comparative evaluation, to discuss the positive and negative aspects of the two countries' quality indicators and their approaches to unexpected events, and to suggest alternative methods for application updates.In conclusion; In Germany, the Quality Program can be defined as a "Data-Based Quality Program with Wide Participation". Hospitals are encouraged for Unexpected Event Notifications in Germany, they are directed towards quality, and quality competition which created in healthcare services. However, when the payments and financial concerns are taken into consideration, it is felt that this competition cannot be achieved only by publishing the quality indicators to the public. Although a very good level has been achieved in the system that will enable the use of quality indicators in Turkey, there are problems in unexpected event notification, use of quality indicators and sharing of results.

Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis.

The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care. We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools. We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances. A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.

Clays of the Republic of Belarus as engineering barriers for disposal of radioactive waste

Тhe criteria for compliance with which the properties and characteristics of clays from industrially exploited deposits of the Republic of Belarus were assessed in order to determine the possibility of their further use as part of the underlying screen of the radioactive waste disposal facility (RWDF) of the Belarusian NPP are defined. The performed experimental analysis of clay samples from 12 deposits of the Republic of Belarus showed that clays from the “Gorodnoye” deposits of the Brest region and the “Markovskoye” deposits of the Gomel region have optimal quality indicators for use as part of the RWDF engineering barrier (underlying screen). It has been established that these clay samples have high sorption properties for 137Cs and 85Sr radionuclides. The values of the degree of sorption of 137Cs and 85Sr radionuclides from an aqueous solution for the above clay samples are about 99 %, and the values of the quantitative indicator of sorption the coefficient of distribution of radionuclides – are about 104 l/kg. Over time, the fixation of 137Cs on the studied clay samples increases; as part of the underlying RWDF screen, these clays will be an effective anti-migration barrier to prevent the migration of radionuclides into the environment in the event of depressurization of radioactive waste packages.

Cardiac rehabilitation patient data management and quality improvement in Australia: A national survey

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council Synergy Grant Background Receipt of guideline-indicated comprehensive cardiac rehabilitation improves patient outcomes. Optimum service delivery and meeting quality standards necessitates accurate standardised data collection and reporting. The methods, processes and systems used for data capture and reporting in cardiac rehabilitation are under-documented, limiting identification of areas needing change and creation of a platform for quality improvement (QI) at national levels. Purpose To describe data capture, management, and reporting and the awareness and use of quality indicators in contemporary Australian CR programs. Methods CR programs (n=396) were identified through professional and national directories, jurisdictional networks, webinars, and direct provider contact. Program coordinators completed an online survey on individual service characteristics, data capture and management systems (paper, electronic, database, integrated platform) including awareness, use and usefulness of the published National Cardiac Rehabilitation Quality toolkit components. Results Respondents totalled 319 (80.5%), from all eight states and territories. Coverage of Metropolitan, rural and remote towns, and regional centres was 46.3%, 45.9% and 7.8%, respectively. Indicative annual patient enrolments were >200 (31.0%), 51-200 (46.4%) and ≤50 (22.6%). Most programs used ≥2 data management systems: paper and electronic 62.6% or multiple e-systems 19.1%, or one system, either paper 20.9% or electronic 16.3%. Use of multiple systems and combinations of systems did not differ by number of patients enrolled. QI systems were infrequently used: QI Platforms 17.2%, QI Databases 10.0%. Supplementary to patient care, data gained was used for reports for management (57.0%), QI (56.1%), funding support (43.2%), required jurisdictional reporting (41.1%) and research (30.7%). Higher volume programs were more likely to be using the data capture for multiple purposes. Independent covariates of services using data for QI were enrolments of >200 (OR 3.83 95% CI 1.76, 8.34) and the state/territory location, such that use of QI was less likely in the states of Victoria (OR 0.24 95% CI 0.08, 0.77), New South Wales (OR 0.25 95% CI 0.08, 0.76) and Western Australia (OR 0.16 95% CI 0.05, 0.57). Conclusions Management of cardiac rehabilitation patient data is highly variable across Australian programs and jurisdictions, often including multiple different systems, with limited use of the data for QI. A national user-friendly, low burden approach to CR data collection incorporated into daily work-flow that is capable of benchmarking and informs QI is essential.

Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke.

Stroke is the leading global cause of permanent disability and the second leading cause of dementia within the first year of the event. Systematic quality improvement interventions such as Audit & Feedback (A&F) can monitor and improve the performance of post-stroke care in conjunction with the use of quality indicators (QIs). The scientific literature shows limited studies on quality improvement and QIs design for poststroke rehabilitation. In Italy, the National Outcomes Evaluation Programme (PNE) annually provides several QIs concerning the acute wards. On the contrary, indicators for quality assessment of post-acute stroke rehabilitation are not available nationwide. In recent years, the Italian Ministry of Health has funded a national network project, the aim of which is to provide and evaluate the effectiveness of A&F strategies in healthcare improvement. Part of this project is the development of a set of IQs for ischemic stroke rehabilitation used to conduct an A&F. In this study, we describe the design and development process of these QIs from administrative databases and report the results of the pilot test conducted on a small sample of Sicilian rehabilitation facilities, comparing them from 2019 to 2021. Feedback from the participating centers was mainly positive, and the quality indicators were found to be comprehensible and appreciated. However, the study highlighted the need for better adherence to indicators measuring processes of rehabilitation care. The set of quality indicators presented in this study, relevant to inpatient settings, could be considered a starting point on which to base quality improvement initiatives both nationally and internationally.

Breast cancer care and surgery in Australia and New Zealand: compliance of the BreastSurgANZ quality audit with international standards.

The Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit (BQA) of Breast Cancer Care is a prospective population-based database designed for annual audit of compliance with internally derived Quality Indicators (QI)s. While there is no international consensus for QIs, audit against an external international benchmark is possible through use of QIs defined by the 2017 European Society of Breast Cancer Specialists (EUSOMA) Guidelines. BQA data from 29,088 female patients between 1/1/2018 and 31/12/2019 were stratified by the EUSOMA definition of low-volume hospitals (LVH <150 patients p.a.) and high-volume hospitals (HVH ≥150 patients p.a.), and percentage compliance (±95% CI) with 14 mandatory EUSOMA QI sub-parts were determined. ANZ LVH met the quality threshold for 10, and HVH for 8 EUSOMA QI that assessed MDT, surgical approach, adjuvant radiotherapy in the LVH setting, avoidance of overtreatment, and use of endocrine therapy. ANZ did not meet the quality thresholds for QIs assessing use of neoadjuvant chemotherapy, and adjuvant radiotherapy in the HVH setting. Breast cancer care in ANZ is comparable with an international standard. ANZ surgeons performed at a high standard in discussion of breast cancer patients by MDT, and appropriate use of adjuvant radiotherapy by LVH. Improvements can be made in completeness of data capture, and inclusion of genetic syndromeand Ki67% in data collection. Due to the rapid evolution of breast cancer treatments, there is need for contemporary update of QI relating to the use of neoadjuvant systemic therapies.

Quality indicators in laboratory medicine: state-of-the-art, quality specifications and future strategies.

In the last few decades, quality in laboratory medicine has evolved in concert with the transformation and the changes (technological, scientific and organizational) in this sector. Laboratory professionals have faced great challenges, at times being overwhelmed, yetalso involved in this progress. Worldwide, laboratory professionals and scientific societies involved in laboratory medicine have raised awareness concerning the need to identify new quality assurance tools that are effective in reducing the error rate and enhancing patient safety, in addition to Internal Quality Control (IQC) procedures and the participation in the External Quality Assessment Schemes (EQAS). The use of Quality Indicators (QIs), specifically designed for laboratory medicine are effective inassessing and monitoring all critical events occurring inthe different phases of Total Testing Process (TTP), in particular, in the extra-analytical phases. The Model ofQuality Indicators (MQI), proposed by the Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of the International Federation of Clinical Chemistry andLaboratory Medicine (IFCC) and validated by experts in consensus conferences, is an important window of opportunity for the medical laboratory to demonstrate the use of an effective quality assurance tool fit for this purpose. Aim of this paper is to provide an update of the state-of-the-art concerning the most used QIs data collected in 2021 and the Quality Specifications (QSs) proposed for their evaluation. Moreover, a strategy for the future is proposed in order to improve the MQI and encourage its use in medical laboratories throughout the world.

Development of Quality Indicators to Evaluate the Appropriateness of Empiric Antimicrobial Use in Pediatric Patients.

Use of quality indicators is one strategy recommended to assess antimicrobial prescribing for pediatric inpatients. To achieve consensus from infectious diseases clinicians on quality indicators that characterize appropriate empiric antimicrobial use for the management of infectious syndromes in pediatric inpatients. This study was completed using the Delphi technique. The research team developed an initial list of quality indicators, informed by a literature search. A multidisciplinary group of health care providers with expertise in infectious diseases was invited to participate. The list was disseminated to this panel of experts using Opinio survey software. The experts were asked to rate the indicators on a 9-point Likert scale in relation to the following criterion: "The importance of each item in determining appropriateness considering benefit or harm at the individual or population level". Consensus was defined as at least 75% agreement and a median score of 7 or higher. Twelve of 31 invited experts completed at least 1 round of the survey, and 10 completed all rounds. Consensus was achieved on 28 of 31 proposed indicators after 3 rounds. Indicators with consensus were categorized under "empiric choice" (n = 12 indicators), "dose" (n = 5), "duration" (n = 2), "administration" (n = 4), "diagnosis" (n = 2), and "documentation" (n = 3). Six of the indicators for which consensus was achieved were rephrased by the experts. Consensus was achieved on quality indicators to assess the appropriateness of empiric antimicrobial use in pediatric patients. Clinicians and researchers can use these consensus-based indicators to assess adherence to best practice.

Protocol to Monitor Water Governance Based on Indicators for Rural Basins

The use of quality indicators guarantees the accurate monitoring of sustainability processes around the world. This work proposes a protocol to detail the indicators that make up the rural basin management index (GWI) in order to assess the degree of water management in a predominantly rural basin or region. The methodology contemplates the development of indicators to evaluate performance and its monitoring over time as the basis for planning. This research is based on the in situ evaluation of four municipalities within the department of Boyacá, Colombia, where there is a lack of a culture regarding the long-term planning and management of water and environmental resources. Water availability is the most sensitive factor in this context. This study raises the need for the use of monitoring systems in sustainability processes at the level of rural basins, as a result of the findings of four study cases, where processes with a low level of sustainability were evidenced.

Abstract 14403: Hospital- and Patient-Level Quality Indicators for Acute Coronary Syndrome Using Nationwide Database

Introduction: The efficacy of the quality indicators (QIs) using administrative data was unclear. Hypothesis: The use of QIs is associated with lower mortality in patients with acute coronary syndrome (ACS) at both hospital and patient levels. Methods: Patients with ACS who underwent percutaneous coronary intervention (PCI) between April 2014 and March 2018 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan were included. Twelve quality indicators (QIs) were extracted from the administrative data and the association of the QIs with all-cause mortality was investigated. Results: A total of 221,267 patients from 1,220 hospitals were analyzed. The adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment was high (median proportion &gt;90%), and adherence to outpatient cardiac rehabilitation was low (median proportion &lt;10%) among all the QIs. Higher acute phase composite QI score was associated with reduced risk-adjusted 30-day mortality at hospital level (β=-0.92 [95% confidence interval -1.19 to -0.66], P&lt;0.001). Four acute-phase and six subacute-phase QIs were inversely associated with 30-day and long-term mortalities at patient-level, respectively (all P&lt;0.001). Conclusions: There were substantial variations in the care of ACS in the current nationwide database. A higher adherence to the QI sets was associated with survival gains at both hospital and patient levels. Multilevel approach using QI may be effective for improvement of survival among these populations.

BAĞIMSIZ DENETİMDE RİSK DEĞERLENDİRME SÜRECİNE DENETİM KALİTE GÖSTERGELERİNİN KATKISI

IAASB Aralık 2022 tarihi itibariyle ISQC 1 (Uluslararası Kalite Kontrol Standardı) yerine geçecek ISQM 1 (Uluslararası Kalite Yönetimi Standardı)’i 2020 Eylül ayında onaylamış bulunmaktadır. Yeni standart bağımsız denetim şirketlerinin bir kalite yönetim sistemi dizayn etmelerini, uygulamaya koymalarını ve yürütmelerini beklemektedir. Standart; kalite yönetim sisteminin başarması gereken kalite hedeflerini açıkça reçetelendirirken, bu kalite hedeflerine ulaşmayı zorlaştıran, engelleyen, olumsuz yönde etkileyen risklerin tespitini denetim şirketlerine bırakmaktadır. Denetim şirketleri kalite hedeflerine ulaşmada karşılaşabilecekleri olayları, şartları, koşulları, eylemleri veya eylemsizlikleri değerlendirerek riskleri tanımlayacaklar ve uygun yanıtları dizayn edeceklerdir.Denetim kalitesi göstergeleri kalite risklerinin tespit edilmesinde bir sinyal görevi görürken değerlendirilmesini ve uygun yanıtların tasarlanmasını kolaylaştırabilir. Kalite göstergeleri denetim kalitesinin değerlendirilmesinde kullanılan sayısal bir veri setidir. Bu çalışmanın amacı risk değerlendirme sürecinde kalite göstergelerinin kullanımını modelleyebilmektir. Kalite göstergeleri konusunda bağımsız denetim tedarik zincirinde yer alan (bağımsız denetim şirketleri, kamu gözetim kurumları, yeminli mali müşavirler, vb.) paydaşlar tarafından farklı farklı veri setleri kullanılmaktadır. Bu çalışmada Amerika Halka Açık Şirketler Muhasebe Gözetim Kurumu tarafından kamuya sunulan 28 adet kalite gösterge veri seti kullanılacaktır.

Quality Indicators Targeting Low-Value Clinical Practices in Trauma Care

The use of quality indicators has been shown to improve injury care processes and outcomes. However, trauma quality indicators proposed to date exclusively target the underuse of recommended practices. Initiatives such as Choosing Wisely publish lists of practices to be questioned, but few apply to trauma care, and most have not successfully been translated to quality indicators. To develop a set of evidence and patient-informed, consensus-based quality indicators targeting reductions in low-value clinical practices in acute, in-hospital trauma care. This 2-round Research and Development/University of California at Los Angeles (RAND/UCLA) consensus study, conducted from April 20 to June 9, 2021, comprised an online questionnaire and a virtual workshop led by 2 independent moderators. Two panels of international experts from Canada, Australia, the US, and the UK, and local stakeholders from Québec, Canada, represented key clinical expertise involved in trauma care and included 3 patient partners. Panelists were asked to rate 50 practices on a 7-point Likert scale according to 4 quality indicator criteria: importance, supporting evidence, actionability, and measurability. Of 49 eligible experts approached, 46 (94%; 18 experts [39%] aged ≥50 years; 37 men [80%]) completed at least 1 round and 36 (73%) completed both rounds. Eleven quality indicators were selected overall, 2 more were selected by the international panel and a further 3 by the local stakeholder panel. Selected indicators targeted low-value clinical practices in the following aspects of trauma care: (1) initial diagnostic imaging (head, cervical spine, ankle, and pelvis), (2) repeated diagnostic imaging (posttransfer computed tomography [CT] and repeated head CT), (3) consultation (neurosurgical and spine), (4) surgery (penetrating neck injury), (5) blood product administration, (6) medication (antibiotic prophylaxis and late seizure prophylaxis), (7) trauma service admission (blunt abdominal trauma), (8) intensive care unit admission (mild complicated traumatic brain injury), and (9) routine blood work (minor orthopedic surgery). In this consensus study, a set of consensus-based quality indicators were developed that were informed by the best available evidence and patient priorities, targeting low-value trauma care. Selected indicators represented a trauma-specific list of practices, the use of which should be questioned. Trauma quality programs in high-income countries may use these study results as a basis to select context-specific quality indicators to measure and reduce low-value care.

Quality indicators and performance measures for prison healthcare: a scoping review

BackgroundInternationally, people in prison should receive a standard of healthcare provision equivalent to people living in the community. Yet efforts to assess the quality of healthcare through the use of quality indicators or performance measures have been much more widely reported in the community than in the prison setting. This review aims to provide an overview of research undertaken to develop quality indicators suitable for prison healthcare.MethodsAn international scoping review of articles published in English was conducted between 2004 and 2021. Searches of six electronic databases (MEDLINE, CINAHL, Scopus, Embase, PsycInfo and Criminal Justice s) were supplemented with journal searches, author searches and forwards and backwards citation tracking.ResultsTwelve articles were included in the review, all of which were from the United States. Quality indicator selection processes varied in rigour, and there was no evidence of patient involvement in consultation activities. Selected indicators predominantly measured healthcare processes rather than health outcomes or healthcare structure. Difficulties identified in developing performance measures for the prison setting included resource constraints, data system functionality, and the comparability of the prison population to the non-incarcerated population.ConclusionsSelecting performance measures for healthcare that are evidence-based, relevant to the population and feasible requires rigorous and transparent processes. Balanced sets of indicators for prison healthcare need to reflect prison population trends, be operable within data systems and be aligned with equivalence principles. More effort needs to be made to meaningfully engage people with lived experience in stakeholder consultations on prison healthcare quality. Monitoring healthcare structure, processes and outcomes in prison settings will provide evidence to improve care quality with the aim of reducing health inequalities experienced by people living in prison.

Electrocardiogram Quality Assessment Using Unsupervised Deep Learning.

Noise and disturbances hinder effective interpretation of recorded ECG. To identify the clean parts of a recording, free from such disturbances, various quality indicators have been developed. Previous instances of these indicators focus on human-defined desirable properties of a clean signal. The reliance on human-specified properties places an inherent limitation on the potential power of signal quality indicators. To move away from this limitation, we propose a data-driven quality indicator. We use an unsupervised deep learning model, the auto-encoder, to derive the quality indicator. For different quality assessment settings we compare the performance of our quality indicator with traditional indicators. The data-driven method performs consistently strong across tasks while performance of the traditional indicators varies strongly from task to task. This strong performance indicates the potential of data-driven quality indicators for use in ECG processing, removing the reliance on expert-specified desirable properties. The proposed methodology can easily be extended towards learning quality indicators in other data modalities.