scholarly journals The response of wetland quality indicators to human disturbance indicators across the United States

2019 ◽  
Vol 191 (S1) ◽  
Author(s):  
Alan T. Herlihy ◽  
Jean C. Sifneos ◽  
Gregg A. Lomnicky ◽  
Amanda M. Nahlik ◽  
Mary E. Kentula ◽  
...  
Keyword(s):  
United States ◽  
Quality Indicators ◽  
Human Disturbance ◽  
The United States ◽  
Wetland Quality

National Assessment of Melanoma Care Using Formally Developed Quality Indicators

2009 ◽  
Vol 27 (32) ◽  
pp. 5445-5451 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
Mehul V. Raval ◽  
David J. Bentrem ◽  
Jeffrey D. Wayne ◽  
Charles M. Balch ◽  
...  
Keyword(s):  
United States ◽  
Los Angeles ◽  
Quality Indicators ◽  
The United States ◽  
National Cancer Data Base ◽  
Hospital Level ◽  
Cancer Data ◽  
Cancer Registry Data ◽  
The Individual

Purpose There is considerable variation in the quality of cancer care delivered in the United States. Assessing care by using quality indicators could help decrease this variability. The objectives of this study were to formally develop valid quality indicators for melanoma and to assess hospital-level adherence with these measures in the United States. Methods Quality indicators were identified from available literature, consensus guidelines, and melanoma experts. Thirteen experts ranked potential measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. Adherence with individual valid indicators and a composite measure of all indicators were assessed at 1,249 Commission on Cancer hospitals by using the National Cancer Data Base (NCDB; 2004 through 2005). Results Of 55 proposed quality indicators, 26 measures (47%) were rated as valid. These indicators assessed structure (n = 1), process (n = 24), and outcome (n = 1). Of the 26 measures, 10 are readily assessable by using cancer registry data. Adherence with valid indicators ranged from 11.8% to 96.5% at the patient level and 3.7% to 83.0% at the hospital level. (Adherence required that ≥ 90% of patients at a hospital receive concordant care.) Most hospitals were adherent with 50% or fewer of the individual indicators (median composite score, five; interquartile range, four to seven). Adherence was higher for diagnosis and staging measures and was lower for treatment indicators. Conclusion There is considerable variation in the quality of melanoma care in the United States. By using these formally developed quality indicators, hospitals can assess their adherence with current melanoma care guidelines through feedback mechanisms from the NCDB and can better direct quality improvement efforts.

scholarly journals Assessment of quality indicators among nurse practitioners performing upper endoscopy

2017 ◽  
Vol 05 (09) ◽  
pp. E818-E824 ◽  
Author(s):  
Jeffrey Baumgardner ◽  
Justin Sewell ◽  
Lukejohn Day
Keyword(s):  
United States ◽  
Quality Indicators ◽  
Nurse Practitioners ◽  
Retrospective Chart Review ◽  
The United States ◽  
Gastric Ulcers ◽  
Anatomical Landmarks ◽  
Upper Endoscopy ◽  
Discharge Plan ◽  
Photo Documentation

Abstract Background and study aims Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs). Patients and methods Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed. Results Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period. Conclusion In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States.

scholarly journals Development of National Newborn Screening Quality Indicators in the United States

2019 ◽  
Vol 5 (3) ◽  
pp. 34 ◽  
Author(s):  
Careema Yusuf ◽  
Marci K. Sontag ◽  
Joshua Miller ◽  
Yvonne Kellar-Guenther ◽  
Sarah McKasson ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Newborn Screening ◽  
Quality Indicators ◽  
Technical Assistance ◽  
The United States ◽  
Iterative Refinement ◽  
Data Repository ◽  
Screening System ◽  
Screening Process

Newborn screening is a public health program facilitated by state public health departments with the goal of improving the health of affected newborns throughout the country. Experts in the newborn screening community established a panel of eight quality indicators (QIs) to track quality practices within and across the United States newborn screening system. The indicators were developed following iterative refinement, consensus building, and evaluation. The Newborn Screening Technical assistance and Evaluation Program (NewSTEPs) implemented a national data repository in 2013 that captures the quality improvement metrics from each state. The QIs span the newborn screening process from collection of a dried blood spot through medical intervention for a screened condition. These data are collected and analyzed to support data-driven outcome assessments and tracking performance to improve the quality of the newborn screening system.

scholarly journals Assessment of Pancreatic Cancer Care in the United States Based on Formally Developed Quality Indicators

2009 ◽  
Vol 101 (12) ◽  
pp. 848-859 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
David J. Bentrem ◽  
Keith D. Lillemoe ◽  
Mark S. Talamonti ◽  
Clifford Y. Ko
Keyword(s):  
United States ◽  
Pancreatic Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
The United States

Quality Indicators of Fresh Frozen Plasma and Platelet Utilization

2002 ◽  
Vol 126 (5) ◽  
pp. 527-532 ◽  
Author(s):  
David A. Novis ◽  
Stephen Renner ◽  
Richard C. Friedberg ◽  
Molly K. Walsh ◽  
Andrew J. Saladino
Keyword(s):  
United States ◽  
Quality Indicators ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
Blood Bank ◽  
Private Institutions ◽  
Improvement Program ◽  
Public And Private ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Objective.—To determine the normative rates of expiration and wastage for units of fresh frozen plasma (FFP) and platelets (PLTs) in hospital communities throughout the United States, and to examine hospital blood bank practices associated with more desirable (lower) rates. Design.—In 3 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data retrospectively on the numbers of units of FFP and PLTs that expired (outdated) prior to being used and that were wasted due to mishandling. Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—One thousand six hundred thirty-nine public and private institutions, more than 80% of which were known to be located in the United States. Main Outcome Measures.—Quality indicators of FFP and PLT utilization: the rates of expiration and wastage of units of FFP and PLTs. Results.—Participants submitted data on 8 981 796 units of FFP and PLTs. In all 3 studies, aggregate combined FFP and PLT expiration rates ranged from 5.8% to 6.4% and aggregate combined FFP and PLT wastage rates ranged from 2.0% to 2.5%. Among the top-performing 10% of participants (90th percentile and above), FFP and PLT expiration rates were 0.6% or lower and FFP and PLT wastage rates were 0.5% or lower. Among the bottom-performing 10% of participants (10th percentile and below), expiration rates were 13.8% or higher and wastage rates were 6.8% or higher. We were unable to associate selected hospital characteristics or blood bank practices with lower rates of FFP and PLT utilization. Conclusions.—The rates of FFP and PLT expiration and wastage vary greatly among hospitals in the United States. Hospital blood bank personnel are capable of achieving FFP and PLT expiration and wastage rates below 1%.

scholarly journals Reimagining Long-Term Services and Supports in a Post-Pandemic World

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 252-253
Author(s):  
Katherine Abbott ◽  
Gretchen Alkema ◽  
Robert Applebaum
Keyword(s):  
United States ◽  
Quality Indicators ◽  
The United States ◽  
Complex Care ◽  
Care Recipients ◽  
Global Pandemic ◽  
Services And Supports ◽  
Primary Payer ◽  
Care Costs

Abstract Prior to the global pandemic, the United States struggled to coordinate, deliver, and finance quality, person-centered long-term services and supports (LTSS) through the default primary payer, Medicaid. The pandemic highlights the challenges of not having a LTSS system. LTSS workers are underpaid, overworked, and turning over at alarming rates. Families face mounting pressures of caring for a growing number of loved ones, some with very complex care. Costs continue to climb, and quality indicators are not improving. While our approach to LTSS has improved, costs and quality challenges still dominate the landscape. We are at juncture when we need to reimagine the LTSS system, one that genuinely puts the care recipients and their caregivers at the heart of the system. The pandemic has provided some lessons about how to think differently about what long-term services can look like. Now is the time to embrace innovative opportunities building on this adversity.

Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

1995 ◽  
Vol 53 ◽  
pp. 682-683
Author(s):  
A. Hakam ◽  
J.T. Gau ◽  
M.L. Grove ◽  
B.A. Evans ◽  
M. Shuman ◽  
...  
Keyword(s):  
United States ◽  
Cell Biology ◽  
Tissue Bank ◽  
The United States ◽  
Prostate Adenocarcinoma ◽  
Correlative Microscopy ◽  
Client Server ◽  
Critical Elements ◽  
Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

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