Auditing integrated stroke care to support quality improvement activities: development of a peer-to-peer audit framework

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bianca Buijck ◽  
Bert Vrijhoef ◽  
Monique Bergsma ◽  
Diederik Dippel
Keyword(s):  
Quality Improvement ◽  
Integrated Care ◽  
Care Program ◽  
Stroke Care ◽  
Peer To Peer ◽  
Multiple Stakeholders ◽  
Content Type ◽  
Care Services ◽  
Continuous Quality

PurposeTo organize stroke care, multiple stakeholders work closely together in integrated stroke care services (ISCS). However, even a well-developed integrated care program needs a continuous quality improvement (CQI) cycle. The current paper aims to describe the development of a unique peer-to-peer audit framework, the development model for integrated care (DMIC), the Dutch stroke care standard and benchmark indicators for stroke.Design/methodology/approachA group of experts was brought together in 2016 to discuss the aims and principles of a national audit framework. The steering group quality assurance (SGQA) consisted of representatives of a diversity of professions in the field of stroke care in the Netherlands, including managers, nurses, medical specialists and paramedics.FindingsAuditors, coordinators and professionals evaluated the framework, agreed on that the framework was easy to use and valued the interesting and enjoyable audits, the compliments, feedback and fruitful insights. Participants consider that a quality label may help to overcome necessity issues and have health care insurers on board. Finally, a structured improvement plan after the audit is needed.Originality/valueAn audit offers fruitful insights into the functioning of an ISCS and the collaboration therein. Best practices and points of improvement are revealed and can fuel collaboration and the development of partnerships. Innovative cure and care may lead to an increasing area of support among professionals in the ISCS and consequently lead to improved quality of delivered stroke care.

Abstract TP390: Continuous Quality Improvement Implementation Across a Large Stroke Network of Affiliated Rural Hospitals Demonstrates Improved Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lisa M Bellamy ◽  
Kelley L Elkins ◽  
Michael R Dobbs
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
System Analysis ◽  
Stroke Care ◽  
Substantial Improvement ◽  
Great Success ◽  
Quality Improvement Process ◽  
Continuous Quality ◽  
Data Elements

Background and Purpose: Currently, the stroke care network includes 28 affiliate hospitals. One of the network missions is to improve quality of care through an evidence-based, standardized approach. In 2014, a formalized continuous quality improvement process began. Methods: Each affiliate receives quality education and utilizes a data report to collect and submit monthly stroke data elements quarterly. Data were compared for system analysis. Results: 18 of 24 (75%) affiliates submitted data in 2014, compared to 23 of 26 (88%) in 2015. For STK[PM]-7: dysphagia screening, 42% of the affiliates submitted data in 2014, compared to 73% in 2015. Out of the hospitals submitting inpatient data for both years, the average for all appropriate measures was 84% in 2014, compared to 88% in 2015. Of these, 27% (4/15) improved, 60% (9/15) remained the same and 13% (2/15) worsened on these inpatient measures. For CT interpretation time ( < 45 minutes), the average time was 50 minutes in 2014, and 52 minutes in 2015. 55% (6/11) improved on the CT interpretation time and 45% (5/11) worsened. For Door to Needle time ( < 60 minutes), the average time was 89 minutes in 2014, and 65 minutes in 2015. 70% (7/10) improved on the Door to Needle time and 30% (3/10) worsened. Conclusions: The network showed substantial improvement with the CQI program in: data submission rates, CT interpretation time, and Door to Needle time. Additionally, for inpatient measures, 87% of affiliates who submitted data for both years improved or remained the same. This is a great success overall. We believe this reflects focused improvement efforts at individual affiliates and network-wide. Areas for focus in the next year were determined: Door to Needle and CT interpretation times, STK-4, STK[PM]-7 and quality of abstraction.

CQI: Meeting the Mandate for Quality

1995 ◽  
Vol 112 (5) ◽  
pp. P111-P111
Author(s):  
Carl A. Patow
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Continuous Quality Improvement ◽  
Educational Objectives ◽  
Continuous Quality

Educational objectives: To understand the principles of continuous quality improvement and to use these principles to enhance patient satisfaction through increased efficiency and improved quality of care.

Cost effectiveness in palliative care setting

2018 ◽  
Vol 21 (2) ◽  
pp. 62-71
Author(s):  
Henry O’Lawrence ◽  
Rohan Chowlkar
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Hospice Care ◽  
Home Health ◽  
Data Set ◽  
Content Type ◽  
Care Services ◽  
The Cost

Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

The effect of export tax rebates on product quality: evidence from China's agricultural product processing industry

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Yue Liang ◽  
Jingqi Dang ◽  
Shuai Chen
Keyword(s):  
Quality Improvement ◽  
Product Quality ◽  
Policy Implications ◽  
Medium Size ◽  
Agricultural Product ◽  
Firm Innovation ◽  
Processing Industry ◽  
Content Type ◽  
Export Tax

PurposeThis study aims to establish the linkage among export tax rebate (ETR), firm innovation and product quality of Chinese agricultural product processing industry (APPI), so that more targeted policy implications can be discussed.Design/methodology/approachUsing highly disaggregated firm-product-destination-level data through 2001 to 2013 of Chinese APPI, this study employs a two-way fixed effects specification to establish the linkage between ETR and product quality, while the mediational model is adopted to examine potential mechanisms.FindingsBaseline estimates show that a 1% increase in ETR rate leads to a significant increase in the product quality of APPI by 0.12% on the whole. However, there is a nonlinear, inverse-U shaped relationship between ETR and product quality, and the optimal inflection point occurs when ERT rate equals 0.15. Mechanism analyses show that firm innovation is an important impact channel, which explains 9.8% of quality improvement induced by raising ETR. Further heterogeneous analyses reveal both the total effects of ETR on product quality and the mediation effects of innovation are dominated by young SMEs (small and medium-size enterprises).Practical implicationsAuthorities can promote the innovation and then product quality improvement of young SMEs by moderately increasing ETR rate. To ensure ETR more effective in improving quality, it is necessary for the government to encourage innovation. Authorities can reduce the risk of innovation failure for low-tech firms by increasing R&D subsidies, while ensuring innovation returns for high-tech firms in combination with stronger intellectual property protection.Originality/valueFirst, this is one of the earlier studies to explore the relationship between ETR and product quality specifically for Chinese APPI. Second, we show firm innovation as an important mediator so that policies aim at raising ETR rates are eventually beneficial to product quality. Third, using the highly disaggregated data, we allow ETR rate to vary across different products, which is an improvement in the accuracy of previous literature. Finally, our research provides additional empirical evidence for revealing the micro-mechanism of ETR affecting firm behaviors.

Cross-sectional study of the quality of neonatal care services in Armenia

2019 ◽  
Vol 32 (8) ◽  
pp. 1145-1161
Author(s):  
Suren H. Galstyan ◽  
Hrant Z. Kalenteryan ◽  
Arshak S. Djerdjerian ◽  
Hovhannes S. Ghazaryan ◽  
Naira T. Gharakhanyan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Quality Assessment ◽  
Neonatal Care ◽  
Health Facilities ◽  
Cross Sectional ◽  
Content Type ◽  
Neonatal Deaths ◽  
Live Births ◽  
Care Services

Purpose The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. Design/methodology/approach The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. Findings In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. Originality/value Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure–process–outcomes approach as a theoretical basis.

Enhancing data-driven elderly appointment services in domestic care communities under COVID-19

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
H.Y. Lam ◽  
G.T.S. Ho ◽  
Daniel Y. Mo ◽  
Valerie Tang
Keyword(s):  
Artificial Intelligence ◽  
Real Time ◽  
Care Service ◽  
The Elderly ◽  
Care Centre ◽  
Service Matching ◽  
Content Type ◽  
Care Services ◽  
Domestic Care

PurposeUnder the impact of Coronavirus disease 2019 (COVID-19), this paper contributes in the deployment of the Artificial Intelligence of Things (AIoT)-based system, namely AIoT-based Domestic Care Service Matching System (AIDCS), to the existing electronic health (eHealth) system so as to enhance the delivery of elderly-oriented domestic care services.Design/methodology/approachThe proposed AIDCS integrates IoT and Artificial Intelligence (AI) technologies to (1) capture real-time health data of the elderly at home and (2) provide the knowledge support for decision making in the domestic care appointment service in the community.FindingsA case study was conducted in a local domestic care centre which provided elderly oriented healthcare services to the elderly. By integrating IoT and AI into the service matching process of the mobile apps platform provided by the local domestic care centre, the results proved that customer satisfaction and the quality of the service delivery were improved by observing the key performance indicators of the transactions after the implementation of the AIDCS.Originality/valueFollowing the outbreak of COVID-19, this is a new attempt to overcome the limited research done on the integration of IoT and AI techniques in the domestic care service. This study not only inherits the ability of the existing eHealth system to automatically capture and monitor the health status of the elderly in real-time but also improves the overall quality of domestic care services in term of responsiveness, effectiveness and efficiency.

Health care providers' experiences with delivering person centred care in an Integrated Care Program for thoracic surgery patients in Ontario, Canada

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kathy Kornas ◽  
Meghan O'Neill ◽  
Catherine Y. Liang ◽  
Lori Diemert ◽  
Tsoleen Ayanian ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Health Care Providers ◽  
Work Life ◽  
Quality Of Work Life ◽  
Care Providers ◽  
Content Type ◽  
Quality Of Work ◽  
Provider Experiences

PurposeThe purpose of this study is to understand health care providers' experiences with delivering a novel Integrated Care (IC) Program that co-ordinates hospital-based clinical services and home care for thoracic surgery patients, including perceptions on the provision of person-centred care and quality of work life.Design/methodology/approachThe authors conducted a process evaluation using qualitative methods to understand provider experiences in the Integrated Care (IC) Program and to identify areas for programme improvement. Study data were collected using a focus group with thoracic surgeons, open-ended survey with home care providers, and semi-structured interviews with lead thoracic surgeons and IC leads, who are nurses serving as the primary point of contact for one consistent care team. Data were analysed using thematic analysis.FindingsThe IC Program was successful in supporting a partnership between health care providers and patients and caregivers to deliver a comprehensive and person-centred care experience. Informational continuity between providers was facilitated by IC leads and improved over time with greater professional integration and adaptation to the new care delivery processes. Differential impacts were found on quality of work life for providers in the IC Program.Originality/valueThis study describes provider experiences with delivering integrated and person-centred care across the hospital to home continuum, which can inform future integrated care initiatives.

An expanded nomological network of experienscape

2020 ◽  
Vol 32 (3) ◽  
pp. 999-1040 ◽  
Author(s):  
Asli D.A. Tasci ◽  
Abraham Pizam
Keyword(s):  
Quality Of Life ◽  
Well Being ◽  
Future Research ◽  
Subjective Happiness ◽  
Subjective Well Being ◽  
Nomological Network ◽  
Multiple Stakeholders ◽  
Content Type ◽  
Holistic Understanding

Purpose Bitner’s (1992) concept of servicescape has received widespread academic attention, resulting in many conceptual and empirical studies. By scanning the servicescape literature and other relevant concepts, Pizam and Tasci (2019) provided experienscape, an expanded version of servicescape, to be measured from different stakeholders’ perspectives with a multidisciplinary approach. This paper aims to build on Pizam and Tasci’s conceptualization of experienscape and expand its nomological network with other pertinent concepts related to different stakeholders with an interdisciplinary approach. Design/methodology/approach This is a conceptual study analyzing diverse literature related to servicescape, experienscape and other related concepts and theories to provide an integrated and holistic picture of experienscape for more robust theory development. Several new relationships are synthesized for hypothesis development and testing in future research. Findings The review of past research reveals that servicescape literature has mostly focused on outcomes for the benefit of brands and firms and missed outcomes for consumers and other stakeholders. In addition, servicescape literature lacks several critical concepts in the affective, cognitive and behavioral reaction domains, as well as moderator factors. The relevance of some theories such as branding (e.g. brand identity, personality, image, perceived quality, consumer value, brand value and self-congruity), cocreation/coproduction/codestruction, transformation, subjective happiness, subjective well-being and quality of life is completely overlooked. Research limitations/implications Experienscape is a container of complex systems where needs, wants and expectations of multiple stakeholders are entertained, often at the same time through dynamic interactions among multiple stakeholders. Thus, a holistic understanding of experienscape requires dynamic integration of theories explaining the behavior of different stakeholders by cross-fertilizing theories through interdisciplinary research rather than unidisciplinary or multidisciplinary research conducted in separate silos. Originality/value By adopting Pizam and Tasci’s (2019) experienscape concept, this study expanded the relational network of service environment components (i.e. sensory, functional, social, natural and cultural components of experienscape) by incorporating diverse theories and concepts that explain cognitive, affective and conative reactions of different stakeholders to an experience environment. Additionally, the current study recommends attention to human-centric outcomes such as transformation, subjective well-being, subjective happiness and quality of life, which were completely overlooked in previous servicescape research.

Measuring the continuous quality improvement orientation of medical education programs

2020 ◽  
Vol 33 (2) ◽  
pp. 158-171
Author(s):  
Danielle Blouin ◽  
Everett V. Smith
Keyword(s):  
Medical Education ◽  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Scale Model ◽  
Validity Evidence ◽  
Rasch Modeling ◽  
Questionnaire Data ◽  
Content Type ◽  
Continuous Quality ◽  
Interpretation Of Results

PurposeThere is a growing interest in applying continuous quality improvement (CQI) methodologies and tools to medical education contexts. One such tool, the “Are We Making Progress” questionnaire from the Malcolm Baldrige National Quality Award framework, adequately captures the dimensions critical for performance excellence and allows organizations to assess their performance and identify areas for improvement. Its results have been widely validated in business, education, and health care and might be applicable in medical education contexts. The measurement properties of the questionnaire data were analyzed using Rasch modeling to determine if validity evidence, based on Messick's framework, supports the interpretation of results in medical education contexts. Rasch modeling was performed since the questionnaire uses Likert-type scales whose estimates might not be amenable to parametric statistical analyses.Design/methodology/approachLeaders and teachers at 16 of the 17 Canadian medical schools were invited in 2015–2016 to complete the 40-item questionnaire. Data were analyzed using the ConQuest Rasch calibration program, rating scale model.Findings491 faculty members from 11 (69 percent) schools participated. A seven-dimensional, four-point response scale model better fit the data. Overall data fit to model requirements supported the use of person measures with parametric statistics. The structural, content, generalizability, and substantive validity evidence supported the interpretation of results in medical education contexts.Originality/valueFor the first time, the Baldrige questionnaire results were validated in medical education contexts. Medical education leaders are encouraged to serially use this questionnaire to measure progress on their school's CQI focus.

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