scholarly journals Data quality audit of a clinical quality registry: a generic framework and case study of the Australian and New Zealand Hip Fracture Registry

2019 ◽  
Vol 8 (3) ◽  
pp. e000490 ◽  
Author(s):  
Aidan Christopher Tan ◽  
Elizabeth Armstrong ◽  
Jacqueline Close ◽  
Ian Andrew Harris
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Hip Fracture ◽  
Data Quality ◽  
Data Abstraction ◽  
Data Set ◽  
Clinical Quality ◽  
Data Completeness ◽  
Quality Registry ◽  
Generic Framework

ObjectivesThe value of a clinical quality registry is contingent on the quality of its data. This study aims to pilot methodology for data quality audits of the Australian and New Zealand Hip Fracture Registry, a clinical quality registry of hip fracture clinical care and secondary fracture prevention.MethodsA data quality audit was performed by independently replicating the data collection and entry process for 163 randomly selected patient records from three contributing hospitals, and then comparing the replicated data set to the registry data set. Data agreement, as a proxy indicator of data accuracy, and data completeness were assessed.ResultsAn overall data agreement of 82.3% and overall data completeness of 95.6% were found, reflecting a moderate level of data accuracy and a very high level of data completeness. Half of all data disagreements were caused by information discrepancies, a quarter by missing discrepancies and a quarter by time, date and number discrepancies. Transcription discrepancies only accounted for 1 in every 50 data disagreements. The sources of inaccurate and incomplete data have been identified with the intention of implementing data quality improvement.ConclusionsRegular audits of data abstraction are necessary to improve data quality, assure data validity and reliability and guarantee the integrity and credibility of registry outputs. A generic framework and model for data quality audits of clinical quality registries is proposed, consisting of a three-step data abstraction audit, registry coverage audit and four-step data quality improvement process. Factors to consider for data abstraction audits include: central, remote or local implementation; single-stage or multistage random sampling; absolute, proportional, combination or alternative sample size calculation; data quality indicators; regular or ad hoc frequency; and qualitative assessment.

scholarly journals Development of a binational thyroid cancer clinical quality registry: a protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023723
Author(s):  
Liane J Ioannou ◽  
Jonathan Serpell ◽  
Joanne Dean ◽  
Cino Bendinelli ◽  
Jenny Gough ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
New Zealand ◽  
South Australia ◽  
Steering Committee ◽  
Population Based ◽  
Outcome Data ◽  
Term Outcome ◽  
Data Set ◽  
Clinical Quality ◽  
Quality Registry

IntroductionThe occurrence of thyroid cancer is increasing throughout the developed world and since the 1990s has become the fastest increasing malignancy. In 2014, a total of 2693 Australians and 302 New Zealanders were diagnosed with thyroid cancer, with this number projected to rise to 3650 in 2018. The purpose of this protocol is to establish a binational population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand.Methods and analysisThe Australian and New Zealand Thyroid Cancer Registry (ANZTCR) aims to capture clinical data for all patients over the age of 16 years with thyroid cancer, confirmed by histopathology report, who have been diagnosed, assessed or treated at a contributing hospital. A multidisciplinary steering committee was formed which, with operational support from Monash University, established the ANZTCR in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 20 sites expected to come on board across Australia in 2018. A modified Delphi process was undertaken to determine the clinical quality indicators to be reported by the registry, and a minimum data set was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery and 90-day follow-up.Future plansThe establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand current practice in the treatment of thyroid cancer and identify variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer term outcome data particularly for patients with poor prognostic disease will add significant further value to the registry.

scholarly journals What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Adeel Akmal ◽  
Nataliya Podgorodnichenko ◽  
Tim Stokes ◽  
Jeff Foote ◽  
Richard Greatbanks ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Leadership Competencies ◽  
Learning Needs ◽  
Structured Interviews ◽  
District Health ◽  
Clinical Quality ◽  
Interpersonal Competencies ◽  
Clinical Quality Improvement

Abstract Purpose Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers’ accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives. Design Qualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically. Setting and participants. Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education—typically operations managers or process engineers. The latter group was represented by clinical staff—physicians and nurses—who received on-the-job training. Results Three themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers. Conclusions We differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.

Abstract TP291: Developing an Electronic Medical Record Based Data Abstraction Tool to Allow for Real Time Clinical Quality Review in Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Angela Lewis ◽  
Erin Rindels ◽  
Mark Ackman ◽  
Mark Renshaw ◽  
Enrique Leira ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Stroke Care ◽  
Quality Data ◽  
Data Abstraction ◽  
Stroke Patients ◽  
Time Saving ◽  
Clinical Quality

Background: University of Iowa Hospitals and Clinics (UIHC) participates in American Heart Association’s Get with the Guidelines® - Stroke (GWTG) registry to help drive quality improvement. As the only Comprehensive Stroke Center in Iowa, UIHC discharges many stroke patients and experiences exponential stroke patient growth each year. Due to ever-growing patient volumes and limited staff resources, UIHC identified a need to be able to abstract more quickly and efficiently to assess patient level clinical quality and adherence to evidence-based stroke guidelines. Purpose: UIHC engaged their Information Technology (IT) Department to assist in developing a process to expedite the process and reduce the workload associated with collecting stroke data for quality improvement, with the aim of collecting data as close as possible to the episode of care. Methods: UIHC pioneered the connection between GWTG - Stroke and Epic, their electronic medical record, via a re-abstraction tool embedded in Epic. The IT team worked closely with the stroke coordinator and quality improvement team to identify efficient workflows and time saving strategies. Gaps in discrete data collection were identified and collaboration between interdisciplinary care teams commenced to standardize processes for improved charting. Results: Historically, a self-reported average of 30 minutes was spent on each patient chart in GWTG. As of August 2019, that time declined to an average of 10 minutes per chart, representing a 66% reduction in manual labor required. Prior to project implantation, lag time from patient discharge to data abstraction averaged 4 weeks. After implementing the tool, quality data is abstracted and chart review to compare the stroke care episode against current guidelines occurs while the patient is still an inpatient. Conclusions: Investing in and fostering collaboration between IT, stroke, and quality departments at UIHC led to substantial, sustainable reduction in manual work required to collect stroke quality data. Hospitals should explore their ability to create an EMR based re-abstraction tool to not only save time but improve the quality and timeliness of data collection.

scholarly journals Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey

BMJ Open ◽  
2016 ◽  
Vol 6 (11) ◽  
pp. e011562 ◽  
Author(s):  
Ann Catrine Eldh ◽  
Lars Wallin ◽  
Mio Fredriksson ◽  
Sofie Vengberg ◽  
Ulrika Winblad ◽  
...  
Keyword(s):  
Quality Improvement ◽  
National Survey ◽  
Clinical Quality ◽  
Quality Registry ◽  
National Quality ◽  
National Quality Registry ◽  
Clinical Quality Improvement

scholarly journals 1157. GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S413-S414
Author(s):  
Aldo Martinez ◽  
Deborah Parilla ◽  
Melissa Green ◽  
Anne Murphy ◽  
Sylvia Suarez-Ponce ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Night Shift ◽  
Healthcare Research ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Clinical Quality ◽  
Tract Infections ◽  
Clinical Quality Improvement ◽  
Critical Reviews

Abstract Background Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15–25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired. Methods As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)-based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked Results Figure 1 shows the number of UCs recommended for removal by RNs vs. CQIS (bars), as well as the percent discordance between RNs and CQIS (line). CQIS identified many more removable UCs than the RNs (888 vs. 256). 211 UC were removed after RN recommendations, and an additional 386 UCs were removed as a result of the CQIS audits. Figure 2 shows the marked corresponding decline in our SUR over this intervention. Conclusion As more units participated in the initiative, we saw increasing numbers of “discontinue UC” recommendations. Over time there was also a moderate decrease in the discordance between RN and CQIS recommendations for UC removal. CQIS routinely identified many more UCs to be removed compared with RNs, and more than doubled the number of discontinued UC. Notably, the UC SUR markedly improved, decreasing from 0.98 to 0.78. Disclosures All authors: No reported disclosures.

Clinical quality improvement project: finding a repeatable approach for improving STAT lab testing

2003 ◽  
Vol 16 (2) ◽  
pp. 1-5
Author(s):  
Lynette Lutes ◽  
Sarvesh Logsetty ◽  
Jan McGuinness ◽  
Joan M. Carlson
Keyword(s):  
Quality Improvement ◽  
Pilot Project ◽  
Improvement Project ◽  
Clinical Quality ◽  
University Of Alberta ◽  
Improved Performance ◽  
The University ◽  
Culture Of Quality ◽  
Quality Process ◽  
Clinical Quality Improvement

Explores the development of a clinical quality improvement pilot project at the University of Alberta Hospital and Stollery Children’s Hospital which aimed to establish a team of individuals that could disseminate a culture of quality improvement and develop a framework for a quality process that could be replicated and repeated. Outcomes of the clinical pilot project included improved performance as well as opportunities to learn some key lessons around team membership and involvement.

scholarly journals Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Franziska Zúñiga ◽  
Magdalena Osinska ◽  
Franziska Zuniga
Keyword(s):  
New Zealand ◽  
Quality Indicators ◽  
Long Term Care ◽  
Grey Literature ◽  
Public Reporting ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Residential Long Term Care

Abstract Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.

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