Abstract 177: National Trends in Inpatient Stroke Quality: VHA Experience

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Linda S Williams ◽  
Teresa Damush ◽  
James Slavin ◽  
Zhangsheng Yu ◽  
Danielle Sager ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Indicators ◽  
Randomized Study ◽  
Stroke Care ◽  
Fiscal Year ◽  
Smoking Cessation Counseling ◽  
Chi Square ◽  
Passing Rates ◽  
National Quality ◽  
Student’S T

Objectives: In 2009, the VHA reported inpatient stroke quality indicators based on chart abstractions of fiscal year (FY) 2007 data at all VA medical centers (VAMCs). Prior to a randomized trial of a Systems Redesign-based intervention, we re-measured VA stroke quality indicators (QIs) from 2009 data in 11 of the largest volume VAMCs. The purpose of this analysis is to examine whether any significant changes occurred in inpatient stroke care in these sites between 2007 and 2009. Methods: Data for 10 Joint Commission (JC) inpatient stroke QIs were obtained by experienced external VA chart abstractors via review of FY 2007 electronic medical records. We abstracted 2009 data at 11 sites as baseline data for a quality improvement randomized study. We calculated eligibility and passing rates for ten inpatient stroke QIs defined similarly to the 10 JC indicators from the FY 2007 study. We compared patient demographics, clinical variables, and passing rates for each QI between the FY 2007 and CY 2009 data at the 11 sites using Student’s t-test and Chi-square tests. Results: Comparing 2007 (N =750) to 2009 (N =817) data, mean age (66.3, 66.6), % male (97%, 96%), and % Black (34%, 33%) were similar but mean NIH Stroke Scale score was increased in 2009 (4.2, 5.9, p < 0.001). Three QIs were unchanged over time: DVT prophylaxis, anticoagulation for atrial fibrillation, and antithrombotic at discharge (Table). Performance on four indicators was significantly improved: dysphagia screening (16%, 45%), receipt of rehabilitation consultation (62%, 89%), stroke education (17%, 31%), and receipt of tPA (17%, 47%). Performance on three indicators was significantly reduced: antithrombotic by hospital day two (98%, 87%), cholesterol lowering medication at discharge (90%, 72%), and receipt of smoking cessation counseling (100%, 89%). Conclusions: Prior to VHA national quality improvement efforts, both positive and negative shifts in performance occurred for common inpatient stroke QIs. Future work should examine whether focusing efforts on one aspect of stroke care can lead to reduction in quality in other areas, and on whether consistent reporting of these QIs can promote maintenance of high quality stroke care across a large national healthcare system.

Peer review in radiotherapy (RT): A national quality improvement initiative.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 221-221 ◽  
Author(s):  
Michael Donald Brundage ◽  
Brenda H Bass ◽  
Sophie Foxcroft ◽  
Ross Halperin ◽  
Thomas McGowan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Peer Review ◽  
Quality Indicators ◽  
Radiation Oncology ◽  
Preliminary Evidence ◽  
Steering Committee ◽  
Perceived Barriers ◽  
Quality Improvement Initiative ◽  
Implementation Framework ◽  
National Quality

221 Background: Peer review (PR) in Radiation Oncology has been shown to be effective in improving quality of treatment by detecting and correcting deficiencies in proposed treatment plans prior to treatment. PR is also effective in: guiding departmental treatment planning policies and processes; reducing variation in practice; providing a venue for multi-disciplinary communication, and increasing staff and trainee awareness of evolving treatment processes. The importance of PR is reflected in the inclusion of 3 PR-specific quality indicators in the Canadian Partnership for Quality Radiotherapy QA Guidelines for Radiation Oncology programs. Given this endorsement, we aim to enhance PR implementation across all Canadian cancer centres using a knowledge-translation and implementation framework. Methods: This project will facilitate increased uptake of PR in Canadian RT programs by implementing the top-down model used with success in Ontario. This model has several key components, including: a) engaging the leadership of provincial cancer agencies to promote PR at every Provincial cancer centre; b) providing modest financial support for the acquisition of the required hardware and/or staff time for coordinating PR activities; c) systematic collection of each centre’s baseline PR activities, perceived barriers and potential facilitators of PR at each centre; d) creation of a continuous quality improvement cycle by monitoring PR quality indicators over time; e) systematic knowledge and information sharing regarding effective PR processes. Results: Funding for this initiative was obtained from the Canadian Partnership against Cancer (CPAC) in April 2014. A steering committee consisting of stakeholders from across Canada has been struck and provincial launches, based on the tenets used in Ontario, have commenced in 7 of 13 provinces with others expressing interest. A national survey to obtain baseline data relating to PR activities, perceived barriers, and facilitators is underway and will be reported. Conclusions: Preliminary evidence suggests a “snowball effect” of increasing PR uptake across Canada. The implementation model could be applied in other jurisdictions interested in increasing PR in radiation oncology.

scholarly journals Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Ann Catrine Eldh ◽  
Mio Fredriksson ◽  
Christina Halford ◽  
Lars Wallin ◽  
Tobias Dahlström ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Stroke Care ◽  
Quality Registry ◽  
National Quality ◽  
Facilitators And Barriers ◽  
National Quality Registry

scholarly journals Quality Indicators for Avalanche Victim Management and Rescue

2021 ◽  
Vol 18 (18) ◽  
pp. 9570
Author(s):  
Alexandre Kottmann ◽  
Mathieu Pasquier ◽  
Giacomo Strapazzon ◽  
Ken Zafren ◽  
John Ellerton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Indicators ◽  
Clinical Performance ◽  
Evaluation Criteria ◽  
Nominal Group Technique ◽  
Quality Measurement ◽  
Nominal Group ◽  
Continuous Quality ◽  
National Quality ◽  
Objective Feedback

Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.

Roadmap for developing a national quality indicator set for general practice

2015 ◽  
Vol 28 (4) ◽  
pp. 382-393 ◽  
Author(s):  
Ailis ni Riain ◽  
Catherine Vahey ◽  
Conor Kennedy ◽  
Stephen Campbell ◽  
Claire Collins
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Quality Indicator ◽  
Delphi Process ◽  
Road Test ◽  
Practice Staff ◽  
Content Type ◽  
The Road ◽  
National Quality

Purpose – The purpose of this paper is to describe a national, comprehensive quality indicator set to support delivering high-quality clinical care in Irish general practice. Design/methodology/approach – Potential general practice quality indicators were identified through a literature review. A modified two-stage Delphi process was used to rationalise international indicators into an indicator set, involving both experts from key stakeholder groups (general practitioners (GPs), practice nurses, practice managers, patient and health policy representatives) and predominantly randomly selected GPs. An illustrative evaluation approach was used to road test the indicator set and supporting materials. Findings – In total, 80 panellists completed the two Delphi rounds and staff in 13 volunteer practices participated in the road test. The original 171 indicators was reduced to 147 during the Delphi process and further reduced to 68 indicators during the road test. The indicators were set out in 14 sub-domains across three areas (practice infrastructure, practice processes and procedures, and practice staff). Practice staff planned 77 quality improvement activities after their assessment against the indicators and 31 (40 per cent) were completed with 44 (57 per cent) ongoing and two (3 per cent) not advanced after a six-month road test. A General Practice Indicators of Quality indicator set and support materials were produced at the conclusion. Practical implications – It is important and relatively easy to customise existing quality indicators to a particular setting. The development process can be used to raise awareness, build capacity and drive quality improvement activity in general practices. Originality/value – The authors describe in detail a method to develop general practice quality indicators for a regional or national population from existing validated indicators using consensus, action research and an illuminative evaluation.

Setting performance benchmarks for stroke care delivery: Which quality indicators should be prioritized in quality improvement; an analysis in 500,331 stroke admissions

2020 ◽  
pp. 174749302095860
Author(s):  
Xi Li ◽  
Chao Wang ◽  
Shazia Rehman ◽  
Xinyu Wang ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
Adherence Rate ◽  
Thrombosis Prophylaxis ◽  
Performance Targets ◽  
Performance Benchmarks

Background and aim Benchmarking is a management approach for implementing best medical practices at the lowest cost. The objectives of this study were to set achievable performance benchmarks for individual quality indicators to determine the predicted quality achievement related to better adherence, and to select optimal quality indicators for improving the quality of acute ischemic stroke care. Methods We analyzed data on 500,331 patients diagnosed with acute ischemic stroke who were treated at 518 hospitals in China from January 2011 to May 2017. The primary outcome was independence (modified Rankin Scale score ≤2) at discharge. Data-driven achievable benchmarking used the “pared-mean” approach to set objective performance targets. Hierarchical logistic regression models were employed to evaluate the process–outcome association, as well as the predicted quality improvement if all hospitals were to operate at the benchmark level. Results Of the overall population, 64.01% were independent patients at discharge. The performance benchmarks were >90% for most of the quality indicators. After adjusting for patient-level and hospital-level characteristics and unifying hospital performance to the benchmark level, the quality indicators with high increase in both overall adherence rate and independence rate were thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis. Conclusions Performance targets for three acute treatments, including thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis, could best motivate improvements in both overall adherence rate and independence rate at discharge. The finding suggests that the above three types of acute treatment should be given priority to improve the quality of acute ischemic stroke care.

Abstract P23: Age Disparities in Quality of Care and Clinical Outcomes in US Veterans With Ischemic Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Neale R Chumbler ◽  
Huanguang Jia ◽  
Xinli Li ◽  
Michael Phipps ◽  
Diana Ordin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
Smoking Cessation Counseling ◽  
Early Ambulation ◽  
Post Stroke ◽  
Age Disparities ◽  
Patient Groups ◽  
Us Veterans

Background This is the first study of age disparities in ischemic stroke care quality and post-stroke outcomes across the Department of Veterans Affairs (VA) system. Methods This was a retrospective study of a national sample of US veterans admitted to VA medical centers for ischemic stroke between 10/1/06 and 9/30/07. The following 14 inpatient stroke quality indicators were assessed: 1) dysphagia screening before oral intake; 2) NIH Stroke Scale completion ; 3) thrombolysis; 4) DVT prophylaxis; 5) early antithrombotic therapy; 6) early ambulation; 7) fall risk assessment; 8) pressure ulcer risk assessment; 9) rehabilitation consultation); 10) antithrombotic therapy at discharge; 11) atrial fibrillation management; 12) lipid management; 13) smoking cessation counseling; and 14) stroke education. Post-stroke outcomes included: risk-adjusted mortality (in-hospital and 6-month post-stroke); and hospital readmission (30-day and 6-month). Four age categories were assigned (<65, 65-74, 75-84, and ≥85 years). We modeled each quality indicator (defined as pass or fail among eligible patients) using multivariable logistic regression adjusting for race, stroke severity, comorbidity, smoking status, APACHE II score, hospital geography, complexity and volume. Results Among the 3,937 US Veterans with ischemic stroke, the overall pass rate among the quality indicators was > 70% for 9 of the 14 processes of care. Patients ≥85 years old were less likely than younger patients to receive atrial fibrillation management, smoking cessation counseling, NIHSS documentation, and early ambulation (p < .05). Patients aged ≥85 years were more likely to have dysphagia screening (p < .05). Risk adjusted mortality was higher among patients aged ≥85 years compared with each of the younger patient groups in both in-hospital mortality (p < .0001) and 6-month mortality (p < .0001). The oldest patients also had higher 6-month hospital re-admission rates than each of the younger patient groups (p = .002). Conclusions Despite overall good quality of inpatient stroke care within the VA system, further work is needed to investigate possible associations between patient age, disparities in quality indicators and outcomes of post-stroke.

Abstract W P270: Quality of In-Hospital Stroke Care in Veterans Affairs Hospitals

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Michael J Lyerly ◽  
Danielle Sager ◽  
Jessica Coffing ◽  
Theresa Damush ◽  
Gary Cutter ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Stroke Care ◽  
Veterans Affairs ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Chi Square ◽  
Veterans Affairs Hospitals ◽  
Hospital Patients ◽  
Student’S T

Introduction: Increasing focus is being placed on quality metrics for stroke care in an effort to improve outcomes. This study aims to examine if quality of stroke care is the same for Veterans experiencing an in-hospital stroke compared to patients presenting through the emergency department (ED). Methods: We analyzed data from an 11-site VA quality improvement study, where 30 months of ICD-9 defined stroke admissions were chart reviewed by a central, trained group of abstractors to assess stroke diagnosis, clinical data, and eligibility and passing for 11 stroke quality indicators (QIs; 8 Joint Commission and 3 others). Stroke severity was determined by retrospective NIHSS scoring of the admission exam. Strokes were classified as presenting to the ED or in-hospital (already admitted for another diagnosis). Transfers (N = 362) were excluded. We compared clinical and QI data between the in-hospital and ER groups using Student’s t-tests and Chi-square tests. Results: There were 35 in-hospital and 1788 ED strokes. The two groups did not differ with respect to age, race or sex, however in-hospital strokes had higher stroke severity (mean 11.1 vs 5.1, p=0.002), increased length of stay (12.8 vs 7.3, p=0.003), and were less likely to be discharged home (34.3% vs 63.8%, p<0.001). QI results are shown in the Table; those with in-hospital stroke were more likely to be eligible for tPA, but received less dysphagia screening. Conclusions: Veterans who develop an in-hospital stroke receive similar quality of care as patients presenting to the ED although fewer in-hospital patients had dysphagia screening. Interestingly, tPA eligibility and utilization were higher for in-hospital strokes although utilization did not reach significance. While it is reassuring that in-hospital strokes are receiving similar quality of care, there is still room for improvement in all patient care settings and in-hospital stroke patients should be included in future QI processes.

PREEMPTIVE ANALGESIA WITH AMITRIPTYLINE IN WOMEN UNDERGOING ABDOMINAL HYSTERECTOMY: A RANDOMIZED CLINICAL TRIAL

2020 ◽  
pp. 2-5
Author(s):  
Antônio Henriques De França Neto ◽  
Alexandre Magno Nóbrega Marinho ◽  
Eveline Pereira De Arruda Agra ◽  
Priscilla Guimarães Alves ◽  
Josikwylkson Costa Brito ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pressure Pain Threshold ◽  
Abdominal Hysterectomy ◽  
Tricyclic Antidepressant ◽  
Preemptive Analgesia ◽  
Chi Square ◽  
Double Blind ◽  
Exact Test ◽  
Student’S T

The concept of preemptive analgesia, albeit long-standing, has reemerged. Consequently, recent research has focused on testing a variety of drugs preoperatively to prevent the occurrence of postoperative pain, a major factor of morbidity. Amitriptyline is a tricyclic antidepressant used to treat chronic pain. Because amitriptyline acts on pain transmission pathways, it could theoretically be used as an agent for the prevention of postoperative pain. This study evaluated the effectiveness of amitriptyline in preventing pain in patients submitted to hysterectomy, the most commonly performed gynecological surgery. A randomized, double-blind clinical trial was conducted with 145 patients, 72 of these receiving amitriptyline and 73 placebo. All patients were evaluated at 6, 12, 24 and 48 hours after surgery using a visual analog scale (VAS) for pain and algometry to determine the pressure-pain threshold. Statistical analysis was conducted using the chi-square test of association, Student's t-test, and the Mann-Whitney test, with Fisher's exact test being used whenever appropriate. No statistically signicant difference was found between the two groups with respect to pain at any of the time points evaluated, leading to the conclusion that at a dose of 25 mg, amitriptyline is ineffective in preventing postoperative pain in patients submitted to abdominal hysterectomy

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