Abstract P309: Provider Specific Quality Metrics: A Qualitative Approach to Quantitative Data

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rebecca Van Vliet ◽  
Chris Fanale
Keyword(s):  
Patient Outcomes ◽  
Additional Data ◽  
Data Entry ◽  
Objective Measure ◽  
Clinical Excellence ◽  
Quality Measures ◽  
Stroke Care ◽  
Qualitative Approach ◽  
Client Feedback ◽  
Constructive Feedback

Introduction: Quality measures and benchmarks are well known constants in the stroke world, but there are no established metrics for provider-specific quality related to the practice of stroke care via telemedicine technologies. We propose quality measures uniquely attributable to the practice of stroke telemedicine, regardless of the site where the telemedicine is provided. Methods: By analyzing client feedback obtained through surveys and reviewing historical opportunities, we identified four common themes essential to an excellent telemedicine provider. We then defined and refined each category into reportable measures. Data for the measures are obtained from data entry fields in our internal electronic medical record and reported using Tableau analytics software. Additional data is obtained from client reports and converted into a numerical score. Results: The four thematic areas we identified are responsiveness, documentation compliance, clinical metrics, and citizenship. Responsiveness is measured by callback time and on-camera time. Documentation compliance is measured by percent compliance with documentation of NIHSS score, IV thrombolytic contraindication, and intra-arterial (IA) intervention contraindication. Clinical metrics are defined as alteplase decision making time and alteplase recommendation rate. Although not a purely objective measure, citizenship is a critical component of telemedicine, and thus included for all providers. We investigate and inventory both compliments and complaints received, which are then converted into a score based on all telemedicine encounters. Conclusion: There is a lack of definition in what constitutes clinical excellence for telemedicine, apart from benchmarks that exist for hospitals. Our approach is a novel perspective on categorizing and quantifying telemedicine performance, which can be used as a constructive feedback tool for providers, as well as a mechanism to evaluate and define clinical excellence. We can track performance over time and recognize providers for excellence. Future study is required to correlate these measures with patient outcomes.

Abstract TP252: Using Hospital Door-to-Needle Times to Individualize Hospital Bypass Times in Order to Minimize Regional Onset-to-Needle Times

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jin-Moo Lee ◽  
Andria Ford ◽  
Jo-Ann Burns ◽  
Peter Panagos
Keyword(s):  
Patient Outcomes ◽  
Treatment Options ◽  
Stroke Care ◽  
Smartphone Application ◽  
System Level ◽  
Acute Stroke Care ◽  
Web Based ◽  
Arrival Times ◽  
Get With The Guidelines ◽  
Individual Hospital

Introduction: With enhanced treatment options but limited resources, acute stroke care is becoming regionalized. Regional pre-hospital triage plans are being developed to permit bypass of certain hospitals in order to deliver patients to hospitals with higher-level resources for advanced treatment options. One of the most contentious issues in these plans is the “bypass time”_time allowed for EMS to bypass one hospital in order to transport to a hospital with presumed higher level stroke care. Hypothesis: Incorporating transport times and individual hospital door-to-needle times (DNTs) into regional pre-hospital triage bypass plans will expedite regional treatment times which may lead to improved patient outcomes at the system level. Methods: To minimize onset-to-needle times (ONTs), it is essential not only to find the fastest route to the nearest capable hospital, but to find the nearest capable hospital with the shortest DNTs. We examined specific time components comprising ONT, including Onset-to-Arrival times (OATs) and DNTs using Get-with-the-Guidelines data (GWTG), comparing the hospital with fastest DTN times (Hospital A) with that of the average in the St. Louis metropolitan area. Results: Hospital A had a mean DNT that was 20 min faster than the average St. Louis DNT (31 min vs. 51 min, p<.0.001), while OATs were not different. This 20 min advantage might be translated into a longer bypass time specifically for hospital A, to provide equivalent or faster ONTs for patients in the region. Conclusion: The incorporation of hospital DNTs into regional pre-hospital triage plans can individualize bypass times for each hospital. This practice may accelerate treatment times throughout a region, and could be trialed with the aid of web-based smartphone application that could provide EMS with important information that could minimize both transport times and DNTs.

scholarly journals EVALUASI DAN DESAIN SISTEM INFORMASI AKUNTANSI PEMUNGUTAN DAN PENYETORAN PPN DALAM UPAYA MENINGKATKAN EFISIENSI KINERJA SUBDINAS PERPAJAKAN PADA PT. PELABUHAN INDONESIA III (PERSERO) CABANG TANJUNG PERAK

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Anindya Retno Wardhani ◽  
A.A Gde Satia Utama
Keyword(s):  
Information System ◽  
Accounting Information ◽  
Data Entry ◽  
Qualitative Approach ◽  
Real Problem ◽  
Research Subject ◽  
Case Study Method ◽  
Accounting Information System ◽  
The Government

Branch of PT Pelabuhan Indonesia III (Persero) in Tanjung Perak is one of the institution body that appointed by the Government to carry out the collection and remittance of WAPU VAT according to PMK No. 85 / PMK.03 / 2012 (amended by PMK No. 136 / PMK.03 / 2012). WAPU VAT collection and deposit system are inefficient because it requires a lot of time and effort when it comes to input the data entry of tax invoice, printing Tax Deposit and sent it to Bank Perception. Three steps activities need to be done more than once. Therefore, Branch of PT Pelabuhan Indonesia III (Persero) in Tanjung Perak need the collection and remittance of the WAPU VAT system that sufficient to improve the efficiency of tax suboffices performance.This research aims to design the accounting information system for collecting and depositing process WAPU VAT. WAPU VAT Deposit using e-tax payment application are expected to overcome the problems that will arise in the WAPU VAT system deposit.Exploratory qualitative approach with case study method chosen in order to dig up the real problem occurs and find a solution. This research are expected to contribute significantly towards Branch of PT Pelabuhan Indonesia III (Persero) in Tanjung Perak as a research subject. In addition, the implementation of draft e-tax application payment system are expected to improve efficiency process of collection and remittance of WAPU VAT. Keyword : System Design, Wapu VAT, Efficiency, e-tax payment

Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Carol J Parker ◽  
Mathew J Reeves
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Base ◽  
Quality Metrics ◽  
Care Quality ◽  
Stroke Recurrence ◽  
The Impact ◽  
The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

Abstract T P260: Utilizing Concurrent Chart Review With Electronic Medical Record to Improve Stroke Core and Quality Measures

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jenny Fung
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Performance Measures ◽  
Chart Review ◽  
Heart Association ◽  
Quality Measures ◽  
Stroke Care ◽  
Thromboembolism Prophylaxis ◽  
Gradual Improvement ◽  
Stroke Team

Background and Purpose: The purpose of this project was to utilize concurrent chart review with electronic medical record as one method to improve stroke performance measures. In order to standardize and improve stroke care in the acute care setting, stroke performance measures have been set forth by the American Heart Association/American Stroke Association through Get With The Guidelines Registry, and from the Joint Commission. Maintaining stroke measures above goal can present a challenge in the world of paper documentation and chart review after discharge. Electronic medical record (EMR) allows multiple providers, including physicians, nurses, therapists, and stroke coordinator to access the health record concurrently during the patient’s hospital stay. Methods: Guided by a successful program implemented by St Mary’s Health Center in Jefferson City, Missouri, a 2 step concurrent chart review process was initiated for all stroke and transient ischemic attack (TIA) patients admitted to our facility. A stroke coordinator conducted chart review via EMR focusing on 8 of the quality measures (Early Antithrombotics, venous thromboembolism prophylaxis, antithrombotics at discharge, anticoagulation at discharge for atrial fibrillation/atrial flutter, smoking cessation, statin at discharge, dysphagia screen, and stroke education). Chart review was conducted the day after admission and the day of discharge with the goal of correcting potential outliers on the same day of chart review. Monthly performance data was collected over 1 year. Results: Concurrent chart review was conducted on 409 stroke/TIA patients. There was gradual improvement in quality and core stroke measures following implementation with achieving and sustaining 100% in 7 measures by month 6 and acheivement of >90% for dysphagia screen. Conclusions: In conclusion, concurrent chart review with the use of electronic medical record allows the stroke coordinator to focus on core and quality measures, while allowing multiple members of the stroke team (physician, nurse, and therapist) to access the same patient record. This also provides opportunities for collaboration and process improvement within the same stroke team.

scholarly journals Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038776
Author(s):  
Susanne Drynda ◽  
Wencke Schindler ◽  
Anna Slagman ◽  
Johannes Pollmanns ◽  
Dirk Horenkamp-Sonntag ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Quality Indicators ◽  
Patient Outcomes ◽  
Claims Data ◽  
Quality Measures ◽  
Patient Questionnaire ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

IntroductionQuality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up.Methods and analysisThe study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6–8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes.Ethics and disseminationApproval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs.Trial registration numberGerman Clinical Trials Registry (DRKS00015203); Pre-results.

Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study

2017 ◽  
Vol 13 (6) ◽  
pp. 585-591 ◽  
Author(s):  
Tara Purvis ◽  
Monique F Kilkenny ◽  
Sandy Middleton ◽  
Dominique A Cadilhac
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Acute Stroke ◽  
Patient Outcomes ◽  
Stroke Unit ◽  
Stroke Care ◽  
Initial Assessment ◽  
Evidence Based ◽  
Clinical Practices ◽  
Evidence Based Care

Background Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.

scholarly journals Evaluation of Rural Stroke Services

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2848-2853 ◽  
Author(s):  
Dominique A. Cadilhac ◽  
Tara Purvis ◽  
Monique F. Kilkenny ◽  
Mark Longworth ◽  
Katherine Mohr ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Rural Areas ◽  
Stroke Care ◽  
Stroke Units ◽  
Care Plans ◽  
Cohort Design ◽  
South Wales ◽  
Health Assessments ◽  
Multivariable Analyses

Background and Purpose— The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. Methods— A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. Results— Sample: pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P <0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P <0.001); use of care plans (pre 15%; post 63%, P <0.001); and allied health assessments within 48 hours (pre 65%; post 82% P <0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34–2.66). Conclusions— Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.

Managing a Stroke Unit: An Example from Australia with an Emphasis on Nursing Roles

2007 ◽  
Vol 2 (3) ◽  
pp. 201-207 ◽  
Author(s):  
Louise Weir ◽  
Dominique A. Cadilhac
Keyword(s):  
Patient Outcomes ◽  
Clinical Care ◽  
Stroke Care ◽  
Multidisciplinary Teams ◽  
Special Report ◽  
Royal Melbourne Hospital ◽  
Team Members ◽  
Stroke Team ◽  
Nursing Roles ◽  
Participation In Research

Stroke care units (SCUs), which are co-ordinated by dedicated multidisciplinary teams and geographically located in one area, are currently the most generaliseable form of effective treatment for stroke. Although the evidence for SCUs is compelling, to date there has been limited evidence regarding the contribution of the different clinical team members who assist in producing the better patient outcomes observed in SCUs. In particular, there has been limited exploration of the different nursing roles. The purpose of this special report is to describe how an SCU operates and highlight the contribution of the various nursing roles as part of the multidisciplinary stroke team. The article is based on one of the longest established stroke services in Melbourne, Australia. The characteristics and composition of the Royal Melbourne Hospital stroke service in providing clinical care and management will be highlighted as an example. Further, the nursing roles related to avoiding complications, education for patients and families and other staff in the unit, as well as participation in research and future career development opportunities are discussed.

scholarly journals Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055247
Author(s):  
Lisha Lo ◽  
Leahora Rotteau ◽  
Kaveh Shojania
Keyword(s):  
Patient Outcomes ◽  
Safety Climate ◽  
Data Extraction ◽  
Implementation Fidelity ◽  
Quality Measures ◽  
Relative Increase ◽  
Controlled Trials ◽  
Clinical Settings ◽  
High Fidelity ◽  
Multifaceted Interventions

ObjectiveTo characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures.Data sourcesMedline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals.Study selection and outcome measuresEligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes).Data extraction and synthesisTwo reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%–40%) or large (>40%).ResultsTwenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems).ConclusionsHigh fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred.PROSPERO registration numberCRD42018111377.

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