Pathology quality improvement in British Columbia using performance measurement and knowledge mobilization.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 54-54
Author(s):  
Nick van der Westhuizen ◽  
Cheng-Han Lee ◽  
Brigette Rabel ◽  
Katherine Young ◽  
Shaheena Mukhi
Keyword(s):  
British Columbia ◽  
Quality Improvement ◽  
Data Collection ◽  
Communities Of Practice ◽  
Performance Metrics ◽  
Comparative Data ◽  
Action Plans ◽  
Knowledge Mobilization ◽  
The Impact ◽  
Synoptic Reporting

54 Background: Pathology reporting content and formatting varies considerably in British Columbia (BC). The impact of this variability on the quality of care is unknown but it hinders effective data collection and measurement to guide quality improvement. A knowledge mobilization project that digitalized standardized reporting would ensure report completeness and generation of comparative performance data could be used within communities of practice to facilitate peer-to-peer conversations and create action plans to improve patient care. Methods: In 2014 BC adopted the College of American Pathologists cancer checklists as the standard for synoptic reporting using a single standalone electronic synoptic reporting program which interfaced with all five provincial laboratory information systems. Using the tool ensures all mandatory clinical prognostic indicators are reported. Discrete data elements were transmitted to a central data repository (CDR) which was mined to compile key performance indices reports for individual pathologists and generate comparative data reports at the institutional, regional and provincial level. Results: In the first six months of its implementation there was variation from 11-94% across different laboratories in their adoption of the reporting tool. The goal is to increase the average adoption rate from 76% to 90%. Analysis of data showed a highly comparable pattern of pathology practice across the major cancer sites/types and comparable to other Canadian provinces and the literature. Advisory committee reviews with interdisciplinary discussion of comparative data reports revealed potential areas for clinical improvement. For example, significant variation in the number of lymph nodes in colorectal resections was identified with some sites falling short of published recommendations. Conclusions: Population-based standardized digitalized pathology data reporting with centralized data collection can be achieved. Analysis of this data enables monitoring of performance metrics and meaningful discussions via communities of practice identify areas for quality improvement and create action plans.

scholarly journals Haemodialysis therapy and sustainable growth: a corporate experience in France

2020 ◽  
Vol 35 (12) ◽  
pp. 2154-2160 ◽  
Author(s):  
Georges Bendine ◽  
Fabien Autin ◽  
Bruno Fabre ◽  
Olivier Bardin ◽  
François Rabasco ◽  
...  
Keyword(s):  
Water Treatment ◽  
Data Collection ◽  
Power Consumption ◽  
Water Consumption ◽  
Environmental Parameters ◽  
High Water ◽  
Sustainable Growth ◽  
Action Plans ◽  
Dialysis Unit ◽  
The Impact

Abstract Introduction Sustainable growth and environmental issues are currently a topic for all human activities, and dialysis represents a real challenge in this field because of high water and power consumption and the production of large amounts of care-related waste. In this article we describe data collection implemented in the NephroCare centres in France and the changes observed during a 13-year period regarding environmental parameters. Methods Monthly data collection (eco-reporting) was implemented in NephroCare centres in France in 2005. It covers three topics designed as key performance indicators (KPIs): electricity and water consumption and care-related waste production expressed, respectively, as kilowatt-hour (kWh), litres (L) and kilograms per session. We report on the three action plans (2005–10, 2011–14 and 2015–18) and changes observed during this 13-year period. Results During the period, power and water consumption declined by 29.6% (from 23.1 to 16.26 kWh/session) and 52% (from 801 to 382 L/session), respectively. At the same time, the yearly number of dialysis sessions has increased from 169 335 to 399 336. The sources of savings came both from improvements in the dialysis technology (dialysis machines and water treatment systems) and from updating and remodelling of the dialysis unit equipment and buildings. The care-related waste decreased from 1.8 to 1.1 kg because of regular staff training and the retrofiltration system, allowing the voiding of the remaining saline solution after dialysis. These savings have been estimated as equivalent to 102 440 tons of carbon dioxide. Discussion Implementation of KPIs and their regular monitoring by trained staff to evaluate water and power consumption and the reduction of care-related water production are essential to implement actions to reduce the impact of dialysis on the environment. These data show the importance of water treatment and dialysis technology to decrease water and power consumption and the production of care-related waste as well as upgrading or remodelling of buildings housing dialysis units. Other measures are discussed, including the reuse of rejected water by reverse osmosis, as well as behavioural changes that are needed to reach sustainable development of dialysis. Conclusion The first step to reach ‘green’ dialysis is to collect precise information from defined KPIs. This is the only way to design action plans to reduce the impact of dialysis therapy on the environment. Beyond this, the nephrology community must be sensitized to this challenge to be proactive and to anticipate future regulations.

scholarly journals Patient safety and quality improvement: Ethical principles for a regulatory approach to bias in healthcare machine learning

2020 ◽  
Vol 27 (12) ◽  
pp. 2024-2027 ◽  
Author(s):  
Melissa D McCradden ◽  
Shalmali Joshi ◽  
James A Anderson ◽  
Mjaye Mazwi ◽  
Anna Goldenberg ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Patient Safety ◽  
Quality Improvement ◽  
Performance Metrics ◽  
Ethical Principles ◽  
Healthcare Decision ◽  
Healthcare Decision Making ◽  
Regulatory Approach ◽  
The Impact

Abstract Accumulating evidence demonstrates the impact of bias that reflects social inequality on the performance of machine learning (ML) models in health care. Given their intended placement within healthcare decision making more broadly, ML tools require attention to adequately quantify the impact of bias and reduce its potential to exacerbate inequalities. We suggest that taking a patient safety and quality improvement approach to bias can support the quantification of bias-related effects on ML. Drawing from the ethical principles underpinning these approaches, we argue that patient safety and quality improvement lenses support the quantification of relevant performance metrics, in order to minimize harm while promoting accountability, justice, and transparency. We identify specific methods for operationalizing these principles with the goal of attending to bias to support better decision making in light of controllable and uncontrollable factors.

scholarly journals The Impact of Point-of-Care Hemoglobin A1c Testing on Population Health-Based Onsite Testing Adherence: A Primary-Care Quality Improvement Study

2020 ◽  
pp. 193229682097275
Author(s):  
Joseph Benjamin Crocker ◽  
Stephen H. Lynch ◽  
Anthony J. Guarino ◽  
Kent Lewandrowski
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Population Health ◽  
Hemoglobin A1c ◽  
Performance Metrics ◽  
Diabetes Management ◽  
Point Of Care ◽  
Care Quality ◽  
Health Performance ◽  
The Impact

Background: The hemoglobin A1c (HbA1c) is a gold-standard test to diagnose and monitor diabetes mellitus and has been incorporated into population health performance metrics for quality care. However, patients and practices remain challenged in completing timely HbA1c tests. Point-of-care testing (POCT) for HbA1c provides a quick, easy, reliable method for monitoring diabetes in the primary care office setting. The objectives of this quality improvement study were to evaluate the impact of HbA1c POCT on onsite HbA1c testing frequency as a component of population health performance, as well as to measure the utility of HbA1c POCT in identifying clinically meaningful change in disease. Method: Prospective quality improvement cohort study among sequentially scheduled adult patients with diabetes due for HbA1c testing across three primary care practices. Results: Practices with HbA1c POCT were 3.7 times less likely to miss HbA1c testing at the time of the visit compared with practices in which HbA1c POCT was not available ( P < .001). Nearly one in four patients in each group were found to have clinically worsening diabetes (defined by an increase in HbA1c of ≥0.5% or 5.5 mmol/mol). Nearly half of those patients in the intervention group were identified by POCT. Conclusions: HbA1c POCT can improve population health-driven HbA1c testing adherence at office visits in primary care and may enable more timely intervention of diabetes management for patients with worsening disease.

scholarly journals P085: A low-cost solution to high-risk problem: enhancing communication of emergency physician x-ray interpretations to reading radiologist

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S107
Author(s):  
D.J. MacKinnon ◽  
M. McGowan ◽  
T. Dowdell ◽  
G. Bandiera
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Data Collection ◽  
Reporting System ◽  
Low Cost ◽  
Emergency Physicians ◽  
X Ray ◽  
It Systems ◽  
User Friendly ◽  
The Impact

Introduction: There was a recognized lack of available system for Emergency Physicians (EPs) to communicate their x-ray interpretations to the reading Radiologist; this resulted in unnecessary flagging of cases with significant findings already seen by the EP or the possibility of incorrectly assuming a finding was seen by the EP. Our aim was to develop an IT-based system that permitted Radiologists to view EPs documented x-ray interpretations real-time. Based on engagement with both groups, it was essential that the system be user friendly and not add significantly to an already busy workload. Methods: An online reporting system was introduced in 2011, but with complaints that interpretations were not readily accessible, nor automatic. A revised system was launched in 2014 with 2 improvements: i) EP entered interpretation onto “sticky note” in PACs directly; and ii) EP interpretation “popped up” when a film was opened by Radiologist. Results: Both systems allowed data collection of the percentage of events EPs entered an interpretation. Prior to 2011, 0% of films had EP interpretations available to Radiologist, 33% with initial, and 53% with PACS. The revised system has enabled EPs to enter their x-ray interpretation which has resulted in improvement both subjectively, based on regular feedback from both EPs and Radiologists, and objectively. Conclusion: From this and other quality improvement initiatives, we have learned the importance of engaging frontline practitioners in process changes, specifically the impact on workflow. Also, utilizing existing IT systems and resources can result in positive change with minimal costs.

The Backlog of Unstocked Forest Land in British Columbia and the Impact of Reforestation Programs

1986 ◽  
Vol 62 (6) ◽  
pp. 514-521 ◽  
Author(s):  
Peter H. Pearse ◽  
Andrea J. Lang ◽  
Kevin L. Todd
Keyword(s):  
British Columbia ◽  
Data Collection ◽  
Special Reference ◽  
Site Quality ◽  
Forest Land ◽  
Rate Of Increase ◽  
The Impact

The current reforestation effort in British Columbia is examined with special reference to the accumulated backlog of "not satisfactorily restocked" (NSR) forest land in the province. The confusing statistics on the backlog are evaluated and the rate of increase is calculated. The statistics suggest that some 1302 thousand hectares now fall in this category, with 588 thousand hectares of good and medium site quality which, by the Ministry of Forest criteria, warrant rehabilitation.The available data suggest that the backlog NSR has been growing at an average of 59 thousand hectares per year during the last five years. This growth can be expected to be arrested during the next few years, as a result of expanded basic silviculture programs combined with new efforts to rehabilitate the backlog of unstocked lands. However, the total area of the backlog will not be reduced significantly.Statistical information about the backlog NSR lands is very weak. A number of suggestions are made for improving data collection and interpretation, and for focusing the rehabilitation effort.

INDONESIA LANGUAGE INTERFERENCE FORM IN BASIC PPL LEARNING THAILAND UNHASY COLLEGE SYUDENTS

2020 ◽  
Vol 8 (2) ◽  
pp. 38
Author(s):  
Siti Mariana Ulfa
Keyword(s):  
Qualitative Research ◽  
Data Analysis ◽  
Data Collection ◽  
Teaching Practice ◽  
Data Presentation ◽  
Analysis Techniques ◽  
Thai Students ◽  
The Impact ◽  
Collection Methods ◽  
Recording Techniques

AbstractHumans on earth need social interaction with others. Humans can use more than one language in communication. Thus, the impact that arises when the use of one or more languages is the contact between languages. One obvious form of contact between languages is interference. Interference can occur at all levels of life. As in this study, namely Indonesian Language Interference in Learning PPL Basic Thailand Unhasy Students. This study contains the form of interference that occurs in Thai students who are conducting teaching practices in the classroom. This type of research is descriptive qualitative research that seeks to describe any interference that occurs in the speech of Thai students when teaching practice. Data collection methods in this study are (1) observation techniques, (2) audio-visual recording techniques using CCTV and (3) recording techniques, by recording all data that has been obtained. Whereas the data wetness uses, (1) data triangulation, (2) improvement in perseverance and (3) peer review through discussion. Data analysis techniques in this study are (1) data collection, (2) data reduction, (3) data presentation and (4) conclusions. It can be seen that the interference that occurs includes (1) interference in phonological systems, (2) interference in morphological systems and (3) interference in syntactic systems. 

The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

2020 ◽  
Vol 33 (6) ◽  
pp. 812-821
Author(s):  
Scott L. Zuckerman ◽  
Clinton J. Devin ◽  
Vincent Rossi ◽  
Silky Chotai ◽  
E. Hunter Dyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Discharge Planning ◽  
Lumbar Fusion ◽  
Nonparametric Tests ◽  
Learning System ◽  
Design Quality ◽  
Implementation Phase ◽  
Healthcare Improvement ◽  
The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

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