Multi-level QI interventions in a safety-net academic oncology clinic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18665-e18665
Author(s):  
Aparna Chakravarti Jotwani ◽  
Courtney Nicole Miller-Chism ◽  
Margaret Griffin Crawford ◽  
Claire Mach ◽  
LaToya Woods ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Cycle Time ◽  
Safety Net ◽  
T Test ◽  
Wait Times ◽  
Patient Volume ◽  
Test Analysis ◽  
Cycle Times ◽  
Clinic Efficiency ◽  
Multi Level

e18665 Background: Clinic cycle time is a performance metric and prolonged wait times may impact patient satisfaction and/or treatment outcomes. In primary care clinics, studies show prolonged cycle times detract from patient satisfaction. Fewer studies examine specialty clinics such as oncology which require multi-faceted care. Our Harris Health System (HHS) serves a diverse county with high patient volume with physician learners and limited providers due to limited resources. Our patient satisfaction assessments previously identified prolonged wait times as an area for improvement. Our team studied and process mapped operations with the goal of improving clinic efficiency. Our primary objective is to streamline the process for our outpatient oncology appointments measured through patient cycle times. We aimed to decrease the cycle time by 25% and improve patient satisfaction. Methods: From January 2018 through December 2019, the cycle time processes for Smith Thursday Oncology Clinics in the HHS were mapped and analyzed, and sequential PDSA (Plan-Do-Study-Act) cycles were completed to reduce non-value-added time. Six-month cycle times before and after implementation of three process changes implemented were compared with t-test analysis. Next, NRC (National Research Corporation) Health patient satisfaction data for the corresponding time frames was compared with both t-test and chi-square analyses. Results: Patient cycle time from July 2018 – December 2018 was compared to July 2019 – December 2019 with a t-test analysis. Our results showed a significant (p = 0.036) reduction in cycle time. The average percent decrease in cycle time was 19%. NRC patient satisfaction data inquiries, including overall satisfaction, informed regarding appointment delays, and waiting for more than 15 minutes were reviewed for this same time frame. We found trends in all three categories showing improvements in scores with p-values of 0.483, 0.821 and 0.282 respectively. Conclusions: Through multi-level interventions we were able to significantly reduce clinic cycle times. Trends towards improvement were seen as the population assessed was in the hundreds and not thousands needed for significance. Our academic teaching model is meaningful to study as it serves a high patient volume and educates future oncologists, especially pertinent when a shortage of oncologists in anticipated in the future. Additionally, our patients receive high quality care with nursing, education and infusion services. An area for improvement is communication with patients during their cycle times and other early QI work in our clinics show patients are interested in further education. Our underserved patient population is multi-ethnic, has unassessed health literacy, and frequent language barriers. Better efficiency in the clinics and utilization of cycle time can have multiple patient benefits that warrant further work in QI.

scholarly journals A Longitudinal Comparison of Telemedicine Versus In-Person Otolaryngology Clinic Efficiency and Patient Satisfaction During COVID-19

2021 ◽  
pp. 000348942110553
Author(s):  
Karen K. Hoi ◽  
Sloane A. Brazina ◽  
Rachel Kolar-Anderson ◽  
David A. Zopf ◽  
Lauren A. Bohm
Keyword(s):  
Patient Satisfaction ◽  
Cycle Time ◽  
Care Delivery ◽  
Tertiary Care ◽  
Primary Diagnosis ◽  
Travel Distance ◽  
Care Experience ◽  
Cycle Times ◽  
Clinic Efficiency ◽  
Tube Dysfunction

Objectives: Telemedicine was increasingly adopted in otolaryngology as a result of the COVID-19 pandemic, but how it compares to in-person visits over the longitudinal course of the pandemic has not been characterized. This study compares telemedicine visits to in-person visits on measures of clinical efficiency and patient satisfaction. Methods: We examined all in-person and telemedicine encounters that occurred during the 13-month period from April 1, 2020 to April 30, 2021 at a pediatric otolaryngology clinic associated with a large tertiary care children’s hospital. We compared patient demographics, primary encounter diagnoses, completions, cancellations, no-shows, cycle time, and patient satisfaction. Results: A total of 19 541 (90.5%) in-person visits and 2051 (9.5%) telemedicine visits were scheduled over the study period. There was no difference in patient age or gender between the visit types. There was a difference in race (75% White or Caucasian for in-person and 73% for telemedicine, P = .007) and average travel distance (53.3 miles for in-person vs 71.0 for telemedicine, P = .000). The most common primary diagnosis was Eustachian tube dysfunction for in-person visits (11.8%) and sleep disordered breathing for telemedicine visits (13.7%). Completion rate was greater for telemedicine visits (52.4% in-person vs 62.5% telemedicine). Cancellations were greater for in-person visits (42.6% in-person vs 24.2% telemedicine), but no-shows were greater for telemedicine (5.0% in-person vs 13.3% telemedicine, all P = .000). Average cycle time was shorter for telemedicine visits (56.5 minutes in-person vs 47.6 minutes telemedicine, P = .000). Patient satisfaction with provider interactions and overall care experience was high for both visit types. Conclusions: Telemedicine was utilized more during months of heightened COVID-19 cases, with higher completion rates, fewer cancellations, shorter cycle times, saved travel distance, and comparable patient satisfaction to in-person visits. Telemedicine has the potential to remain an efficient mode of care delivery in the post-pandemic era.

scholarly journals The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

2020 ◽  
Vol 33 (1) ◽  
pp. 95-105
Author(s):  
Rasheedat T. Zakare-Fagbamila ◽  
Christine Park ◽  
Wes Dickson ◽  
Tracy Z. Cheng ◽  
Oren N. Gottfried
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Mixed Model ◽  
Performance Metrics ◽  
Univariate Analysis ◽  
Wait Times ◽  
Waiting Room ◽  
Clinic Efficiency ◽  
Global Access ◽  
Room Time

OBJECTIVEMost clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship of these metrics with patient experience is unclear. The goal of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the standard patient experience survey, and clinic performance metrics to understand the determinants of patient satisfaction and identify targets for improving patient experience.METHODSThe authors performed a retrospective single-institution cohort review of spine surgeon metrics over 15 months including demographics, waiting-room times, in-room times, lead times, timely note closure, timely MyChart responses, and monthly patient volume. Kruskal-Wallis tests and mixed-model regression were used to determine the predictors of 3 domains of patient satisfaction—Global, Access, and Communication.RESULTSOver 15 months, 22 surgeons conducted 27,090 visits. The average clinic visit total time was 85.17 ± 25.75 minutes. Increased wait times were associated with poor Global (p = 0.008), Access (p < 0.001), and Communication scores (p = 0.003) in univariate analysis. Every 10-minute increase in waiting time was associated with a 3%, 9.8%, and 2.4% decrease in Global, Access, and Communication scores, respectively. Increased in-room time was also an independent predictor of poor Access scores (p < 0.001). In multivariate analysis, increased wait times were negative predictors of Global (p = 0.005), Access (p < 0.001), and Communication (p = 0.002) scores.CONCLUSIONSExcessive waiting-room time significantly impacts unexpected dimensions of the patient experience and impacts communication with patients. Understanding the complex relationship between the factors that inform the patient experience will help target effective interventions to improve clinic efficiency and patient satisfaction.

FAKTOR-FAKTOR YANG MEMPENGARUHI KUALITAS AUDIT

2019 ◽  
Vol 5 (1) ◽  
pp. 50-63
Author(s):  
Heru Heryanto ◽  
Nur Laela ◽  
Riana R Dewi
Keyword(s):  
Linear Regression ◽  
Multiple Linear Regression ◽  
Audit Quality ◽  
Positive Influence ◽  
T Test ◽  
Coefficient Of Determination ◽  
Analysis Tool ◽  
Validity And Reliability ◽  
Test Analysis ◽  
Analysis Technique

This study aims to determine the significance of the influence of competence, independence, professionalism, auditor experience, accountability, and auditor's knowledge of audit quality. This study uses a questionnaire with a population and sample, namely all auditors who work at the Public Accounting Office (KAP) in the Special Region of Yogyakarta and Surakarta. Sampling techniques using Convenience Sampling with a sample of 61 respondents. The data used in this study is a questionnaire using a Likert scale 1 to 5. The data analysis technique used in this study is multiple linear regression using the SPSSprogram for Windows. The analysis tool in this study using validity and reliability, the classical assumption (normality test, multicollinearity, heteroscedasticity test and autocorrelation test) while the data were analyzed using multiple linear regression test, t test, F test and the coefficient of determination (R2).Based on the results of the t-test analysis performed, it shows that there is a positive influence of competence, independence, professionalism, auditor experience, accountability, and auditor's knowledge of audit quality and simultaneously competency, independence, professionalism, auditor experience, accountability, and auditor knowledge variables affect quality audit

PERBEDAAN PENGARUH COGNITIVE THERAPY (CT) DAN LOGO THERAPY TERHADAP DEPRESI PADA PASIEN DENGAN HEMODIALISIS DI RS WAVA HUSADA KEPANJEN

2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Nia Agustiningsih ◽  
Setyawati Soeharto ◽  
Rinik Eko Kapti
Keyword(s):  
Cognitive Therapy ◽  
Hemodialysis Patient ◽  
Sampling Procedure ◽  
Mean Value ◽  
T Test ◽  
Physical Aspect ◽  
Test Design ◽  
Test Analysis ◽  
Post Test ◽  
Quasi Experimental

Abstract : Patient with chronical diease such as Hemodialysis more likely need psycotherapy because until now medical atention only focus on physical aspect. Psycotherapy that can be used on Hemodialysis that going through depression is cognitive therapy and logo therapy. This study was to analysed the difference of influence between cognitive therapy and logo therapy on Hemodialysis patient that going through depression. This study was used quasi experimental pre–post test design. Respondent taking part in this study was 15 respondent for cognitive therapy and 15 respondent for logo therapy with puporsive sampling procedure. Study was conducted on Hemodialysis unit on RS Wava Husada Kepanjen from 21 April until 26 Mey 2017. Data analysis used on this study was dependent t test  and independent t test. Dependent t test  analysis showed  significant value is 0,000 (less than < 0,05).Analysis showed  significant value is 0,000 (less than < 0,05) that means there is difference between cognitive therapy and logo therapy to decrease depression on hemodialysis patient with mean value cognitive therapy (1,62) dan logo therapy (3,82). Conclussion on this study is that logo therapy more effective to reduce depression on Hemodialysis patient than cognitive therapy so logo therapy can applicated in hemodialysis patient.Keyword : cognitive therapy, logo therapy, depression in hemodialysis patient Abstrak : Pasien dengan penyakit kronis dengan hemodialisis diperlukan psikoterapi karena selama ini fokus penanganan di pelayanan kesehatan hanya pada masalah fisik. Psikoterapi yang bisa digunakan pada pasien hemodialisis yang mengalami depresi adalah cognitive therapy dan logo therapy. Penelitian ini bertujuan untuk menganalisis perbedaan pengaruh cognitive therapy dan logo therapy terhadap depresi pada pasien dengan hemodialisis. Penelitian ini menggunakan desain penelitian quasi experimental pre – post test design. Jumlah responden dalam penelitian ini 15 responden untuk kelompok cognitive therapy dan 15 responden untuk kelompok logo therapy yang didapatkan dengan menggunakan tehnik purposive sampling. Penelitian dilakukan di unit hemodialisis RS Wava Husada Kepanjen mulai tanggal 21 April – 26 Mei 2017. Pemberian terapi dilakukan oleh peneliti sendiri yang telah mendapatkan lisensi dari perawat spesialis jiwa. Analisis data yang digunakan dalam penelitian ini adalah dependent t test dan independent t test. Hasil analisis dependent t test  pada kelompok sebelum dan setelah diberikan cognitive therapy dan logo therapy didapatkan hasil nilai signifikansi 0,000 < 0,05 yang berarti bahwa ada perbedaan skor depresi antara sebelum dan sesudah diberikan pemberian cognitive therapy dan logo therapy  Sedangkan hasil analisis independent t test menunjukkan bahwa nilai signifikansi 0,000 < 0,05 yang berarti  ada perbedaan yang bermakna antara cognitive therapy dan logo therapy dalam menurunkan depresi pada pasien dengan hemodialisis yaitu dengan rata – rata penurunan terhadap depresi untuk cognitive therapy dan logo therapy masing – masing yaitu 1,62 dan 3,86.  Hal ini berarti bahwa logo therapy lebih efektif menurunkan depresi pada pasien hemodialisis dari pada cognitive therapy. Berdasarkan hasil penelitian tersebut diharapkan bahwa logo therapy bisa diaplikasikan sebagai alternatif psikoterapi pada pasien hemodialisis.Kata Kunci: cognitive therapy, logo therapy, depresi pada pasien hemodialisis

Absorption, Wicking and Drying Characteristics of Compression Garments

2015 ◽  
Vol 10 (3) ◽  
pp. 155892501501000 ◽  
Author(s):  
Canan Saricam
Keyword(s):  
Correlation Analysis ◽  
T Test ◽  
Test Analysis ◽  
Drying Characteristics ◽  
Compression Garments ◽  
Production Parameters ◽  
The Relationship

This paper discusses the influence of the production parameters on the moisture related comfort characteristics of the compression garments that differ according to the tension applied during the production and elastane count. Correlation analysis, two sided independent t-test analysis and ANOVA tests were applied to analyze the relationship between the production parameters and comfort characteristics which are absorption, vertical and transfer wicking and drying. It was found that tension and elastane composition affect the comfort characteristics by changing the porosity, thickness and the pathways within the fabric.

27 Oral Supplementation for Burn Patients: Would YOU Eat That?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S23-S24
Author(s):  
Alisa Savetamal ◽  
Melissa Ebdon
Keyword(s):  
Burn Injury ◽  
Nutritional Supplements ◽  
Oral Route ◽  
T Test ◽  
Lower Percentage ◽  
Test Analysis ◽  
Trimmed Mean ◽  
Oral Supplementation ◽  
Percentage Point Increase ◽  
Oral Supplements

Abstract Introduction The metabolic demands of burn injury often require that patients consume a high-calorie diet. For patients taking nutrition solely by the oral route, this can be challenging, and supplementation is necessary. The burn team is sometimes frustrated at patients’ inability or perceived unwillingness to consume the daily prescribed supplementation. The purpose of this study was to expose the burn team to the various nutritional supplements offered to patients, and to gain a better understanding of the palatability those supplements. Methods Nine volunteers from the burn team participated in this blinded study: an attending surgeon; surgical residents (2); students (1); therapists (2); and nurses (3). Samples of 9 different nutritional supplements were placed in numbered cups, with the contents known only to the dietitians. The supplements consisted of: “milkshake” consistency drinks (#1,4,6,7, 9); gelatin (#2); frozen custard (#3); clear thin liquid (#5); and pudding (#8). Each participant received one cup of each supplement and was asked to rate the contents on a scale of 1 to 10, with 10 being tastiest. Mean, trimmed mean, and median taste scores were noted. Data were analyzed by t-test and by regression to assess for differences based on protein content. Results The highest mean and trimmed mean scores (7.3 and 7.4) were given to product #8. Product #1 had slightly lower scores (6.4 and 6.1). Product #9 received the lowest mean score (2.2); the trimmed mean was even lower (1.7). Median scores for the products upheld these results, and most of the remainder of the products received median scores of 4 or 5. T-test analysis showed significant differences in preference for products 1 and 8 versus the rest of the products (with means of 2.2 to 5.3). Regression analysis suggests that taste scores tend to be higher for products with a lower percentage of calories from protein, while the higher protein products fare less well in taste (a decline of roughly 0.47 in mean taste score for every 10-percentage point increase in percentage of calories from protein). Conclusions A blinded taste test of commonly offered supplements revealed that most products are, at best, moderately acceptable (median score 4–5). This suggests two potential changes in the approach to oral supplementation. First, the burn team should be sympathetic to the challenges that patients face with oral supplements, particularly the high-protein versions. Second, the burn team may need to be innovative. Chilling the drinks, offering different flavors, mixing flavors, or mixing with other liquids may help patients to take oral supplements more enthusiastically. Sampling these oral supplements has helped our team to understand better what we ask our patients to do to achieve their nutritional goals.

An Exploratory Study of Operations Management Best Practices

2013 ◽  
Vol 64 (3) ◽  
Author(s):  
Mastora Mustafar ◽  
Amran Rasli ◽  
Azlin Shafinaz Mohamad Arshad ◽  
Nadhirah Norhalim
Keyword(s):  
Best Practices ◽  
Operations Management ◽  
Process Management ◽  
Descriptive Analysis ◽  
High Technology ◽  
Simple Random Sampling ◽  
Mean Value ◽  
T Test ◽  
Test Analysis ◽  
Exploratory Investigation

The purpose of this paper is to conduct an exploratory investigation on the level of operations management best practices.  A sample random t-test analysis was used upon a high technology company that was selected based on simple random sampling from government agency directory. After various attempts, 72 out of 138 are providing feedback. However, only 34 can be used, the rest did not answer completely. Descriptive analysis and t-test analysis were performed on 34 completed feedbacks. Six factors in the form of quality commitment, customer focus, formalization of performance measurement, people management, process management and technology management were examined as predictors for operations management best practices. Findings indicated that the mean value is more than 3 for all dimensions. Furthermore, most cases are significant as the selected samples are high technology based companies and their workers are knowledgeable in terms of operations management best practices.

Fuzzy-neural-network-based fluctuation smoothing rule for reducing the cycle times of jobs with various priorities in a wafer fabrication plant: A simulation study

2009 ◽  
Vol 223 (8) ◽  
pp. 1033-1043 ◽  
Author(s):  
T Chen
Keyword(s):  
Neural Network ◽  
Cycle Time ◽  
Fuzzy Neural Network ◽  
Optimal Solution ◽  
Wafer Fabrication ◽  
Estimation Accuracy ◽  
Cycle Times ◽  
Fuzzy Neural ◽  
The Difference ◽  
Fluctuation Smoothing

This paper presents a fuzzy-neural-network-based fluctuation smoothing rule to further improve the performance of scheduling jobs with various priorities in a wafer fabrication plant. The fuzzy system is modified from the well-known fluctuation smoothing policy for a mean cycle time (FSMCT) rule with three innovative treatments. First, the remaining cycle time of a job is estimated by applying an existing fuzzy-neural-network-based approach to improve the estimation accuracy. Second, the components of the FSMCT rule are normalized to balance their importance. Finally, the division operator is applied instead of the traditional subtraction operator in order to magnify the difference in the slack and to enhance the responsiveness of the FSMCT rule. To evaluate the effectiveness of the proposed methodology, production simulation is applied to generate some test data. According to the experimental results, the proposed methodology outperforms six existing approaches in the reduction of the average cycle times. In addition, the new rule is shown to be a Pareto optimal solution for scheduling jobs in a semiconductor manufacturing plant.

Design and Testing of Innovative Rotational Mould Heated by Thermal Fluid

2010 ◽  
Author(s):  
M. D. Monzo´n ◽  
A. N. Beni´tez ◽  
P. Bordo´n ◽  
P. M. Herna´ndez ◽  
M. D. Marrero ◽  
...  
Keyword(s):  
Cycle Time ◽  
Energetic Efficiency ◽  
Internal Stresses ◽  
Cycle Times ◽  
Transfer Processes ◽  
Computational Fluids Dynamics ◽  
Heating And Cooling ◽  
Computational Fluids ◽  
Plastic Parts ◽  
Design And Testing

Rotomoulded plastic parts have no internal stresses, as it is a process carried out at lower temperatures than injection moulding and no pressure is applied. The main disadvantage is the high cycle times needed. This paper focuses on reducing this cycle time and in producing a mould using standardized parts. For cycle time reducing, it is proposed to heat the mould by thermal fluid in continuous circulation; heat transfer processes have been studied for over 20 different configurations of the oil’s inlet – outlet, obtaining acceptable results with a manifold with 25 perforations in the front and rear faces. This configuration has been optimized by computational fluids dynamics, allowing reducing heating and cooling time and improving the energetic efficiency and the uniformity of heating. Design, simulations and testing of a 100 mm3 cube have been carried out in order to produce a standardized mould; this mould consists in some standardized parts and a nickel shell, obtained by rapid prototyping and electroforming process. This shell can be removed from the rest of elements in the mould, allowing thus to obtain parts with any other geometry just by changing the nickel shell. An experimental machine for testing has been developed as well.

scholarly journals The Effectiveness Of Reflexology Massage In Lowering The Blood Pressure In Elderly With Hypertension

2014 ◽  
Vol 1 (3) ◽  
pp. 200-204 ◽  
Author(s):  
Levi Tina Sari ◽  
Nevy Norma Renityas ◽  
Wahyu Wibisono
Keyword(s):  
Blood Pressure ◽  
Progressive Increase ◽  
Left Ventricular ◽  
Pharmacological Therapy ◽  
T Test ◽  
Lower Systolic Blood Pressure ◽  
Test Analysis ◽  
Ratio Data ◽  
Before And After ◽  
Scale Ratio

Elderly in the age of 60 or above is a natural process that can not be avoided where the life of man as a human being is limited by a rule of nature. As a result of the aging process, the blood vessels become stiff and affect the left ventricular wall reduce its elasticity, resulting in a progressive increase of blood pressure. The treatment of hypertension in addition to pharmacological therapy could also use non-pharmacological therapies such as reflexology massage.  Method: The research design used in this study was pre-experimental using one group pretest-posttest approach. In this research, the researchers measured blood pressure before and after the treatment (reflexology massage). The sample of this study was 20 respondents using purposive sampling. This research used statistical t-test analysis test, because it had a scale ratio data. Result : The result of t-test showed that p <0.0001, means that there was significantly different result before and after treatment with reflexology massage on the feet with a medium timber. Discussion : It is expected that people with hypertension do the feet reflexology massage in order to taking medication because can lower systolic blood pressure.

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