The quality of physiotherapy care: the development and application of quality indicators using scientific evidence and routinely collected data embedded in the process of clinical reasoning

IntroductionHistorically, ambulance services were established to provide rapid transport of patients to hospital. Contemporary prehospital care involves provision of sophisticated ‘mobile healthcare’ to patients across the lifespan presenting with a range of injuries or illnesses of varying acuity. Because of its young age, the paramedicine profession has until recently experienced a lack of research capacity which has led to paucity of a discipline-specific, scientific evidence-base. Therefore, the performance and quality of ambulance services has traditionally been measured using simple, evidence-poor indicators forming a deficient reflection of the true quality of care and providing little direction for quality improvement efforts. This paper reports the study protocol for the development and testing of quality indicators (QIs) for the Australian prehospital care setting.Methods and analysisThis project has three phases. In the first phase, preliminary work in the form of a scoping review was conducted which provided an initial list of QIs. In the subsequent phase, these QIs will be developed by aggregating them and by performing related rapid reviews. The summarised evidence will be used to support an expert consensus process aimed at optimising the clarity and evaluating the validity of proposed QIs. Finally, in the third phase those QIs deemed valid will be tested for acceptability, feasibility and reliability using mixed research methods. Evidence-based indicators can facilitate meaningful measurement of the quality of care provided. This forms the first step to identify unwarranted variation and direction for improvement work. This project will develop and test quality indicators for the Australian prehospital care setting.Ethics and disseminationThis project has been approved by the University of Adelaide Human Research Ethics Committee. Findings will be disseminated by publications in peer-reviewed journals, presentations at appropriate scientific conferences, as well as posts on social media and on the project’s website.

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We are missing more. An international measurable model of clinical reasoning using quality indicators and routinely collected data

Journal of Manual & Manipulative Therapy ◽

10.1080/10669817.2019.1648714 ◽

2019 ◽

Vol 27 (5) ◽

pp. 253-257 ◽

Cited By ~ 1

Author(s):

Rob A.B. Oostendorp ◽

J.W. Hans Elvers ◽

Emiel Van Trijffel

Keyword(s):

Quality Indicators ◽

Clinical Reasoning ◽

Routinely Collected Data

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Identifying validated nursing quality indicators for the intensive care unit: an integrative review

Connect The World of Critical Care Nursing ◽

10.1891/1748-6254.12.2.28 ◽

2018 ◽

Vol 12 (2) ◽

pp. 28-39 ◽

Cited By ~ 1

Author(s):

Efi Evangelou ◽

Ekaterini Lambrinou ◽

Christiana Kouta ◽

Nicos Middleton

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Indicators ◽

Nursing Care ◽

Methodological Quality ◽

Scientific Evidence ◽

Health Care Research ◽

Guidance Document ◽

List Type

SUMMARYBackground: Quality indicators (QIs) play an important role in evaluating quality improvement initiatives. A generally accepted set of QIs specific to the nursing care in the intensive care unit (ICU) is not available.Aim: To identify QIs associated with nursing care for adult ICU in the literature. The methodological quality of QIs was assessed and associated variables of quality and quantity of nursing care were also identified.Methods: We employed an integrative literature review. A focused search of electronic databases was applied. Inclusion and exclusion criteria were used for the selection of relevant articles. Quality assessment of the included studies was based on the guidance document of domains and elements suggested by the Agency of Health Care Research and Quality. QIs’ methodological quality was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument.Results: The review identified 13 studies and 45 QIs associated with nursing care in the ICU. The set of QIs assessed in each study, the type of nurse staffing measure as well as morbidity and mortality rates varied considerably. Findings suggest that quality and quantity of nursing care are strongly associated with higher rates of adverse events, mortality, infections and complications in adult ICUs. Methodological quality of the QIs also differed considerably. Higher AIRE scores, indicating higher scientific evidence of methodological quality, can be used to select evidence-based and valid QIs.Conclusions: A number of QIs quantifying nursing care in the ICU have been identified. These QIs could be combined to form a tool which would allow to the quantification and assessment of the quality of ICU nursing care provided in a regular basis.

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Criteria for evaluation of the coordinate measurements quality of parts geometric parameters at pilot-experimental production

Izmeritel`naya Tekhnika ◽

10.32446/0368-1025it.2019-12-3-8 ◽

2019 ◽

pp. 3-8

Author(s):

N.Yu. Bobrovskaya ◽

M.F. Danilov

Keyword(s):

Quality Indicators ◽

Quality Management System ◽

Technical Specification ◽

Experimental Production ◽

Technological Heredity ◽

Coordinate Measurements ◽

Reasonable Choice ◽

The Stability ◽

Geometric Elements

The criteria of the coordinate measurements quality at pilot-experimental production based on contemporary methods of quality management system and traditional methods of the measurements quality in Metrology are considered. As an additional criterion for quality of measurements, their duration is proposed. Analyzing the problem of assessing the quality of measurements, the authors pay particular attention to the role of technological heredity in the analysis of the sources of uncertainty of coordinate measurements, including not only the process of manufacturing the part, but all stages of the development of design and technological documentation. Along with such criteria as the degree of confidence in the results of measurements; the accuracy, convergence, reproducibility and speed of the results must take into account the correctness of technical specification, and such characteristics of the shape of the geometric elements to be controlled, such as flatness, roundness, cylindrical. It is noted that one of the main methods to reduce the uncertainty of coordinate measurements is to reduce the uncertainty in the initial data and measurement conditions, as well as to increase the stability of the tasks due to the reasonable choice of the basic geometric elements (measuring bases) of the part. A prerequisite for obtaining reliable quality indicators is a quantitative assessment of the conditions and organization of the measurement process. To plan and normalize the time of measurements, the authors propose to use analytical formulas, on the basis of which it is possible to perform quantitative analysis and optimization of quality indicators, including the speed of measurements.

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Using the alveograph in developing requirements for the quality of flour for wafer sheet production

Khleboproducty ◽

10.32462/0235-2508-2020-29-12-52-58 ◽

2020 ◽

Vol 29 (12) ◽

pp. 52-58

Author(s):

E.P. Meleshkina ◽

◽

S.N. Kolomiets ◽

A.S. Cheskidova ◽

◽

...

Keyword(s):

Rheological Properties ◽

Quality Indicators ◽

Wheat Flour ◽

Mathematical Statistics ◽

Intended Purpose ◽

The Future ◽

Relationship Of ◽

The Relationship

Objectively and reliably determined indicators of rheological properties of the dough were identified using the alveograph device to create a system of classifications of wheat and flour from it for the intended purpose in the future. The analysis of the relationship of standardized quality indicators, as well as newly developed indicators for identifying them, differentiating the quality of wheat flour for the intended purpose, i.e. for finished products. To do this, we use mathematical statistics methods.

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The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3175 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Raparelli ◽

L Pilote ◽

H Behlouli ◽

J Dziura ◽

H Bueno ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Quality Of Care ◽

Healthcare System ◽

Quality Indicators ◽

Funding Source ◽

Post Discharge ◽

Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

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Effectiveness of Shock Wave Therapy as a Treatment for Spasticity: A Systematic Review

Brain Sciences ◽

10.3390/brainsci11010015 ◽

2020 ◽

Vol 11 (1) ◽

pp. 15

Author(s):

Isabel María Martínez ◽

Nuria Sempere-Rubio ◽

Olga Navarro ◽

Raquel Faubel

Keyword(s):

Shock Wave ◽

Botulinum Toxin ◽

Methodological Quality ◽

Scientific Evidence ◽

Motor Impairment ◽

Functional Independence ◽

Shock Wave Therapy ◽

Jadad Scale ◽

Type Of Injury

Background: The purpose of this study was to collect and analyse the available scientific evidence on the effectiveness of shock wave therapy as a treatment for spasticity. Methods: the search was performed in the following databases: PubMed, PEDro, Cochrane, Embase, and the Virtual Health Library. All publications from November 2009 to November 2019 were selected that included a sample of patients with spasticity and prior suspension of botulinum toxin, to whom shock wave therapy was applied. The methodological quality of the articles was evaluated using the Jadad scale and the pyramid of quality of scientific evidence. Results: 25 studies involving 866 participants with spasticity were selected. The results obtained suggest that shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect. Conclusions: shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin. However, due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies.

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Quality in Assisted Living: Does It Lie in the Eyes of the Beholder?

Innovation in Aging ◽

10.1093/geroni/igaa057.2578 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 726-727

Author(s):

Diana White ◽

Tunalilar Ozcan ◽

Serena Hasworth ◽

Jaclyn Winfree

Keyword(s):

Quality Indicators ◽

Residential Care ◽

Assisted Living ◽

Physical Environment ◽

Sampling Strategy ◽

Perceived Quality ◽

Two Stage ◽

Regulatory Perspective ◽

To Receive

Abstract Quality is defined in multiple ways and by different stakeholders (e.g., residents, regulators, informed observers). Using a two-stage stratified sampling strategy, we collected data from N=241 residents living in 31 assisted living and residential care communities (AL/RC) in Oregon. Residents rated their overall satisfaction and satisfaction with the AL/RC as a place to live and to receive care. Each interviewer completed a facility profile summarizing their observations about the setting, including quality of staff-resident interactions and physical environment. Residents and interviewers were also asked whether they would recommend the community to others. Finally, we used deficiency citations given during regular inspections by the licensing agency to proxy regulatory perspective. Results show that perceived quality varied by stakeholder (e.g., residents’ assessments differed from deficiency citations). Given this variation, findings suggest that efforts to make quality indicators publicly available should include multiple measures and perspectives, especially residents.

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Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review

Healthcare ◽

10.3390/healthcare9070879 ◽

2021 ◽

Vol 9 (7) ◽

pp. 879

Author(s):

Aida Agost-González ◽

Isabel Escobio-Prieto ◽

Azahara M. Pareja-Leal ◽

María Jesús Casuso-Holgado ◽

María Blanco-Diaz ◽

...

Keyword(s):

Systematic Review ◽

Urinary Incontinence ◽

Electrical Stimulation ◽

Overactive Bladder ◽

Tibial Nerve ◽

Scientific Evidence ◽

Transcutaneous Electrical Stimulation ◽

Posterior Tibial Nerve ◽

Posterior Tibial

Background: Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. Methods: A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. Results: The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. Conclusions: TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence.

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