UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

Optimal day-ahead scheduling of integrated urban energy systems

An optimal day-ahead scheduling method (ODSM) for the integrated urban energy system (IUES) is introduced, which considers the reconfigurable capability of an electric distribution network. The hourly topology of a distribution network, a natural gas network, the energy centers including the combined heat and power (CHP) units, different energy conversion devices and demand responsive loads (DRLs), are optimized to minimize the day-ahead operation cost of the IUES. The hourly reconfigurable capability of the electric distribution network utilizing remotely controlled switches (RCSs) is explored and discussed. The operational constraints from the unbalanced three-phase electric distribution network, the natural gas network, and the energy centers are considered. The interactions between the electric distribution network and the natural gas network take place through conversion of energy among different energy vectors in the energy centers. An energy conversion analysis model for the energy center was developed based on the energy hub model. A hybrid optimization method based on genetic algorithm (GA) and a nonlinear interior point method (IPM) is utilized to solve the ODSM model. Numerical studies demonstrate that the proposed ODSM is able to provide the IUES with an effective and economical day-ahead scheduling scheme and reduce the operational cost of the IUES.