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

Integrated Optimal Power Flow for Distribution Networks in Local and Urban Scales

This paper develops an integrated optimal power flow (OPF) tool for distribution networks in two spatial scales. In the local scale, the distribution network, the natural gas network, and the heat system are coordinated as a microgrid. In the urban scale, the impact of natural gas network is considered as constraints for the distribution network operation. The proposed approach incorporates unbalance three-phase electrical systems, natural gas systems, and combined cooling, heating, and power systems. The interactions among the above three energy systems are described by energy hub model combined with components capacity constraints. In order to efficiently accommodate the nonlinear constraint optimization problem, particle swarm optimization algorithm is employed to set the control variables in the OPF problem. Numerical studies indicate that by using the OPF method, the distribution network can be economically operated. Also, the tie-line power can be effectively managed.