Public reporting of nursing home quality of care : Lessons from the United States experience for Canadian policy discussion

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy.

Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.

Evaluation of individual program plan content and quality in a Victorian residential service

The study assesses the quality and content of Individual Program Plans for 284 Victorian adults with profound intellectual disabilities living in one residential service. A checklist was developed for improving plan quality, and measurement difficulties with checklists discussed. Recommends that a quality improvement process be implemented.

The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Discovering the value that the library can contribute to quality teaching and learning through student evaluation data

Large surveys of library user service quality perception are common. However, student evaluation of teaching (SET) data often show a disparity between ratings of library service quality and library resource quality. In this situation, perhaps SET data can also provide insights into what contributes to the perception of library resource quality, and hence identify leverage points for quality improvement interventions. This paper documents an analysis of available Deakin University SET data relating to student interaction with, and evaluation of, library resources. It highlights significant correlations associated with library-related SET items, and from them infers actions that the library could undertake to improve the value and perception of the quality of library resources. The following results were observed. High ratings for library resources were likely to be associated with high general ratings of teaching and unit quality. Postgraduate coursework students rated library resources significantly higher than students in the first three years of undergraduate programs. Students in one faculty (Health) rated library resources significantly higher than students in all other faculties. There was a strong correlation observed in Australasian Survey of Student Engagement data for both 2009 and 2010 between the two items “Used library resources on campus or online” and “Worked on an essay or assignment that required integrating ideas or information from various sources”. These findings suggest the following conclusions. Well-planned learning environments are likely to integrate meaningful student interaction with the library. Initiatives to improve the value and perception of the quality of library resources should be focussed on the specific characteristics and needs of particular student cohorts to have maximum impact. More sophisticated assessment tasks that require students to interact with the library have the potential to result in higher student ratings of the value of library resources.

Perceptions of quality in higher education : a comparative study of Turkish and Australian business academics

Finding a common definition of ‘quality’ in studies of quality and quality improvement in higher education institutions is very important. This study identifies the views of a key stakeholder group, academics, with reference to their beliefs (what is currently occurring) and their attitudes (what ought to be occurring) in relation to quality in their departments. The focus of this paper is on the collection of data from 64 business administration academics in Turkish universities. Face-to-face interviews were conducted using an instrument titled ‘Quality in Accounting Education Survey’. The questionnaire was developed by Watty and is based on the conceptions of quality framework, developed by Harvey and Green. The results are compared with the beliefs and attitudes of Australian accounting academics as reported in an earlier paper by Watty. The findings show that academics from Turkey adopt the perspective of quality as excellent or élitist, both in their beliefs (current situation perception) and in their attitudes (desired situation perception). This compares with the findings that Australian academics’ attitudes reflect a quality perspective as fitness for purpose in the current situation and beliefs that reflect a transformational quality perspective as the desired situation (what ought to be).

Assessing data quality issues in the Emergency Department through data and process mapping

Data and information quality is a well-established research topic and gradually appears on the decision-makers' top concern lists. Many studies have been conducted on how to investigate the generic data/information quality issues and factors by providing a high-level abstract framework or model. Based on these previous studies, this study tries to discuss the actual data quality issues with the operation-level and middle-level managers emerged during the emergency department data collection and reporting processes. By conduct data quality issues and business processes mapping, possible data quality issues are summarised under the well-known TOP model and the recommendations of data quality improvement are suggested.)

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Systematic review and quality appraisal of economic evaluation publications in dentistry

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

A Influência da Concentração de Poder na Melhoria da Qualidade: O Caso Royal

This work intends to analyze the influence of the power in the process of quality improvement in managerial organizations, being taken based on a case study regarding to a company of medium load placed in the southeast area of Brazil which in the intention of solving difficulties in inserting its products in the market, it opted to implement quality programs. The data were collected through observations and bibliographical researches about the company, where the author participated as employee for a close period of 6 years. The results indicate that the imported methodologies of administration ¿ as it is the case of the quality models ¿ cannot produce the expected results, when these methodologies are implemented by ignoring cultural factors, mainly related to form as the power is shared and practiced in the organizations.

Qualidade em obras públicas: um estudo comparativo entre as metodologias Seis Sigma, ISO 9000 e PBQP-H no RN

In Brazil the theme quality in public construction has been widely discussed in the early 1990s, with the creation of the Brazilian Program of Quality and Productivity for the Habitat (PBQP-H) which is strongly influenced by the wave of studies on issues of quality in the world, such as the ISO 9000. Over the years, other approaches have emerged and been consolidated, evolving from market and customer´s needs. An example is the Six Sigma methodology. This study aims to examine the Six Sigma, ISO 9000 and PBQP-H methodologies, noting the common elements, differences, gaps and how the methods are complementary, so that with the ongoing work, proposed initiatives can be developed to improve the quality that enables its application in public construction. Still aiming to optimize the deployment of the proposed initiatives, it was performed an analysis of ISO 9001 and PBPQ-H certifications in Brazil and in the state of Rio Grande do Norte, with respect to the construction industry and a case study to identify the factors that influence the adoption of initiatives to improve quality, and check if the selected construction company is prepared to implement the proposed initiatives. This research is characterized as exploratory and applied, with literature review and a case study. The data collection instrument was a questionnaire and the statistical analysis used a multidimensional scaling method. The conclusion is that the methodologies are compatible and complementary, and their integration could potentialize the goals set. It was identified that the state of Rio Grande do Norte has a few number of certifications in construction. Nine initiatives are proposed for implementation at construction companies. In the case study it was found that the studied company would be able to implement the suggestions proposed and the requirement for certification by clients and funding institutions influence the adoption of quality improvement initiatives. This result confirms the literature which states that top management support is crucial for the successful implementation of quality methodologies

The variability and predictors of quality of AIDS care services in Brazil

Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery.Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality.Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities.Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).

Technology assessment for power quality mitigation devices - Micro-DVR case study

This work presents a case study on technology assessment for power quality improvement devices. A system compatibility test protocol for power quality mitigation devices was developed in order to evaluate the functionality of three-phase voltage restoration devices. In order to validate this test protocol, the micro-DVR, a reduced power development platform for DVR (dynamic voltage restorer) devices, was tested and the results are discussed based on voltage disturbances standards. (C) 2011 Elsevier B.V. All rights reserved.

Heterogeneidade e interdisciplinaridade na escola especial: a música como forma de proporcionar equilíbrio e qualidade de vida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)