The impact of rehabilitation support services on health-related quality of life for women with breast cancer

As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre/post-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20-40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.

Quality improvement in professional local government services : a longitudinal study

This sustained longitudinal study, carried out in a single local authority, investigates the implementation of a Total Quality Management (TQM) philosophy in professional local government services. At the start of this research, a large majority of what was written about TQM was polemical and based on limited empirical evidence. This thesis seeks to provide a significant and important piece of work, making a considerable contribution to the current state of knowledge in this area. Teams from four professional services within a single local authority participated in this research, providing the main evidence on how the quality management agenda in a local authority can be successfully implemented. To supplement this rich source of data, various other sources and methods of data collection have been used: 1) Interviews were carried out with senior managers from within the authority; 2) Customer focus groups and questionnaires were used; 3) Interviews were carried out with other organisations, all of which were proponents of a TQM philosophy. A number of tools have been developed to assist in gathering data: 1) The CSFs (critical success factors) benchmarking tool; 2) Five Stages of Quality Improvement Model. A Best Practice Quality Improvement Model, arising from an analysis of the literature and the researcher's own experience is proposed and tested. From the results a number of significant conclusions have been drawn relating to: 1) Triggers for change; 2) Resistance of local government professionals to change 3) Critical success factors and barriers to quality improvement in professional local government services; 4) The problems associated with participant observation and other methodological issues used.

Process improvement and quality management systems in the financial services industry:the case for the OPEX quality management system and framework

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A comprehensive approach to quality management of intensive care services

Purpose – The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. Design/methodology/approach – The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Findings – Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. Practical implications – The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. Originality/value – The paper focuses on a uniform model that can be applied to most intensive care units.

Professional Services in the EU Internal Market: Quality Regulation and Self-Regulation, by T. Heremans (Oxford: Oxford University Press, 2012, ISBN 9781849462402); xxii+366pp., £75.00 hb.

Book review

Dimensioning of Telecommunication Network Based on Quality of Services Demand and Detailed Behaviour of Users

The aim of this paper is to be determined the network capacity (number of necessary internal switching lines) based on detailed users’ behaviour and demanded quality of service parameters in an overall telecommunication system. We consider detailed conceptual and its corresponded analytical traffic model of telecommunication system with (virtual) circuit switching, in stationary state with generalized input flow, repeated calls, limited number of homogeneous terminals and losses due to abandoned and interrupted dialing, blocked and interrupted switching, not available intent terminal, blocked and abandoned ringing (absent called user) and abandoned conversation. We propose an analytical - numerical solution for finding the number of internal switching lines and values of the some basic traffic parameters as a function of telecommunication system state. These parameters are requisite for maintenance demand level of network quality of service (QoS). Dependencies, based on the numericalanalytical results are shown graphically. For proposed conceptual and its corresponding analytical model a network dimensioning task (NDT) is formulated, solvability of the NDT and the necessary conditions for analytical solution are researched as well. It is proposed a rule (algorithm) and computer program for calculation of the corresponded number of the internal switching lines, as well as corresponded values of traffic parameters, making the management of QoS easily.

Evaluation of low vision services on the quality of life of individuals with age-related macular degeneration

Background: Age-related macular degeneration (ARMD) is a major cause of irreversible visual loss in the elderly and a significant threat to their quality of life. Although low vision services often improve the functional outcomes of individuals with macular disease, it remains unclear whether or not they have any impact on quality of life. The principal aim of this study was to determine the effect of a hospital-based low vision clinic on the quality of life of individuals with ARMD. Methods: Forty patients with ARMD attended the low vision clinic at Milton Keynes University Hospital. Quality of life was measured with the vision-specific Low Vision Quality of Life (LVQOL) questionnaire and the general health EuroQol (EQ-5D-5L) questionnaire. Measures were completed at baseline (time zero, T0), and at three- (T3) and six-month (T6) follow-up visits. Results: The near visual acuity of individuals attending the low vision clinic for the first time improved significantly between visits T0 and T3 (p=0.005), reflecting the practiced use of their newly-dispensed low vision aids. As expected, there was no significant change in near acuity over this time period for existing patients. For both new and existing patients, a significant increase in LVQOL score was evident between visits T0 and T3, with a further significant improvement between T3 and T6. Similarly, there was a significant decrease in EQ-5D-5L questionnaire scores between visits T0 and T6. Conclusions: The higher LVQOL scores obtained at the end of the study period (T6) provide evidence that low vision services at Milton Keynes University Hospital served to improve patient quality of life. The reduction in EQ-5D-5L scores over the same time period suggests that low vision services also provide for an improvement in general health-related quality of life. Impact: The findings support the cause of low vision services to improve not only the vision and functional outcomes of individuals with macular disease but also their quality of life. Moreover, the findings suggest that a more efficient allocation of resources at low vision clinics may be possible through the standardisation of patient follow-up frequency.

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

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

ASSESSING QUALITY IN HIGH-UNCERTAINTY MARKETS: ONLINE REVIEWS OF CREDENCE SERVICES

In economics of information theory, credence products are those whose quality is difficult or impossible for consumers to assess, even after they have consumed the product (Darby & Karni, 1973). This dissertation is focused on the content, consumer perception, and power of online reviews for credence services. Economics of information theory has long assumed, without empirical confirmation, that consumers will discount the credibility of claims about credence quality attributes. The same theories predict that because credence services are by definition obscure to the consumer, reviews of credence services are incapable of signaling quality. Our research aims to question these assumptions. In the first essay we examine how the content and structure of online reviews of credence services systematically differ from the content and structure of reviews of experience services and how consumers judge these differences. We have found that online reviews of credence services have either less important or less credible content than reviews of experience services and that consumers do discount the credibility of credence claims. However, while consumers rationally discount the credibility of simple credence claims in a review, more complex argument structure and the inclusion of evidence attenuate this effect. In the second essay we ask, “Can online reviews predict the worst doctors?” We examine the power of online reviews to detect low quality, as measured by state medical board sanctions. We find that online reviews are somewhat predictive of a doctor’s suitability to practice medicine; however, not all the data are useful. Numerical or star ratings provide the strongest quality signal; user-submitted text provides some signal but is subsumed almost completely by ratings. Of the ratings variables in our dataset, we find that punctuality, rather than knowledge, is the strongest predictor of medical board sanctions. These results challenge the definition of credence products, which is a long-standing construct in economics of information theory. Our results also have implications for online review users, review platforms, and for the use of predictive modeling in the context of information systems research.

Impact of dental caries on quality of life of adolescents according to access to oral health services: a cross sectional study

Aim: This study presents the prevalence of dental caries and its relation to the quality of life of adolescents according to the access to dental health services. Methods: Two hundred and fifty-six adolescents between 15 and 19 years of age participated in the study; they were all enrolled in public schools in a countryside municipality of the São Paulo State. Data related to dental caries were evaluated by the DMFT Index, and OHIP-14 was used for evaluating the quality of life. Mann Whitney and Spearmann correlation tests were also used (p<0.05). Results: A DMFT of 3.09 (±3.30) was found with a higher prevalence among the adolescents who used public dental services (3.43±3.34) compared with those who used private services (2.94±3.28). A statistically significant relationship between the decay component of DMFT with physical pain (0.020), physical disability (0.002) and quality of life (0.017) was verified. Conclusions: A low prevalence of dental caries was observed, and it was higher in adolescents who used public oral health services rather than private ones, evidencing the low influence of oral health on the quality of life of the participants.

Ensuring Quality Services for Infants and Toddlers with Disabilities and their Families within the BabyNet Early Intervention System: An Analysis of Current and Needed Resources

This report prioritizes the targeted, additional resources First Steps and system stakeholders believe will be necessary to ensure the BabyNet system earns a federal designation of “meets requirements” for the first time in its 25 year history. It lists key recommendations to help meet those requirements.