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Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk-taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner-Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32%, respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29%, respectively). We found, overall, that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system-level well-being.

Objective: To illustrate the importance of a multidimensional view of disparities in quality of antidepressant medication management (AMM), as well as discriminating "within‐facility" disparities from disparities that exist between facilities. Data Sources and Study Setting: We used data from the Veterans Health Administration's (VA) Corporate Data Warehouse (CDW) which contains clinical and administrative data from VA facilities nationally. Study Design: CDW data were used to measure five indicators of AMM quality, including the HEDIS Effective Acute‐Phase and Effective Continuation‐Phase measures. Mixed effects regression models were used to examine differences in quality indicators between racial/ethnic groups, controlling for other demographic and clinical factors. An adaptation of the Kitagawa‐Blinder‐Oaxaca (KBO) method was used to decompose mean differences in treatment quality between racial and ethnic groups into within‐ and between‐facility effects. Data Extraction Methods: Demographic, clinical, and health service utilization data were extracted for patients in fiscal year 2017 with a diagnosis of depression and a new start of an antidepressant medication. Principal Findings: The decomposition of the overall differences between White and Black patients on receiving an initial 90‐day prescription (46.7% vs. 32.7%), Effective Acute‐Phase (79.7% vs. 66.8%), and Effective Continuation‐Phase (64.0% vs. 49.6%) HEDIS measures revealed that most of the overall effects were "within‐facility," meaning that Black patients are less likely to meet these measures regardless of where they are treated. Although the overall magnitude of disparities between White and Hispanic patients on these three measures was very similar (46.7% vs. 32.7%; 79.7% vs. 69.2%; 64.0% vs. 53.6%), the differences were more attributable to Hispanic patients being treated in facilities with overall lower performance on these measures. Conclusions: Discriminating within‐ and between‐facility disparities and taking a multidimensional view of quality are essential to informing efforts to address disparities in AMM quality. [ABSTRACT FROM AUTHOR]

Live-streaming commerce (LSC) is a new shopping method that combines the characteristics of social commerce and e-commerce. Since the global coronavirus disease 2019 (COVID-19) outbreak, the number of branded platforms is growing rapidly, and their competition is fiercer than ever. Understanding consumer needs and improving service quality have become the key issues for survival. This study aims to develop and empirically validate a multidimensional hierarchical model for measuring service quality on LSC platforms. A hierarchical reflective construct was proposed to capture dimensions based on the literature on e-retail and social commerce service quality. The proposed model was rigorously tested using two waves of survey data through the partial least squares method. Results showed that the service quality of LSC is a third-order, reflective construct and includes five primary dimensions (the streamer's interaction quality, physical environment, website quality, outcome quality, and ordering process) and twelve sub-dimensions (trustworthiness, expertise, responsiveness, telepresence, consumption scenarios, information quality, system operation quality, fulfillment and refund/compensation, privacy/security, contact, and ease of use). Findings also supported the hypothesis that service quality has a significant impact on customers' satisfaction and their behavioral intentions. Furthermore, we tested an alternative model, and the results showed that the relationship between dimensions and overall assessment is reflective rather than formative. We offered directions for further research on LSC service quality and discussed managerial implications stemming from the empirical findings. [ABSTRACT FROM AUTHOR]

Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high‐stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced. [ABSTRACT FROM AUTHOR]

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Image encryption is an indispensable technique in the realm of information security, serving as a pivotal mechanism to safeguard visual data against unauthorized access and potential breaches. This study scrutinizes the effectiveness of merging columnar transposition with the Hill Cipher methodologies, unveiling specific metrics from a curated set of sample images. Notably, employing column transposition with the key "JAYA" and the Hill Cipher with the key "UDINUSSMG," the encrypted images underwent rigorous evaluation. 'Lena.png' demonstrated an MSE of 513.32 with a PSNR of 7.89 dB, while 'Peppers.png' and 'Baboon.png' recorded MSE values of 466.67 and 423.92, respectively, with corresponding PSNR figures of 7.12 dB and 7.31 dB. Across all samples, a consistent BER of 50.00% indicated uniform error propagation, while entropy values settled uniformly at 7.9999, highlighting consistent data complexity. While the findings underscore a consistent error rate and complexity, there's a compelling need for further refinement to enhance image quality and security. Moreover, the study proposes future research avenues exploring a three-layer super encryption paradigm, amalgamating columnar transposition, Hill Cipher, and other robust algorithms. This approach aims to fortify encryption methodologies against evolving threats and challenges in data protection, offering heightened resilience and efficacy in safeguarding sensitive information. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To determine the feasibility of integrating Medicare Advantage (MA) admissions into the Centers for Medicare & Medicaid Services (CMS) hospital outcome measures through combining Medicare Advantage Organization (MAO) encounter‐ and hospital‐submitted inpatient claims.Beneficiary enrollment data and inpatient claims from the Integrated Data Repository for 2018 Medicare discharges.We examined timeliness of MA claims, compared diagnosis and procedure codes for admissions with claims submitted both by the hospital and the MAO (overlapping claims), and compared demographic characteristics and principal diagnosis codes for admissions with overlapping claims versus admissions with a single claim.We combined hospital‐ and MAO‐submitted claims to capture MA admissions from all hospitals and identified overlapping claims. For admissions with only an MAO‐submitted claim, we used provider history data to match the National Provider Identifier on the claim to the CMS Certification Number used for reporting purposes in CMS outcome measures.After removing void and duplicate claims, identifying overlapped claims between the hospital‐ and MAO‐submitted datasets, restricting claims to acute care and critical access hospitals, and bundling same admission claims, we identified 5,078,611 MA admissions. Of these, 76.1% were submitted by both the hospital and MAO, 14.2% were submitted only by MAOs, and 9.7% were submitted only by hospitals. Nearly all (96.6%) hospital‐submitted claims were submitted within 3 months after a one‐year performance period, versus 85.2% of MAO‐submitted claims. Among the 3,864,524 admissions with overlapping claims, 98.9% shared the same principal diagnosis code between the two datasets, and 97.5% shared the same first procedure code.Inpatient MA data are feasible for use in CMS claims‐based hospital outcome measures. We recommend prioritizing hospital‐submitted over MAO‐submitted claims for analyses. Monitoring, data audits, and ongoing policies to improve the quality of MA data are important approaches to address potential missing data and errors. [ABSTRACT FROM AUTHOR]

In recent years, open-source software (OSS) has attracted increasing attention due to its easy accessibility via cloud repositories, voluntary community, no vendor lock-in, and low total cost of ownership. In turn, specifying and evaluating OSS quality has become a significant challenge for OSS adoption in organizations that are inclined to use them. Although many OSS quality models have been proposed in the literature, the dynamic and diverse nature of OSS has caused these models to be heterogeneous in terms of structure and content. This has adversely affected the standardization of evaluations and led to the evaluation results obtained from different OSS quality models for the same purpose being incomparable and sometimes unreliable. Therefore, in this study, a meta-model for OSS quality (OSS-QMM), which employs a unified structure from existing quality models and enables the derivation of homogeneous models, has been proposed. For this purpose, a systematic and laborious effort has been spent via a step-based meta-model creation process including review-and-revise iterations. In order to validate the OSS-QMM, case study and expert opinion methods have been applied to answer three research questions (RQs) targeted to investigate practical applicability, results comparability, and effectiveness of using the meta-model. Multiple and embedded case study designs have been employed for evaluating three real ERP systems, and 20 subject matter experts have been interviewed during the validation process. The results of multi-faceted empirical studies have indicated that the OSS-QMM has addressed solving problems in OSS quality evaluation and its adoption with high degrees of confidence. [ABSTRACT FROM AUTHOR]

Person-centered primary care measures (PCPCM) facilitate high-quality and culturally appropriate primary care. Access to PCPCM remains unequal between rural and urban areas, and the available evidence on rural PCPCM is still lacking. A cross-sectional survey was conducted with stratified sampling by regions, and four districts (Xicheng, Fengtai, Huairou, and Daxing) in Beijing were selected to test the performance of PCPCM in both urban and rural areas. Descriptive statistical methods were used to compare the urban–rural differences in the demographic characteristics of PCPCM. Correlation and regression analyses were performed to determine the associations between PCPCM in demographics and utilization of primary care. The PCPCM showed good reliability and validity in both urban and rural areas (P  <.001), slightly lower in rural areas, but scores of rural PCPCM (R-PCPCM) in all items were lower than urban PCPCM (U-PCPCM). Patients in either the preferred urban or rural health centers all showed the highest PCPCM scores, with U-PCPCM= 3.31 for CHCs and R-PCPCM= 3.10 for RHCs, respectively. Patients in urban areas were more likely to receive higher-quality primary care than in rural areas (P  < .001). Patients who preferred hospitals (β = 2.61, P  < .001) or CHCs (β = 0.71, P  = .003) as providers was a significant positive predictor of U-PCPCM but it was the preference for hospitals (β = 2.95, P  < .001) for R-PCPCM. Urban–rural differences existed in the performance of PCPCM, with rural areas typically more difficult to access better PCPCM. To promote health equity in rural areas, healthcare providers should strive to minimize urban–rural differences in the quality and utilization of primary care services as much as feasible. [ABSTRACT FROM AUTHOR]

Background: Fractures around the hip in older adults have increased in the last two decades, and the numbers are projected to rise over the next 30 years with estimates that half of them will occur in Asia. Proximal hip fractures should be operated within 48 h of injury to prevent poor outcomes. This study aims to benchmark current hip fracture care using quality improvement tools of care structure, care processes, and outcomes in a tertiary care hospital in Eastern India and determine the evidence-practice gaps and barriers to implementing the six best practices that reduce mortality and morbidity in fragility hip fractures. Methods: A total of 101 consecutive patients above 50 years of age with proximal femoral fractures after a trivial fall were included. Patients were divided into two groups: those operated within [Group A] and beyond [Group B] 72 h of admission. Care structure assessment included delays in admission, delay in surgery, and anesthesia risk grading. Care processes included the type of surgery performed and postoperative complications. The primary outcomes were the 30-day and 1-year mortality and the secondary outcomes included the length of stay, mobility at 6 months, return to pre-fracture independence, activity limitations, pressure sores, and readmission to the hospital. Results: Group A comprised 26 individuals, and the remaining 75 were in Group B. There were two deaths in Group A as compared to one death in Group B at 30 days; however, there were no new deaths at 1 year in Group A and 14 deaths in Group B (p = 0.187). Group B had lengthier hospital stays, poorer mobility, and higher physical and mental difficulties. No patients had re-operation on the initial fracture. Conclusion: This study emphasizes the importance of early admission and fast provision of surgical fixation to reduce mortality and morbidity. Benchmarking institutional practices allows for defining the evidence-practice gaps and barriers to best practice implementation. This is an essential step to begin care quality improvement for geriatric patients with proximal femur fragility fractures. [ABSTRACT FROM AUTHOR]

Iran Scientific Information Database (or “Ganj”) is the only comprehensive database of theses/ dissertations of the Iranian scholars and is considered one of the most reliable and most visited academic databases in Iran. Nowadays, tools like “Ganj” database are essential to support research and academic services and activities in higher education institutions. Therefore, expanding and making these tools more efficient can result in the efficiency of research and educational systems. But expanding and making these tools more efficient is not possible without measuring and evaluating their activities and services. Therefore, this research was conducted with the aim of evaluating “Ganj” database and knowing the views of the users of this database in order to improve the services. In order to carry out this evaluation, the viewpoints of 577 users of this database were collected and analyzed in an online survey about the three key dimensions of the E-qual model, i.e. usability, information quality, and service interaction. The findings of the research showed that the highest level of user satisfaction with the features of “Ganj” database is related to the “usability” dimension of the E-qual questionnaire (with an average of 5.32). Against this, the lowest level of user satisfaction with the features of “Ganj” database is related to the “Information Quality” dimension of the E-qual questionnaire (with an average of 5.10). In addition, the findings of inferential statistics showed that the difference in the views of users with different educational employment in different dimensions of E-qual, i.e. applicability (“F” = 0.376 and sig. = 0.865), information quality (Chisquare = 6.771 and sig. = 0.238), service interaction (chi-square = 2.751 and sig. = 0.738) is not statistically significant. However, the relationship between users’ familiarity with “Ganj” database and their opinion about the usability of this database is significant from a statistical point of view (correlation coefficient = 0.106 and sig. = 0.011). Therefore, it can be said that the more familiar users are with “Ganj” database, the more satisfied they are with the usability of this database. Also, based on the findings of the research, the more users use “Ganj” database, the more satisfied they are with the usability, quality of information, and service interaction of this database. Based on the findings of this research, it can be concluded that users’ satisfaction with “Ganj” database is at a high level in all three dimensions of the E-qual tool; however, the continuous improvement of this database should not be overlooked. Practical suggestions have been provided to improve the services of “Ganj” database. Some helpful solutions for improving “Ganj” database include adding more details to the records (such as adding an English abstract), making the database search more efficient, and shortening the “embargo” (delay in accessing full-text files). [ABSTRACT FROM AUTHOR]

▪ ▪ ▪ • The report includes endometrial and ovarian cancer rating and subspecialty rankings. • Procedure and condition ratings for gyn cancer are more reflective of quality of care. • Endometrial cancer methodology can improve by including MIS. • Ovarian cancer methodology can improve by including controls for complex surgery. [ABSTRACT FROM AUTHOR]

BackgroundPatient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities.MethodsWe analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS.Results13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures.ConclusionWhile satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.

The aim: to investigate changes in the interpretation of the content of the characteristics of the quality of medical care and medical service; to propose practical approaches to the formation of modern quality criteria and indicators in health care institutions. Materials and methods: sources of scientific literature from the databases PubMed, NICE, according to the selected research topic, were selected as research materials; methods: bibliosemantic; analysis and generalization of the obtained data. Results. Classic characteristics of quality – safety, quality of resources, quality of the medical care process, treatment outcome, patient satisfaction, timeliness, fairness, efficiency – are reviewed over time and acquire additional or radically changed content. The selection of relevant quality characteristics is important for health care managers to define quality criteria and indicators according to the requirements of the local context. In addition to the traditional components of infectious safety and the safety of medical interventions, the safety criterion is today complemented by the components of radiation, environmental, epidemic, physical, informational, and terrorist safety. Safety also refers to the ability of professionals to avoid, prevent and reduce harmful interventions or risks to themselves and the environment. Patient-centeredness must include respect for the relationship not only between physician and patient, but also between the patient and all providers of health care for that patient. Effective, safe health care is reflected in a culture of excellence that includes collaboration, communication, compassion, competence, advocacy, respect, accountability and reliability. The most relevant criteria and indicators of the quality of medical care must be developed in accordance with the structure of innovative organizational models of academic health care centers, where scientific, clinical and educational activities are integrated. This requires the formation of end-to-end quality criteria and indicators that cover all activities of academic centers. Conclusions: criteria and indicators of the quality of medical care and medical service are constantly supplemented with new components, in accordance with the achievements of medical science and practice. The transformation of the organizational structures of medical care into academic centers, where scientific and educational activities are added to traditional medical practice, requires the development and introduction of end-to-end criteria for the quality of medical care.

Live-streaming commerce (LSC) is a new shopping method that combines the characteristics of social commerce and e-commerce. Since the global coronavirus disease 2019 (COVID-19) outbreak, the number of branded platforms is growing rapidly, and their competition is fiercer than ever. Understanding consumer needs and improving service quality have become the key issues for survival. This study aims to develop and empirically validate a multidimensional hierarchical model for measuring service quality on LSC platforms. A hierarchical reflective construct was proposed to capture dimensions based on the literature on e-retail and social commerce service quality. The proposed model was rigorously tested using two waves of survey data through the partial least squares method. Results showed that the service quality of LSC is a third-order, reflective construct and includes five primary dimensions (the streamer’s interaction quality, physical environment, website quality, outcome quality, and ordering process) and twelve sub-dimensions (trustworthiness, expertise, responsiveness, telepresence, consumption scenarios, information quality, system operation quality, fulfillment and refund/compensation, privacy/security, contact, and ease of use). Findings also supported the hypothesis that service quality has a significant impact on customers’ satisfaction and their behavioral intentions. Furthermore, we tested an alternative model, and the results showed that the relationship between dimensions and overall assessment is reflective rather than formative. We offered directions for further research on LSC service quality and discussed managerial implications stemming from the empirical findings.

This paper presents a model that establishes a relationship between the financial resources allocated to maintain and replace railway station infrastructure assets and the resulting infrastructure quality. Until now, there has been no known relationship between quality and financial resources, making targeted planning for railway stations and the control of financial resources challenging. This model aims to predict infrastructure quality by analyzing the age-related degradation of infrastructure assets using historical data. The effects of maintenance and replacement measures are implemented in the model to map quality-improving measures. This allows for the comparison and analysis of different budget allocation scenarios on different assets, with different approaches for prioritizing replacement and maintenance measures. In this paper, the influence of budget allocation and prioritization strategies on station infrastructure quality is quantified by comparing different scenarios. Based on the results of the analysis, a quality assessment method can be evaluated, and disincentives can be identified. The analyses in this paper are carried out for quality measurement defined in Germany and the German railway station infrastructure. [ABSTRACT FROM AUTHOR]

A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement's (IHI) Quadruple Aim, classify these PQIs under general "areas of focus" categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight. [ABSTRACT FROM AUTHOR]

Background: In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. Aim: To examine the validity of the QI programme indicators using explicit measure review criteria. Methods: The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine‐point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. Results: All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Conclusions: Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes. [ABSTRACT FROM AUTHOR]

Abstract Background Recovery, a primary goal of addiction treatment, goes beyond abstinence. Incorporating broad domains with key elements that vary across individuals, recovery is a difficult concept to measure. Most addiction-related quality measurement has emphasized process measures, which limits evaluation of treatment quality and long-term outcomes, whereas patient-reported outcomes are richer and nuanced. To address these gaps, this study developed and tested a patient-reported outcome measure for addiction recovery, named Response to Addiction Recovery (R2AR). Methods A multi-stage mixed methods approach followed the Patient-Reported Outcomes Measurement Information System (PROMIS) measure development standard. People with lived experience (PWLE) of addiction, treatment providers, and other experts contributed to item distillation and iterative measure refinement. From an item bank of 356 unique items, 57 items were tested via survey and interviews, followed by focus groups and cognitive interviews. Results Face validity was demonstrated throughout. PWLE rated item importance higher and with greater variance than providers, yet both agreed that “There are more important things to me in my life than using substances” was the most important item. The final R2AR instrument has 19 items across 8 recovery domains, spanning early, active, and long-term recovery phases. Respondents assess agreement for each item as (1) a strength, and (2) importance to ongoing recovery. Conclusion R2AR allows PWLE to define what is important to their recovery. It is designed to support treatment planning as part of clinical workflows and to track recovery progress. Inclusion of PWLE and providers in the development process enhances its face validity. Including PWLE in the development of R2AR and using the tool to guide recovery planning emphasizes the importance of patient-centeredness in designing clinical tools and involving patients in their own care.

Dimensionality reduction methods can be used to project high-dimensional data into low-dimensional space. If the output space is restricted to two dimensions, the result is a scatter plot whose goal is to present insightful visualizations of distance- and density-based structures. The topological invariance of dimension indicates that the two-dimensional similarities in the scatter plot cannot coercively represent high-dimensional distances. In praxis, projections of several datasets with distance- and density-based structures show a misleading interpretation of the underlying structures. The examples outline that the evaluation of projections remains essential. Here, 19 unsupervised quality measurements (QM) are grouped into semantic classes with the aid of graph theory. We use three representative benchmark datasets to show that QMs fail to evaluate the projections of straightforward structures when common methods such as Principal Component Analysis (PCA), Uniform Manifold Approximation projection, or t-distributed stochastic neighbor embedding (t-SNE) are applied. This work shows that unsupervised QMs are biased towards assumed underlying structures. Based on insights gained from graph theory, we propose a new quality measurement called the Gabriel Classification Error (GCE). This work demonstrates that GCE can make an unbiased evaluation of projections. The GCE is accessible within the R package DR quality available on CRAN.

Abstract Background A novel incentive scheme based on a joint agreement of a large Swiss health insurance with 56 physician networks was implemented in 2018. This study evaluated the effect of its implementation on adherence to evidence-based guidelines among patients with diabetes in managed care models. Methods We performed a retrospective cohort study, using health care claims data from patients with diabetes enrolled in a managed care plan (2016–2019). Guideline adherence was assessed by four evidence-based performance measures and four hierarchically constructed adherence levels. Generalized multilevel models were used to examine the effect of the incentive scheme on guideline adherence. Results A total of 6′273 patients with diabetes were included in this study. The raw descriptive statistics showed minor improvements in guideline adherence after the implementation. After adjusting for underlying patient characteristics and potential differences between physician networks, the likelihood of receiving a test was moderately but consistently higher after the implementation of the incentive scheme for most performance measures, ranging from 18% (albuminuria: OR, 1.18; 95%-CI, 1.05–1.33) to 58% (HDL cholesterol: OR, 1.58; 95%-CI, 1.40–1.78). Full adherence was more likely after implementation of the incentive scheme (OR, 1.37; 95%-CI, 1.20–1.55), whereas level 1 significantly decreased (OR, 0.74; 95%-CI, 0.65 – 0.85). The proportions of the other adherence levels were stable. Conclusion Incentive schemes including transparency of the achieved performance may be able to improve guideline adherence in patients with diabetes and are promising to increase quality of care in this patient population.

Abstract Background Internationally, the need for appropriately structured, high-quality care in psycho-oncology is more and more recognized and quality-oriented care is to be established. Quality indicators are becoming increasingly important for a systematic development and improvement of the quality of care. The aim of this study was to develop a set of quality indicators for a new form of care, a cross-sectoral psycho-oncological care program in the German health care system. Methods The widely established RAND/UCLA Appropriateness Method was combined with a modified Delphi technique. A systematic literature review was conducted to identify existing indicators. All identified indicators were evaluated and rated in a two-round Delphi process. Expert panels embedded in the Delphi process assessed the indicators in terms of relevance, data availability and feasibility. An indicator was accepted by consensus if at least 75% of the ratings corresponded to category 4 or 5 on a five-point Likert scale. Results Of the 88 potential indicators derived from a systematic literature review and other sources, 29 were deemed relevant in the first Delphi round. After the first expert panel, 28 of the dissented indicators were re-rated and added. Of these 57 indicators, 45 were found to be feasible in terms of data availability by the second round of expert panel. In total, 22 indicators were transferred into a quality report, implemented and tested within the care networks for participatory quality improvement. In the second Delphi round, the embedded indicators were tested for their practicability. The final set includes 16 indicators that were operationalized in care practice and rated by the expert panel as relevant, comprehensible, and suitable for care practice. Conclusion The developed set of quality indicators has proven in practical testing to be a valid quality assurance tool for internal and external quality management. The study findings could contribute to traceable high quality in cross-sectoral psycho-oncology by providing a valid and comprehensive set of quality indicators. Trial registration “Entwicklung eines Qualitätsmanagementsystems in der integrierten, sektorenübergreifenden Psychoonkologie—AP “Qualitätsmanagement und Versorgungsmanagement” zur Studie "integrierte, sektorenübergreifende Psychoonkologie (isPO)" a sub-project of the “integrierte, sektorenübergreifende Psychoonkologie (isPO)”, was registered in the German Clinical Trials Register (DRKS) (DRKS-ID: DRKS00021515) on 3rd September 2020. The main project was registered on 30th October 2018 (DRKS-ID: DRKS00015326).

Objective: To develop a risk adjustment approach and test reliability and validity for oncology survival measures. Data Sources and Study Setting: We used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)‐Medicare data from 2010 to 2013, with mortality data through 2015. Study Design: We developed 2‐year risk‐standardized survival rates (RSSR) for melanoma, non‐small cell lung cancer (NSCLC), and small cell lung cancer (SCLC). Patients were attributed to group practices based on the plurality of visits. We identified the risk‐adjustment variables via bootstrap and calculated the RSSRs. Reliability was tested via three approaches: (1) signal‐to‐noise ratio (SNR) reliability, (2) split‐half, and (3) test–retest using bootstrap. We tested known group validity by stage at diagnosis using Cohen's d. Data Collection/Extraction Methods: We selected all patients enrolled in Medicare and linked to SEER during the measurement period with an incident first primary diagnosis of stage I–IV melanoma, NSCLC, or SCLC. We excluded patients with missing data on month and/or stage of diagnosis. Principal Findings: Results are based on patients with melanoma (n = 4344); NSCLC (n = 16,080); and SCLC (n = 2807) diagnosed between 2012 and 2013. The median (interquartile range) for the RSSRs at the group practice‐level were 0.89 (0.83–0.87) for melanoma, 0.37 (0.30–0.43) for NSCLC, and 0.19 (0.11–0.25) for SCLC. C‐statistics for the models ranged from 0.725 to 0.825. The reliability varied by approach with median SNR 0.20, 0.25, and 0.13; median test–retest 0.59, 0.57, and 0.56; median split‐half reliability 0.21, 0.29, and 0.29 for melanoma, NSCLC, and SCLC, respectively. Cohen's d for stage I‐IIIa and IIIb+ was 1.27, 0.86, 0.60 for melanoma, NSCLC, and SCLC, respectively. Conclusions: Our results suggest that these cancer survival measures demonstrated adequate test–retest reliability and expected findings for the known‐group validity analysis. If data limitations and feasibility challenges can be addressed, implementation of these quality measures may provide a survival metric used for oncology quality improvement efforts. [ABSTRACT FROM AUTHOR]

Background: Recovery, a primary goal of addiction treatment, goes beyond abstinence. Incorporating broad domains with key elements that vary across individuals, recovery is a difficult concept to measure. Most addiction-related quality measurement has emphasized process measures, which limits evaluation of treatment quality and long-term outcomes, whereas patient-reported outcomes are richer and nuanced. To address these gaps, this study developed and tested a patient-reported outcome measure for addiction recovery, named Response to Addiction Recovery (R2AR). Methods: A multi-stage mixed methods approach followed the Patient-Reported Outcomes Measurement Information System (PROMIS) measure development standard. People with lived experience (PWLE) of addiction, treatment providers, and other experts contributed to item distillation and iterative measure refinement. From an item bank of 356 unique items, 57 items were tested via survey and interviews, followed by focus groups and cognitive interviews. Results: Face validity was demonstrated throughout. PWLE rated item importance higher and with greater variance than providers, yet both agreed that "There are more important things to me in my life than using substances" was the most important item. The final R2AR instrument has 19 items across 8 recovery domains, spanning early, active, and long-term recovery phases. Respondents assess agreement for each item as (1) a strength, and (2) importance to ongoing recovery. Conclusion: R2AR allows PWLE to define what is important to their recovery. It is designed to support treatment planning as part of clinical workflows and to track recovery progress. Inclusion of PWLE and providers in the development process enhances its face validity. Including PWLE in the development of R2AR and using the tool to guide recovery planning emphasizes the importance of patient-centeredness in designing clinical tools and involving patients in their own care. [ABSTRACT FROM AUTHOR]

Dimensionality reduction methods can be used to project high-dimensional data into low-dimensional space. If the output space is restricted to two dimensions, the result is a scatter plot whose goal is to present insightful visualizations of distance- and density-based structures. The topological invariance of dimension indicates that the two-dimensional similarities in the scatter plot cannot coercively represent high-dimensional distances. In praxis, projections of several datasets with distance- and density-based structures show a misleading interpretation of the underlying structures. The examples outline that the evaluation of projections remains essential. Here, 19 unsupervised quality measurements (QM) are grouped into semantic classes with the aid of graph theory. We use three representative benchmark datasets to show that QMs fail to evaluate the projections of straightforward structures when common methods such as Principal Component Analysis (PCA), Uniform Manifold Approximation projection, or t-distributed stochastic neighbor embedding (t-SNE) are applied. This work shows that unsupervised QMs are biased towards assumed underlying structures. Based on insights gained from graph theory, we propose a new quality measurement called the Gabriel Classification Error (GCE). This work demonstrates that GCE can make an unbiased evaluation of projections. The GCE is accessible within the R package DR quality available on CRAN. [ABSTRACT FROM AUTHOR]

Context: In the last two decades, open-source software (OSS) has gained increasing attention due to its voluntary supporters, growing community, and ease of accessibility in cloud repositories. Standardization in OSS quality is of vital importance as a communication vehicle for stakeholders in identifying and selecting high-quality products. Thus, meta-models help to define a standardized language and enable to propose quality models that can be used to perform comparable measurements. Objective: Considering the lack of a comprehensive meta-model of OSS quality in the literature, there appears a need to see a more complete picture of OSS quality and to represent its concepts more formally. Therefore, in this study, it is aimed to develop a solid base for a comprehensive meta-model of OSS quality to create a common understanding among stakeholders. Method: A systematic way has been followed toward developing a common structure, defining a consistent terminology and, finally, providing a meta-model of OSS quality. In this context, (1) the common structure of the quality models for OSS has been investigated, (2) the terms of the general-purpose meta-models of software quality have been analyzed based on the international standards, and (3) the terms of the quality models for OSS have been mapped with the elements of these meta-models. Results: An initial meta-model of OSS quality, which employs a unified structure from the OSS quality models and eliminates the inconsistencies determined in the general-purpose meta-models of software quality, has been proposed and an implementation of this meta-model has been demonstrated. Conclusion: This initial meta-model of OSS quality with a standard terminology can be taken as a guide by researchers who will propose or revise their OSS quality models. It will allow developing multiple OSS quality models with homogenous structure and terms, and also enable comparing the evaluation results obtained by these models. [ABSTRACT FROM AUTHOR]

ContextWith rising concerns about quality of care in hospice, federal agencies recently began mandating quality measurement in hospice, including measures of advance care planning (ACP).ObjectivesTo characterize hospice providers' experiences with ACP quality measurement and their reflections on ways to improve it.MethodsSemi-structured in-depth interviews of fifty-one hospice providers from various clinical backgrounds and organizational roles in four geographically diverse non-profit, community-based hospices in the U.S. Participants were queried about their experiences with and barriers to ACP quality measurement processes in their organization, opinions about the impacts of federally mandated quality measures, and ideas for improvement. Data were analyzed using thematic analysis with an interdisciplinary team, facilitated by ATLAS.ti and Excel.ResultsFour key findings of the ACP quality measurement experience for hospice staff included variation, barriers, attitudes, and recommendations for improvement. 1) Variation: Within and across organizations, participants applied a variety of processes to measure ACP quality, and exposure to and experiences with quality measurement varied based on organizational role. 2) Barriers: ACP quality measurement was impeded by limited resources, technological problems, and measurement challenges. 3) Attitudes: Participants' opinions of recently implemented federally mandated requirements for ACP quality measurement highlighted numerous downsides, unintended consequences, and few upsides. 4) Recommendations: improvements included personalizing ACP quality measures, elevating the importance of quality measurement, and streamlining processes.ConclusionHospice staff take ACP quality measurement seriously, but insufficient organizational resources and regulatory bureaucracy create challenges. Efforts to enhance ACP quality measure nuance and assess outcomes are needed to improve care.

Abstract Background Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. Methods In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. Results Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (− 1.04, 95% CI = − 2.00/ − 0.08, p = 0.033) and had higher health-related quality of life (− 1.37, 95% CI = − 2.39/ − 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p

Abstract Background Nursing home (NH) residents’ experiences are embedded within their relationships to others. Our objectives were to describe how residents and care partners (family or staff members) jointly construct, discuss, and act on care priorities. Methods We used Action-Project Method, a qualitative method focused on action within social context. We recruited 15 residents and 12 care partners (5 family and 7 staff members) from 3 urban NHs in Alberta, Canada. Residents and care partners participated in a video-recorded conversation about their experiences in the NH, then individually reviewed the video-recording to add context to the conversation. Following transcription, preliminary narrative construction, and participant feedback, the research team conducted in-depth analysis to identify participant actions, goals, and projects, including those jointly shared by dyad members. Results All participants’ intentions could be broadly described as “making time in the NH as good as possible” and projects were grouped into five categories: resident identity, relationships (both presence and absence), advocacy, positivity, and respectful care. Participants often raised issues of short-staffing as a significant barrier to respectful care. Care partners, especially staff, used positivity to redirect residents from difficult topics. Joint projects could be identified in some, but not all, cases. Conclusions We found that maintaining a sense of identity, fostering relationships, and receiving respectful care were important to residents but that short-staffing created barriers. Methods to capture these aspects of the resident experience are needed but should not be influenced by care partners’ tendency towards positivity in resident interactions.

Developing ambulatory health services (AHS) of optimal quality is a pending issue for many health systems at a global level, especially in middle- and low-income countries. An effective health response requires indicators to measure the quality of care that are context-specific and feasible for routine monitoring. This paper aimed to design and validate indicators for assessing the technical and interpersonal quality dimensions for type 2 diabetes (T2D) and acute respiratory infections (ARI) care in AHS. The study was conducted in two stages. First, technical and user-centered-based indicators of quality of care for T2D and ARI care were designed following international recommendations, mainly from the American Diabetes Association standards and the National Institute for Health and Care Excellence guidelines. We then assessed the validity, reliability, relevance, and feasibility of the proposed indicators implementing the modified Delphi technique. A panel of 17 medical experts from five countries scored the indicators using two electronic questionnaires, one for each reason for consultation selected, sent by email in two sequential rounds of rating. We defined the levels of consensus according to the overall median for each performance category, which was established as the threshold. Selected indicators included those with scores equal to or higher than the threshold. We designed 36 T2D indicators, of which 16 were validated for measuring the detection of risks and complications, glycemic control, pharmacological treatment, and patient-centered care. Out of the 22 indicators designed for ARI, we validated 10 for diagnosis, appropriate prescription of antimicrobials, and patient-centered care. The validated indicators showed consistency for the dimensions analyzed. Hence, they proved to be a potentially reliable and valuable tool for monitoring the performance of the various T2D and ARI care processes in AHS. Further research will be needed to verify the applicability of the validated indicators in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: A novel incentive scheme based on a joint agreement of a large Swiss health insurance with 56 physician networks was implemented in 2018. This study evaluated the effect of its implementation on adherence to evidence-based guidelines among patients with diabetes in managed care models. Methods: We performed a retrospective cohort study, using health care claims data from patients with diabetes enrolled in a managed care plan (2016–2019). Guideline adherence was assessed by four evidence-based performance measures and four hierarchically constructed adherence levels. Generalized multilevel models were used to examine the effect of the incentive scheme on guideline adherence. Results: A total of 6′273 patients with diabetes were included in this study. The raw descriptive statistics showed minor improvements in guideline adherence after the implementation. After adjusting for underlying patient characteristics and potential differences between physician networks, the likelihood of receiving a test was moderately but consistently higher after the implementation of the incentive scheme for most performance measures, ranging from 18% (albuminuria: OR, 1.18; 95%-CI, 1.05–1.33) to 58% (HDL cholesterol: OR, 1.58; 95%-CI, 1.40–1.78). Full adherence was more likely after implementation of the incentive scheme (OR, 1.37; 95%-CI, 1.20–1.55), whereas level 1 significantly decreased (OR, 0.74; 95%-CI, 0.65 – 0.85). The proportions of the other adherence levels were stable. Conclusion: Incentive schemes including transparency of the achieved performance may be able to improve guideline adherence in patients with diabetes and are promising to increase quality of care in this patient population. [ABSTRACT FROM AUTHOR]

Background: Internationally, the need for appropriately structured, high-quality care in psycho-oncology is more and more recognized and quality-oriented care is to be established. Quality indicators are becoming increasingly important for a systematic development and improvement of the quality of care. The aim of this study was to develop a set of quality indicators for a new form of care, a cross-sectoral psycho-oncological care program in the German health care system. Methods: The widely established RAND/UCLA Appropriateness Method was combined with a modified Delphi technique. A systematic literature review was conducted to identify existing indicators. All identified indicators were evaluated and rated in a two-round Delphi process. Expert panels embedded in the Delphi process assessed the indicators in terms of relevance, data availability and feasibility. An indicator was accepted by consensus if at least 75% of the ratings corresponded to category 4 or 5 on a five-point Likert scale. Results: Of the 88 potential indicators derived from a systematic literature review and other sources, 29 were deemed relevant in the first Delphi round. After the first expert panel, 28 of the dissented indicators were re-rated and added. Of these 57 indicators, 45 were found to be feasible in terms of data availability by the second round of expert panel. In total, 22 indicators were transferred into a quality report, implemented and tested within the care networks for participatory quality improvement. In the second Delphi round, the embedded indicators were tested for their practicability. The final set includes 16 indicators that were operationalized in care practice and rated by the expert panel as relevant, comprehensible, and suitable for care practice. Conclusion: The developed set of quality indicators has proven in practical testing to be a valid quality assurance tool for internal and external quality management. The study findings could contribute to traceable high quality in cross-sectoral psycho-oncology by providing a valid and comprehensive set of quality indicators. Trial registration: "Entwicklung eines Qualitätsmanagementsystems in der integrierten, sektorenübergreifenden Psychoonkologie—AP "Qualitätsmanagement und Versorgungsmanagement" zur Studie "integrierte, sektorenübergreifende Psychoonkologie (isPO)" a sub-project of the "integrierte, sektorenübergreifende Psychoonkologie (isPO)", was registered in the German Clinical Trials Register (DRKS) (DRKS-ID: DRKS00021515) on 3rd September 2020. The main project was registered on 30th October 2018 (DRKS-ID: DRKS00015326). [ABSTRACT FROM AUTHOR]

Pediatric palliative care (PPC) programs vary widely in structure, staffing, funding, and patient census, resulting in inconsistency in service provision. Improving the quality of palliative care for children living with serious illness and their families requires measuring care quality, ensuring that quality measurement is embedded into day-to-day clinical practice, and aligning quality measurement with healthcare policy priorities. Yet, numerous challenges exist in measuring PPC quality. This paper provides an overview of PPC quality measurement, including challenges, current initiatives, and future opportunities. While important strides toward addressing quality measurement challenges in PPC have been made, including ongoing quality measurement initiatives like the Cambia Metrics Project, the PPC What Matters Most study, and collaborative learning networks, more work remains. Providing high-quality PPC to all children and families will require a multi-pronged approach. In this paper, we suggest several strategies for advancing high-quality PPC, which includes 1) considering how and by whom success is defined, 2) evaluating, adapting, and developing PPC measures, including those that address care disparities within PPC for historically marginalized and excluded communities, 3) improving the infrastructure with which to routinely and prospectively measure, monitor, and report clinical and administrative quality measures, 4) increasing endorsement of PPC quality measures by prominent quality organizations to facilitate accountability and possible reimbursement, and 5) integrating PPC-specific quality measures into the administrative, funding, and policy landscape of pediatric healthcare. [ABSTRACT FROM AUTHOR]

Alzheimer's disease and related dementias (ADRD) are prevalent conditions in long-term care homes (LTCHs) with most LTCH residents living with ADRD in many countries. Despite the prevalence of ADRD in LTCHs, a recent examination of LTCH quality measurement programs in 4 countries revealed few LTCH quality measures addressed ADRD, most commonly as a risk adjuster. We sought to better understand how quality measurement programs address ADRD internationally. International comparative analysis. We examined LTCH quality measures in 4 European countries—Germany, Switzerland, Belgium, and the Netherlands. The specifications to calculate each measure were assessed to determine whether the measure was calculated without assessing for ADRD, included only residents with ADRD, excluded residents with ADRD, or was risk adjusted for the presence of ADRD among the LTCH residents. A total of 143 measures were examined across 4 quality measurement programs. Thirty-seven percent of the measures explicitly address ADRD. The programs addressed ADRD in starkly different ways. In Germany, most (13 of 15) measures addressed ADRD, and did so as an exclusion or inclusion criterion, and in Switzerland all the measures addressed ADRD through risk adjustment. In Flanders, Belgium, all measures were calculated without assessing for ADRD. In the Netherlands, one-third of the measures explicitly addressed ADRD by restricting the measure to psychogeriatric units. Although limited to examining measures from LTCH quality measurement programs in 4 European countries, this study adds evidence that ADRD tends not to be addressed by LTCH quality measures, but when ADRD is addressed, it tends to be through inclusion or exclusion criteria. LTCH regulators, policymakers, and providers can use this information to assess options for addressing ADRD in quality measurement programs. Future research is needed to assess how standard indicators of ADRD care quality differ across quality measurement programs. [ABSTRACT FROM AUTHOR]

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited. [ABSTRACT FROM AUTHOR]

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The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting. [ABSTRACT FROM AUTHOR]

ObjectiveMedical billing data are an attractive source of secondary analysis because of their ease of use and potential to answer population-health questions with statistical power. Although these datasets have known susceptibilities to biases, the degree to which they can distort the assessment of quality measures such as colorectal cancer screening rates are not widely appreciated, nor are their causes and possible solutions.MethodsUsing a billing code database derived from our institution's electronic health records, we estimated the colorectal cancer screening rate of average-risk patients aged 50-74 years seen in primary care or gastroenterology clinic in 2016-2017. 200 records (150 unscreened, 50 screened) were sampled to quantify the accuracy against manual review.ResultsOut of 4611 patients, an analysis of billing data suggested a 61% screening rate, an estimate that matches the estimate by the Centers for Disease Control. Manual review revealed a positive predictive value of 96% (86%-100%), negative predictive value of 21% (15%-29%) and a corrected screening rate of 85% (81%-90%). Most false negatives occurred due to examinations performed outside the scope of the database-both within and outside of our institution-but 21% of false negatives fell within the database's scope. False positives occurred due to incomplete examinations and inadequate bowel preparation. Reasons for screening failure include ordered but incomplete examinations (48%), lack of or incorrect documentation by primary care (29%) including incorrect screening intervals (13%) and patients declining screening (13%).ConclusionsBilling databases are prone to substantial bias that may go undetected even in the presence of confirmatory external estimates. Caution is recommended when performing population-level inference from these data. We propose several solutions to improve the use of these data for the assessment of healthcare quality.

Research results, as well as the author’s own observations show that the quality of educational services is one of the most important factors affecting the level of civilization of modern states, by affecting all aspects of their socio-economic life, including health, natural environment and economic growth, in the long run. The quality of education directly influences the formation of the human capital of the society, and this impacts the pace of economic development. The starting point for actions aimed at improving the quality of educational services is undoubtedly both the proper recognition of the main factors determining the quality of educational services and the measurement of this quality determinants. Thus, measuring the quality of educational services, identification and gradation of key determinants were considered the main purpose of this study. The research method used to achieve the set goal was a two-part, anonymous questionnaire sent to secondary schools’ principals in the Zachodniopomorskie province in Poland. The conducted evaluation of the factors shaping the quality of educational services in the surveyed institutions indicated numerous needs in terms of improving their activity. It should be emphasized that none of the estimated factors obtained a fully satisfactory outcome in the survey of respondents' opinions. The general conclusion from the conducted research is to confirm the importance of recognizing properly the determinants of the educational services quality as the basis for developing a proposal for shaping the desired level of these services’ quality.

Abstract Background This systematic literature review identifies hospital value-based healthcare quality measures, measurement practices, and tools, as well as potential strategies for improving cardiovascular diseases and cancer care. Methods A systematic search was carried out in the PubMed, Embase, CINAHL, and MEDLINE (OvidSP) databases. We included studies on quality measures in hospital value-based healthcare for cardiovascular diseases and cancer. Two reviewers independently screened titles and abstracts, conducted a full-text review of potentially relevant articles, assessed the quality of included studies, and extracted data thematically. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and four validated tools were used for methodological quality assessment. Results The search yielded 2860 publications. After screening the titles and abstracts, 60 articles were retrieved for full-text review. A total of 37 studies met our inclusion criteria. We found that standardized outcome sets with patient involvement were developed for some cardiovascular diseases and cancer. Despite the heterogeneity in outcome measures, there was consensus to include clinical outcomes on survival rate and disease control, disutility of care, and patient-reported outcome measures such as long-term quality of life. Conclusion Hospitals that developed value-based healthcare or are planning to do so can choose whether they prefer to implement the standardized outcomes step-by-step, collect additional measures, or develop their own set of measures. However, they need to ensure that their performance can be consistently compared to that of their peers and that they measure what prioritizes and maximizes value for their patients. Trial registration PROSPERO ID: CRD42021229763 .

Background: Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. Methods: In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. Results: Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (− 1.04, 95% CI = − 2.00/ − 0.08, p = 0.033) and had higher health-related quality of life (− 1.37, 95% CI = − 2.39/ − 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p < 0.001) were more likely to have lower GP-reported healthcare quality scores. Patients who had fewer GP contacts (0.12, 95% CI = 0.04/0.20, p = 0.002) and were less willing to use their GP to coordinate their care (0.16, 95% CI = 0.10/0.21, p < 0.001) were more likely to have lower patient-reported healthcare quality scores. Conclusions: The quality indicator core sets are the first brief measurement tools specifically designed to assess quality of care for patients with multimorbidity. The indicators can facilitate implementation of treatment standards and offer viable alternatives to the current practice of combining disease-related metrics with poor applicability to patients with multimorbidity. [ABSTRACT FROM AUTHOR]