Browsing by Subject "Quality"
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Item Open Access American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery.(Perioper Med (Lond), 2017) Moonesinghe, S Ramani; Grocott, Michael PW; Bennett-Guerrero, Elliott; Bergamaschi, Roberto; Gottumukkala, Vijaya; Hopkins, Thomas J; McCluskey, Stuart; Gan, Tong J; Mythen, Michael Monty G; Shaw, Andrew D; Miller, Timothy E; Perioperative Quality Initiative (POQI) I WorkgroupBACKGROUND: This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. METHODS: Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection. DISCUSSION: Core, Quality Improvement, and Best Practice datasets are proposed. The suggested datasets incorporate patient data to describe case-mix, process measures to describe delivery of enhanced recovery and clinical outcomes. The fundamental importance of routine collection of data for the initiation, maintenance, and enhancement of enhanced recovery pathways is emphasized.Item Open Access American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU.(Perioper Med (Lond), 2017) McEvoy, Matthew D; Scott, Michael J; Gordon, Debra B; Grant, Stuart A; Thacker, Julie KM; Wu, Christopher L; Gan, Tong J; Mythen, Monty G; Shaw, Andrew D; Miller, Timothy E; Perioperative Quality Initiative (POQI) I WorkgroupBACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia," which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document.Item Open Access American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.(Perioper Med (Lond), 2017) Scott, Michael J; McEvoy, Matthew D; Gordon, Debra B; Grant, Stuart A; Thacker, Julie KM; Wu, Christopher L; Gan, Tong J; Mythen, Monty G; Shaw, Andrew D; Miller, Timothy E; Perioperative Quality Initiative (POQI) I WorkgroupBACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of "optimal analgesia" as set forth in this document.Item Open Access Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI): The 1st Consensus Conference of the Perioperative Quality Initiative (POQI).(Perioper Med (Lond), 2016) Miller, Timothy E; Shaw, Andrew D; Mythen, Michael G; Gan, Tong J; Perioperative Quality Initiative (POQI) I WorkgroupThe 1st POQI Consensus Conference occurred in Durham, NC, on March 4-5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The conference focused on enhanced recovery for colorectal surgery and discussed four topics-perioperative analgesia, perioperative fluid management, preventing nosocomial infection, and measurement and quality in enhanced recovery pathways.Item Open Access Implementation of an Online Family Health History Tool using Research Assistants in Rural North Carolina(2018) Wittmer, Ashley NicoleIntroduction: Chronic diseases have been increasing globally for decades, while the leading chronic diseases worldwide are cancer, cardiovascular disease (CVD), chronic respiratory disease, and diabetes.1 Behavioral risk factors of chronic diseases that can be modified include physical activity, diet, alcohol consumption and tobacco use.3 4 Several guidelines for screening and prevention recommend that family health history (FHH) is collected by primary care providers for disease risk stratification and management.6 7 MeTree, developed in 2014, is a computerized, patient-facing program that collects information about family health history and generates decision support for providers and patients.6 15 There are several potential barriers to implementation of an online FHH software tool including health literacy, computer skills, and behavioral components. This study collects FHH information through MeTree in a rural population in North Carolina through a unique implementation process using research assistants to manually and verbally assist participants. The aims of this study are to characterize the quality of pedigrees collected and to estimate familial disease aggregation among the families of participants.
Methods: This study enrolled 44 participants from an ongoing study conducted by collaborators from Duke University Health System, Duke Clinical Research Institute,
University of North Carolina Pembroke, and Southeastern Regional Medical Center. To collect FHH information, participants constructed family pedigree in MeTree, one family member at a time with the help of one study research assistant. Once participants created a full family pedigree, an individual risk assessment was generated by MeTree.
Results: More than half of the participants were female (n= 30, 68.2%). The ethnic group that composed the largest part of our study population were Lumbee Indians (n=23, 52.3%) followed by White/Caucasians (n=13, 29.5%) and African Americans (n=7, 15.9%). For quality, the average score across all pedigrees was higher than 65% for all seven components of the criteria. The total number of diseases present among all participants and relatives in the study was 930 (Table 3). Cancer was present in 81.8% of pedigrees and made up 12.2% of all reported diseases. Twenty-five percent of all pedigrees had at least one family member that was diagnosed with lung cancer. Diabetes was also frequently reported and was observed in 75% of all pedigrees. Kidney Disease was reported in at least one or more relatives in 52.3% of pedigrees.
Conclusions: Using a patient-facing online Health Information Technology tool such as MeTree could potentially lead to better health outcomes due to risk assessment and individually-targeted prevention strategies. MeTree may be an important tool to use to address the large burden of chronic diseases in this region.
Item Open Access The Impact of Spectrum Quality on Wireless Telecom Competition(2012-04-16) Zhu, StephenThis paper explores the metrics used by FCC and others for evaluating competition between wireless telecom carriers. It focuses on the impact of wireless spectrum quality on the results of FCC spectrum auctions and the estimated market shares of wireless carriers. In this case, it is revealed that quality is affected by the physical attributes of and the policies that are imposed at auction. Further, accounting for quality can lead to changes in the perception of concentration in local markets. The findings here give insights that can be used to better evaluate the competitive landscape of telecom in the future.