Enligt Socialstyrelsens föreskrifter om ledningssystem för kvalitet och patientsäkerhet i hälso- och sjukvården, SOSFS 2005:12, krävs det av vårdgivaren att denne arbetar efter mål. Att formulera mål inom hälso- och sjukvården kräver eftertanke. Målen måste vara mätbara och inkludera flera olika delar av verksamheten. Varje förbättringsprojekt är unikt och bör relateras till de resurser som avsatts. Ett stort problem vid kontinuerlig uppföljning är att välja ut parametrar som ger tillräcklig information och är lätta att skapa. Här krävs mer utvecklade datasystem och även integrering mellan befintliga datasystem  I uppsatsen diskuteras med vilka parametrar man kan utvärdera ett förbättringsprojekt inom laboratoriemedicin. Det finns för närvarande inte några standardiserade kvalitetsparametrar inom klinisk kemi. De parametrar som i denna undersökning visade sig vara mest lämpliga att använda kontinuerligt i det korta perspektivet var svarstider, personalresurser och reagenskostnader. I det längre perspektivet kan ovanstående data kombineras till indikatorer som visar kostnad per analyspoäng och analyspoäng per årsarbetare. De indikatorer som kan få användning först när datasystem utvecklas är data från avvikelsesystem och analyskommentarer som visar t.ex. att svar inte har kunnat lämnas ut. / According to the National Board of Health and Welfare, SOSFS 2005:12, it is required that the caregiver adheres to his work through following stated objectives. Formulating goals in health care requires careful consideration. Goals must be measurable and include many different aspects of the project. Each improvement project is unique and should be directly related to the resources allocated to the project. A major problem for continuous monitoring is to select parameters that provide sufficient information and are easy to produce. This requires more advanced computer systems and integration with existing computer systems. The paper discusses the parameters an improvement project in laboratory medicine can evaluate its results after. There are currently no standardized quality parameters in clinical chemistry. The parameters used in this study that proved to be the most suitable to be used continuously in the short term was the response times, staffing and reagent costs. In the long term, the above data are combined with indicators that show cost per analysis score and analysis points per full-time employees. The indicator that may be used when the computer system is developed is deviation systems and analytical comments that show for example that a response has not been disclosed.

In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention.<p> This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008.<p> The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province.<p> The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.

BACKGROUND: Radical prostatectomy is the surgical procedure performed on men with clinically localized prostate cancer. In recent years, radical prostatectomy quality indicators have been recommended, but the feasibility and validity for many of these listed surgical quality indicators have yet to be examined. We tested the convergent construct validity of these quality indicators by assessing their associations with hospital volume, a variable repeatedly associated with the quality of surgical care, for prostate cancer patients treated with radical prostatectomy. OBJECTIVES: (1) To assess variations in quality indicators by hospital volume; and (2) To investigate whether certain explanatory variables account for some of the variation observed in Objective 1. METHODS: This was a retrospective cohort study using medical chart review data that had already been collected as part of a parent study. The study population consisted of a stratified random sample of prostate cancer patients diagnosed between 1990 and 1998 in Ontario, who were treated by radical prostatectomy with curative intent within six months of diagnosis (n = 645). The feasibility of using this data to assess a number of quality indicators was explored, and where possible, variables were developed for analysis. Ultimately, detailed analyses were performed for the quality indicators: total blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique. RESULTS: Even using high-quality chart data, it was not feasible to evaluate all of the quality indicators that were explored. For blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume, both before and after adjusting for the effect of explanatory variables. CONCLUSIONS: We demonstrated convergent construct validity for three quality indicators (blood transfusions, length of hospital stay, and non-nerve-sparing surgery). If their validity is further demonstrated in future studies, these indicators could be used for quality assessment and could provide feedback to surgeons, surgical department heads, hospital administrators, and quality councils by suggesting areas for quality improvement in surgical care, such that future outcomes can be optimized. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-08-23 17:53:33.166

Doctor of Philosophy (PhD) / This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / "May 2002." Typescript. Vita. Includes bibliographical references (leaves 90-96).

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 90-96). Also available on the Internet.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4122. Adviser: Osama I. Mikhail. Includes bibliographical references.

Thesis (Ph.D. in Nursing) -- University of Colorado, 2005. / Typescript. Includes bibliographical references (leaves 198-212). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--Virginia Commonwealth University, 2005. / Prepared for: Dept. of Health Administration. Bibliography: leaves 202-251. Also available online.

Type 2 diabetes mellitus (T2DM) is a chronic and debilitating disease contributing to the rise in healthcare associated costs in the United States (ADA, 2013a; USDHHS, 2013). T2DM management is complex and requires an ongoing multi-system approach (Goderis et al., 2010). In this quality improvement project, the DNP student led a team in a family care practice setting through a systematic quality improvement process, the PDSA cycle, for the improvement of performance rates of quality indicators including A1C testing, LDL testing, and performance of comprehensive foot examinations. The QI team developed a multi-component intervention to include utilization of an electronic type 2 diabetes mellitus (T2DM) decision support tool. The expected outcome was to increase current performance rates of A1C testing, LDL testing, and comprehensive foot examinations at a family care practice by at least 10% within four weeks of implementing the intervention. A1C testing improved from a pre-intervention median of 70.97% to a post-intervention median of 91.38%, an increase of 20.41%. LDL testing improved from a pre-intervention median of 74.19% to a post-intervention median of 91.38%, an increase of 17.19%. Comprehensive foot examinations improved from a pre-intervention median of 58.06% to a post-intervention median of 84.48%, an increase of 26.42%. While results demonstrate a trend of improvement, the duration of the intervention was insufficient for statistical significance. The QI project served as a first systematic change process for the family care practice and a model for future change processes at the clinic. This project highlights the DNP's role in utilizing evidence-based research and applying a systematic change model for quality improvement in the primacy care practice setting.