Objective: determine whether accreditation through Accreditation Canada is associated with more favorable resident safety in Ontario LTC homes and which facility characteristics are predictive of accreditation. Methods: logistic regression was used to determine predictors of accreditation. To examine the association between accreditation and safety, safety was operationalized as five MDS-RAI quality indicators: prevalence of falls, restraints, catheters, pressure ulcers, and infections. Separate multivariable models were developed for each indicator. Results: the odds of accreditation were approximately six times smaller for municipal (p < 0.001) and non-profit facilities (p < 0.001) relative to for-profits; three times greater for chains relative to non-chains (p < 0.001); and twice as large for urban relative to rural facilities (p = 0.04). Of the five quality indicators examined, only one (falls) was associated with accreditation. After adjusting for confounders, accredited homes were estimated to have 8% lower fall rates than non-accredited homes (p = 0.01).

Patients with acute myocardial infarction (AMI) are at high risk for reinfarction and death, with the highest rate of death and reinfarction occurring within 30 days of AMI. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization. The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of an NP delivered secondary prevention intervention. The specific objectives were: 1) to describe NP activities when delivering the secondary prevention intervention; 2) to evaluate the effect of the NP intervention on the rate of implementation of evidence-based secondary prevention treatment strategies and the patients’ achievement of secondary prevention target goals; and, 3) to examine the relationship between the NP activities delivering the intervention and secondary prevention goal achievement by patients. A prospective cohort design was used, in which patients’ achievement of target goals were compared between patients who received secondary prevention care from an NP and those who received usual care. The sample of convenience consisted of 65 patients with AMI. Data on practice activities and implementation of secondary prevention by the NP were collected before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients’ achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups. This study’s results provide preliminary evidence that an NP delivered secondary prevention intervention, beginning prior to discharge and continuing for three months post myocardial infarction, significantly improves the implementation and uptake of guideline based secondary prevention treatments and risk factor reduction strategies. NP-led interventions such as this warrant replication. The unique contribution of the NP with this patient population is the training and skills needed to deliver all aspects of secondary prevention, including pharmacological and nonpharmacological therapies, without the immediate availability of a physician.

Patients with acute myocardial infarction (AMI) are at high risk for reinfarction and death, with the highest rate of death and reinfarction occurring within 30 days of AMI. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization. The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of an NP delivered secondary prevention intervention. The specific objectives were: 1) to describe NP activities when delivering the secondary prevention intervention; 2) to evaluate the effect of the NP intervention on the rate of implementation of evidence-based secondary prevention treatment strategies and the patients’ achievement of secondary prevention target goals; and, 3) to examine the relationship between the NP activities delivering the intervention and secondary prevention goal achievement by patients. A prospective cohort design was used, in which patients’ achievement of target goals were compared between patients who received secondary prevention care from an NP and those who received usual care. The sample of convenience consisted of 65 patients with AMI. Data on practice activities and implementation of secondary prevention by the NP were collected before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients’ achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups. This study’s results provide preliminary evidence that an NP delivered secondary prevention intervention, beginning prior to discharge and continuing for three months post myocardial infarction, significantly improves the implementation and uptake of guideline based secondary prevention treatments and risk factor reduction strategies. NP-led interventions such as this warrant replication. The unique contribution of the NP with this patient population is the training and skills needed to deliver all aspects of secondary prevention, including pharmacological and nonpharmacological therapies, without the immediate availability of a physician.

Introduktion Medicinsk vetenskap och sjukvårdens möjligheter att hjälpa utvecklas ständigt. Sjukvården idag kan i många fall ställa rätt diagnos och ge en effektiv behandling för att bota den som drabbats av ohälsa. Radiologiska undersökningar är ett viktigt hjälpmedel men innebär också risker i form av strålning samt felaktigt resursanvändande. Syfte Syftet med förbättringsarbetet var att skapa en bättre användning av radiologi och följsamhet till medicinska riktlinjer så att patienten får rätt undersökning utifrån sitt behov samt att resur-ser nyttjas mer optimalt. Målsättningen var att öka andelen berättigade undersökningar. Syftet med studien av förbättringsarbetet var att få en förståelse för vilka faktorer som påverkar remittentens val av radiologisk undersökning och därmed berättigandegraden vilka aktiviteter i förbättringsarbetet påverkar berättigandegraden och på vilket sätt Metod Interventioner i form av utbildning och mätningar användes för att höja berättigandegraden. Bedömning av berättigandegraden gjordes av en ST-läkare. En fallstudie med kvalitativ ansats genomfördes och fokusgruppintervju användes för att stu-dera förbättringsarbetet. Resultat Studien visar att berättigandegraden ökar något som ett resultat av de valda interventionerna. Utbildningen på plats gav också upplevda positiva effekter i form av bättre kunskap och lä-rande för deltagare. Analysen visade att osäkerhet som läkare upplever i sitt arbete med patienten kan härledas till kategorierna kunskap och krav. Diskussion/Slutsats Utbildning genomförd av radiologispecialist har visat sig vara framgångsrikt koncept. Mät-ningar som metod för lärande och förändring uppfattades istället som mätning för uppföljning. Förbättrad kunskap kring vilka faktorer som styr läkares val av undersökning har uppnåtts och områden för fortsatt förbättring har identifierats / Introduction Medical science and medical facilities and clinical possibilities to help patients evolve con-stantly. Healthcare today can often make the diagnosis and provide effective treatment to cure the victim of ill health. Radiological surveys are an important tool but also provide risks in the form of radiation, and improper use of resources. Purpose The purpose of the improvement work was to create a better use of radiology and adherence to medical guidelines so that the patient gets the right for increase based on their needs and resources will be used more optimally. The goal was to increase the proportion of eligible studies. The purpose of the study of the improvement was to gain an understanding of what factors affect physicians choice of radiological investigation and thereby provide entitlement degree which activities in the improvement process affects eligibility degree and in what way Method Interventions in the form of education and measurements used to improve eligibility rate. As-sessment of the eligibility rate was made by a resident physician. A case study with a qualitative approach was implemented and focus-group interviews were used to study the improvement process. Results Results indicates that the eligibility rate increased slightly as a result of the selected interven-tions. Education in place, however, gave perceived benefits in terms of improved knowledge and learning for participants. The analysis showed that the uncertainty that physicians experience in their work with pa-tients can be attributed to the categories of knowledge and requirements. Discussion / Conclusion Education conducted by a radiology specialist has is shown to be a successful concept. Meas-urements as a method of learning and change were perceived as measurement for monitoring. Improved knowledge about the determinants of physician choice of survey has been achieved and areas for further improvement are identified.

The purpose with the thesis was to create a general model that can help companies to take the best decision when it comes to improving the quality of an object. The model was created to solve the problem formulation; How to find the best way to improve the quality of an object, focusing primarily on the relationship between cost and quality but also take other important aspects into consideration. Before the model was created a literature study was performed in ELIN without any useable result. After the literature study was performed quality models like Quality Function Deployment (QFD) and Total Quality Management (TQM) were studied. The study of QFD and TQM showed that they are somewhat complicated and often consider the entire organisation. Simple Quality Model is a smaller model and focuses only at one object at a time. TQM and QFD have however been good inspiration for the creation of SQM. The model was tested in a real-time situation at Saab Communication. Together with Saab Communication we decided to apply SQM to the Swedish defence telenetwork (FTN). In FTN the model was tested at the basic connections. SQM generated 7 different alternatives to improve the dependability in a basic connection. After the application of SQM it showed that alternative 7 was the best alternative. Alternative 7 was to decrease the switch over time. The switch over is today not handled by a special employee and is instead shared among several workers. By employing two new employees there is a possibility to lower the switch over time with 50% down from today’s 60 minutes to 30. To implement this alternative would bring a cost of 5 374 034 SEK and a quality increase of 0,1398955% for the basic connections in the Swedish defence tele-network.

To handle potentially large size and complicated nonstationary functional data, we present the wavelet-based methodology in data mining for process monitoring and fault classification. Since traditional wavelet shrinkage methods for data de-noising are ineffective for the more demanding data reduction goals, this thesis presents data reduction methods based on discrete wavelet transform. Our new methods minimize objective functions to balance the tradeoff between data reduction and modeling accuracy. Several evaluation studies with four popular testing curves used in the literature and with two real-life data sets demonstrate the superiority of the proposed methods to engineering data compression and statistical data de-noising methods that are currently used to achieve data reduction goals. Further experimentation in applying a classification tree-based data mining procedure to the reduced-size data to identify process fault classes also demonstrates the excellence of the proposed methods. In this application the proposed methods, compared with analysis of original large-size data, result in lower misclassification rates with much better computational efficiency. This thesis extends the scalogram's ability for handling noisy and possibly massive data which show time-shifted patterns. The proposed thresholded scalogram is built on the fast wavelet transform, which can effectively and efficiently capture non-stationary changes in data patterns. Finally, we present a SPC procedure that adaptively determines which wavelet coefficients will be monitored, based on their shift information, which is estimated from process data. By adaptively monitoring the process, we can improve the performance of the control charts for functional data. Using a simulation study, we compare the performance of some of the recommended approaches.

<p>The purpose with the thesis was to create a general model that can help companies to take the best decision when it comes</p><p>to improving the quality of an object. The model was created to solve the problem formulation; How to find the best way to</p><p>improve the quality of an object, focusing primarily on the relationship between cost and quality but also take other</p><p>important aspects into consideration. Before the model was created a literature study was performed in ELIN without any</p><p>useable result. After the literature study was performed quality models like Quality Function Deployment (QFD) and Total</p><p>Quality Management (TQM) were studied. The study of QFD and TQM showed that they are somewhat complicated and</p><p>often consider the entire organisation. Simple Quality Model is a smaller model and focuses only at one object at a time.</p><p>TQM and QFD have however been good inspiration for the creation of SQM. The model was tested in a real-time situation</p><p>at Saab Communication. Together with Saab Communication we decided to apply SQM to the Swedish defence telenetwork</p><p>(FTN). In FTN the model was tested at the basic connections. SQM generated 7 different alternatives to improve</p><p>the dependability in a basic connection. After the application of SQM it showed that alternative 7 was the best alternative.</p><p>Alternative 7 was to decrease the switch over time. The switch over is today not handled by a special employee and is</p><p>instead shared among several workers. By employing two new employees there is a possibility to lower the switch over time</p><p>with 50% down from today’s 60 minutes to 30. To implement this alternative would bring a cost of 5 374 034 SEK and a</p><p>quality increase of 0,1398955% for the basic connections in the Swedish defence tele-network.</p>

Background: The Alliance for Patient Medication Safety (APMS) helps community pharmacies comply with continuous quality improvement requirements of many states and third party payment contracts through use of their Pharmacy Quality Commitment (PQC) program. Aims: To assess changes in the incidence of prescription Quality Related Events (QREs) and adoption of patient safety culture attitudes after guided PQC implementation. Methods: Twenty-one pharmacies were randomized to standard PQC practices (control) or guided PQC implementation (treatment). Pharmacy staff completed retrospective pre and post safety culture questionnaires. Negative binomial mixed and linear regression analyses were employed to examine changes in QREs rates and attitudes, respectively. Rasch analysis was used to assess questionnaire validity and reliability. Results: During the 2-month study period 3,343 QREs were reported to the online PQC system. At baseline, no difference in the average QRE reporting rate was identified between groups. Treatment group QRE reporting rates differed in one category post treatment (more incorrect safety caps QREs reported in treatment group, p<0.034). Seventy-one employees completed the questionnaire (70% response). Attitude improvement in the treatment group was 36% greater than in control (p<0.0001). The questionnaire demonstrated acceptable reliability and validity evidence. Conclusions: Guided PQC implementation increased reporting of certain QREs and increased the adoption of patient safety culture attitudes among staff pharmacy.

Darbo tikslas: nustatyti sveikatos priežiūros paslaugų kokybės gerinimo perspektyvas Ukmergės ligoninėje medicinos personalo požiūriu. Tyrimo metodika. Anonimine anketa apklausti visi ligoninėje dirbantys gydytojai ir slaugytojai (n=231). Užpildytas anketas grąžino 187 respondentai (atsako dažnis 76,2 proc.). Anketinių duomenų analizei naudota 10 versijos SPSS for Windows statistinė programa. Ryšiai tarp požymių vertinti Chi kvadrato kriterijumi. Rezultatai. 63,2 proc. medikų žino padalinio kokybės sistemos tikslus, 41,6 proc. medikų susipažinę su ligoninės kokybės tikslais ir tik 11,8 proc. yra iš esmės susipažinę su nacionaliniais sveikatos priežiūros kokybės dokumentais. Pacientų padėkos ir darbo sąlygų pagerinimas, vadovų ir kolegų pripažinimas yra svarbi skatinimo priemonė 76,3 – 61,8 proc. respondentų. Profesionalumas ir nuolatinis tobulėjimas (67,4 proc.) bei asmeninė darbuotojo atsakomybė (67,9 proc.) yra labiausiai puoselėjamos vertybės padaliniuose. 40,9 proc. respondentų mano, jog jų pacientai gali visiškai pasitikėti paslaugomis. Kas antras medikų jaučia aiškų vadovų skatinimą dirbti geriau. Išvados. Medicinos personalo informuotumas apie sveikatos priežiūros paslaugų kokybės gerinimo sistemą yra didžiausias skyriuje. Svarbiausia audito grupės funkcija siejama su planiniais patikrinimais padaliniuose. Didesnė dalis gydytojų nei slaugytojų žino apie audito grupės funkcijas nagrinėti pacientų skundus, rengti dokumentaciją, atlikti tikslinius patikrinimus... [toliau žr. visą tekstą] / The purpose of the study - to determine the perspectives of medical staff in relation to health care quality improvement in Ukmerge Hospital. Methods. Analysis of hospital organizational activity was performed. All physicians and nurses were questioned by an anonymous questionnaire (n=231). 187 of questionnaires were completed and returned by the respondents. The response rate was 76,2 percent. The data was analyzed using statistical package SPSS 10.0 for Windows. The associations between the variables were measured using the Chi-squared test. Results: 63.2 percent of medical staff were informed about the quality tasks in the unit, 46.6 percent of them know the quality tasks in the hospital and 11.8 percent are familiar with the national health care quality legislation. The acknowledgments from the patients and improvement of work conditions, recognition from leaders and colleagues give physicians and nurses (76.3 – 61.8 percent) an important incentive to work better. Professional competency with knowledge improvement (67.4 percent) and personal employee’s responsibility (67.9 percent) were the main value enshrined in the organization. By the opinion of 40.9 percent of respondents, patients can trust absolutely in the services or hospital. Work motivation from leaders is appreciable for every second of respondents. Conclusions. Knowledge of medical staff about the health care service quality improvement system was the most remarkable in the unit. The scheduled... [to full text]

Baigiamojo magistro darbo tikslas suformuluotas taip: nustačius veiksmus, lemiančius UAB „Marškinėlis“ paslaugų kokybę, pateikti jos gerinimo sprendimus. Teorinėje šio darbo dalyje yra analizuojama paslaugų kokybės samprata, praktinė reikšmė bei jos vertinimo modeliai, svarba ir galimybės; pateikiamos vadybos autorių siūlomos paslaugų kokybės gerinimo perspektyvos. Analitinėje baigiamojo darbo dalyje analizuojama reklamos paslaugas teikianti įmonė UAB „Marškinėlis“ ir pateikiami tyrimo rezultatai, atlikto dviem etapais: interviu su UAB „Marškinėlis“ įmonės direktore ir anketiniu empiriniu tyrimu: tiriant įmonės klientų paslaugų kokybės vertinimą. Remiantis gautais rezultatais pateikiami pasiūlymai įmonės paslaugų kokybei gerinti. Praktinėje darbo dalyje pateikiami konkretūs pasiūlymai, padėsiantys pagerinti UAB „Marškinėlis“ paslaugų kokybę, pavyzdžiui procesinio požiūrio į veiklas vykdymas, kokybės užtikrinimo modelis, klientų aptarnavimo standarto įdiegimas. / The aim of the final Master work is determined as follows: after identification of factors implementing service quality of JSC “Marskinelis”, to provide the solutions for its improvement. In the theoretical part of the paper work the conception of service quality, practical value and models of assessment, importance and opportunities are analyzed. Perspectives for improving service quality provided by authors of management field are presented. In the analytical part of the paper work, advertising service company JSC “Marskinelis” is analyzed. The results of the research are presented and analyzed in two stages: interview with headmaster of JSC “Marskinelis” and empirical questionnaire research. Questionnaire research was provided to get the assessment of service quality by company’s clients. There were presented the proposals of service quality improvement based on results of research. In the projecting part of the paper work the alternative and particular problems’ solving solutions are supplied which help to improve service quality of company JSC “Marskinelis”. The examples of proposal are process approach of operations, model of quality assurance, and standard of customer service installation.