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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23764号 / 医博第4810号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長尾 美紀, 教授 佐藤 俊哉, 教授 永井 洋士 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Context: Software quality has a multi-faceted description encompassing several quality attributes. Central to our efforts to enhance software quality is to improve the quality of the source code. Poor source code quality impacts the quality of the delivered product. Empirical studies have investigated how to improve source code quality and how to quantify the source code improvement. However, the reported evidence linking internal code structure information and quality attributes observed by users is varied and, at times, conflicting. Furthermore, there is a further need for research to improve source code quality by understanding trends in feedback from code review comments. Objective: This thesis contributes towards improving source code quality and synthesizes metrics to measure improvement in source code quality. Hence, our objectives are 1) To synthesize evidence of links between source code metrics and external quality attributes, & identify source code metrics, and 2) To identify areas to improve source code quality by identifying recurring code quality issues using the analysis of code review comments. Method: We conducted a tertiary study to achieve the first objective, an archival analysis and a case study to investigate the latter two objectives. Results: To quantify source code quality improvement, we reported a comprehensive catalog of source code metrics and a small set of source code metrics consistently linked with maintainability, reliability, and security. To improve source code quality using analysis of code review comments, our explored methodology improves the state-of-the-art with interesting results. Conclusions: The thesis provides a promising way to analyze themes in code review comments. Researchers can use the source code metrics provided to estimate these quality attributes reliably. In future work, we aim to derive a software improvement checklist based on the analysis of trends in code review comments.

Performance based contracting in the transportation arena is a rather recently implemented concept which has a few number of applications in the United States up to date. Nonetheless, the US Department of Transportation has vigorously promoted (by issuing memorandums to be distributed to the Highway Agencies and State Departments of Transportation) the conversion of traditional contracts to performance based contracts to reach a goal of 80% of the service contracts and actions being performance based by the end of fiscal year 2004 (Tomanelli 2003.) Virginia Department of Transportation (VDOT) has been one of the first state agencies that took the initiative of using a performance based contract for the maintenance of a portion of its interstate highway system. This initiative resulted in the establishment of the 'Comprehensive Agreement for Interstate Highway Asset Management Services' between VDOT and a private contractor in 1996 which resulted in the privatization of highway maintenance services. One of the important aspects of this contract related to this research is that it does not encompass any warranty clauses. In other words, the contractor does not provide any warranty to the VDOT for the services it is obligated to undertake. The contract is mute in this subject, making the contractor incur no liability for the underperformance of the maintenance activities. According to this research, this might lead to some cases which VDOT would not be willing to encounter. Just like performance based contracting, the use of warranties in highway contracts in the United States is a quite new concept which mainly dates back to 1995. There are different views possessed by different parties about the possible outcomes of implementing warranties in highway contracts. Nonetheless, this research proposes that the incorporation of warranty clauses into the VDOT issued performance based road maintenance contracts is vital to ensure the quality and durability of the work after the project completion. According to this research, warranty clauses, if developed carefully, give the contractor the motivation to implement superior maintenance practices to improve the overall conditions of the assets during the contract period. This is done in order to lengthen the life of each asset item and achieve the long term performance. Ultimately, the incorporation of warranty clauses is believed to reduce the risk imposed upon VDOT. Within the context of the discussion presented above, this research first illustrates that the complete satisfaction of one of the parties (VDOT) may be in question due to the absence of the warranty clauses within the contract, then lists and explores the benefits that would/may be gained by the incorporation of warranty clauses into the contract, and finally develops a warranty clause template and proposes it to be used in the future performance based road maintenance contracts issued by VDOT. At the bottom line, this study aspires to help the party in question (VDOT) to reduce the risk imposed upon it and to improve the future performance based road maintenance contracts it will issue. This research uses the VDOT contract as a baseline to define the problem and to propose a solution (i.e. the developed warranty clause template) for that. Nonetheless, some of the principles and approaches used during the development of the warranty clause template can also be referred to for the development of warranty clauses for the performance based road maintenance contracts issued by the other state DOTs. / Master of Science

Yes / National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. Methods We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism=Outcome configurations. Results We identified five mechanisms that explained interactions between providers and NCA feedback: reputation, professionalism, competition, incentives, and professional development. Underpinned by the mechanisms professionalism and incentives, feedback was used most routinely within clinical services resourced to maintain local databases, where data were stored before upload to NCA suppliers. Local databases enabled staff to access data easily, customise reports and integrate them within governance processes. Use of feedback generated in this way was further supported where staff supporting audit participation were trusted to collect timely and accurate data. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity. Challenges accessing data from NCA supplier databases, concerns about the quality of data across participating organisations and timeliness were reported to constrain the perceived usefulness of this type of feedback as a tool for stimulating quality improvement. Conclusion The findings suggest that there are a number of mechanisms through which healthcare providers, in particular staff within clinical services, engage with NCA feedback, but that there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely within clinical services resourced to maintain local databases, where data were considered timely, trusted as accurate and could be easily accessed to customise reports for the needs of the service.

No / Purpose – This paper aims to examine the role of e-commerce in hospital pharmacy in the procurement of pharmaceuticals and determine how this has improved the internal pharmaceutical supply chain. Whilst e-commerce is in its infancy in this area it is still considered to be an important facet of supply chain management. E-trading within NHS pharmacies is conducted via electronic data interchange (EDI) offering proven benefits and ensuring the efficient and effective transmission of data between remote parties. Design/methodology/approach – The data were collected via a case-study in an NHS trust pharmacy supported and by questionnaires distributed to NHS and community pharmacies in the north-west of England. Findings – The findings support the view that there are benefits to be gained from introducing EDI into a purchasing department as the next logical step towards a total e-commerce solution (internet-based) and instigating quality improvements. It also proposes that the implementation and use of e-commerce in hospital pharmacies can be aligned with progress made in small- to medium-sized enterprises (SMEs), and questions why, if such benefits can be realised, the use of e-commerce systems are not more widespread. Research limitations/implications – The implications of this research is that it offers a “snap-shot” of progress made-to-date of e-commerce in NHS Pharmacy, which can provide guidance for mangers and healthcare professionals managing their e-commerce/quality improvement agenda. The research conducted was restricted to a specific regional area of the NHS and could be applied to a larger national sample group. Future research within this field should also consider the cost of not introducing e-commerce in pursuing quality improvement. Originality/value – This discussion offers an insight into how a pharmacy approached EDI, and this is further supported by recent research conducted into examining the pharmacy systems in operation in the north-west of England and accompanying EDI systems and an analysis of EDI uptake and use in a sample of pharmacies in the same region, the latter being supported by anecdotal evidence of pros and cons to using EDI and potential barriers to its introduction.

This study deals with the impact of the Education Quality Improvement Partnerships programme (EQUIP) on school management teams in two rural schools where it was implemented for three years. A qualitative evaluative research design was used involving initial baseline studies, document analysis, observation and eight naïve sketches. The literature study discusses factors that constitute effective management and leadership and characteristics of effective schools. The findings were based on an analysis of the impact of the EQUIP programme on the key performance areas of school management before and after the intervention. Important conclusions derived from this study showed that there was significant improvement in the way schools were managed after the intervention, particularly in achieving the goals of the schools' strategic plans. It was also found that curriculum monitoring was only partially successful and that remedial programmes for learners with reading and other learning challenges needs serious attention. / Educational Studies / M.Ed. (Education Management)

This study deals with the impact of the Education Quality Improvement Partnerships programme (EQUIP) on school management teams in two rural schools where it was implemented for three years. A qualitative evaluative research design was used involving initial baseline studies, document analysis, observation and eight naïve sketches. The literature study discusses factors that constitute effective management and leadership and characteristics of effective schools. The findings were based on an analysis of the impact of the EQUIP programme on the key performance areas of school management before and after the intervention. Important conclusions derived from this study showed that there was significant improvement in the way schools were managed after the intervention, particularly in achieving the goals of the schools' strategic plans. It was also found that curriculum monitoring was only partially successful and that remedial programmes for learners with reading and other learning challenges needs serious attention. / Educational Studies / M.Ed. (Education Management)

Det senaste årets granskning av lärosätens kvalitetssystem som genomfördes avuniversitetskanslersämbetet (UKÄ) visar att även högre utbildning behöver arbeta med sitt internakvalitetsarbete och att lärosätena behöver ta fram arbetssätt och metoder för att genomföra det.Syftet med det här arbetet var att bidra med kunskap om hur arbete med kvalitetsutveckling ser utinom högre utbildning samt att ta fram en modell för att arbeta med förbättrings ochkvalitetsutveckling inom lärarutbildning. Författaren deltog i ett projektarbete sominteraktionsforskare för att ta fram en modell för arbetet med förbättrings- och utvecklingsarbetetinom lärarutbildning. Den här studien har bidragit med kunskap om att högre utbildning idagarbetar med kvalitetsarbetet utifrån de riktlinjer som finns i Högskolelag, Högskoleförordning ochStandards and Guidelines for Quality Assurances in the European Higher Education Area (ESG).Slutsatsen var, att den modell för att arbeta med utvecklingsprojekt som togs fram i projektarbetet,behöver följa dessa lagar, förordningar och riktlinjer som anges i ESG och att arbetssättet imodellen bör vara cykliskt och kan utgå från PDSA. Vidare är slutsatsen att modellen med fördelkan ta utgångspunkt i offensiv kvalitetsutveckling och hörnstensmodellen och att om lärandetinom organisationen sker på alla nivåer kontinuerligt kan modellen stödja arbetet till en lärandeorganisation. Den här studien kan vara av intresse för andra som vill lära mer ominteraktionsforskning samt för lärosäten som står inför att utveckla sitt eget interna kvalitetsarbete. / The latest year's review of the higher education institutions' quality systems carried out by theuniversity chancellor's office (UKÄ) shows that even higher education needs to work with itsinternal quality work and that the higher education institutions need to develop working methodsand methods for implementing it. The purpose of this work was to contribute with knowledgeabout how work with quality development looks within higher education and to develop a modelfor working with improvement and quality development in teacher education. The authorparticipated in a project work as an interaction researcher to develop a model for the work onimprovement and development work in teacher education. This study has contributed with theknowledge that higher education today works with the quality work based on the guidelines foundin the Higher Education Act, the Higher Education Ordinance and the Standards and Guidelinesfor Quality Assurances in the European Higher Education Area (ESG). The conclusion was thatthe model for working with development projects developed in the project work must follow theselaws, regulations and guidelines stated in the ESG and that the working method in the modelshould be cyclical and can be based on PDSA. Furthermore, the conclusion is that the model canadvantageously be based on offensive quality development and the cornerstone model and that ifthe learning within the organization takes place at all levels continuously, the model can supportthe work of a learning organization. This study may be of interest to others who want to learnmore about interaction research and for higher education institutions that are faced withdeveloping their own internal quality work. / <p>2019-06-27</p>

Introduction: Quality improvement (QI) encompasses a wide range of healthcare studies and activities with the common goal of improving patient outcomes, healthcare system performance, and professional development. QI is characterized by a diversity of definitions, stakeholders, clinical fields and study designs, which creates challenges for rigorous reporting and evaluation of these studies. Understanding and addressing the methodological issues that arise from conducting QI studies from multiple clinical disciplines is critical for generating good evidence for healthcare improvement to tackle health system challenges. Objectives: This thesis addressed three independent objectives: (i) Determine the quality of reporting of QI studies in neonatology. (ii) Compare different statistical methods that can be used to analyze data from a cluster randomized controlled trial with repeated measures data and examine how the estimate of intervention effects varies between these approaches. (iii) Determine the cost-effectiveness of providing timely surgery or timely rehabilitation for patients with hip fracture. Methods: Objective 1: We conducted a systematic survey of quality improvement studies in neonatology to examine the extent to which these publications adhered to SQUIRE 2.0, the guidelines for reporting studies that sought to improve the quality, safety, and value of healthcare. Using the same set of articles, we examined how various methodological attributes, such as stakeholder engagement, outcome measures, and statistical process controls, are reported in these studies. Objective 2: To compare the differences in the statistical estimates of intervention effects between linear mixed models and Generalized Estimating Equations, for the CP@Clinic Program cluster randomized RCT, which contains routinely collected monthly outcome data aggregated at the cluster level. Objective 3: We constructed a Markov cohort model to estimate the cost-effectiveness of receiving timely surgery within 24 hours of admission to the emergency department, receiving immediate admission to inpatient rehabilitation following acute care discharge, receiving both, or none. Results: Objective 1: In our assessment of reporting quality, we found that adherence to SQUIRE 2.0 guidelines was inadequate and that journals should endorse the SQUIRE 2.0 guideline for improvement publications to alleviate this issue. We found that process measures was the most frequently reported methodological attribute (89%), while stakeholder engagement with leadership (32%) or caregivers (10%) were infrequently reported or conducted. Objective 2: In comparing statistical methods for analyzing a cluster randomized controlled trial with correlated data, we found that it was critical to apply a correction to the variance estimator of generalized estimating equations to produce robust estimates of the intervention effects. Objective 3: In our economic evaluation, both timely surgery alone and the combination of timely surgery and timely rehabilitation yielded cost-effective improvements in the quality-adjusted life-years of patients with hip fracture. However, the combination of receiving timely surgery and timely rehabilitation requires a high willingness-to-pay threshold, above $128,000 per quality-adjusted life-years, to be considered cost-effective. Conclusions: Overall, understanding the state of reporting and the broad spectrum of methods and methodologic issues for evaluating quality improvement initiatives will advance its rigorous research, evaluation, reporting, and contribution towards informed decision-making for tackling pressing healthcare issues. / Thesis / Doctor of Philosophy (PhD) / Quality improvement (QI) is a field of healthcare research that can be defined in many ways, and research in this field is conducted by researchers from various medical disciplines. Consequently, challenges may arise in reporting and evaluating QI interventions. Thus, it is important to examine how QI interventions are reported in academic literature and the methods used to evaluate their effectiveness in improving health. The current thesis aims to address these issues through three independent objectives: (1) examine the details reported in QI studies in neonatology, (2) compare different statistical methods that can be used to analyze data from a community paramedicine cluster randomized controlled trial, and (3) investigate whether providing timely surgery and timely hospital-based rehabilitation is a cost-effective way to improve the quality of life of patients who have experienced hip fracture. The findings of these studies will provide insights into the challenges of reporting and evaluating QI interventions, and suggest ways to improve them.