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Quality Initiative (quality + initiative)
Selected AbstractsMineral metabolism disturbances in patients with chronic kidney diseaseEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 8 2007B. Kestenbaum Abstract Background Kidney disease, especially chronic kidney disease (CKD), is a worldwide public health problem with serious adverse health consequences for affected individuals. Secondary hyperparathyroidism, a disorder characterized by elevated serum parathyroid hormone levels, and alteration of calcium and phosphorus homeostasis are common metabolic complications of CKD that may impact cardiovascular health. Materials and methods Here, we systematically review published reports from recent observational studies and clinical trials that examine markers of altered mineral metabolism and clinical outcomes in patients with CKD. Results Mineral metabolism disturbances begin early during the course of chronic kidney disease, and are associated with cardiovascular disease and mortality in observational studies. Vascular calcification is one plausible mechanism connecting renal-related mineral metabolism with cardiovascular risk. Individual therapies to correct mineral metabolism disturbances have been associated with clinical benefit in some observational studies; clinical trials directed at more comprehensive control of this problem are warranted. Conclusions There exists a potential to improve outcomes for patients with CKD through increased awareness of the Bone Metabolism and Disease guidelines set forth by the National Kidney Foundation,Kidney Disease Outcomes Quality Initiative. Future studies may include more aggressive therapy with a combination of agents that address vitamin D deficiency, parathyroid hormone and phosphorus excess, as well as novel agents that modulate circulating promoters and inhibitors of calcification. [source] Development and utility of a multi-dimensional grid to assess individual mineral metabolism control in hemodialysis patients: A potential aid for therapeutic decision making?HEMODIALYSIS INTERNATIONAL, Issue 2 2010A. Ross MORTON Abstract A grid was developed to evaluate control of serum calcium, phosphate, and parathyroid hormone levels in hemodialysis patients, based on guideline recommendations (National Kidney Foundation Kidney Disease Outcomes Quality Initiative and Canadian Society of Nephrology), and its face validity was examined in a representative sample of Canadian patients. A retrospective chart review was undertaken in hemodialysis patients from 7 Canadian units. Patients >18 years, on hemodialysis for ,12 months, and ,3 parathyroid hormone levels measured ,1 month apart were included. The grid classified mineral metabolism control as optimal, suboptimal, or poor (mean of 3 measurements). Medication use, hospitalization, and Emergency Department visits were evaluated in relation to grid occupancy. A second comparative analysis of grid occupancy was undertaken on prevalent hemodialysis cases in British Columbia in 2008. Data from 268 patients (mean age 62.3 years) were analyzed. Using National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines, 17.5%, 28.8%, and 53.7% of patients had optimal, suboptimal, and poor control, respectively, of all 3 parameters (calcium, phosphate, and parathyroid hormone). Using Canadian Society of Nephrology criteria, optimal, suboptimal, and poor control rates were 6.3%, 4.2%, and 89.5%, respectively. Poor control was a possible or a probable cause of hospitalization or Emergency Department attendance in 8 patients. Data from British Columbia in 2008 (n=1858) show optimal, suboptimal, and poor control rates of 15.8%, 24.5%, and 59.7%, respectively. Poor mineral metabolism control among Canadian hemodialysis patients is not showing improvement. The therapeutic grid is a valid tool and may help guide therapeutic decisions, quality control initiatives, and patient counseling. http://www.ukidney.com/bone-and-mineral-metabolism-resource. [source] Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunitiesPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2010Richard A. Hansen Abstract Purpose To explore the use of disproportionality analysis of medication error data as a novel method to identify relationships that might not be obvious through traditional analyses. This approach can supplement descriptive data and target quality improvement efforts. Methods Data came from the Medication Error Quality Initiative (MEQI) individual event reporting system. Participants were North Carolina nursing homes who submitted incident reports to the Web-based MEQI data repository during the 2006 and 2007 reporting years. Data from 206 nursing homes were summarized descriptively and then disproportionality analysis was applied. Associations between medication type and possible causes at the state level were explored. A single nursing home was selected to illustrate how the method might inform quality improvement at the facility level. Disproportionality analysis of drug errors in this home was compared with benchmarking. Results Statewide, 59 drug-cause pairs met the disproportionality signal and 11 occurred in 10 or more reports. Among these, warfarin was co-reported with communication errors; esomeprazole, risperidone, and nitrofurantoin were disproportionately associated with transcription error; and oxycodone and morphine were disproportionately reported with name confusion. Facility-level analyses illustrate how descriptive frequencies and disproportionality analysis are complementary, but also identify different safety targets. Conclusions Exploratory analysis tools can help identify medication error types that occur at disproportionate rates. Candidate associations might be used to target patient safety work, although further evaluation is needed to determine the value of this information. Copyright © 2010 John Wiley & Sons, Ltd. [source] Potential Advantages and Limitations of Applying the Chronic Kidney Disease Classification to Kidney Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2006J. S. Gill The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) classification of Chronic Kidney Disease (CKD) characterizes patients by their level of kidney function and includes kidney transplant recipients (KTRs). Most KTRs have stage ,3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and may benefit from aggressive CKD care. Recent modifications to the K/DOQI CKD classification reflect the recognition of KTRs as a unique subset of CKD patients in whom the presentation, progression and implications of CKD may vary from those in nontransplant CKD populations. Currently, there is limited information about how adopting the CKD classification in KTRs will influence clinical management and outcomes. Appropriately designed studies are needed to develop transplant-specific CKD treatment recommendations, and to ensure patient, health provider and payer acceptance of the continued need for aggressive CKD care after transplantation. Education and implementation strategies will be required to ensure appropriate integration of the CKD classification and treatment guidelines into existing posttransplant care programs. The CKD classification thus represents an exciting potential strategy to improve clinical outcomes that should be adopted, further studied and modified to incorporate considerations unique to KTRs. [source] SHARE: A superordinate online rural communityPROCEEDINGS OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE & TECHNOLOGY (ELECTRONIC), Issue 1 2008Janet Capps Comprehensive School Reform in Rural K-8 Schools in the Southeast: Integrative Technologies for Quality Initiatives is a three-year technology intervention funded by the US Department of Education. As part of this project, teachers in eight rural K-8 schools in Georgia, Florida, and Alabama were given access to an online community Web-portal built on Sakai called SHARE (Schools Helping to Advance Rural Education). This Web-portal supports the project's goal to expand teachers' ability to access and exchange information by providing server space for each school community as well as the larger project community. Through SHARE, communities of teachers at the school level can create a new community of information exchange among all project teachers and across all project schools. The exchange at the higher project level creates a superordinate level. Data collected through multiple methods is used to make comparisons between teachers' attitudes and online information exchange practices in base-level communities and in the larger superordinate community established through the SHARE Web-portal. The four-tier pyramid of Hersberger, Murray, and Rioux (2007) is used to inform the evaluation of the teachers' information sharing activities and to assist in the assessment of the overall level of gratification or discontentment of the project's community of teachers. [source] Principles of evaluating quality investmentsQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 5 2008Johannes Freiesleben Abstract Quality departments often experience difficulties selling the idea that first priority should be given to quality improvement. Most approaches to project budgeting favour traditional investments such as new product development, which are perceived as potential profit boosters. To compete with such investments, a clear economic logic is needed, which stresses the long-term benefits of better quality. The aim of this paper, therefore, is to provide a concise framework of how to think about quality investments in economic terms. By focusing on the principles of an economic evaluation, it highlights the major aspects of an improvement assessment and derives a simple measure for helping practitioners to determine the advantageousness of a quality initiative. Copyright © 2008 John Wiley & Sons, Ltd. [source] The medical emergency team: does it really make a difference?INTERNAL MEDICINE JOURNAL, Issue 11 2003M. Cretikos Abstract Hospital systems are failing the critically ill. This has been well documented in many countries around the world, with detailed reports of suboptimal care prior to intensive care and high rates of serious adverse events, including death. These events are potentially preventable, but insufficient attention has been directed towards developing solutions to these important problems to date. The medical emergency team (MET) is a system approach that promotes early and appropriate intervention in the care of critically ill hospital patients. The benefits of the MET in terms of absolute in-patient mortality and cardiac arrest rates are not yet well-defined, although preliminary studies are promising. The MET does provide a potentially beneficial impact on many other aspects of patient care. These benefits include: (i) facilitating an integrated and coordinated approach to patient care across the hospital, (ii) increasing awareness of at-risk patients, (iii) encouraging early referral of seriously ill patients to clinicians with expertise in critical care and (iv) providing a foundation for quality initiatives for hospital-wide care of the seriously ill. The MET also empowers nursing staff and junior medical staff to call for immediate assistance in cases where they are seriously concerned about a patient, but may not have the experience, knowledge, confidence or skills necessary to manage them appropriately. (Intern Med J 2003; 33: 511,514) [source] Effectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door-to-Balloon Times in Primary AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004F.A.C.C., STUART W. ZARICH M.D. Primary angioplasty (PA) for acute myocardial infarction (AMI) has emerged as the standard of care in hospitals with cardiac interventional facilities. The benefits from the PA are time dependent, but recent data raise concerns regarding the timeliness of delivery of care in AMI and the level of benefit achieved by current standards. We assessed the effectiveness of an extensive multidisciplinary quality improvement initiative in reducing door-to-balloon (DTB) times in PA. The PA process was divided into six separate time periods, which were assessed individually. Subsequent quality initiatives resulted in a dramatic reduction in the mean DTB time (141.3 minutes preintervention compared to 95.1 minutes postintervention; P < 0.001). [source] Organizational Differentiation through Badging: Investors in People and the Value of the SignJOURNAL OF MANAGEMENT STUDIES, Issue 8 2002Emma Bell This paper explores the meaning of the state,sponsored initiative for people management, Investors in People (IiP), through deconstruction of the signifiers that represent its articulation. Semiotic analysis is employed in order to consider the sign,value that is associated with IiP and to explore the symbolic meaning of cultural artefacts, such as ,the badge' and ,the flag', which feature in the experience of managers and employees in six case study organizations. This post,structuralist approach enables us to focus on the discursive construction of textual meaning surrounding IiP as a ,readerly' as well as a writerly project. It is suggested that organizations are subject to a process of image production and consumption. This process requires them to seek differentiation from other organizations by acquiring quality initiatives that constitute a system of objects. In particular, the meaning of IiP signifiers as emblems of achievement is explored and the extent to which these become simulacra is considered. It is argued that there is a significant gap between writerly intentions as to what quality initiatives ought to signify and their organizational, context,bound, indeterminate meanings. By elucidating the conditions of IiP's signification it is shown that this discourse has the potential to undermine the very philosophy it asserts. Finally, drawing on this analysis, we outline the way that badge acquisition develops over time through processes of accumulation and adaptation. [source] | ||||||||||