Quality Services, Better Outcomes: A Quality Framework for Achieving Outcomes.

The Childhood Development Initiative (CDI) is an innovative, community based response to a comprehensive consultation process undertaken in Tallaght West. Working with a wide range of locally established service providers, CDI is delivering services to children and families which meet identified needs. Etch of these is being rigorously evaluated, and considerable attention is being given to quality assurance, promotion of reflective practice, and professional training and support. The insights gained, and techniques developed during this process are central to delivering high quality services with the view to improving our understanding of what enables children to meet their potential, gain their developmental milestones within appropriate timeframes and become healthy and active citizens. This Workbook describes key processes relating to practice, organisational culture and systems change which support the implementation of evidence-based and evidence-informed programmes and practices. From CDI's experience, implementing evidence-based programmes not only requires specific structures and processes in place to support programme implementation and fidelity (e.g. training, coaching, and supervision) but also necessities a focus on the more generic aspects of delivering quality services (e.g. engaging in reflective practice in order to promote and maintain fidelity to a programme). The Workbook also addresses some fundamental areas in relation to monitoring and evaluation as a way of determining whether an intervention was effective or not. In effect, this Workbook hopes to explain the 'what', 'why', 'how' and 'did we?' of evidence-based practice. The Workbook is intended to provide readers with a comprehensive introduction to both the shared language and concepts underpinning the science and practice of implementation. It complements the 'What Works Process' guide published by the Centre for Effective Services (CES, 2011) which supports services in assessing how effective they are in improving outcomes for children and helps them to think about what works

Telehealth in Palliative Care: A Systematic Review of Patient Reported Outcomes

A systematic review was conducted to explore published quantitative and qualitative research describing patient-reported outcomes of palliative telehealth intervention studies. Multiple databases were searched for articles published between January 2006 and May 2016, which met study criteria. Methodological quality was assessed using Cochrane Collaboration’s tool for assessing risk of bias for quantitative articles. For studies reporting qualitative outcomes, a checklist was used to evaluate trustworthiness of the methodology. Of the 6 studies reporting quantitative outcomes, 3 studies were rated as having moderate study quality, and 3 studies were rated as having low study quality. Of the 6 studies reporting qualitative outcomes, 3 reported 5 different methods for ensuring trustworthiness, whereas 1 article reported 4 methods, 1 reported 3, and 1 article reported 2 methods. Studies were notably diverse in terms of patient population, technology used, outcomes measures, and methodology. Results across studies were also variable. Methodological factors were major limitations. Recruitment problems, participant attrition, and lack of standardized outcomes measures impacted outcome assessment. Overall, research support for positive patient outcomes in palliative telehealth interventions was weak. However, all studies but one found positive results to support the intervention

Assessing individual support needs to enhance personal outcomes

Education and human service organizations providing services to people with intellectual and closely related developmental disabilities are increasingly being impacted by the supports paradigm, the quality of life concept, and the evaluation of personal outcomes. In this article the authors discuss the relationship among these three areas, including examples that illustrate how assessed support needs data can be aligned with quality-of-life-related core domains so as to establish individualized support systems that enhance personal outcomes. The article concludes with a discussion of the implications for educators and habilitation professionals of integrating the supports paradigm, the quality of life concept, and the evaluation of personal outcomes

A Brief History of Quality Improvement in Health Care and Spinal Surgery.

While medical and technological advances continue to shape and advance health care, there has been growing emphasis on translating these advances into improvement in overall health care quality outcomes in the United States. Innovators such as Abraham Flexner and Ernest Codman engaged in rigorous reviews of systems and patient outcomes igniting wider spread interest in quality improvement in health care. Codman\u27s efforts even contributed to the founding of the American College of Surgeons. This society catalyzed a quality improvement initiative across the United States and the formation of the Joint Commission on Accreditation of Hospitals. Since that time, those such as Avedis Donabedian and the Institute of Medicine have worked to structure the process of improving both the quality and delivery of health care. Significant advances include the defining of minimum standards for hospital accreditation, 7 pillars of quality in medicine, and the process by which quality in medicine is evaluated. All of these factors have affected current practice more each day. In a field such as spinal surgery, cost and quality measures are continually emphasized and led to large outcome databases to better evaluate outcomes in complex, heterogeneous populations. Going forward, these databases will be instrumental in developing practice patterns and improving spinal surgery outcomes

Impact of Baseline Magnetic Resonance Imaging on Neurologic, Functional, and Safety Outcomes in Patients With Acute Traumatic Spinal Cord Injury

Study Design: Systematic review. Objective: To perform a systematic review to evaluate the utility of magnetic resonance imaging (MRI) in patients with acute spinal cord injury (SCI). Methods: An electronic search of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar was conducted for literature published through May 12, 2015, to answer key questions associated with the use of MRI in patients with acute SCI. Results: The literature search yielded 796 potentially relevant citations, 8 of which were included in this review. One study used MRI in a protocol to decide on early surgical decompression. The MRI-protocol group showed improved outcomes; however, the quality of evidence was deemed very low due to selection bias. Seven studies reported MRI predictors of neurologic or functional outcomes. There was moderate-quality evidence that longer intramedullary hemorrhage (2 studies) and low-quality evidence that smaller spinal canal diameter at the location of maximal spinal cord compression and the presence of cord swelling are associated with poor neurologic recovery. There was moderate-quality evidence that clinical outcomes are not predicted by SCI lesion length and the presence of cord edema. Conclusions: Certain MRI characteristics appear to be predictive of outcomes in acute SCI, including length of intramedullary hemorrhage (moderate-quality evidence), canal diameter at maximal spinal cord compression (low-quality evidence), and spinal cord swelling (low-quality evidence). Other imaging features were either inconsistently (presence of hemorrhage, maximal canal compromise, and edema length) or not associated with outcomes. The paucity of literature highlights the need for well-designed prospective studies. © 2017, © The Author(s) 2017

Do we understand health-related- quality-of-life outcomes?

Last year I was afforded the opportunity of investigating Health Related Quality of Life (HRQoL) outcomes for patients with wounds, through a Florence Nightingale Travel Scholarship. Since my return from Australia, I have been thinking about how we identify and enhance HRQoL outcomes for the range of wound conditions that we see and treat in clinical practice

Should the Quality and Outcomes Framework be abolished? No

Head to Head: Steve Gillam (doi:10.1136/bmj.c2710) argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena (doi:10.1136/bmj.c2794) believes it needs to be improved not remove

Improving mental health outcomes: achieving equity through quality improvement

Objective. To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design. Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting. A psychological therapy service in Westminster, London, UK. Participants. People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s). Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s). (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results. Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), com-pared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low