Over the period 1987–1991 an inter-disciplinary five-country group developed the EuroQol instrument, a five-dimensional three-level generic measure subsequently termed the ‘EQ-5D’. It was designed to ...measure and value health status. The salient features of its development and its consolidation and expansion are discussed. Initial expansion came, in particular, in the form of new language versions. Their development raised translation and semantic issues, experience with which helped feed into the design of two further instruments, the EQ-5D-5L and the youth version EQ-5D-Y. The expanded usage across clinical programmes, disease and condition areas, population surveys, patient-reported outcomes, and value sets is outlined. Valuation has been of continued relevance for the Group as this has allowed its instruments to be utilised as part of the economic appraisal of health programmes and their incorporation into health technology assessments. The future of the Group is considered in the context of: (1) its scientific strategy, (2) changes in the external environment affecting the demand for EQ-5D, and (3) a variety of issues it is facing in the context of the design of the instrument, its use in health technology assessment, and potential new uses for EQ-5D outside of clinical trials and technology appraisal.
Healthcare regulatory agencies are increasingly concerned not just with assessing the current performance of the organisations they regulate, but with assessing their improvement capability to ...predict their future performance trajectory. This study examines how improvement capability is conceptualised and assessed by healthcare UK regulatory agencies.
Qualitative analysis of data from six UK healthcare regulatory agencies was conducted. Three data sources were analysed using an a priori framework of eight dimensions of improvement capability identified from an extensive literature review.
The focus of the research study was the regulation of hospital-based care, which accounts for the majority of UK healthcare expenditure. Six UK regulatory agencies that review hospital care participated.
Data sources included interviews with regulatory staff (n = 48), policy documents (n = 90) and assessment reports (n = 30).
None-this was a qualitative, observational study.
This research study finds that of eight dimensions of improvement capability, process improvement and learning, and strategy and governance, dominate regulatory assessment practices. The dimension of service-user focus receives the least frequency of use. It may be that dimensions which are relatively easy to 'measure', such as documents for strategy and governance, dominate assessment processes, or there may be gaps in regulatory agencies' assessment instruments, deficits of expertise in improvement capability, or practical difficulties in operationalising regulatory agency intentions to reliably assess improvement capability.
The UK regulatory agencies seek to assess improvement capability to predict performance trajectories, but out of eight dimensions of improvement capability, two dominate assessment. Furthermore, the definition and meaning of assessment instruments requires development. This would strengthen the validity and reliability of agencies' assessment, diagnosis and prediction of performance trajectories, and support development of more appropriate regulatory performance interventions.
The current study was carried out to delineate the seasonal hydrochemical characteristics and to quantify the suitability of groundwater for drinking and irrigation purposes in an alluvial plain ...adjacent to a paper wastewater irrigation zone, northwest China. Groundwater samples were collected from 14 groundwater monitoring wells in pre-monsoon, monsoon and post-monsoon seasons, respectively. Statistical analysis and Chadha diagram were used to delineate the groundwater hydrochemical characteristics. The matter element extension analysis (MEEA) model was proposed to quantify the overall groundwater quality. Irrigation water quality indicators were applied to assess the suitability of groundwater for irrigation purpose. The research results show that the hydrochemical facies for the majority of the groundwater samples is SO
4
·Cl–Na type with some minor hydrochemical facies of HCO
3
–Ca·Mg, HCO
3
–Na, and Cl·SO
4
–Ca·Mg types. The sequences of ions are Na
+
> Ca
2+
> Mg
2+
> K
+
for cations, and HCO
3
−
> Cl
−
> SO
4
2−
> CO
3
2−
for anions. The major ions and contaminants in the groundwater are controlled by multiple factors including hydrogeological conditions, rock weathering, water–rock interactions and human activities. The values of pH, TDS and TH show reduction in the monsoon season, indicating slight improvement of water quality during the monsoon season. Water quality assessment results based on MEEA show that the overall groundwater quality in the wastewater irrigation zone is generally fair to poor quality. Some groundwater samples are even classified as very poor quality, which is unsuitable for human consumption. They are also unsuitable for irrigation because of potential sodium hazard and salinity hazard. Groundwater from the Yellow River irrigation zone and the alluvial plain is generally suitable for domestic and irrigation uses. Some local water sampling locations may experience water quality improvement during the monsoon season, which, however, will generally not affect the final water quality classification for domestic and irrigation purposes. Interestingly, the study also finds that the variation trend of the correlation degree computed from MEEA can be useful in determining water quality improvement. This study may provide insights for people to make educated decisions in efficient groundwater quality protection and sustainable groundwater quality management.
We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation ...of these quality indicators.
A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.
The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%).
This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.
Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. Methods: The business and health care literature was systematically reviewed ...to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Conclusions: Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context.
Perceptual quality assessment plays a vital role in the visual communication systems owing to the existence of quality degradations introduced in various stages of visual signal acquisition, ...compression, transmission and display. Quality assessment for visual signals can be performed subjectively and objectively, and objective quality assessment is usually preferred owing to its high efficiency and easy deployment. A large number of subjective and objective visual quality assessment studies have been conducted during recent years. In this survey, we give an up-to-date and comprehensive review of these studies. Specifically, the frequently used subjective image quality assessment databases are first reviewed, as they serve as the validation set for the objective measures. Second, the objective image quality assessment measures are classified and reviewed according to the applications and the methodologies utilized in the quality measures. Third, the performances of the state-of-the-art quality measures for visual signals are compared with an introduction of the evaluation protocols. This survey provides a general overview of classical algorithms and recent progresses in the field of perceptual image quality assessment.
China has been experiencing severe air pollution in recent decades. Although an ambient air quality monitoring network for criteria pollutants has been constructed in over 100 cities since 2013 in ...China, the temporal and spatial characteristics of some important pollutants, such as particulate matter (PM) components, remain unknown, limiting further studies investigating potential air pollution control strategies to improve air quality and associating human health outcomes with air pollution exposure. In this study, a yearlong (2013) air quality simulation using the Weather Research and Forecasting (WRF) model and the Community Multi-scale Air Quality (CMAQ) model was conducted to provide detailed temporal and spatial information of ozone (O3), total PM2.5, and chemical components. Multi-resolution Emission Inventory for China (MEIC) was used for anthropogenic emissions and observation data obtained from the national air quality monitoring network were collected to validate model performance. The model successfully reproduces the O3 and PM2.5 concentrations at most cities for most months, with model performance statistics meeting the performance criteria. However, overprediction of O3 generally occurs at low concentration range while underprediction of PM2.5 happens at low concentration range in summer. Spatially, the model has better performance in southern China than in northern China, central China, and Sichuan Basin. Strong seasonal variations of PM2.5 exist and wind speed and direction play important roles in high PM2.5 events. Secondary components have more boarder distribution than primary components. Sulfate (SO42−), nitrate (NO3−), ammonium (NH4+), and primary organic aerosol (POA) are the most important PM2.5 components. All components have the highest concentrations in winter except secondary organic aerosol (SOA). This study proves the ability of the CMAQ model to reproduce severe air pollution in China, identifies the directions where improvements are needed, and provides information for human exposure to multiple pollutants for assessing health effects.
Rivers are a vital component of both urban and rural aquatic ecosystems, and the rapidly increasing pollution in rivers severely threatens the security of these ecosystems. In this study, the surface ...water quality in the Maozhou River basin, Guangdong Province, China, was assessed from 2018 to 2020 using multivariate statistical techniques and the Integrated Water Quality Index (IWQI). In addition, spatial trends in surface water quality were studied using a geographic information system. The results indicated that the water quality in 82.17% of the studied section met the Class V standard for surface water quality, with IWQI values ranging from 12.157 to 3.650. The surface water quality was clustered into eight groups and further divided into unsuitable (low quality) and suitable (acceptable quality) according to standard surface water quality thresholds (China in Environmental quality standards for surface water, 2002). Four groups (G1, G2, G3, and G4) were classified as unsuitable, because they fell short of the Class V standard for surface water quality. In these groups, industrial sewage, endogenous pollution, domestic sewage, and rainfall runoff, were the primary sources of pollution, and the main background pollutants for the water quality target of the functional zones were COD, NH
3
-N, TP, and LAS. The other four groups were classified as suitable. In these groups, endogenous pollution and rainfall runoff were the primary sources of pollution, and the main background pollutants for the water quality target of the functional zones were NH
3
-N and TP. Among them, NH
3
-N and LAS were recognized as responsive and sensitive to the surface water quality and spatio-temporal variability. Owing to pollution treatment and management measures undertaken by the Chinese government, the black-odorous water in the Maozhou River basin has disappeared, and the water quality in the Maozhou River basin has been maintained at the “medium and good” level. However, the surface water quality in the estuary region and the southwest tributary in the basin requires further improvement. This calls for further efforts to improve surface water quality and to properly deal with various sources of pollution in the watershed. This combined method has proved to be effective for surface water quality evaluation and management at river or basin scales. The results of this work are expected to provide a scientific foundation for aquatic ecosystem management and planning.
The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study ...objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada.
Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework.
Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement.
The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health ...interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
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