A Framework for Assessing Quality Indicators for Cancer Care at the End of Life
ABSTRACT Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas and settings most in need of improvement. However, recent reviews and policy initiatives identified only a few indicators that met these criteria. To help advance quality indicator development and implementation in this area, we developed a conceptual framework based on previous related initiatives, updated reviews of end-of-life cancer quality indicators and relevant data sources, and expert input. The framework describes five steps for developing and assessing a quality indicator for end-of-life care, defining the 1) population of focus, 2) broad quality domains, 3) specific target areas, 4) steps of the care process, and 5) evaluation criteria for quality indicators. The defined population includes seriously or terminally ill cancer patients, who are unlikely to recover or stabilize, and their families. Domains include the structure and processes of care; the physical, psychiatric, psychosocial, spiritual, and cultural aspects of care; as well as the care of the imminently dying, ethical and legal issues, and the delivery of care. Evaluation criteria include importance; scientific acceptability, including validity, evidence to improve outcomes, reliability, responsiveness, and variability; usability; and feasibility, including ready data sources. By using this conceptual framework, indicator developers, researchers, and policymakers can refine and implement indicator sets to effectively evaluate and improve care at the end of life.
Conference Paper: A 64x17 Non-blocking Crosspoint SwitchSolid-State Circuits Conference, 1988. Digest of Technical Papers. ISSCC. 1988 IEEE International; 03/1988
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ABSTRACT: The present paper gives a haptic feedback control of a holonomic omni-directional mobile wheelchair (OMW) with a haptic joystick for the operation of disable people or elderly people considering not only the navigation task but also user's comfort and safety. In the present research a haptic joystick was designed and applied with being maneuverable for users and free of joystick's vibrations. If an obstacle is detected in the direction of movement, the impedance of the joystick in this direction is changed. Namely, the closer the obstacle is the bigger the impedance value becomes. By this function, users spontaneously understand that they are in risk of obstacle collision and then users can change the direction of movement, by their decision, in order to avoid it. Furthermore, for the command input by human joystick operation, velocity control of OMW is executed by means of frequency shaped control to achieve the comfort drive for users. The proposed approach is thought to be reasonable as a man-machine existing control system.Intelligent Robots and Systems, 2004. (IROS 2004). Proceedings. 2004 IEEE/RSJ International Conference on; 01/2004
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ABSTRACT: Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach). The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step.Indian Journal of Palliative Care 03/2010; 16(1):8-15. DOI:10.4103/0973-1075.63128