View source for Quality Assurance

This article presents the content of Julie's Quality Assurance presentation from the data collection meeting on April 8 2009. 

For discussion or questions re. the '''concepts''' of QA or Julie's presentation please post your discussions in this article as usual.

==What is QA?==
An integrated system of activities involving:
* planning
* quality control
*quality assessment
*reporting and 
*quality improvement 
to ensure that a product or service meets 
standards of quality with stated  levels of confidence.

==History of QA==
* Started early 19th century in Great Britain during the Industrial Revolution emphasis on product inspection
* Early 20th century by  manufacturers and included quality processes
* WWII, US used quality processes in manufacturing of bullets and rifles- sampling technique of inspection 
* Japan’s Quality Revolution on automobiles and electronics – focus on improving the organization processes thru people
* 20th century, US introduced [http://en.wikipedia.org/wiki/Total_quality_management Total Quality Management (TQM)] – quality on the entire organization
* 21st century, moved beyond manufacturing into service, healthcare, education and government sector

==QA in Healthcare==
*“All the arrangements and activities that are meant to safeguard, maintain, and promote the quality of care”
*“Set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and safe as possible”

==What is QA to a Medical Database?==
*Our product is medical data
*General Goal: To assure the users of these data that they meet standards of quality with stated levels  of confidence 
**Specific Goal: To determine [http://en.wiktionary.org/wiki/quantitative?rdfrom=Quantitative#Adjective quantitatively] the level of confidence of our data, and to improve that level of quality if needed.
* “Standards” is something set up as a rule for measuring or a model to be followed. 
**Quality does not mean “BEST” but may mean “BEST for certain conditions”
**Medically sound, Defensible, Of know quality
*Level of confidence
**Degree of certainty
**Degree of assurance

==Principles of  QA==
*Oriented toward meeting the needs and expectations of the clients 
*Focuses on systems and processes
*Uses quantitative data to analyze the problem in the processes  
*Encourages a team approach to problem solving and quality improvement

== Data Flow at the Critical Care and Medicine Database ==
<imagemap>
Image:CCMDB Description.png|700px|alt=Description of CCMDB sources and outputs
rect 8 79 143 101    [[Data available in the Critical Care and Medicine Database]]
rect 9 104 141 128   [[Demographics]]  
rect 9 132 141 155   [[ADT]]  
rect 9 158 141 182   [[APACHE_II]]  
rect 9 188 141 211   [[Diagnostic Data available in the Critical Care and Medicine Database]]  
rect 9 215 141 237   [[Procedure Data available in the Critical Care and Medicine Database]] 
rect 9 244 141 266   [[Acquired_Diagnosis_/_Complication]] 
rect 8 269 142 293   [[Pharmacy_collection]] 
rect 75 297 139 379  [[TISS]]  

rect 8 384 143 407   [[Projects]]  
rect 15 404 138 427  [[QA_Infection_CLI]]  
rect 14 428 137 452  [[QA_Infection_VAP]]  
rect 14 454 140 477  [[Database Request Process]]

rect 7 509 140 532   [[Category:External Source]]
rect 49 533 141 556  [[DSM_Lab_Extract]]  
rect 5 563 140 604   [[Validation_against_Patient_Registry_Data]]  

rect 168 209 228 366 [[Data_Collector]]  
rect 319 245 377 322 [[Data_Processor]] 
rect 282 330 379 356 [[Data_Processing]]   
rect 438 245 496 322 [[Statistician]]  
rect 437 330 497 356 [[Statistical_Analysis]]  

rect 481 68 649 91   [[Postal_Code_field#Data_Use]] 
rect 666 84 801 106  [[Avoidable Days (Critical Care)]]
rect 528 96 582 120  [[Age]] 
rect 589 111 776 134 [[Night Time Discharges]] 
rect 538 137 664 161 [[LOS]]  
rect 670 137 766 160 [[Bed_occupancy]]  
rect 533 167 641 190 [[Patient flow]]
rect 643 168 809 190 [[Readmission]]  
rect 577 197 676 218 [[ARO]]  
rect 679 197 811 218 [[Ulcers_-_Decubitus_only]]  
rect 572 223 626 245 [[Acuity]]
rect 629 222 777 245 [[Central Line Tracking]]  
rect 596 250 715 272 [[Confusion_Assessment_Method]]   
rect 720 248 812 273 [[Ventilator Utilization Ratio]]
rect 558 278 704 300 [[Nursing Workload]]
rect 708 276 814 300 [[CRRT]]

rect 626 302 715 325 [[QA_Infection_CLI]]  
rect 717 320 814 343 [[QA_Infection_VAP]]  
rect 610 344 734 367 [[CRRT]]  

rect 679 374 790 437 [[Reporting]]  
rect 709 446 794 509 [[Statistical_Analysis]]  
rect 576 573 690 654 [[Before/After comparisons for QI Interventions]]

rect 468 547 562 641 [[Database_Request_Process]]  
rect 347 569 439 649 [[Critical_Care_Vital_Sign_Monitor]]
rect 233 535 318 615 [[Manitoba_Centre_for_Health_Policy]] 
rect 238 624 337 646 [[Publications]]
</imagemap>

== Factors Affecting Quality of Data ==
*Data collection phase
**Sources of data (what, where and how each element is collected)
**Timing of recording
**Hospital protocols/system
**Guidelines (clarity / comprehensive)
**Volume of patients
*Hardwares (PDAs, PCs)
**Memory and capabilities, etc.
*Softwares (Handibase, ACCESS, TMSX & MEDTMS, SAS)
**User friendly/confusing
**Easy/hard to use
**Capabilities in handling large data volume
**Error control features
**Etc.
*Human Factor
**Staff training for new staff
**Staff compliance on the on-going changes in the process
**Staff motivation
**Staff perception on workload
**etc.

==Key Elements of QA==
*Standard Operating Procedures (SOPs)
*Hardware & Software
*Training
*Statistical considerations
*Monitoring data quality indicators
*Audits
*Documentation

==Data Quality Indicators==
In assuring the quality of data, the usual concern is to minimize ( or if possible eliminate) errors in the measurement process

Two indicators related in evaluating errors [http://en.wikipedia.org/wiki/Accuracy_and_precision Accuracy and Precision].

=== Accuracy ===
Refers to the closeness of the measurement '''to its true or expected or accepted value'''.

===Precision ===
Refers to the closeness of the '''repeated measurements''' made under the same conditions.


==Advantages of QA==
*Produces well-documented, reliable and defensible data
*Enhances confidence and credibility of the organization
*Results in efficient use of resources – personnel, equipment and finances
*Improves the staff’s morale and commitment

==Conclusion==
*QA is not an easy task
*Requires collaboration, cooperation and commitment of staff and management
*Challenge to improve quality of our product 

[[Category:QA]]