Developing a parent guide to quality day care centers

A set of items characterizing high-quality day care programs were rationally derived from the empirical literature and were presented to both day care experts and mothers of preschool children to obtain their evaluations of each item's operational clarity and face validity. The items were then revised and organized in checklist form in preparation for field testing. The items, along with a global nine-point rating scale of quality, comprise the Parent Guide to Quality Day Care Centers.     

Field testing a parent guide to quality day care centers

The present study describes the field testing procedures used to evaluate the reliability and predictive validity of the Parent Guide to Quality Day Care Centers. Twenty-six women were asked to use the items in the guide as a basis for observing in several local day care centers prejudged by local child care professionals to provide a given quality level of services. The results showed that a significant number of the items (80%) were reliably observed more frequently in centers prejudged to provide above-average services than in centers prejudged to provide below-average services.Reprints and an extended version of this paper can be obtained from Marilyn R. Bradbard, Department of Child and Family Development, Auburn University, Auburn, Alabama 36830.     

Providers' evaluations of family day care services

Family day care is an informal and largely unregulated form of child care with providers a key element in creating effective programs. Relatively little is known of how providers perceive the needs of clients [parents and children] and how they evaluate the adequacy of their services in meeting family needs. Thirty-two registered home providers estimated parents' reasons for selecting family day care, and the degree to which their services met parents' and children's needs for care. They also evaluated the importance of program goals and provider qualifications and indicated their experience and training for day care. Knowledge of providers' perceptions of the quality of their services and their ability to meet client needs can help educators create training programs with appropriate content and format.     

Improving quality of health care through pay-for-performance programs

The issue of quality of care is not new to the US health care system. Providers have been required to participate in quality improvement activities by governmental and accrediting agencies for quite some time. The public, too, is becoming increasingly involved in evaluating the quality of care provided in facilities from which they seek care. Transparency in pricing and quality of care is of critical interest to patients, health plans, and employers. On August 22, 2006, President George W. Bush signed an executive order supporting the promotion of efficient and quality health care to US citizens in health care programs administered and sponsored by the federal government, such as Medicare, Medicaid, and Tricare.However, the idea of tying reimbursement to these quality standards is growing and becoming a significant element of the health care field. Value-based purchasing refers to the many ways that health care purchasers are attempting to measure, monitor, and improve the quality of care that is received for money spent. Pay for performance is one of the emerging programs in this area. The expectation of pay for performance is that patient outcomes will be improved by rewarding providers based on predetermined measures.     

Improving cancer care through public reporting of meaningful quality measures

Historically, quality measures for cancer have followed a different route than overall quality measures in the health care system. Many specialized cancer treatment centers were exempt from standard reporting on quality measures because of the complexity of cancer. Additionally, it has been difficult to create meaningful quality measures for cancer because the disease can strike so many different organs; is discovered at and progresses through different stages; and is treated using different modalities, such as surgery, radiation, and chemotherapy. Over the past decade the National Quality Forum, a nonprofit organization dedicated to bettering the quality of US health care, has endorsed measures of quality for cancer providers and patients. The Affordable Care Act of 2010, which has sections specific to cancer reporting, will also further the development and public reporting of cancer quality measures-important steps in improving the delivery of cancer care.     

Improving quality in long-term care facilities through increased regulations and enforcement

This research addresses the origins and motivations that drive long-term-care regulations and enforcement. It outlines the historical development of the US long-term-care system and describes regulations that focus on improving quality of care. Current long-term-care regulations are inadequate and ineffective because of fragmentation and inconsistencies that have resulted in conflicts of interest, inequitable services, underfunded care, low reimbursement, cumbersome and duplicative processes, and inadequate training and compensation for providers. Reforms such as establishing higher standards and modifying enforcement procedures are necessary to bring about increased quality of care for long-term-care consumers.     

Improving quality through identifying inappropriate care: the use of guideline-based utilization review protocols in the Washington State Workers' Compensation System

Utilization review (UR) is widely instituted to ensure that medical treatment is clinically necessary and appropriate. UR programs have been criticized for their failure to promote quality and for relying on proprietary review criteria that are rarely subject to external, independent evaluation or validation. In fashioning its UR program for workers' compensation, the Washington State Department of Labor and Industries sought to address these shortcomings. Working collaboratively with the state medical association, the Department of Labor and Industries developed treatment guidelines and then used these guidelines to formulate review criteria for UR. From 1993 through 1998, 100,005 UR reviews were conducted, half of which used the guideline-based review criteria. We analyzed these reviews to examine the patterns of denied requests. The overall denial rate for the guideline-based reviews was 7.3%. The highest denial rates were for thoracic outlet syndrome surgery (19.1%) and lumbar fusion (17.7%). The use of guideline-based UR protocols may improve the effectiveness of UR as a tool to identify potentially inappropriate care.     

Reporting about health care quality: a guide to the galaxy

A review of research on the reporting of health care quality information and related fields in applied social and cognitive science led to identification of seven basic principles that should be followed when planning to report health care quality information to consumers or other audiences: (a) know the audience: who they are, what they care about, and what actions they can take; (b) identify constraints that limit what is feasible; (c) consider barriers and facilitators to achieving objectives; (d) identify specific behaviors to target for change, and prioritize objectives; (e) design a report that specifically incorporates priorities and reflects trade-offs; (f) develop a plan for promotion and dissemination from the beginning; and (g) build in ongoing testing and evaluation to identify successes and areas needing improvement. Case studies provide many examples of unsuccessful reporting efforts that might have succeeded had these guiding principles been followed.     

Improving quality through the built environment

State-of-the-art hospitals feature private rooms, tree-filled courtyards, fountains, family lounges and more--all in an effort to make patients and visitors more comfortable with their surroundings in a time of stress. A soothing atmosphere doesn't take a complete renovation: Many changes can be made for little investment. Such an environment does take a philosophical commitment by the entire institution, however, and that can't be changed with paint alone.     

Good food in family day care: Improving nutrition and food safety in family day care

Aim:  To determine the effectiveness of a nutrition and food safety intervention in family day care schemes.
Methods:  Staff and carers from seven Sydney family day care schemes completed a nutrition and food safety knowledge questionnaire and diet history about food and drinks offered to children in care before and after attending workshops and receiving advice and resources. Participating schemes' nutrition and food safety policies were assessed before and after intervention. At baseline, 18 staff members and 104 carers were interviewed. Diet histories were collected for 20 infants and 103 one-to-five-year olds. Post intervention, 21 staff and 102 carers were interviewed and diet histories collected for 22 infants and 102 one-to-five-year olds. Baseline and post-intervention data were compared using the χ²-test for categorical data (or the Fisher's exact test when expected values were below five), and t -tests for independent samples for normally distributed means.
Results:  Nutrition and food safety knowledge and the number (from one to seven) and quality of appropriate policies improved post intervention. Changes in mean per cent nutrition scores for infants (78.2% to 83.4%) and for one-to-five-year olds (68.8% to 75.2%; P  < 0.01) indicated improvements in nutritional quality of food and drinks offered during care.
Conclusion:  Health promotion strategies can improve food and drinks offered in family day care and make a sustainable contribution to children's access to safe and nutritious food.     

Improving the quality control of health care

The problem of raising the quality and effectiveness of medical care in the agricultural region of the country is being considered from the point of view of systems approach where a priority is given to the formation of a common modern scientific technology of delivering medical care different from feldsher-midwifery units to specialized centres. Three years period of introducing the system of improving the management of quality and effectiveness of medical care delivery resulted in reduction of morbidity associated with temporary and persistent disability from respiratory diseases, reduction of mortality from circulatory diseases in working age population.