• Quality Improvement in Health Care
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• v.27 no.2
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• Journal of Construction Engineering and Project Management
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• v.6 no.3
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• pp.14-21
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• 2016

One of the major issues in the material-based or acceptance quality characteristics asphalt pavement Quality Assurance (QA) is that the method does not have rationality to link between the individual materials and the projected performance of the pavement. A new asphalt mix QA method has been recently developed under a national research project using the probabilistic Performance Related Specification (PRS). This advanced PRS QA methodology integrates the AASHTOWare Pavement ME Design$^{(R)}$ technology with the simple performance test concept that bridges the material characteristics with the pavement performance. This paper presents a case study of asphalt pavement performance using the developed PRS QA computer program, named Quality Related Specification Software (QRSS), with an actual pavement project, to demonstrate the developed PRS procedure and to assess the robustness of QRSS in terms of the rationality of the distress predictions. The results of this limited case study show that the new PRS QA method reasonably predicts the pavement performance, properly applied the probabilistic methods, and produced rational pay adjustment.

• Progress in Medical Physics
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• v.13 no.3
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• pp.109-113
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• 2002

In recent years, the radiotherapy equipment has become much more sophisticated, and with the complication comes an increased set of quality assurance (QA) responsibilities. Today's computer controlled linear accelerator requiring QA of not only the radiation integrity, but also the mechanical accuracy of the linear accelerator. The existing QA sheets are adequate for acceptance testing and commissioning but those sheets are somewhat descriptive form for routine QA. establishing the QA sheets for a facility are more efficient if the sheets could estimate the long-term stability for the result of QA. We are going to develope new prototype of mechanical QA sheet to visualize and to verify long-term stability of mechanical QA for clinical linear accelerator. The items included in mechanical QA sheet were 1) gantry rotation, 2) collimator rotation, 3) couch rotation, 4) optical distance indicator (ODI), and 5) laser alignment. We compared new prototype sheet with conventional sheet for several hospitals in Korea for those items. The QA acceptance criteria in this study mainly followed published recommendations. The contents of test for mechanical QA are the following. Confirm that the digital and/or mechanical gantry angle readouts are correct. Verify that digital and/or mechanical readouts of collimator angle agree with the true angle, as determined with the protractor. Measure the light field using a graph paper and compare with the digital readouts. Confirm digital readout accuracy. Verify that the sagittal laser, the left and right lasers, and the ceiling laser intersect at the isocenter. In the design of new QA sheet, we emphasized the representation of the long-term stability of mechanical QA by using Excel program. By using the new prototype QA sheet, we simplified and visualized the mechanical QA process, and could estimate the long-term stability of mechanical error of linear accelerator.

• Progress in Medical Physics
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• v.30 no.4
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• pp.128-138
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• 2019

Purpose: Segmental analysis of volumetric modulated arc therapy (VMAT) is not clinically used for compositional error source evaluation. Instead, dose verification is routinely used for plan-specific quality assurance (QA). While this approach identifies the resultant error, it does not specify which machine parameter was responsible for the error. In this research study, we adopted an approach for the segmental analysis of VMAT as a part of machine QA of linear accelerator (LINAC). Methods: Two portal dose QA plans were generated for VMAT QA: a) for full arc and b) for the arc, which was segmented in 12 subsegments. We investigated the multileaf collimator (MLC) position and dosimetric accuracy in the full and segmented arc delivery schemes. A MATLAB program was used to calculate the MLC position error from the data in the dynalog file. The Gamma passing rate (GPR) and the measured to planned dose difference (DD) in each pixel of the electronic portal imaging device was the measurement for dosimetric accuracy. The eclipse treatment planning system and a MATLAB program were used to calculate the dosimetric accuracy. Results: The maximum root-mean-square error of the MLC positions were <1 mm. The GPR was within the range of 98%-99.7% and was similar in both types of VMAT delivery. In general, the DD was <5 calibration units in both full arcs. A similar DD distribution was found for continuous arc and segmented arcs sums. Exceedingly high DD were not observed in any of the arc segment delivery schemes. The LINAC performance was acceptable regarding the execution of the VMAT QA plan. Conclusions: The segmental analysis proposed in this study is expected to be useful for the prediction of the delivery of the VMAT in relation to the gantry angle. We thus recommend the use of segmental analysis of VMAT as part of the regular QA.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.15 no.7
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• pp.2455-2475
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• 2021

Patient Navigation Program (PNP) is considered as an important implementation of health care systems that can assist in patient's treatment. Due to the feasibility of PNP implementation, a systematic reuse is needed for a wide adoption of PNP computerized system. SPL is one of the promising systematic reuse approaches for creating a reusable architecture to enabled reuse in several similar applications of PNP systems which has its own variations with other applications. However, stakeholder decision making which result from the imprecise, uncertain, and subjective nature of architecture selection based on quality attributes (QA) further hinders the development of the product line architecture. Therefore, this study aims to propose a quality-driven approach using Multi-Criteria Decision Analysis (MCDA) techniques for Software Product Line Architecture (SPLA) to have an objective selection based on the QA of stakeholders in the domain of PNP. There are two steps proposed to this approach. First, a clear representation of quality is proposed by extending feature model (FM) with QA feature to determine the QA in the early phase of architecture selection. Second, MCDA techniques were applied for architecture selection based on objective preference for certain QA in the domain of PNP. The result of the proposed approach is the implementation of the PNP system with SPLA that had been selected using MCDA techniques. Evaluation for the approach is done by checking the approach's applicability in a case study and stakeholder validation. Evaluation on ease of use and usefulness of the approach with selected stakeholders have shown positive responses. The evaluation results proved that the proposed approach assisted in the implementation of PNP systems.

• Progress in Medical Physics
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• v.23 no.1
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• pp.33-41
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• 2012

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, $360^{\circ}$. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of $360^{\circ}$ directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.

• Quality Improvement in Health Care
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• v.28 no.2
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• pp.30-38
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• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• Quality Improvement in Health Care
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• v.1 no.1
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• pp.26-31
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• 1994

• Quality Improvement in Health Care
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• v.5 no.1
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• pp.76-91
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• 1998

Background : The purpose of this study was to understand general attitudes of physicians toward hospital quality improvement activities who have been members of QA committee in 32 Korean university hospitals. Methods : A postal survey about opinions of hospital quality improvement activities and desirable policy directions was sent to 328 QA committee member physicians. The questionnaires were composed of 48 items. In total 152 physicians responded to this survey(response rate: 49.3%). This study was carried out from January to February 1996. Results : Most physicians(97.5%) recognized the necessity of hospital QA activities. The most dominant supporting reason for quality activities was to improve clinical outcome. Two thirds of physicians regarded their own hospital activities for quality improvement as inactive. They considered that the obstacles were too little concern(33.6%), unclear objectives(28.9%), lack of human resources(14.3%), and insufficient education and training for quality improvement(10.1%). The most favoring policy among respondents was to give health care providers economic incentives. Provision of education and training for implementing quality improvement was the next to it. Physicians revealed their preferences for professional society, government, health insurance societies, consumer groups, hospital labor unions, and mass media in sequence as sponsoring agencies for hospital accreditation program. Conclusion : These study suggested that the concrete means for motivating physicians and promoting constructive partnership among related parties should be developed in order to activate current hospital quality activities in Korea.

• Progress in Medical Physics
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• v.15 no.4
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• pp.186-191
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• 2004

The periodic Quality Assurance (QA) of each radiation treatment related equipments is important one, but quality assurance of the radiation treatment planning system (RTPS) is still not sufficient rather than other related equipments in clinics. Therefore, this study will present and test the periodic QA program to compare, evaluation the efficiency of the treatment planning systems. This QA program is divided to terms for the input, output devices and dosimetric data and categorized to the weekly, monthly, yearly and non-periodically with respect to the job time, frequency of error, priority of importance. CT images of the water equivalent solid phantom with a heterogeneity condition are input into the RTPS to proceed the test. The actual measurement data are obtained by using the ion chamber for the 6 MV, 10 MV photon beam, then compared a calculation data with a measurement data to evaluate the accuracy of the RTPS. Most of results for the accuracy of geometry and beam data are agreed within the error criteria which is recommended from the various advanced country and related societies. This result can be applied to the periodic QA program to improve the treatment outcome as a proper model in Korea and used to evaluate the accuracy of the RTPS.