Browsing by Subject "Quality Improvement"

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    Measuring Quality of Diabetes Care for Medicare Beneficiaries
    (2013-05) Parashuram, Shriram
    This dissertation consists of three papers studying existing practices in measuring quality of care for Medicare beneficiaries that warrant further examination. Quality of diabetes care is currently reported at the practice or plan level as a composite, summarizing multiple binary measures in the diabetes measure set. Medicare's Accountable Care organization demonstration uses an all-or-none approach deeming only diabetics who receive all measures in the diabetes care measure set to have met the quality threshold. This approach while simple might not be as meaningful as a graduated approach. Other approaches to composite quality measurement, like Medicare's value based payment system for physicians, add up binary measures in the diabetes care measure set, weighting them equally. But all measures in the set might not be equally important for quality, making the case for weighting measures accordingly. Finally, Medicare's Physician Quality Reporting System (PQRS) offers incentive payments to physicians for reporting quality for their patients. In the absence of incentives for outcomes, the impact of reporting on outcomes is questionable. The dissertation employs Medicare administrative claims to answer the above questions. Paper 1 compares prediction of subsequent outcomes for Medicare beneficiaries using all-or-none approach against a graduated approach to quality measurement. Paper 2 compares measure weights for diabetes care processes obtained using three alternate approaches to weighting composites, to study whether equal weighting is justified in practice. Paper 3 studies whether PQRS quality reporting for diabetics is linked to receipt of more recommended diabetes care processes and better outcomes. This dissertation ultimately emphasizes the need to better understand quality mechanisms to measure it appropriately for quality improvement.
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    Quality Improvement of Whole Wheat Precooked Alkaline Noodles
    (2014-04) Wang, Wang
    Asian noodles are popular foods commonly consumed in Asia and rapidly expanding into new markets throughout the world. The purpose of this study was to develop a convenient whole-wheat precooked alkaline noodle and to examine its quality attributes. Key variables studied in this project included effects of whole-wheat flour ratio, water addition in the formula, mixing condition, flour protein content and functional ingredients on quality characteristics of the noodle product. The color test, Texture Profile Analysis (TPA), Rapid Visco Analysis (RVA) of the starch, and sensory evaluation of cooked noodles were conducted to verify the effects of these variables. The color test showed that an increase in whole-wheat flour made the noodle color darker and yellower. Vacuum mixing condition and water addition level had negative correlations with the noodle color. High protein content induced larger color change after 24 h storage. For starch pasting properties, the higher whole-wheat flour ratio decreased peak, trough and final viscosity values. Protein content did not have any significant effects on pasting properties. Phosphates blends increased peak and final viscosities while decreased setback values were observed for the low and the high protein whole-wheat flour blends. TPA results showed that although the higher whole-wheat flour ratio impaired texture properties of cooked noodles, the vacuum mixing condition improved the texture profile by enhancing the gluten development. Functional ingredients improved the noodle texture but the effects were dependent on protein content. Sensory evaluation indicated a lower perceived quality for springiness and mouth-feel for whole-wheat precooked noodles. However, no significant differences were noticed in the whole-wheat flour and the refined flour precooked noodles concerning water addition level, mixing condition, and protein content. In conclusion, the overall quality of the newly developed whole-wheat precooked alkaline noodle was quite acceptable. This noodle appears to satisfy consumer's needs for taste and convenience, and their potential desire for whole grains and related health benefits.