Air Quality And Health Journal

[Macedonio Heninger]

AirQuality, Atmosphere and Health is a multidisciplinary journal focusing on atmospheric consequences of human activities and their implications for human and ecological health. The journal addresses such topics as acid precipitation; airborne particulate matter; air quality monitoring and management; exposure assessment; risk assessment; indoor air quality; atmospheric chemistry; atmospheric modeling and prediction; air pollution climatology; climate change and air quality; air pollution measurement; atmospheric impact assessment; forest-fire emissions; atmospheric science; greenhouse gases; health and ecological effects; clean air technology; regional and global change and satellite measurements.It offers research papers, critical literature reviews and commentaries, as well as special issues devoted to topical subjects or themes. The journal benefits a diverse audience of researchers, public health officials and policy makers addressing problems that call for solutions based in evidence from atmospheric and exposure assessment scientists, epidemiologists, and risk assessors. Publication in the journal affords the opportunity to reach beyond defined disciplinary niches to this broader readership.

The Journal encourages the science of improvement, debate, and new thinking on improving the quality of healthcare. The journal is led by a patient-focused editorial team with a view towards helping all team members improve their knowledge with the overall goal of improving patient care. The journal integrates the academic and clinical aspects of quality and safety in healthcare by encouraging academics to create evidence and knowledge valued by clinicians and clinicians to value using evidence and knowledge to improve quality.

At NAHQ, our purpose is to elevate the profession and advance the discipline of healthcare quality & safety. We believe the workforce is the greatest lever available to accomplish this goal, but that they do not have the resources required to do their best work. That's why we're on a mission to set the industry standard for quality & safety and help individuals and organizations achieve it.

Learn more about the domains that have been identified as being critical to a high-functioning quality program. Discover how the Framework can help you (and your organization) achieve quality excellence.

A handful of analytic frameworks for quality assessment have guided measure development initiatives in the public and private sectors. One of the most influential is the framework put forth by the Institute of Medicine (IOM), which includes the following six aims for the healthcare system.[1]

Existing measures address some domains more extensively than others. The vast majority of measures assess effectiveness and safety. Some capture timeliness and patient-centeredness. Fewer measures focus on efficiency and equity of care, but attention to those domains has been growing.[2]

Frameworks like the IOM domains also make it easier for consumers to grasp the meaning and relevance of quality measures. Studies have shown that providing consumers with a framework for understanding quality helps them value a broader range of quality indicators. For example, when consumers are given a brief, understandable explanation of safe, effective, and patient-centered care, they view all three categories as important. Further, when measures are grouped into user-friendly versions of those three IOM domains, consumers can see the meaning of the measures more clearly and understand how they relate to their own concerns about their care.[3]

[1] Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001.

[2] Institute of Medicine (IOM). Performance Measurement: Accelerating Improvement. Washington, D.C: National Academy Press; 2005.

[3] Hibbard JH, Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351.

Copyright: 2019 Thapa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

From Nepal, Gagan Thapa argues that strong political commitment is required to ensure that each individual has access to affordable and quality healthcare. Political actors need to be informed about issues related to affordability and other quality issues related to health services and have the political will to resolve them. Critical reform areas such as medical education, procurement of medicines, minimum quality standards, regulation, and partnerships with the private sector will require meaningful engagement of lawmakers as well as their commitment to increases in national budgets for health.

People in all countries must be empowered to demand health services that are responsive to their health needs. We have to be better at giving people platforms to express their health needs by including citizen voices during policymaking, budgeting, and planning processes of governments. Yet people are ill-informed about their rights to access quality and affordable healthcare. All too often, people do not access care because it is too expensive, inconvenient, remote from their household, or insensitive to their cultural practices. Many face catastrophic expenditures because of the high costs of surgery, medicines, and related costs for travel and accommodation. We need to have the political courage to include citizen voices in government processes, understand and document the difficulties people face, and use creative methods to resolve them.

For Address Malata, one of the most compelling ideas for improving healthcare quality is that tried and tested measures that have improved quality of care in high-income countries cannot just be adopted for the health sector in low- and middle-income countries (LMICs). Country- and in some cases site-specific measures and practices need to be researched, tried, and tested in target areas before being implemented. In particular, it is evident that many LMICs like Malawi are not making significant progress in maternal healthcare as indicators are still poor [7]. A rise in noncommunicable diseases has also strained the healthcare system [8]. Therefore, there is a need to have a more strategic conversation among researchers, policymakers, educators, and practitioners in countries.

So as to induce policymakers to act, several types of evidence will be needed. First, robust data on mortality (especially maternal and neonatal) related to poor quality of care. Second, a systematic assessment of what difference minimal investment in various measures of quality care can make in saving lives. Finally, evidence is required to indicate that some quality of care packages are not necessarily too expensive to be employed.

Manoj Jhalani notes that in India, at Sub-Health Centres catering to population groups of about 5,000 people, Auxiliary Nurse Midwives with short-duration midwifery training are expected to provide reproductive, maternal, and child health services, including delivery care. This strategy was designed at a time when access to safe delivery was constrained by cultural and geographic barriers [11]. Expanding such access for delivery has not led to commensurate reductions in maternal and early newborn mortality. Conversely, care for chronic diseases, including ambulatory care, is currently available at higher level facilities, limiting geographic and financial access, and compromising early detection and follow-up for treatment adherence. As a result, the burden of noncommunicable diseases has continued to increase [12]. Redesigning service delivery, wherein delivery and newborn care is provided at higher level facilities to ensure quality and long-term ambulatory care for chronic diseases is provided at peripheral facilities, is therefore the most transformative idea for India.

The provision of comprehensive primary healthcare visualizing this shift to delivery of improved quality care is already national policy in India, in the form of the Ayushman Bharat Yojana health scheme, but requires the use of regularly updated data through dashboards to provide evidence of gains in conjunction with patient satisfaction surveys, so as to sustain and accelerate policy commitment.

As countries reach better levels of access to healthcare, quality becomes even more visible as a key element to bridge the gap towards universal health coverage and better results in health, argues Sebastin Garca-Sais. Mexico has over the past two decades made important efforts towards universal healthcare but has struggled to improve health outcomes despite the investment made in health. This is one of the most compelling arguments towards quality improvement: no matter how much investment goes into health service provision, if quality is not at the center of all health interventions then improved results will not automatically follow.

As a fragmented federal health system with multiple institutions and levels interacting in terms of health insurance and service provision, Mexico has developed an important number of quality indicators based on episodic measurement of structural elements and user experiences. Despite this consideration, the system has yet to implement robust transverse information systems in order to systematically evaluate and monitor health outcomes, including the capacity to monitor individual health outcomes and follow patients throughout the system. This is particularly relevant at local levels and primary health service provision. Overall, there is an urgent need to improve local decision-making towards quality improvement, emphasizing the role of health and healthcare in equity, and the need for better transparency and accountability in resource allocation and utilization.

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