QUALITY ASSURANCE

STUDY

QA STUDY
means for;

the whole process from

problem identification to reevaluation, or
systematic verification of a
quality problem and analysis of its
causes.

QA STUDY
The purpose is to verify of whether a
problem exists ( compared with
acceptable care ) and analyze its possible
causes so that you can choose
appropriate remedial actions
Must use sound methods but not a
research project aiming at the finding the
scientific truth

Methodology of QA Study
1.
2.
3.
4.
5.
6.
7.
8.
9.

Problem / Opportunity Statement

Literature Review / Situational Analysis
Objectives of the study
Type of Study
Variables
Sampling
Data Collection Techniques
Mapping the Proposal
References

Methodology of QA Study
1. Problem / Opportunity Statement
A complete opportunity/ problem statement
should describe :
* the problem or area of concern and its
significance for the quality of care
* possible causes and contributory factors
* rationale of the study
* scope of the study
* intention to use the results to improve the
quality of care

PROBLEM
Other

QUALITY

Scientific / academic interest

PRACTICAL DAILY LIFE

CAN DO SOMETHING

Do nothing
Severity
Benefit
ABNA

yes

BIG MAGNITUDE
? Feasible
? Cost benefit

Do nothing

Problem
prioritisation

Small magnitude

? Possible
? Study module

DO QA STUDY

2. Literature Review / Situational Analysis

Source of literature;
* text books
* scientific journals
* proceedings of conferences
* local, state and national statistics
* reports on QA studies

Literature review will help us in;

clarify our problem
state the study objectives
know what has happen elsewhere
check the implicit standards
set explicit criteria and standards
suggest suitable study methods
find appropriate remedial actions
avoid duplication of works

3. Objectives of the study

Objectives of study summarise what is
finally to be achieved by the study
If an objective is planning what is to be
accomplished by the study in general term,
it is called a general objective
It is possible to be down general objectives
into smaller logically connected parts
which are normally referred to as specific
objectives

 Objectives should be closely related to

the statement of the problem.
For example; if the problem identified
is high defaulter rate amongst TB
patients, the objectives will be to identify
reasons for this high defaulters and to
find means to improve it.

Purpose of objectives
To focus the study ( narrow down )
To prevent collecting unnecessary data
To better understand and solve the
problem identified
To organised what is to accomplish in the
study in clearly define part and phases

Objectives should..
be phrased in such a way that they focus on

what the study is attempting to solve, in

different parts of the problem in a logical
way
be clear, phrased in operational term
specifying exactly what one is going to do
keep in mind that when the study / poject is
evaluated , the result will be compared to the
objectives
be realistic to be achieved

Phrasing of objectives
The general objective will mention the overall
final aim to be achieved in the study
The specific objectives should be stated using
action verbs that specific enough to
measures:
To determine
- To compare
To verify
To calculate

- To establish
- To describe

Avoid the use of vague non-action verbs

such as;
To appreciate
To understand
To believe.

Specific objectives for QA study

1. To verify the existence of the quality
problem
2. To measure the magnitude of the
problem
3. To identify/describe the actual causes or
contributory factors involved
4. To formulate the remedial or
improvement measures
5. To evaluate the effectiveness of the
measures taken.

4. Type of Study
STUDY

NON-EXPERIMENTAL

DESCRIPTIVE
QUANTITATIVE
QUALITATIVE

EXPERIMENTAL

ANALYTICAL
CASE-CONTROL
( retrospective)
COHORT
(prospective )

Descriptive study:

Systematic collection and presentation

of data to give a clear picture of a
particular situation within a particular
period ( cross-sectional )

describe in term of qualitative

measure or quantitative measure

Analytical study ( or; comparative study )

Aims at determining and testing the

relationship between several variables to suggest

possible causes of problem
Case-control/Retrospective: Check the present
outcome and examine the past possible
exposure factors
Cohort/Prospective: Expose different factors to
different group of study samples ( of similar
characteristic ) and measure their outcomes after
certain time period

Experimental study
Strongest possible type of study to prove
causation
Individuals are randomly allocated to at least
two groups; one group is subject to an
intervention or experiment while the other
group is not
The outcome of the intervention ( effect of
intervention of the dependent variable) is
obtained by comparing the two groups

Time perspective
PAST

NOW

FUTURE

RETROSPECTIVE

CROSS-SECTIONAL

PROSPECTIVE

Looks for past exposure

to a factor or describe
the past event

Looks at the present

situation

Looks at development of a
condition over time

Descriptive study; can be retrospective, prospective or

cross-sectional

Analytical study; can be either retrospective or prospective

Experimental study is always prospective

5. Variables
A characteristic of a person, object or
phenomenon that is measureable and
can take on different values
Examples;
Variable: Height value: tall , short
variable: Sex
value: male , female
variable: Knowledge value: Good, poor
variable: Socioeconomic status
value: High income, middle-income,
low income group

Key Word Definition

To describe the definition of certain/
selective key words and terminology used
in this study
The terminology probably applied only for
this study including application of certain
variables, situation, standard.
Must be sound valid, acceptable, reliable,
clear and not ambiguous.

Study Criteria
Inclusion criteria:
Specific conditions or characteristics that are
applied and included in the study
Exclusion criteria:
The certain characteristic of the samples that
to be excluded in the data collection for
specific reason.
The excluded data shouldnt has any effect
( little or almost negligible ) on the result of the
study

Proposed Indicator and

Standard
Describe the indicator proposed to be
applied in the study.
If rate based, what numerator and
denominator will you use.
Proposed the most acceptable standard.

6. Sampling

Better to get intended information from

a certain population ( all ), but limited

with problems of logistics, costs, time &
other resources.

Thus, we have to do sampling;

a
representative sample with all important
characteristics of the drawn population

Sampling procedures
1. Non-probablility

- Convenience & Non-convenience

2. Probability sampling
- simple randomized
- systematic random
3. Stratified sampling
4. Cluster sampling
5. Multi-stage sampling

7. Data Collection Techniques

Review of recorded sources
Observation
Interview
Written questionaires

Plan for Data Collection

WHAT data to collect

WHERE to get the data
HOW to collect them
WHO will collect
WHEN will the data be collected
HOW LONG will it takes
QUALITY CONTROL of the data

Plan for Data Analysis

The plan includes;

Data handling and
storing
Data processing
Data analysis

8. Mapping the Proposal

Construct the Gantts Chart
List down the the plan of processes to be
undertaken in conducting the study
Chart the appropriate time frame for each
process
To mark the plan and actual task carried
out

Gantts Chart
Responsibility
Prepare
Proposal

Group
members

Prepare
Checklist

Group
members

Staff
Briefing

Group
members

QA Study

SN ED/ward

Data
collection

SN ED/ward

Data
Analysis

Group
members

Remedial
Action

Group
members

Evaluation

Group
members

Report
Writing

Group
Members

Oct
1st wk

2nd wk

3rd wk

4th wk

Nov
1st wk

2nd
wk

3rd
wk

4th
wk

9. References
List down all references quoted or referred
in the study

References
1. Clinical Practice Guidelines on The
Management of HPT
( Academy of Medicine; 2002 )
2. Standard Operating Procedure for MA
( Ministry of Health; 2000 )

References
1. McCarty D., Zimmet P. 1997. Diabetes 1994 to 2010: Global

estimates and Projection- Interact in International

diabetes. Melbourne, Australia, 1997 ISBN 0640.2448.10.

2. Langer D et al, Pregestational diabetic: Insulin requirement

throughout pregnancy. Am J Obstet Gynae 1988; 159:616621

3. Life-style changes linked to global rise in diabetes- Experts

say, Press Release ; WHO/59 14 July 1994.12.
4. King H. Revers M. Diabetes in adults is now a third world
problem. Bulletin of WHO 1991. 69 (b):643 648.14
5. Diabetes facts and figures. 1997. Persatuan Diabetes
Malaysia homepage, page 15.
6. America Diabetes Association. Screening for Diabetes,
Diabetes Care, 1989; 12: 588 590.5.