Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.

ABSTRACT: In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the "High Value Framework (HVF)" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.

Plant Density and Rhizosphere Chemistry: Does Marigold Root Exudate Composition Respond to Intra- and Interspecific Competition?

The development of techniques to non-destructively monitor allelochemical dynamics in soil using polydimethylsiloxane (PDMS) microtubing (silicone tubing microextraction, or STME) provides a means to test important ecological hypotheses regarding the roles of these compounds in plant-plant interactions. The objective of this study was to investigate the impact of intra- and interspecific competition on the exudation of thiophenes by marigolds (Tagetes patula L.). Marigolds were grown at a density of 1, 3 and 5 plants in pots (8.75 × 8.75 cm) containing two STME samplers. An additional treatment included one marigold surrounded by four velvetleaf (Abutilon theophrasti L.) plants. Marigold roots released two primary thiophenes, 3-buten-1-ynyl)-2,2'-bithienyl and α-terthienyl, which are readily absorbed by silicone microtubing. Thiophene exudation was monitored over the period 15-36 days after planting, at 2-5 day intervals. At the end of the study, root and soil samples were also analyzed for thiophene content. Thiophene production per plant increased over time, and thiophene release was strongly correlated with plant size. These results indicate that thiophene release in this study was passively controlled by resource availability. However, poor growth of velvetleaf plants competing with marigold suggests that thiophenes negatively influenced velvetleaf growth. This study, then, provides indirect evidence that thiophene exudation is insensitive to neighbor identity but differentially effective in inhibiting the growth of heterospecific neighbors.