Crossing the Quality Chasm


Book Description

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.










An Asset Management Approach for Drainage Infrastructure and Culverts


Book Description

Drainage infrastructure systems (culvert, storm sewer, outfall and related drainage elements) are mostly buried underground and are in need of special attention in terms of proactive/preventive asset management strategy. Drainage infrastructure systems represent an integral portion of roadway assets that routinely require inspection, maintenance, repair and renewal. Further challenges are the wide geospatial distribution of these infrastructure assets and environmental exposure. There has been considerable research conducted on culverts, but mostly looked at the problem from a traditional structural/geotechnical perspective. Asset management procedures for culverts and drainage infrastructure systems are complex issues, and can benefit a great deal from an optimal asset management program that draws from programs pertaining to buried pipes. The first and most important step in an asset management initiative is the establishment of mechanism for asset inventory and asset conditions in a format compatible with the routine procedures of field operators and inspectors. The first objective of this research project was to develop field protocols and operational business rules for inventory data collection and management and inspection of drainage infrastructures in terms of types of data to be collected, frequency of inspection, and analysis and reporting mechanisms. After review of these protocols by the project oversight committee, a pilot study was conducted to verify efficiency of their implementation. The condition assessment protocol introduced is useful in evaluating the overall condition of culverts and can be used for decision making regarding the repair, renewal or replacement of culverts. For the second objective of this project, investigators examined the inventory and inspection protocols employed by Ohio Department of Transportation (ODOT) and developed a decision support platform, which establishes a link between the inspection results and appropriate repair, renewal and replacement procedures. After applying the recommended procedures, the transportation agencies can better track the conditions of culverts thereby reducing the risks of culvert failures.










Great Lakes Basin Framework Study


Book Description







Transportation Conformity


Book Description

Transportation conformity is required under the Clean Air Act (CAA) Section 176(c) to ensure that Federally-supported transportation activities are consistent with (“conform to”) the purpose of a State Implementation Plan (SIP). Transportation conformity establishes the framework for improving air quality to protect public health and the environment. Conformity to the purpose of the SIP means Federal Highway Administration (FHWA) and Federal Transit Administration (FTA) funding and approvals are given to highway and transit activities that will not cause new air quality violations, worsen existing air quality violations, or delay timely attainment of the relevant air quality standard, or any interim milestone. This Guide was prepared to help State and local officials understand transportation conformity and how conformity requirements relate to transportation investments in their communities. Specifically, the implications of conformity on metropolitan transportation plans, transportation improvement programs (TIPs), and transportation projects are discussed. The Guide provides overview information on the major elements of the conformity process and provides answers to basic questions. Several exhibits are included in the Guide to illustrate key elements of the conformity process. Appendices are also included that discuss the health effects of pollutants, options to reduce on-road mobile source emissions, and resource agency contacts.




UMTA-CA


Book Description