Abstract Paper aims This study has the objective of mapping and empirically validating KPIs that can be used to assess healthcare supply chain risks. Originality We combined two methodological approaches: i) we conducted a systematic literature review to identify the healthcare supply chain risk assessment KPIs and ii) We grouped these KPIs into five constructs and validated their relations using PLS-SEM. Research method This is the only study that presents a systematic literature review to identify KPIs that measure healthcare supply chain risks, groups the KPIs into a theoretical framework, and presents a PLS-SEM validation. This study used data from Brazil, from a variety of healthcare supply chain organizations (suppliers, OEMs, clinics, and hospitals), therefore we cannot guarantee that the study can be generalized. Main findings The systematic literature review identified 27 KPIs which were grouped into five constructs. The structural model supported by the PLS-SEM technique revealed that reliability, responsiveness, costs, and agility are antecedents to healthcare supply chain quality. Implications for theory and practice Managers may rely upon this study to understand that healthcare supply chain reliability and responsiveness are antecedents to healthcare supply chain costs and agility, which are antecedents to healthcare supply chain quality.

ABSTRACT: Key performance indicators (KPI) are essential to decision-making in an organization, but the approach to analysis and composition used in the formulation of the KPIs can lead to errors. Analysis based only on averages does not allow for discriminating between variations that are natural to the process or special cases which require investigation. The use of control charts can identify this differentiation. However, when several charts are presented encompassing different measurement units and scales, systemic interpretation can be impaired. To assist in this interpretation, this research study aimed at proposing a method to facilitate the analysis of control charts when multiple indicators are employed in the monitoring of agricultural operations. Based on the data obtained over 26 weeks from a mechanized sugarcane (Saccharum officinarum L.) harvesting front, six indicators were defined and analyzed through individual control charts and, systemically, through a standardized group control chart. Results show that the points identified as being outside the control zone (special causes of variation) according to the standardized group control chart were the same as those identified by the six individual charts, which demonstrates the potential of this method to summarize the information with no loss of quality of analysis.

Resumen La presente investigación aplicó la gestión por procesos del Consorcio Ferretero Cielo Azul SAC para diagnosticar las fallas dentro del proceso de venta corporativa en el año 2020. El tipo de investigación fue aplicada, así como el diseño descriptivo simple. El estudio tuvo como población los tres procesos realizados durante una venta corporativa del Consorcio Ferretero Cielo Azul SAC. Para ello se utilizaron técnicas de mapeo de procesos, diagrama de flujo, mapa de recorrido del cliente, diagrama FAST, diagrama SIPOC, criterio SMART, Casa 1 de la Calidad, Casa 2 de la Calidad, diagrama de Pareto, diagrama Causa-Efecto y Matriz AMEF. Este trabajo se limita porque solo se realiza el diagnóstico de los procesos de una venta corporativa de la empresa. Finalmente, como resultado encontramos nueve actividades críticas con sus respectivas causas potenciales de falla dentro del proceso estudiado.

Abstract The present research applied the process management of the Consortium Ferretero Cielo Azul SAC to diagnose failures within the corporate sales process in 2020. The type of research was applied and the descriptive design simple. The study had as a population the 3 processes carried out during a corporate sale of the Consorcio Ferretero Cielo Azul SAC. Process mapping techniques, flow diagram, customer travel map, FAST diagram, SIPOC diagram, SMART criteria, Quality House 1, Quality House 2, Pareto diagram, Cause-Effect diagram and AMEF matrix were used for this purpose. This work is limited because only the processes of a corporate sale of the company are diagnosed. Finally, as a result we found 9 critical activities with their respective potential causes of failure within the process studied.

Abstract: The study’s objectives are to make a definition of Creative University and describe the activities management towards creative university based on the Key Performance Indicator (KPI) completion. Universities have KPI which consists of Index of Activities Performance (IAP) and Index of Main Performance (IMP) with the constraints of time and cost. Creative University is a university with creative activities such that the completion of KPI is accomplished within shorter duration and less cost. There are three activities management to accelerate the KPI completion those are creating activities that could minimize the distance between IAP and IMP, creating the schedule of activities, and managing the schedule based on the strategy of academic phases in university.

Abstract Background and objective: Assess changes in disease management and the treatment of renal cancer after the implementation of improvement initiatives, particularly from the Renal Tumor Board at the Oncology hospital at Centro Médico Nacional (CMN) Siglo XXI. Material and methods: Observational and retrospective study over a sample of kidney cancer patients at CMN Siglo XXI. KPI (Key Performance Indicators) were selected to measure time, efficiency, and compliance level in patient journey key processes. Results: A database was created with information of 741 patients with variables obtained from different therapeutic areas. After 5 months of the Renal Tumor board implementation, results showed an average compliance level of 37% in the KPIs assessed. After 2 years of the Renal Tumor Board implementation, results showed a compliance level of 47% in KPIs assessed. Conclusions: Implementation of initiatives resulted in better kidney patient management and care at the Oncology Hospital at CMN Siglo XXI. Particularly, improvements in waiting time from reference to treatment initiation was observed.

Resumen Introducción y objetivo: Medir el impacto en la gestión del tratamiento del cácer renal a partir de la implementación de acciones, incluyendo el comité de tumores renales, en el Hospital de Oncología del Centro Médico Nacional (CMN) Siglo XXI. Material y métodos: Estudio observacional retrospectivo sobre una muestra de pacientes con cáncer renal en la Unidad Médica de Alta Especialidad (UMAE), Hospital de Oncología del CMN Siglo XXI. Se seleccionaron indicadores de gestión para medir tiempo, eficiencia y nivel de cumplimiento de procesos clave en el flujo de un paciente con cáncer renal. Resultados: Se creó una base de datos con información de 741 pacientes con variables de distintas áreas terapéuticas. Tras 5 meses, se estimó un cumplimiento promedio de 37% en los indicadores evaluados. Tras 2 a ños, un cumplimiento del 47%. Conclusiones: La implementación de las acciones resultó en mejoras en la gestión y atención de pacientes con cáncer renal en la UMAE, Hospital de Oncología del CMN Siglo XXI, particularmente en el tiempo promedio entre referencia e inicio del tratamiento.

ABSTRACT: Key Performance Indicators (KPI) are management tools widely used by companies around the world to measure and evaluate the performance of their processes and manage them in the most effective and efficient way possible. In the port areas, the general trend in the operation analysis of a container terminal is to compare the ratios and international parameters that appear in the international literature on port exploitation and planning. These criteria allow to work and to establish what operation of a terminal moves away or approaches from international parameters. The objective of this research is to find a relationship between KPI and sustainability indicators in their environmental field, of container terminals, applied this to the Spanish Port System. The aim is to find a series of indicators from the point of view of operational and environmental management. The main conclusion of the research is that the terminals of Spanish Port System are heterogeneous in productivity management and in environmental management, so it is very difficult to establish clear relationships.

RESUMEN Los indicadores clave de desempeño de los procesos o KPI (Key Performance Indicator) son herramientas de gestión ampliamente utilizadas por las empresas en todo el mundo para medir y evaluar el desempeño de sus procesos y gestionarlos de la manera más eficaz y eficiente posible. En el ámbito portuario, la tendencia general en el análisis de la explotación de una terminal de contenedores es comparar los ratios y parámetros internacionales que aparecen en la bibliografía internacional sobre explotación y planificación portuaria, criterios con los que se explotan, y así establecer lo que una terminal se aleja o se acerca en su explotación a los valores de estos parámetros internacionales. El objetivo de esta investigación es encontrar una relación entre los indicadores de productividad (KPI) y los indicadores de sostenibilidad en su ámbito medioambiental, de las terminales de contenedores del sistema portuario español. Se pretende encontrar una serie de indicadores para el estudio de las terminales de contenedores, desde el punto de vista de la gestión operativa y ambiental. La principal conclusión de la investigación es que las terminales de contenedores del sistema portuario español, son heterogéneas tanto en la gestión de la productividad como en la ambiental por lo que es muy difícil establecer relaciones claras.

A terceira missão universitária está em constante mudança na tentativa de acompanhar as demandas sociais, promoção e cultura. Mensurar como atividades da universidade e compartilhar com a sociedade é atender os princípios da governança, como transparência, prestação de contas e responsabilidade. Este artigo objetiva identificar possíveis indicadores da terceira missão universitária e os principais conceitos e construções relacionadas ao tema. Desenvolveu-se uma revisão sistemática de literatura (RSL) e da análise bibliométrica, por meio do método Systematic Search Flow (SSF). Conclui-se que, mensurar como atividades da terceira missão universitária e seus impactos sociais, apesar de todos os esforços acadêmicos e governamentais, não é uma tarefa fácil.A dificuldade está nas múltiplas atividades e interpretações do que é a terceira missão, porém,

The third university mission is constantly changing in an attempt to keep up with social, economic and cultural demands. Measuring the activities of the university and sharing it with society is meeting the principles of governance, such as transparency, accountability and responsibility. This article aims to identify possible indicators of the third university mission and the main concepts and constructs related to the theme. A systematic literature review (RSL) and bibliometric analysis was carried out using the Systematic Search Flow (SSF) method. It is concluded that measuring the activities of the third university mission and its social impacts, despite all academic and governmental efforts, is not an easy task. The difficulty lies in the multiple activities and interpretations of what the third mission is, however, as a result of the research, the main indicators covering the theme will be presented. 

La tercera misión universitaria cambia constantemente en un intento por mantenerse al día con las demandas sociales, económicas y culturales. Medir las actividades de la universidad y compartirlas con la sociedad es cumplir con los principios de gobernanza, como la transparencia, la rendición de cuentas y la responsabilidad. Este artículo tiene como objetivo identificar posibles indicadores de la misión de la tercera universidad y los principales conceptos y constructos relacionados con la temática. Se realizó una revisión sistemática de la literatura (RSL) y un análisis bibliométrico mediante el método Systematic Search Flow (SSF). Se concluye que medir las actividades de la tercera misión universitaria y sus impactos sociales, a pesar de todos los esfuerzos académicos y gubernamentales, no es una tarea fácil. La dificultad radica en las múltiples actividades e interpretaciones de lo que es la tercera misión, sin embargo, como resultado de la investigación se presentarán los principales indicadores que cubren el tema.

Resumo: O marketing surgiu para ampliar a relação entre o consumidor e a empresa. Mas para resistirem no contexto atual, as empresas devem aumentar as suas ações estratégicas de marketing digital. Isso requer especificidade, o que ressalta a importância das métricas e monitoramento, que consiste em avaliar os resultados obtidos dessas ações. Este estudo compara as respostas de importantes empresários da região (Algarve), no setor do marketing digital e TIC, a um questionário quanto ao seu desempenho em termos de media social. Da análise qualitativa feita (em Nvivo), sobre o conteúdo obtido, denota-se uma ‘maturidade’ diferenciada em termos das suas perceções dos clientes pelas redes sociais. Alguns revelam um estádio menos maduro, i.e., em termos das métricas de media social usadas no sentido de melhorarem as suas estratégias no atual contexto de mercado. Nesse sentido, estes denotam uma maior preocupação com conteúdos e soluções económicas do que com conteúdos e alterações focadas em produtos chave. A escolha dos KPI certos, a integração de canais e o recurso a influencers são práticas a explorar mais.

Abstract: Marketing emerged to expand the relationship between the consumer and the company. But in order to resist in the current context, companies must increase their strategic actions of digital marketing. This requires specificity, which highlights the importance of metrics and monitoring, which consists of evaluating the results obtained from those actions. This study compares the responses of important entrepreneurs in the region (Algarve), in the sector of digital marketing and ICT, to a questionnaire regarding their performance in terms of social media. From the qualitative analysis carried out (in Nvivo), on the content obtained, there is a different ‘maturity’ in terms of their perceptions of customers through social networks. Some reveal a less mature stage, i.e., in terms of social media metrics used to improve their strategies in the current market context. In this sense, these show a greater concern with content and economical solutions than with content and changes focused on key products. Choosing the right KPIs, integrating channels and using influencers are practices to further explore.

Abstract The key performance indicators (KPI) to the processes are of relevance, of priority and their study is justified, because they make it possible to measure in order to evaluate and improve medical care. Whose objective is to respond to why the KPI are important in the processes and how to define them according to their application. It refers to an analytical, conceptual and deductive reasoning study. Explanatory scope for its correlation of strategic KPI to processes, according to the importance of activities in medical services. The result leads to an understanding of the KPI model proposal for processes with strategic alignment levels. Finally, the KPI model for processes with levels of strategic alignment is presented, which it visualizes in an integral way and that contributes in its application to improve the quality in the medical service to the patient in the process.

Resumen Los indicadores de desempeño (también conocidos como KPI [Key Performance Indicator]) de los procesos son de relevancia, de prioridad y se justifica su estudio, porque posibilitan medir para poder evaluar y mejorar la atención médica. El objetivo es dar respuesta al por qué son importantes los KPI en los procesos y cómo definirlos de acuerdo con su aplicación. Se refiere a un estudio analítico, conceptual y con razonamiento deductivo, de alcance explicativo para su correlación de KPI estratégicos a los procesos, de acuerdo con la importancia de las actividades en los servicios médicos. El resultado lleva a comprender la propuesta de modelo de los KPI para procesos con niveles de alineamiento estratégico. Finalmente, se presenta el modelo de KPI para procesos con niveles de alineamiento estratégico, que visualiza de manera integral y que coadyuva en su aplicación a mejorar la calidad en el servicio médico al paciente en el proceso.

ABSTRACT: The study offers an analysis of the process of Communication 2.0 in the social accounts of the health authorities belonging to the Andean Community during the worldwide public health campaig-ns. Qualitative and quantitative methods were brought together in order to measure content analysis and user involvement. Interviews with experts supplement the findings. Results: None of the health organizations generated an optimal Communication 2.0 index, on FaceBook, corporate messages pre-dominated, but they were not interactive. On Twitter, the messages were educational but not corporate. The health bodies which were evaluated are essential organs of formal communication, so their com-munication strategies should be focused on the needs of their audience. A weak Communication 2.0 and a weak level of interest have been noted in the mandated campaign of these essential bodies that encompass, in considerable measure, institutional management. Nevertheless, users show a greater engagement with educational programs, principally computer graphics and videos, on Facebook.

RESUMEN: El estudio ofrece un análisis de la gestión de la comunicación 2.0 en las cuentas sociales de las autoridades sanitarias pertenecientes a la Comunidad Andina durante las campañas mundiales de salud pública. Se articulan métodos cuantitativos y cualitativos para medir la eficiencia comunicativa, análisis de contenido e involucramiento de los usuarios. Los resultados se complementan con entrevis-tas a expertos. Ninguno de los organismos de salud genera un Índice de Comunicación 2.0 óptimo. En Facebook predominan mensajes corporativos y no interactivos. En Twitter los mensajes son educativos y no corporativos. Los organismos de salud evaluados son entes primordiales de comunicación formal por lo que sus estrategias comunicativas deben estar centradas en las necesidades de sus públicos. Como conclusión se determina una débil comunicación 2.0 e interés de estos organismos por determinadas campañas que abarcan en considerable medida la gestión institucional; sin embargo, los usuarios mues-tran mayor compromiso por publicaciones educativas, principalmente infografías y vídeos en Facebook.

Objective: The Outcomes and Assessment Committee at the Virginia Commonwealth University School of Pharmacy was tasked with refining the school's key performance indicators (KPIs) to improve programmatic assessment by focusing on the most important measures. Methods: Initially, 56 KPIs were tracked, nine of which were university mandated, divided into 10 modules: admissions, community outreach, continuing education, diversity, faculty experience and success, fundraising, graduate program, research and scholarship, staff experience and success, and student experience and success. Using a three-round Delphi consensus technique, KPIs were reviewed by faculty and staff. Each participant responded whether they considered each KPI to be essential or not essential for school quality assessment and improvement. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results: Of 109 faculty and staff invited, 49 participated in the first round, 51 in the second, and 42 in the third. At the end of the third round, accumulated consensus was achieved for 35 out of 88 (39.8%) KPIs that were considered essential and 3 out of 88 (3.4%) that were considered non-essential. Consensus percentage per module was: 15.4% (2/13) admissions, 28.6% (2/7) community outreach, 33.3% (3/9) continuing education, 27.3% (3/11) diversity, 62.5% (5/8) faculty experience and success, 55.6% (5/9) fundraising, 40% (4/10) graduate program, 33.3% (3/9) research and scholarship, 57.1% (4/7) staff experience and success, and 66.7% (4/6) student experience and success. Conclusions: Ultimately, 35 KPIs achieved consensus as essential to measure achievement of benchmarks for the school, which totals 44 KPIs, including nine university mandated KPIs. The process facilitated faculty and staff involvement in KPI selection and achieved improved focus for programmatic assessment.

Resumen Para las organizaciones es importante conocer el comportamiento de los procesos a través de la gestión del riesgo y la evaluación de los indicadores clave de desempeño (Key Performance Indicators, KPI). Un propósito del ciclo de mejoramiento continuo "planear - hacer - verificar - actuar" (PHVA) es determinar el estado de los indicadores y realizar reingeniería de procesos para lograr el cumplimiento ideal. La gestión del riesgo previene la desviación de los indicadores frente a las metas propuestas. Para determinar las variables relevantes de un proceso es necesario establecer mecanismos de monitoreo y control como forma eficiente de obtención de conocimiento basado en el uso de técnicas como las de minería de datos (MD). Estos conceptos se han articulado aquí en un modelo desarrollado para lograr el estado ideal de los KPI en una organización, y se evidencian a través de un caso de estudio aplicado en un proceso misional de una institución de educación superior, por medio del cual se describe el éxito de la teoría y el análisis planteados. Este modelo establece unos componentes a partir de la articulación de características de MD, la gestión de procesos de negocio o Business Process Management (BPM) y el ciclo PHVA con gestión del riesgo, de tal suerte que se hace posible un diseño ajustado a las necesidades particulares que sirve como modelo para investigaciones futuras.

Abstract Recognizing the behavior of processes through risk management and the assessment of value indicators (KPI), which stands for 'Key Performance Indicators', is something of paramount importance for institutions. One of the purposes of the continuous PDCA improvement cycle (Plan - Do - Check - Act) is to determine the state of the indicators and carry out processes reengineering to achieve the ideal goal. Risk management comes from the deviation of the indicators with respect to the proposed goals. In order to determine the relevant variables of a process, monitoring and control mechanisms must be set as an efficient way to obtain the knowledge based on the use of data mining techniques (MD). These concepts articulate in a model that was developed to achieve the ideal condition of the KPIs within an institution, and it is evidenced through a case study applied to a missional process in an institution of higher education. The establishment of data mining, business process management (BPM), PDCA continuous improvement cycle (Plan - Do - Check - Act), and risk management characteristics was used to define the components of the model. The aforementioned allowed to create an effective model, capable of meeting the needs of this research in particular, and able to be used as a model for future research. The proposed model was applied to a specific case, which allowed to describe the success of the theory, as well as the analysis stated.

Resumo Para as organizações é importante conhecer o comportamento dos processos por meio da gestão de risco e da avaliação dos indicadores chave de desempenho (Key Performance Indicators, KPI). Um propósito do ciclo de melhoria contínua "planejar - fazer - verificar - agir" (PHVA) é determinar o estado dos indicadores e realizar reengenharia de processos para conseguir a execução ideal. A gestão de risco previne o desvio dos indicadores diante das metas propostas. Para determinar as variáveis relevantes de um processo é necessário estabelecer mecanismos de monitoramento e de controle como forma eficiente de obtenção de conhecimento baseado no uso de técnicas como as de mineração de dados (MD). Esses conceitos foram articulados aqui num modelo desenvolvido para alcançar o estado ideal dos KPI numa organização, e são evidenciados por meio de um caso de estudo aplicado num processo missional de uma instituição de educação superior, por meio do qual se descreve o sucesso da teoria e das análises propostas. Esse modelo estabelece uns componentes a partir da articulação de características de MD, a gestão de processos de negócio ou Business Process Management (BPM) e o ciclo PHVA com gestão de risco, de tal forma que se torna possível um desenho ajustado às necessidades particulares que serve como modelo para pesquisas futuras.

RESUMEN Objetivo: El objetivo de este trabajo es mostrar cómo el uso de un sistema de control de producción que registra y gestiona las operaciones mineras, enfocado en el seguimiento y control de los equipos, procesos y activos, mejora la eficiencia del sistema de información de una empresa, de modo que tenga un soporte adecuado. Metodología: En este trabajo se utiliza el software Pitram versión 1.0, desarrollado por la empresa Micromine, que permite detectar las falencias en el sistema de información del área de producción en una pequeña mina subterránea de oro y plata, ubicada en Argentina. La metodología consistió en cinco pasos fundamentales: a) capacitación, b) recolección de datos, c) ingreso de datos al sistema, c) validación del modelo y d) análisis y resultados. Resultados: Se obtuvo una mayor cantidad y variedad de datos con respecto a la información que registraba la empresa al momento de realizar el presente trabajo, que fueron propicios para tomar decisiones sobre el control de insumos, seguimiento de equipos primarios, seguimiento de operarios de equipos primarios, cálculo de KPI y control de objetivos. Además, se optimizó la administración de los datos, lo que significó la disponibilidad de estos en todo momento, menor cantidad horas hombres en el manejo de datos, menor consumo de recursos de almacenamiento, mayor seguridad, etc. Conclusiones: El software implementado satisfizo la necesidad de información de la empresa, al minimizar la incertidumbre y reducir la posibilidad de cometer errores que podrían causar pérdidas económicas. Además, permitió mejorar la eficiencia operativa y optimizar la distribución de recursos, y así, una mejor rentabilidad.

ABSTRACT Objective: The objective of this work is to show how the use of a production control system that records and manages mining operations, focused on the monitoring and control of equipment, processes and assets, improves the efficiency of a company's information system, so that it has adequate support. Methodology: This work uses Pitram software version 1.0, developed by the company Micro-mine, which allows detecting the flaws in the information system of the production area in a small underground gold and silver mine, located in Argentina. The methodology consisted of five fundamental steps: 1. Training, 2. Data collection, 3. Data entry to the system, 4. Validation of the model, 5. Analysis and results. Results: A greater amount and variety of data were obtained that were conducive to making decisions about input control, monitoring of primary equipment, monitoring of operators of primary equipment, calculation of KPI and control of objectives. In addition, data management was optimized, which meant their availability at all times, fewer man hours in data management, lower consumption of storage resources, greater security, etc. Conclusions: The software implemented was able to meet the company's information need by minimizing uncertainty and reducing the possibility of making mistakes that could cause economic losses. In addition, it improved operational efficiency and optimized the distribution of resources, achieving better profitability.

Resumo Introdução: Os inquéritos de saúde constituem uma importante fonte de informação para conhecer o estado de saúde da população. Visto que os erros associados aos inquéritos podem afetar significativamente as estimativas, invalidando as suas conclusões, é crucial monitorizar o progresso do trabalho de campo. Este estudo teve como objetivo descrever a monitorização do trabalho de campo realizado durante o primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF) referente a desvios ao protocolo e principais indicadores de desempenho (KPI). Métodos: Dados resultantes da observação dos entrevistadores e do controlo estatístico de qualidade de alguns dos KPI foram utilizados para monitorizar as quatro componentes do inquérito (recrutamento, exame físico; colheita de sangue e questionário de saúde), durante a implementação do trabalho de campo. Os KPI selecionados incluíram a taxa de resposta, distribuição do tempo médio de realização dos procedimentos, proporção do último dígito para medidas específicas, proporção de amostras de sangue hemolisadas e dos valores omissos. Resultados: A observação dos entrevistadores permitiu identificar e corrigir atempadamente desvios ao protocolo. Após a implementação de medidas corretivas, com base na monitorização dos KPI, a taxa de participação aumentou 2,5 vezes e foi observada uma redução de 4,4 vezes na não adesão aos procedimentos padronizados para a medição da pressão arterial. Após o estudo piloto, a proporção de medições com o dígito terminal de 0 ou 5 diminuiu para 19,6% e 16,5%, respectivamente. A proporção de amostras hemolisadas foi inferior a 2,5%. A proporção dos valores omissos foi minimizada comunicando-os imediatamente ao entrevistador, que poderia recontactar o participante e completar a informação. Discussão/Conclusão: Embora a maioria dos desvios ao protocolo tenha ocorrido durante as primeiras semanas do trabalho de campo, os resultados mostram a importância da sua monitorização continua nos inquéritos de saúde de forma a garantir a qualidade dos dados recolhidos.

Abstract Introduction: Health surveys constitute a relevant information source to access the population’s health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey.

Abstract Background: Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored. Objective: This study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke. Methods: We included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients’ baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal. Results: A total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05). Conclusions: KPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients.