Kinney Eleanor D, Kennedy John, Cook Cynthia A Loveland, Freedman Jay A, Lane Kathleen A, Hui Siu L
Center for Law and Health, Indiana University School of Law-Indianapolis, Indianapolis, Indiana 46202, USA.
Med Care. 2003 Sep;41(9):1048-57. doi: 10.1097/01.MLR.0000083744.77092.32.
It has not been demonstrated that the implementation of computerized quality improvement strategies can improve client-centered outcomes in public community based, long-term care (CBLTC) programs.
To test and evaluate 2 innovative computer-assisted, client-centered quality improvement strategies for public community-based, long-term care. The first strategy, the Normative Treatment Planning (NTP) program, assesses needs, prescribes services, and evaluates outcomes. The second strategy, the Client Feedback System (CFS) program, provides service vendors with feedback on client perceptions of services.
A 2 x 2 factorial design with the 2 strategies using cluster randomization.
A total of 2222 clients (86% of eligible program clients) enrolled in Indiana's state case management program and/or the Medicaid home and community-based services waiver program for the aged and disabled as of January 1, 1995.
Outcomes of needs met and client satisfaction were measured through telephone surveys every 6 months for 2 years.
A total of 1006 participants (45%) completed the 2-year evaluation study. For the group using only the NTP program, perception of needs met and client satisfaction were significantly better than the control group over the 2 years. During this period, the group using only the CFS program had significantly better client satisfaction than the control group. However, the effect sizes of the significant differences were small, and no statistically significant effects were found for the group using both programs.
Client-centered quality improvement strategies can be implemented to enable public CBLTC programs to meet client needs better and increase client satisfaction.
尚未证明实施计算机化质量改进策略能够改善基于公共社区的长期护理（CBLTC）项目中以客户为中心的成果。
测试和评估两种创新的、以客户为中心的计算机辅助质量改进策略，用于基于公共社区的长期护理。第一种策略是规范治疗计划（NTP）项目，评估需求、规定服务并评估结果。第二种策略是客户反馈系统（CFS）项目，向服务供应商提供客户对服务看法的反馈。
采用2×2析因设计，将两种策略进行整群随机分组。
截至1995年1月1日，共有2222名客户（占符合条件项目客户的86%）参加了印第安纳州的州病例管理项目和/或针对老年人及残疾人的医疗补助家庭和社区服务豁免项目。
在两年时间里，每6个月通过电话调查来测量需求满足情况和客户满意度等结果。
共有1006名参与者（45%）完成了为期两年的评估研究。在两年期间，仅使用NTP项目的组在需求满足感和客户满意度方面显著优于对照组。在此期间，仅使用CFS项目的组在客户满意度方面显著优于对照组。然而，显著差异的效应量较小，并且对于同时使用两个项目的组未发现统计学上的显著效果。
可以实施以客户为中心的质量改进策略，以使公共CBLTC项目能更好地满足客户需求并提高客户满意度。
