Gillon Maureen, Buetow Stephen, Wellingham John, Talboys Sarah
RNZCGP, Wellington, New Zealand.
N Z Med J. 2003 Nov 21;116(1186):U682.
This paper describes the development, implementation and validation of general practice standards, supported by a continuous quality improvement (CQI) process that teaches practice teams how to work together to identify and enhance the quality of care they provide.
Practice standards were developed through consensus by key stakeholders in general practice, pre-tested in four practices, and refined and piloted in 20 practices throughout New Zealand during 1999. A further field trial was undertaken to validate the standards and test the process of practice assessment. During 2000-2001, 74 practices volunteered to be assessed against the standards. Sixty one general practitioners, practice nurses and practice managers, nominated from independent practitioner associations (IPAs) or primary care organisations (PCOs), were trained to undertake the assessments.
On five of 13 variables, no statistically significant differences at the 0.05 level were identified between the practices in the field trial and a random sample of practices studied by Kljakovic. The Royal New Zealand College of General Practitioners (RNZCGP) standards were found to have excellent face validity and content validity, and good construct validity. Internal consistency was fair. Lessons from the evaluation have informed an improved version of the practice assessment tool.
The validation field trial provided the RNZCGP with a framework and tool for an accreditation process based on the principles of CQI. The tool offers patients and other stakeholders a credible measure of quality and safety at the practice level through a process bridging quality control and quality improvement.
本文描述了全科医疗标准的制定、实施及验证过程，该过程由持续质量改进（CQI）流程提供支持，该流程指导医疗团队如何共同协作，以识别并提高他们所提供的医疗服务质量。
全科医疗标准由全科医疗领域的关键利益相关者通过协商一致制定，在四个医疗机构进行了预测试，并于1999年在新西兰的20个医疗机构进行了完善和试点。又进行了一次现场试验，以验证这些标准并测试医疗评估过程。在2000 - 2001年期间，74个医疗机构自愿对照这些标准接受评估。从独立执业者协会（IPA）或初级保健组织（PCO）中提名的61名全科医生、执业护士和医疗机构管理人员接受了评估培训。
在13个变量中的5个变量上，现场试验中的医疗机构与Kljakovic研究的随机抽取的医疗机构样本之间，在0.05水平上未发现统计学上的显著差异。发现新西兰皇家全科医生学院（RNZCGP）的标准具有出色的表面效度和内容效度，以及良好的结构效度。内部一致性尚可。评估所得经验为改进后的医疗评估工具提供了参考。
验证性现场试验为RNZCGP提供了一个基于CQI原则的认证流程框架和工具。该工具通过一个连接质量控制和质量改进的过程，为患者及其他利益相关者提供了一种在医疗机构层面衡量质量和安全的可靠方法。
