Ward Marcia M, Yankey Jon W, Vaughn Thomas E, BootsMiller Bonnie J, Flach Stephen D, Watrin Shea, Doebbeling Bradley N
Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242-1008, USA.
J Eval Clin Pract. 2005 Aug;11(4):379-87. doi: 10.1111/j.1365-2753.2005.00541.x.
RATIONALE, AIMS AND OBJECTIVES: A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline.
We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers' views of the COPD guideline and guidelines in general, and attitudes about the organizational climate.
Surveys were returned by 242 key informants (58%) at 130 of the 143 VHA hospitals (91%). Adherence to the COPD clinical practice guideline is perceived by quality managers within the VHA to be good. The final multivariable predictor model identified five measures that were related to provider adherence with the COPD guideline (R(2) = 0.43): responsibilities were changed to support adherence to the COPD guideline, physicians believe that guidelines implemented in the past year were applicable to their practice, patient care providers consistently participate in activities to improve the quality of care, the regional network office monitors the pace at which guidelines are implemented, and there is a system to provide feedback on routinely collected guideline adherence data collected in addition to External Peer Review Program data.
Organizations can play an important role in providing a supportive climate to facilitate their providers' adherence to guidelines by implementing processes and culture changes that involve these five measures.
原理、目的和目标：美国所有退伍军人健康管理局（VHA）医院都实施了慢性阻塞性肺疾病（COPD）临床实践指南。当前分析的目的是描述当前的依从率以及与医疗服务提供者对COPD指南依从性相关的组织因素。
我们对关键信息提供者进行了一项调查，评估对COPD指南的依从性、传播和实施COPD指南的方法、医疗服务提供者对COPD指南及一般指南的看法，以及对组织氛围的态度。
143家VHA医院中的130家（91%）的242名关键信息提供者（58%）回复了调查问卷。VHA内部的质量管理人员认为对COPD临床实践指南的依从性良好。最终的多变量预测模型确定了五项与医疗服务提供者对COPD指南依从性相关的指标（R² = 0.43）：职责发生改变以支持对COPD指南的依从性、医生认为过去一年实施的指南适用于他们的实践、患者护理提供者持续参与提高护理质量的活动、区域网络办公室监测指南实施的进度，以及存在一个系统，除了外部同行评审计划数据外，还能就常规收集的指南依从性数据提供反馈。
组织可以通过实施涉及这五项措施的流程和文化变革，在营造支持性氛围以促进其医疗服务提供者遵守指南方面发挥重要作用。
