Solberg Leif I, Hroscikoski Mary C, Sperl-Hillen JoAnn M, Harper Peter G, Crabtree Benjamin F
HealthPartners Research Foundation, Minneapolis, Minn 55440-1524, USA.
Ann Fam Med. 2006 Mar-Apr;4(2):109-16. doi: 10.1370/afm.424.
Most published descriptions of organizations providing or improving quality of care concern large medical groups or systems; however, 90% of the medical care in the United States is provided by groups of no more than 20 physicians. We studied one such group to determine the organizational and cultural attributes that seem related to its achievements in care quality.
A 15-family physician medical group was identified from comparative public performance scores of 27 medical groups providing most of the primary care in our metropolitan area. Semistructured interviews were conducted with diverse personnel in this group, operations were observed, and written documents were reviewed. Four primary care physician researchers and a consultant then reviewed transcriptions, field notes, and materials during semistructured sessions to identify the main attributes of this group and their probable origins.
This medical group ranked first in a composite measure of preventive services and fourth and sixth, respectively, in composite scores for coronary artery disease and diabetes care. Our analysis identified 12 attributes of this group that seemed to be associated with its good care quality, with patient-centeredness being the foundational attribute for most of the others. Historical factors important to most of these attributes included small size, physician ownership, and a high value on practice consistency among the clinicians in the group.
The identified 12 attributes of this medical group seem to be associated with its superior care quality, and most of them might be replicable by other small groups if they choose to work toward that end.
大多数已发表的关于提供或改善医疗质量的组织的描述都涉及大型医疗集团或系统；然而，美国90%的医疗服务是由不超过20名医生的团队提供的。我们研究了这样一个团队，以确定与其在医疗质量方面的成就相关的组织和文化属性。
从为我们大都市区提供大部分初级医疗服务的27个医疗团队的比较公共绩效评分中，识别出一个由15名家庭医生组成的医疗团队。对该团队的不同人员进行了半结构化访谈，观察了其运营情况，并查阅了书面文件。然后，四名初级医疗医生研究人员和一名顾问在半结构化会议期间审查了转录内容、现场笔记和材料，以确定该团队的主要属性及其可能的来源。
在预防服务综合指标中，这个医疗团队排名第一，在冠状动脉疾病和糖尿病护理综合评分中分别排名第四和第六。我们的分析确定了该团队的12个属性，这些属性似乎与其良好的医疗质量相关，以患者为中心是其他大多数属性的基础属性。对这些属性中的大多数来说，重要的历史因素包括规模小、医生所有制以及团队中临床医生对实践一致性的高度重视。
该医疗团队确定的12个属性似乎与其卓越的医疗质量相关，如果其他小团队选择朝着这个目标努力，其中大多数属性可能是可以复制的。
