Engels Yvonne, van den Hombergh Pieter, Mokkink Henk, van den Hoogen Henk, van den Bosch Wil, Grol Richard
Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, KWAZO 229, 6500 HB Nijmegen, Netherlands.
Br J Gen Pract. 2006 Oct;56(531):781-7.
To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management.
Randomised controlled trial.
Twenty-six intervention and 23 control primary care practices in the Netherlands.
Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later.
Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant.
The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument.
研究基于团队的持续质量改进（CQI）模式对初级保健实践管理的影响。
随机对照试验。
荷兰的26家干预初级保健机构和23家对照初级保健机构。
对有兴趣参与CQI项目的机构进行实践组织评估后，将其随机分配到干预组或对照组。在总共五次会议中，一名协调员帮助干预组的团队选择合适的质量改进主题，并采用结构化方法实现改进目标。由一名外展访问者填写的检查表、针对全科医生、工作人员和患者的问卷，用于收集干预开始前和1年后开展的改进活动的数量和质量以及实践管理方面的数据。
对26家干预机构和23家对照机构的测试前和测试后数据进行了比较。在实际确定的改进目标数量（93个对54个，P<0.001）和成功完成的目标数量（项目的80%对69%，P<0.001）方面发现了显著的干预效果。通过我们的实践访问方法衡量，干预组在实践管理的更多方面也比对照组有所改善，但这些差异均无统计学意义。
干预对所开展的改进项目的数量和质量以及实现的自我定义目标产生了显著影响。干预在实践管理的其他维度上未能产生显著效果，可能是由于一些改进项目选择的主题仅部分涵盖在评估工具中。
