Swing Susan R, Schneider Sandra, Bizovi Ken, Chapman Dane, Graff Louis G, Hobgood Cherri, Lukens Thomas, Radford Martha J, Sanders Arthur, Smith-Coggins Rebecca, Spillane Linda, Hruska Laura, Wears Robert L
Department of Research and Education, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
Acad Emerg Med. 2007 May;14(5):463-73. doi: 10.1197/j.aem.2006.12.011. Epub 2007 Mar 29.
To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine.
A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness.
The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality.
Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues.
报告一个项目的结果，该项目旨在开发并实施一种原型方法，用于识别候选患者护理质量指标，以潜在地用于评估急诊医学毕业后医学教育的结果和有效性。
召集了一个由急诊医学住院医师教育和患者护理质量测量专家组成的工作组。工作组成员进行了一个改良的德尔菲法流程，包括对潜在指标的迭代审查；专家对指标在四个维度上进行个体评分，包括护理质量指标和教育有效性指标；就保留的指标达成共识；外部利益相关者对指标进行评分，随后进行工作组最终审查；以及对指标进行事后分层。工作组完成了一项结构化活动，以检查患者护理过程和结果指标与教育有效性之间的联系。
工作组选择了62项指标纳入其最终集合，包括针对21种临床情况的43项指标、8项用药指标、7项操作指标和4项科室效率指标。26项指标符合事后应用的更严格标准，以进一步对指标进行分层并确定开发的优先级。其中19项指标在急诊护理的重要性、护理质量指标和教育有效性指标方面，获得了75%的工作组成员和外部利益相关者评分者的高评分；大多数评分者认为这些指标可进行测量。工作组利用一个简单的框架来探索住院医师培训项目教育活动、来自毕业后医学教育认证委员会六个一般能力领域的能力、患者护理质量指标以及可能干预以影响护理质量的外部因素之间的关系。
众多患者护理质量指标有潜力用于评估急诊医学毕业后医学教育项目的教育有效性和表现。本报告中确定的指标可作为进一步开发、实施和研究的起始集。这些指标的实施，尤其是用于高风险用途时，将需要解决重大的测量问题。
