Margolis Peter A, McLearn Kathryn Taaffe, Earls Marian F, Duncan Paula, Rexroad Annette, Reuland Colleen Peck, Fuller Sandra, Paul Kimberly, Neelon Brian, Bristol Tara E, Schoettker Pamela J
Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45299, USA.
Ambul Pediatr. 2008 Nov-Dec;8(6):383-7. doi: 10.1016/j.ambp.2008.06.007. Epub 2008 Aug 22.
The aim of this study was to use family-centered measures to estimate the effect of a collaborative quality improvement program designed to help practices implement systems to promote early childhood development services.
A cohort study was conducted in pediatric and family practices in Vermont and North Carolina. Eighteen collaborative education practices and 17 comparison practices participated in a 12-month program to assist practices in implementing improved systems to provide anticipatory guidance and parental education. The main outcome measures were change over time in parent-reported measures of whether children received each of 4 aspects of recommended care, documentation of developmental and psychosocial screening, and practice-reported care delivery systems.
The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P=.0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P<.001) and from 22% to 29% (P=.002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care.
The learning collaborative was associated with an increase in the number of practice-based systems and tools designed to elicit and address parents' concerns about their child's behavior and development and a modest improvement in parent-reported measures of the quality of care.
本研究旨在采用以家庭为中心的方法，评估一项协作质量改进项目的效果，该项目旨在帮助医疗机构实施促进幼儿发展服务的系统。
在佛蒙特州和北卡罗来纳州的儿科及家庭医疗诊所开展了一项队列研究。18个协作教育诊所和17个对照诊所参与了为期12个月的项目，以协助诊所实施改进后的系统，提供预期指导和家长教育。主要结局指标包括家长报告的儿童是否接受了推荐护理的4个方面中每一项的变化、发育和心理社会筛查的记录，以及诊所报告的护理提供系统。
协作诊所的护理提供系统数量从平均27个中的12.9个增加到19.4个，对照诊所则保持不变（P = 0.0002）。干预诊所中记录有发育和心理社会筛查的儿童比例分别从78%增至88%（P < 0.001）和从22%增至29%（P = 0.002）。与对照诊所相比，报告至少接受4个护理领域中3个领域护理的家长比例有改善趋势。
学习协作与旨在引发和解决家长对其孩子行为和发育问题担忧的基于诊所的系统和工具数量增加相关，且家长报告的护理质量指标有适度改善。
