Varkey Prathibha, Sathananthan Airani, Scheifer Amanda, Bhagra Sumit, Fujiyoshi Akira, Tom Andrea, Murad Mohammad Hassan
Division of Preventive and Occupational Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Qual Prim Care. 2009;17(3):205-13.
Patients recall less than half the information provided to them by their physicians.
The aim of this study was to use quality-improvement (QI) techniques to enhance patient understanding of diagnosis, management and follow-up at the end of the office visit.
QI techniques including stakeholder analysis, process mapping and plan-do-study-act (PDSA) cycles were used in a pilot study in an outpatient endocrinology clinic specialising in bone disease. The impact of these interventions was evaluated by pre- and post-intervention patient surveys that included qualitative and quantitative data.
A team of endocrinology fellows and faculty with expertise in QI developed a series of tools to encourage conversation and interaction during the encounter and to serve as a reference for patients to take home through five PDSA cycles. The tools were iterations of written materials provided to patients at the end of the clinical encounter. In each cycle, the tools were modified according to feedback from patients and providers. Ninety-three patients participated in this study. Patients were surveyed after the implementation of two of the five cycles. Compared with pre-intervention, modifications during the two cycles were associated with a non-significant increase in patients' understanding of the reasons for testing (from 64% to 80% and 75%); management plan (from 61% to 86% and 79%); and future follow-up plans (from 64% to 86% and 81%); P > 0.05 for all three outcomes. Improvement was not seen in patients' knowledge of their diagnoses (from 74% to 73% and 70%; P > 0.05).
This pilot study shows how QI tools can be used for creating and initiating system improvements aimed at enhancing patient education and counselling.
患者对医生提供给他们的信息的回忆不到一半。
本研究的目的是使用质量改进（QI）技术，以提高患者在门诊结束时对诊断、管理和随访的理解。
在一家专门治疗骨病的门诊内分泌诊所进行的一项试点研究中，使用了包括利益相关者分析、流程映射和计划-实施-研究-改进（PDSA）循环在内的QI技术。通过干预前后的患者调查评估这些干预措施的影响，该调查包括定性和定量数据。
一组具有QI专业知识的内分泌科住院医师和教员开发了一系列工具，以鼓励在诊疗过程中的对话和互动，并作为患者带回家的参考资料，通过五个PDSA循环进行完善。这些工具是在临床诊疗结束时提供给患者的书面材料的迭代版本。在每个循环中，根据患者和提供者的反馈对工具进行修改。93名患者参与了本研究。在五个循环中的两个循环实施后对患者进行了调查。与干预前相比，两个循环中的修改与患者对检查原因的理解（从64%提高到80%和75%）、管理计划（从61%提高到86%和79%）以及未来随访计划（从64%提高到86%和81%）的非显著增加相关；所有三个结果的P>0.05。患者对其诊断的了解没有改善（从74%降至73%和70%；P>0.05）。
这项试点研究展示了如何使用QI工具来创建和启动旨在加强患者教育和咨询的系统改进。
