Ruhe Mary C, Carter Caroline, Litaker David, Stange Kurt C
Department of Family Medicine, Cleveland, OH, USA.
Qual Manag Health Care. 2009 Oct-Dec;18(4):268-77. doi: 10.1097/QMH.0b013e3181bee268.
The ways in which tailored interventions foster sustained improvement in the quality of health care delivery across different practice settings are not well understood. Using the empirically developed Practice Change Model (PCM), we identify and describe assessment and tailoring activities with potential to enhance the fit between proposed interventions and practice settings.
We obtained quantitative and qualitative data from 2 quality improvement trials conducted in diverse primary care practices in northeast Ohio. A multidisciplinary team used a PCM-based template to identify features of practice assessment and tailoring associated with practices' willingness and ability to change.
Our results suggest that intervention tailoring requires assessment of key stakeholders' motivations, external influences, resources and opportunities for change, and the interactions between these factors. Using this information, intervention tailoring then includes seeking and working with key stakeholders, building assets, providing options, keeping change processes flexible, offering feedback, providing exposure to scientific evidence, facilitating group processes, involving new partners, brainstorming, using stories/play acting/humor, assuming a consultant role, reframing, moving meetings off-site, and stepping back or pausing.
A model-driven approach guiding practice assessment enables tailored responses to the unique and emerging conditions that distinguish health care practices and influence implementation of quality management interventions.
针对不同实践环境，定制化干预措施促进医疗服务质量持续提升的方式尚未得到充分理解。利用实证开发的实践变革模型（PCM），我们识别并描述了具有增强拟议干预措施与实践环境适配性潜力的评估和定制活动。
我们从俄亥俄州东北部不同基层医疗实践中开展的两项质量改进试验获取了定量和定性数据。一个多学科团队使用基于PCM的模板来识别与实践评估及定制相关的、与实践变革意愿和能力相关的特征。
我们的结果表明，干预措施定制需要评估关键利益相关者的动机、外部影响、变革资源和机会，以及这些因素之间的相互作用。利用这些信息，干预措施定制随后包括与关键利益相关者寻求合作并开展工作、积累资产、提供选择、保持变革过程灵活性、提供反馈、提供科学证据、促进团队协作、引入新伙伴、头脑风暴、运用故事/角色扮演/幽默、承担顾问角色、重新构建、将会议转移至场外以及后退或暂停。
一种指导实践评估的模型驱动方法能够针对区分医疗实践并影响质量管理干预措施实施的独特且新出现的情况做出定制化应对。
