Newton Warren, Baxley Elizabeth, Reid Alfred, Stanek Michele, Robinson Mark, Weir Samuel
Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA.
Fam Med. 2011 Jul-Aug;43(7):495-502.
Improving the quality of care in residencies is critical for the profession and for our discipline, but how to do this on a large scale is unclear. The purpose of the I³ collaborative was to assess the feasibility of a regional quality improvement collaborative limited to residencies and to improve significantly dramatically the quality of care for diabetes and congestive heart failure.
Ten residencies in North and South Carolina with more than 345,000 patient visits/year, 252 residents and 92 faculty participated in an Institute for Healthcare Improvement breakthrough series type collaborative, enriched with additional support for academic settings, over 3 years.
We improved measured quality of care for diabetes modestly and congestive heart failure (CHF) significantly/substantially, including a 380% reduction of hospitalizations for CHF. Success factors include funding from regional foundations, the use of regional approach for recruitment of residencies and active management of the collaborative, regular data submission, and a blended curriculum with a combination of biannual face to face meetings and monthly telephone conferences.
A regional strategy is feasible and can strongly support quality improvement; investment in residency redesign can reduce total cost of care.
提高住院医师培训中的医疗质量对本专业及我们这个学科至关重要，但如何大规模实现这一点尚不清楚。I³合作项目的目的是评估仅限于住院医师培训的区域质量改进合作的可行性，并显著大幅提高糖尿病和充血性心力衰竭的医疗质量。
北卡罗来纳州和南卡罗来纳州的10个住院医师培训项目，每年有超过345,000人次的患者就诊，252名住院医师和92名教员参与了一个医疗改进研究所突破性系列类型的合作项目，在3年时间里，该项目还获得了对学术环境的额外支持。
我们适度提高了糖尿病的医疗质量测量指标，并显著/大幅提高了充血性心力衰竭（CHF）的医疗质量，包括CHF住院率降低了380%。成功因素包括区域基金会的资金支持、采用区域方法招募住院医师培训项目以及对合作项目的积极管理、定期数据提交，以及一个结合了半年一次面对面会议和每月电话会议的混合课程。
区域战略是可行的，并且能够有力地支持质量改进；对住院医师培训重新设计的投入可以降低医疗总成本。
