Kaufmann-Kolle Petra, Szecsenyi Joachim, Broge Björn, Haefeli Walter Emil, Schneider Antonius
AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2011;105(5):389-95. doi: 10.1016/j.zefq.2011.05.006. Epub 2011 Jun 16.
The purpose of this cluster-randomised controlled trial was to evaluate the efficacy of quality circles (QCs) working either with general data-based feedback or with an open benchmark within the field of asthma care and drug-drug interactions.
Twelve QCs, involving 96 general practitioners from 85 practices, were randomised. Six QCs worked with traditional anonymous feedback and six with an open benchmark. Two QC meetings supported with feedback reports were held covering the topics "drug-drug interactions" and "asthma"; in both cases discussions were guided by a trained moderator. Outcome measures included health-related quality of life and patient satisfaction with treatment, asthma severity and number of potentially inappropriate drug combinations as well as the general practitioners' satisfaction in relation to the performance of the QC.
A significant improvement in the treatment of asthma was observed in both trial arms. However, there was only a slight improvement regarding inappropriate drug combinations. There were no relevant differences between the group with open benchmark (B-QC) and traditional quality circles (T-QC). The physicians' satisfaction with the QC performance was significantly higher in the T-QCs.
General practitioners seem to take a critical perspective about open benchmarking in quality circles. Caution should be used when implementing benchmarking in a quality circle as it did not improve healthcare when compared to the traditional procedure with anonymised comparisons.
本整群随机对照试验旨在评估在哮喘护理及药物相互作用领域中，质量改进小组（QCs）采用基于一般数据的反馈或公开基准进行工作的效果。
12个质量改进小组，涉及来自85家诊所的96名全科医生，被随机分组。6个质量改进小组采用传统匿名反馈方式工作，6个采用公开基准方式工作。围绕“药物相互作用”和“哮喘”主题，举行了两次有反馈报告支持的质量改进小组会议；在这两种情况下，讨论均由一名经过培训的主持人引导。结果指标包括与健康相关的生活质量、患者对治疗的满意度、哮喘严重程度、潜在不适当药物组合的数量以及全科医生对质量改进小组工作表现的满意度。
两个试验组在哮喘治疗方面均有显著改善。然而，在不适当药物组合方面仅有轻微改善。采用公开基准的小组（B-QC）与传统质量改进小组（T-QC）之间没有相关差异。在T-QCs中，医生对质量改进小组工作表现的满意度显著更高。
全科医生似乎对质量改进小组中的公开基准持批判态度。在质量改进小组中实施基准时应谨慎，因为与采用匿名比较的传统程序相比，它并没有改善医疗保健状况。
