McDonald Kathryn M, Schultz Ellen M, Chang Christine
Senior Scholar and Executive Director of the Center for Health Policy/Center for Primary Care and Outcomes Research at Stanford University in CA.
Project Coordinator at the Center for Health Policy/Center for Primary Care and Outcomes Research at Stanford University in CA.
Perm J. 2013 Fall;17(4):52-61. doi: 10.7812/TPP/13-010. Epub 2013 Sep 13.
The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence.
To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI).
We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science.
Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting.
Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.
医疗保健研究与质量局的《缩小质量差距》系列总结了八个高度优先的医疗保健主题的证据：残疾研究中使用的结果、捆绑支付计划、公共报告倡议、医疗保健差异、姑息治疗、以患者为中心的医疗之家、预防医疗保健相关感染以及药物依从性。
提炼该系列中的证据，并深入了解质量改进（QI）的“科学现状”。
我们为主题开发提供了通用指南，并对该系列主题报告中的证据进行了定性综合，以确定与QI实践和科学相关的跨主题主题、挑战和证据差距。
在研究QI干预措施有效性的主题中，我们发现一些结果有所改善，但其他结果并非如此。QI活动的实施背景和潜在危害并未得到广泛评估或报告，尽管市场因素似乎对基于激励的QI策略很重要。以患者为中心和以系统为中心的策略通常比以临床医生为中心的策略更有效，尽管后一种方法提高了临床医生对感染预防策略的依从性。审核和反馈对于针对专业人员和组织似乎更好，但对患者并非如此。主题评审人员观察到用于QI评估的结果存在异质性、研究设计存在缺陷以及报告不完整。
跨主题综合证据为从业者和研究人员提供了对QI领域现状的洞察。为了促进未来的证据综合，需要围绕一套更小的用于QI评估的结果达成共识，并需要一个框架和词汇表来更广泛地描述QI干预措施，以符合负责提高质量的决策者的需求。
