Grazier Kyle L, Quanbeck Andrew R, Oruongo John, Robinson James, Ford James H, McCarty Dennis, Pulvermacher Alice, Johnson Roberta A, Gustafson David H
J Healthc Qual. 2015 Nov-Dec;37(6):342-53. doi: 10.1111/jhq.12064.
Healthcare providers have increased the use of quality improvement (QI) techniques, but organizational variables that affect QI uptake and implementation warrant further exploration. This study investigates organizational characteristics associated with clinics that enroll and participate over time in QI. The Network for the Improvement of Addiction Treatment (NIATx) conducted a large cluster-randomized trial of outpatient addiction treatment clinics, called NIATx 200, which randomized clinics to one of four QI implementation strategies: (1) interest circle calls, (2) coaching, (3) learning sessions, and (4) the combination of all three components. Data on organizational culture and structure were collected before, after randomization, and during the 18-month intervention. Using univariate descriptive analyses and regression techniques, the study identified two significant differences between clinics that enrolled in the QI study (n = 201) versus those that did not (n = 447). Larger programs were more likely to enroll and clinics serving more African Americans were less likely to enroll. Once enrolled, higher rates of QI participation were associated with clinics' not having a hospital affiliation, being privately owned, and having staff who perceived management support for QI. The study discusses lessons for the field and future research needs.
医疗服务提供者增加了质量改进（QI）技术的使用，但影响QI采用和实施的组织变量仍有待进一步探索。本研究调查了与长期参与QI的诊所相关的组织特征。成瘾治疗改进网络（NIATx）对门诊成瘾治疗诊所进行了一项大型整群随机试验，称为NIATx 200，该试验将诊所随机分为四种QI实施策略之一：（1）兴趣圈电话会议，（2）指导，（3）学习课程，以及（4）所有三个组成部分的组合。在随机分组之前、之后以及18个月的干预期间收集了有关组织文化和结构的数据。通过单变量描述性分析和回归技术，该研究确定了参与QI研究的诊所（n = 201）与未参与的诊所（n = 447）之间的两个显著差异。规模较大的项目更有可能参与，而为更多非裔美国人提供服务的诊所参与的可能性较小。一旦参与，更高的QI参与率与诊所没有医院附属关系、为私立所有以及员工认为管理层支持QI有关。该研究讨论了该领域的经验教训和未来的研究需求。
