John Tamara, Morton Michaela, Weissman Mark, O'Brien Ellen, Hamburger Ellen, Hancock Yolandra, Moon Rachel Y
Goldberg Center for Community Pediatric Health, Children's National Medical Center, 111 Michigan Avenue NW, WA 20010, USA.
Int J Qual Health Care. 2014 Apr;26(2):205-13. doi: 10.1093/intqhc/mzu012. Epub 2014 Feb 11.
Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children.
To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process.
Prospective cohort.
Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits.
s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance.
s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients.
Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal.
A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.
质量改进（QI）活动是维持儿科学术认证所必需的。然而，由于缺乏培训和资源，儿科医生可能会因实施QI活动的需求而感到不堪重负。儿科医生在照顾超重和肥胖儿童时也面临挑战。
创建一个虚拟（在线）QI学习协作平台，通过该平台儿科医疗机构能够轻松开展并实施持续的QI流程。
前瞻性队列研究。
邀请了作为儿童国家健康网络一部分的儿科医疗机构参与，这些机构可选择获得继续医学教育学分和维持认证学分。
医疗机构使用计划-执行-研究-行动循环，进行基线和每月病历审核，参加教育网络研讨会并选择每月的实践改进措施。医疗机构每月报告活动情况，并会收到关于其表现的定期反馈。
（i）体重指数（BMI）百分位数记录的改善，（ii）适当的营养和活动咨询，以及（iii）高危患者的后续管理。
29家医疗机构（120名提供者）参与，24家医疗机构完成了所有项目活动。每月病历审核显示，在BMI记录、异常体重诊断、营养和活动筛查与咨询、与体重相关的健康信息以及超重和肥胖患者的后续管理方面持续改善。QI活动对就诊时间和实践效率的影响最小。
虚拟学习协作成功地为儿科医生提供了一个框架，以实施持续的QI流程并实现实践改进。这种形式可用于解决多种健康问题。
