Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, , Cincinnati, Ohio, USA.
BMJ Qual Saf. 2014 Apr;23 Suppl 1:i56-i63. doi: 10.1136/bmjqs-2013-002361.
In 2001, Cincinnati Children's Hospital embarked on a journey to improve healthcare delivery to patients with cystic fibrosis (CF). Data from the Cystic Fibrosis Foundation National Patient Registry revealed our below-average clinical outcomes, prompting us to initiate improvement interventions.
To improve clinical outcomes for patients with CF through a comprehensive quality-improvement approach directed at increasing patient centredness and improving healthcare delivery.
In 2001, we shared our below-average outcomes with patients, families and care providers. We instituted a quality-improvement steering committee with parental and hospital leadership, and our data-management support was restructured to provide real-time clinical data to monitor our progress. In 2002, our weekly chart conference changed to a prospective planning session and individualised daily schedules were created for inpatients. In 2003, an influenza vaccination campaign was initiated and our infection-control practices were redesigned. In 2005, best-practice guidelines were developed for airway-clearance therapy. In 2007, evidence-based clinical algorithms were designed and implemented and key care-team members were added.
Primary outcome measures were median forced expiratory volume in 1 s per cent predicted (age range 6-17 years) and median body mass index percentile (age range 2-20 years).
From 2000 to 2010, median forced expiratory volume in 1 s increased from 81.7% to 100.1% predicted and median body mass index increased from the 35th to the 55th centile.
By focusing on specific outcomes, empowering families and patients, effectively using data, and standardising care processes, we transformed the culture and delivery of care for our patients with CF and learned valuable lessons potentially translatable to other chronic-care providers.
2001 年，辛辛那提儿童医院开始踏上改善囊性纤维化（CF）患者医疗服务的征程。来自囊性纤维化基金会国家患者登记处的数据显示，我们的临床结果低于平均水平，这促使我们启动了改善干预措施。
通过全面的质量改进方法，提高患者的中心地位，改善医疗服务，改善 CF 患者的临床结果。
2001 年，我们与患者、家属和医护人员分享了我们的低水平结果。我们成立了一个由家长和医院领导组成的质量改进指导委员会，我们的数据管理支持进行了重组，以便实时提供临床数据，监测我们的进展。2002 年，我们的每周图表会议改为前瞻性规划会议，并为住院患者制定了个性化的日常时间表。2003 年，启动了流感疫苗接种运动，并重新设计了感染控制措施。2005 年，制定了气道清除治疗的最佳实践指南。2007 年，设计并实施了循证临床算法，并增加了关键护理团队成员。
主要结果测量为 6-17 岁患者的中位 1 秒用力呼气量占预计值的百分比（中位数）和 2-20 岁患者的中位体重指数百分位数。
2000 年至 2010 年，中位 1 秒用力呼气量从预计值的 81.7%增加到 100.1%，中位体重指数从第 35 百分位增加到第 55 百分位。
通过关注特定的结果、赋予家庭和患者权力、有效地使用数据以及标准化护理流程，我们改变了 CF 患者的护理文化和服务，并从中学到了有价值的经验，这些经验可能适用于其他慢性护理提供者。
