衡量对参与质量改进活动以维持认证的反思。

Measuring reflection on participation in quality improvement activities for maintenance of certification.

作者信息

Wittich Christopher M, Reed Darcy A, Ting Henry H, Berger Richard A, Nowicki Kelly M, Blachman Morris J, Mandrekar Jayawant N, Beckman Thomas J

机构信息

Dr. Wittich is associate professor of medicine, Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Reed is associate professor of medicine, Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Ting is professor of medicine and associate dean of continuous professional development, Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Berger is professor of orthopedics and dean of continuous professional development, Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Ms. Nowicki is administrator, Mayo Clinic School of Continuous Professional Development, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Blachman is clinical professor and associate dean of continuous professional development and strategic affairs, University of South Carolina School of Medicine, Columbia, South Carolina. Dr. Mandrekar is professor of biostatistics, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Beckman is professor of medicine and medical education, Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.

出版信息

Acad Med. 2014 Oct;89(10):1392-7. doi: 10.1097/ACM.0000000000000323.

DOI:10.1097/ACM.0000000000000323

PMID:24892403

Abstract

PURPOSE

To validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams.

METHOD

This was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credit from 2010 to 2012. The authors developed a measure of reflection on participation in QI activities and explored associations between participants' overall reflection scores and characteristics of projects, participants, and teams.

RESULTS

A total of 922 participants (567 physicians) on 118 teams completed QI projects and reflections. Factor analysis revealed a two-dimensional model with good internal consistency reliabilities (Cronbach alpha) for high (0.85) and low (0.81) reflection. Reflection scores (mean [standard deviation]) were associated with projects that changed practice (yes: 4.30 [0.51]; no: 3.71 [0.57]; P < .0001), changed the health care system (yes: 4.25 [0.54]; no: 4.03 [0.62]; P < .0001), and impacted patient safety (P < .0001). Physicians' reflection scores (4.27 [0.57]) were higher than support staff scores (4.07 [0.55]; P = .0005). A positive association existed between reflection scores and the number of QI roles per participant (P < .0001). There were no associations with participant gender, team size, or team diversity.

CONCLUSIONS

The authors identified associations between participant reflection and the impact of QI projects, participants' professional roles, and participants' involvement with projects. With further study, the authors anticipate that the new measure of reflection will be useful for determining meaningful engagement in MOC.

摘要

目的

验证一种用于衡量参与质量改进（QI）活动的反思程度的方法，并确定其与QI项目、参与者及团队特征之间的关联。

方法

这是一项对2010年至2012年期间向梅奥诊所提交质量改进项目以获取认证维持（MOC）学分的所有团队参与者进行的前瞻性验证研究。作者开发了一种衡量参与QI活动反思程度的方法，并探讨了参与者的总体反思得分与项目、参与者及团队特征之间的关联。

结果

118个团队中的922名参与者（567名医生）完成了QI项目及反思。因子分析揭示了一个二维模型，高反思（0.85）和低反思（0.81）的内部一致性信度（Cronbach α）良好。反思得分（均值[标准差]）与改变实践的项目相关（是：4.30[0.51]；否：3.71[0.57]；P <.0001），与改变医疗保健系统的项目相关（是：4.25[0.54]；否：4.03[0.62]；P <.0001），并与影响患者安全相关（P <.0001）。医生的反思得分（4.27[0.57]）高于支持人员的得分（4.07[0.55]；P =.0005）。反思得分与每位参与者的QI角色数量之间存在正相关（P <.0001）。与参与者性别、团队规模或团队多样性无关。