Luo Huabin, Sotnikov Sergey, McLees Anita, Stokes Shereitte
Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Dr Luo) and Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Sotnikov and Stokes and Ms McLees).
J Public Health Manag Pract. 2015 Mar-Apr;21(2):176-85. doi: 10.1097/PHH.0000000000000113.
Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives.
(1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs' decision to implement QI initiatives.
In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs' QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration's Area Resource Files and the Association of State and Territorial Health Officials' 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design.
The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives.
According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed.
在过去十年中，质量改进（QI）已成为推进地方卫生部门（LHD）绩效提升目标的主要关注点。然而，关于LHD当前实施质量改进举措的实证数据有限，且缺乏与采用质量改进举措相关的因素。
（1）研究LHD当前实施质量改进举措的情况；（2）确定促使LHD决定实施质量改进举措的因素。
在本研究中，一个基于医学质量改进分析的新型理论框架被用于分析LHD的质量改进情况。LHD对质量改进的采用情况通过LHD报告的正式质量改进项目数量来评估，这些项目来自对全国县市卫生官员协会开展的2010年地方卫生部门概况研究（概况研究）模块1做出回应的LHD。概况研究数据与来自卫生资源与服务管理局的地区资源文件以及州和领地卫生官员协会2010年调查的数据进行了合并。使用Stata 11的SVY程序进行逻辑回归分析，以考虑复杂的抽样设计。
概况研究数据表明，约73%的LHD报告实施了1个或更多的质量改进项目。辖区人口众多（>50000）、人均公共卫生支出较高、有指定的质量改进工作人员或之前参与过绩效改进项目的LHD更有可能开展质量改进举措。
根据概况研究，超过四分之一接受调查的LHD未报告实施任何正式的质量改进项目。对质量改进项目增加投入以及指定质量改进工作人员可能是促进采用质量改进举措的有效策略。需要确定正式质量改进项目定义的有效性。还需要更多研究来确定LHD成功实施质量改进的障碍。
