Dückers Michel L A, Groenewegen Peter P, Wagner Cordula
NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Impact-National knowledge and advice centre for psychosocial care concerning critical incidents, Diemen, The Netherlands.
Implement Sci. 2014 Jul 22;9:91. doi: 10.1186/s13012-014-0091-2.
Many studies have been conducted to evaluate the impact of quality improvement collaboratives (QICs) on the quality of healthcare. This article addresses an underexplored topic, namely the use of QICs as 'intentional spread strategy.' Its objective is to predict the dissemination of projects within hospitals participating in a change programme based on several QICs. We tested whether the average project success at QIC level (based on opinions of individual project team leaders) explains the dissemination of projects one year later.
After one year, 148 project team leaders of 16 hospitals participating in the two-year programme were asked to rate the success of their improvement project on a scale from 1 to 10. At the end of the second year, the programme coordinator of each hospital provided information on the second-year dissemination. Average success scores and dissemination statistics were calculated for each QIC (N = 12). The non-parametric correlation between team leader judgment and dissemination rate at QIC level is 0.73 (P < 0.01).
Previous work, focusing on the team and hospital level, showed which factors contributed to local success stories. It also illustrated how successes play a role in dissemination processes within programme hospitals. The current study suggests that we cannot ignore the extent to which the dissemination potential of individual projects is defined by their QIC. Aggregated team leader judgments at the QIC level might predict the future dissemination in participating organizations. The findings, however, need to be replicated in larger, independent samples.
已经开展了许多研究来评估质量改进协作组织（QICs）对医疗保健质量的影响。本文探讨了一个未被充分研究的主题，即把QICs用作“有意推广策略”。其目的是基于若干QICs来预测参与变革项目的医院内部项目的传播情况。我们测试了QIC层面的平均项目成功率（基于各个项目团队负责人的意见）是否能解释一年后项目的传播情况。
一年后，参与为期两年项目的16家医院的148名项目团队负责人被要求对其改进项目的成功率在1至10的范围内进行评分。在第二年结束时，每家医院的项目协调员提供了关于第二年项目传播情况的信息。计算了每个QIC（N = 12）的平均成功率得分和传播统计数据。QIC层面团队负责人判断与传播率之间的非参数相关性为0.73（P < 0.01）。
以往聚焦于团队和医院层面的研究表明了哪些因素促成了局部的成功案例。它还说明了成功在项目医院内部的传播过程中所起的作用。当前的研究表明，我们不能忽视单个项目的传播潜力在多大程度上由其所在的QIC所决定。QIC层面汇总的团队负责人判断可能预测参与组织未来的项目传播情况。然而，这些研究结果需要在更大规模的独立样本中进行重复验证。
