Dr. Pronovost is senior vice president of quality and safety, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, and professor, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, School of Nursing and Carey Business School, Johns Hopkins University, Baltimore, Maryland. Mr. Armstrong is chairman, Johns Hopkins Medicine Patient Safety and Quality Board Committee, and, until October 2013, was chairman, Johns Hopkins Medicine Board of Trustees, Baltimore, Maryland. Ms. Demski is vice president of quality improvement, Armstrong Institute for Patient Safety and Quality and Johns Hopkins Health System, Baltimore, Maryland. Ms. Callender is senior quality and innovation coach, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Ms. Winner is director of Lean Sigma deployment, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Miller is Johns Hopkins Medicine chief quality officer for pediatrics, vice chair of quality and safety, and professor, Department of Pediatrics, Johns Hopkins University, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Austin is assistant professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Dr. Berenholtz is professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Departments of Anesthesiology and Critical Care Medicine, Surgery, and School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Dr. Yang is senior biostatistician, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.
Acad Med. 2015 Feb;90(2):165-72. doi: 10.1097/ACM.0000000000000610.
In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning.
本文作者介绍了一项计划，该计划建立了一个基础设施，以管理整个复杂医疗保健系统的质量和安全工作，并提高急性心肌梗死、心力衰竭、肺炎、外科护理和儿童哮喘等核心措施的绩效。约翰霍普金斯医学董事会创建了一个治理结构，为整个约翰霍普金斯医学系统建立医疗保健系统范围的监督和医院对质量和安全工作的问责制。成立了阿姆斯特朗患者安全与质量研究所；研究所的领导们使用嵌套在分形基础设施中的概念模型来实施这一计划，以提高两所学术医疗中心和三家社区医院的绩效，该计划从 2012 年 3 月开始实施。该计划旨在实现 7 项住院患者治疗过程核心措施中的≥96%的合规性，并满足德尔玛瓦基金会和联合委员会的要求。主要结果衡量标准是每家医院接受推荐治疗方案的患者比例。作者比较了该计划实施前（2011 年）和实施后（2012 年、2013 年）整个医疗系统和医院的绩效。到 2013 年，整个医疗系统在 7 项目标措施中的 6 项上达到了≥96%的合规性。在 5 家医院中，有 4 家在 2013 年获得了德尔玛瓦基金会奖，有 2 家获得了联合委员会奖。作者认为，为了提高质量和安全，医疗保健系统应该建立一个系统范围的治理结构和问责制。他们还应该定义和沟通目标和措施，并建立一个基础设施来支持同行学习。
