评估黎巴嫩初级保健中心医护人员报告质量和患者安全指标的准备情况：一项全国性横断面调查。
Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey.
作者信息
Alameddine Mohamad, Saleh Shadi, Natafgi Nabil
机构信息
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
Department of Health Management and Policy, College of Public Health, University of Iowa, CPHB - N277, 145 N. Riverside Dr., Iowa City, IA, 52242, USA.
出版信息
Hum Resour Health. 2015 May 22;13:37. doi: 10.1186/s12960-015-0031-5.
BACKGROUND
Successful endorsement of quality indicators hinges on the readiness and acceptability of care providers for those measures. This paper aims to assess the readiness of care providers in the primary health-care sector in Lebanon for the implementation of quality and patient safety indicators.
METHODS
A cross-sectional survey methodology was utilized to gather information from 943 clinical care providers working at 123 primary health-care centres in Lebanon. The questionnaire included two sections: the first assessed four readiness dimensions (appropriateness, management support, efficacy, and personal valence) of clinical providers to use quality and safety indicators using the Readiness for Organization Change (ROC) scale, and the second section assessed the safety attitude at the primary care centre utilizing the Agency of Health Research and Quality (AHRQ) Safety Attitude Questionnaire (SAQ)-Ambulatory version.
RESULTS
Although two thirds (66%) of respondents indicated readiness for implementation of quality and patient safety indicators in their centres, there appear to be differences by professional group. Physicians displayed the lowest scores on all readiness dimensions except for personal valence which was the lowest among nurses (60%). In contrast, allied health professionals displayed the highest scores across all readiness dimensions. Generally, respondents reflected a positive safety attitude climate in the centres. Yet, there remain a few areas of concern related to punitive culture (only 12.8% agree that staff should not be punished for reported errors/incidents), continuity of care (41.1% believe in the negative consequences of lack in continuity of care process), and resources (48.1% believe that the medical equipment they have are adequate). Providers with the highest SAQ score had 2.7, 1.7, 7 and 2.4 times the odds to report a higher readiness on the appropriateness, efficacy, management and personal valence ROC subscales, respectively (P value <0.01). Nurses displayed relatively lower odds of readiness across all other ROC subscales as compared to all other providers.
CONCLUSION
Health-care providers at the primary health care (PHC) centres in Lebanon are ready to engage in employing quality and patient safety indicators. This is a key finding given the active efforts by the MoPH to strengthen the quality culture in the PHC sector through various strategies.
背景
质量指标的成功认可取决于医疗服务提供者对这些措施的准备情况和接受程度。本文旨在评估黎巴嫩初级卫生保健部门的医疗服务提供者对实施质量和患者安全指标的准备情况。
方法
采用横断面调查方法，从黎巴嫩123个初级卫生保健中心工作的943名临床医疗服务提供者中收集信息。问卷包括两个部分：第一部分使用组织变革准备度（ROC）量表评估临床提供者使用质量和安全指标的四个准备维度（适宜性、管理支持、效能和个人价值），第二部分使用卫生研究与质量机构（AHRQ）安全态度问卷（SAQ）-门诊版评估初级保健中心的安全态度。
结果
尽管三分之二（66%）的受访者表示他们所在的中心准备好实施质量和患者安全指标，但不同专业群体之间似乎存在差异。除个人价值维度外，医生在所有准备维度上的得分最低，而护士在个人价值维度上的得分最低（60%）。相比之下，专职医疗人员在所有准备维度上的得分最高。总体而言，受访者反映中心的安全态度氛围积极。然而，仍有一些令人担忧的领域，如惩罚性文化（只有12.8%的人认为员工不应因报告的错误/事件而受到惩罚）、护理连续性（41.1%的人认为护理过程缺乏连续性会产生负面后果）和资源（48.1%的人认为他们拥有的医疗设备足够）。SAQ得分最高的提供者在适宜性、效能、管理和个人价值ROC子量表上报告更高准备度的几率分别是其他提供者的2.7倍、1.7倍、7倍和2.4倍（P值<0.01）。与所有其他提供者相比，护士在所有其他ROC子量表上的准备几率相对较低。
结论
黎巴嫩初级卫生保健（PHC）中心的医疗服务提供者准备好采用质量和患者安全指标。鉴于卫生部通过各种战略积极努力加强初级卫生保健部门的质量文化，这是一个关键发现。
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