Yu Esther Yee Tak, Wan Eric Yuk Fai, Chan Karina Hiu Yen, Wong Carlos King Ho, Kwok Ruby Lai Ping, Fong Daniel Yee Tak, Lam Cindy Lo Kuen
Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
Primary and Community Services Department, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
BMC Fam Pract. 2015 Jun 19;16:71. doi: 10.1186/s12875-015-0291-0.
There is some evidence to support a risk-stratified, multi-disciplinary approach to manage patients with hypertension in primary care. The aim of this study is to evaluate the quality of care (QOC) of a multi-disciplinary Risk Assessment and Management Programme for Hypertension (RAMP-HT) for hypertensive patients in busy government-funded primary care clinics in Hong Kong. The objectives are to develop an evidence-based, structured and comprehensive evaluation framework on quality of care, to enhance the QOC of the RAMP-HT through an audit spiral of two evaluation cycles and to determine the effectiveness of the programme in reducing cardiovascular disease (CVD) risk.
METHOD/DESIGN: A longitudinal study is conducted using the Action Learning and Audit Spiral methodologies to measure whether pre-set target standards of care intended by the RAMP-HT are achieved. A structured evaluation framework on the quality of structure, process and outcomes of care has been developed based on the programme objectives and literature review in collaboration with the programme workgroup and health service providers. Each participating clinic is invited to complete a structure of care evaluation questionnaire in each evaluation cycle. The data of all patients who have enrolled into the RAMP-HT in the pre-defined evaluation periods are used for the evaluation of the process and outcomes of care in each evaluation cycle. For evaluation of the effectiveness of RAMP-HT, the primary outcomes including blood pressure (both systolic and diastolic), low-density lipoprotein cholesterol and estimated 10-year CVD risk of RAMP-HT participants are compared to those of hypertensive patients in usual care without RAMP-HT.
The QOC and effectiveness of the RAMP-HT in improving clinical and patient-reported outcomes for patients with hypertension in normal primary care will be determined. Possible areas for quality enhancement and standards of good practice will be established to inform service planning and policy decision making.
有证据支持在基层医疗中采用风险分层的多学科方法来管理高血压患者。本研究的目的是评估香港繁忙的政府资助基层医疗诊所中针对高血压患者的多学科高血压风险评估与管理计划（RAMP-HT）的护理质量（QOC）。目标是制定一个基于证据、结构化且全面的护理质量评估框架，通过两个评估周期的审核螺旋来提高RAMP-HT的QOC，并确定该计划在降低心血管疾病（CVD）风险方面的有效性。
方法/设计：采用行动学习和审核螺旋方法进行纵向研究，以衡量RAMP-HT设定的预设护理目标标准是否达成。基于计划目标并与计划工作小组及医疗服务提供者合作进行文献综述，制定了一个关于护理结构、过程和结果质量的结构化评估框架。每个参与诊所被邀请在每个评估周期完成一份护理结构评估问卷。在预定义评估期内纳入RAMP-HT的所有患者的数据用于每个评估周期的护理过程和结果评估。为评估RAMP-HT的有效性，将RAMP-HT参与者的主要结局（包括收缩压和舒张压、低密度脂蛋白胆固醇以及估计的10年CVD风险）与未接受RAMP-HT的常规护理高血压患者的结局进行比较。
将确定RAMP-HT在改善正常基层医疗中高血压患者临床和患者报告结局方面的QOC和有效性。将确定可能的质量提升领域和良好实践标准，为服务规划和政策决策提供信息。
