Shahnazarian Vahe, Karu Eric, Mehta Parag
New York Methodist Hospital, USA.
BMJ Qual Improv Rep. 2015 May 20;4(1). doi: 10.1136/bmjquality.u208549.w3409. eCollection 2015.
Both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) have recommended that adults born between the years of 1945-1965 should receive one-time testing for Hepatitis C Virus (HCV). In fact, Governor Andrew Cuomo of the State of New York had signed a bill on October 23, 2013 which mandated NY hospitals and healthcare providers to offer HCV testing to all "Baby Boomers." For our project, we wanted to increase our community hospital's compliance with this law and improve the quality of patient care in doing so. An electronic medical record intervention was implemented in conjunction with our information technology services department. This intervention would flag eligible patients and would run them through a predetermined algorithm to see if they needed HCV testing. Multiple plan, do, study, act (PDSA) cycles were run during the length of the study and many changes were made in order to achieve maximum effect. We ended up increasing our HCV testing rate from 47.2% (pre-intervention) to 87.9% (final month of the study), which was statistically significant with a p-value of <0.0000001. We also ended up with a framework that is both generalizable to other projects and is also self-sustaining, so that it can continue to run itself once all the project members have finished working there as house staff.
美国疾病控制与预防中心(CDC)和美国预防服务工作组(USPSTF)均建议,出生于1945年至1965年之间的成年人应接受一次丙型肝炎病毒(HCV)检测。事实上,纽约州州长安德鲁·科莫于2013年10月23日签署了一项法案,要求纽约的医院和医疗服务提供者为所有“婴儿潮一代”提供HCV检测。对于我们的项目,我们希望提高我们社区医院对该法律的遵守情况,并在此过程中提高患者护理质量。我们与信息技术服务部门联合实施了一项电子病历干预措施。该干预措施会标记出符合条件的患者,并通过预定算法对他们进行筛查,以确定他们是否需要进行HCV检测。在研究期间进行了多个计划、执行、研究、改进(PDSA)循环,并做出了许多改变以达到最大效果。我们最终将HCV检测率从47.2%(干预前)提高到了87.9%(研究的最后一个月),p值<0.0000001,具有统计学意义。我们还最终形成了一个既适用于其他项目又能自我维持的框架,这样一旦所有项目成员完成住院医师工作后,它就能继续自行运行。