Harel Ziv, Silver Samuel A, McQuillan Rory F, Weizman Adam V, Thomas Alison, Chertow Glenn M, Nesrallah Gihad, Chan Christopher T, Bell Chaim M
Division of Nephrology, St. Michael's Hospital.
Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital.
Clin J Am Soc Nephrol. 2016 May 6;11(5):901-907. doi: 10.2215/CJN.11481015. Epub 2016 Mar 25.
To change a particular quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome. After the causes of a particular outcome are known, changes can be made to address these causes and change the outcome. Using the example of home dialysis (home hemodialysis and peritoneal dialysis), this article within this Moving Points feature on quality improvement will provide health care professionals with the tools necessary to analyze the steps contributing to certain outcomes in health care quality and develop ideas that will ultimately lead to their resolution. The tools used to identify the main contributors to a quality of care outcome will be described, including cause and effect diagrams, Pareto analysis, and process mapping. We will also review common change concepts and brainstorming activities to identify effective change ideas. These methods will be applied to our home dialysis quality improvement project, providing a practical example that other kidney health care professionals can replicate at their local centers.
为了改变系统内特定的护理质量结果，质量改进举措必须首先了解导致该结果的原因。在知道特定结果的原因后，就可以做出改变以解决这些原因并改变结果。以家庭透析（家庭血液透析和腹膜透析）为例，本《质量改进动态要点》专题中的这篇文章将为医疗保健专业人员提供必要的工具，以分析对医疗保健质量中某些结果有贡献的步骤，并提出最终能解决这些问题的想法。将介绍用于确定护理质量结果主要促成因素的工具，包括因果图、帕累托分析和流程映射。我们还将回顾常见的变革概念和头脑风暴活动，以确定有效的变革想法。这些方法将应用于我们的家庭透析质量改进项目，提供一个其他肾脏医疗保健专业人员可以在其当地中心复制的实际示例。
