McQuillan Rory Francis, Silver Samuel Adam, Harel Ziv, Weizman Adam, Thomas Alison, Bell Chaim, Chertow Glenn M, Chan Christopher T, Nesrallah Gihad
Division of Nephrology, University Health Network-Toronto General Hospital.
Division of Nephrology, St. Michael's Hospital.
Clin J Am Soc Nephrol. 2016 May 6;11(5):908-914. doi: 10.2215/CJN.11511015. Epub 2016 Mar 25.
This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting.
本文将演示如何利用齐夫·哈雷尔博士及其同事在本期“行动要点”专题文章《如何在临床实践中使用质量改进工具：如何诊断护理质量问题的解决方案》中提出的变革理念开展质量改进项目。这一变革理念是在慢性肾脏病（CKD）诊所引入一名护士教育工作者，目标是提高患者在家中独立进行透析（家庭血液透析或腹膜透析）的比例。通过这个例子，我们将展示实际运行的计划-实施-研究-改进（PDSA）循环，并突出快速循环变革方法的原则。然后，我们将讨论结果指标、过程指标和平衡指标的选择，以及在临床环境中收集这些数据的实际操作。我们还将介绍PDSA工作表，这是监督质量改进项目进展的一种实用方法。最后，我们将演示如何使用运行图直观地实时展示改进情况，以及如何利用这些信息来验证成果、对项目可能遇到的挑战做出适当反应，并证明结果的显著性。本文旨在为读者提供一个清晰实用的框架，以便他们在临床环境中试验自己的质量改进想法。
