Wu Susan, Tyler Amy, Logsdon Tina, Holmes Nicholas M, Balkian Ara, Brittan Mark, Hoover LaVonda, Martin Sara, Paradis Melisa, Sparr-Perkins Rhonda, Stanley Teresa, Weber Rachel, Saysana Michele
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California;
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado;
Pediatrics. 2016 Aug;138(2). doi: 10.1542/peds.2014-3604.
To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges.
This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies.
Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05).
Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings.
评估质量改进协作对儿科出院质量和效率的影响。
这是一项多中心质量改进协作项目，于2011年11月1日至2012年10月31日在美国11家独立的三级医疗儿童医院开展。各机构从专家小组制定的一揽子变革措施中选择干预措施。针对各机构选定的患者群体进行了多个计划-执行-研究-行动循环。各机构每月报告与出院相关的护理失误、家庭出院准备情况以及72小时和30天再入院情况的数据。还对各机构进行了调查，以评估各种变革策略的使用情况。
大多数机构关注出院计划、出院指导质量以及通过电话提供出院后支持。与出院相关的护理失误显著减少，从项目第一季度的34%降至协作结束时的21%（P < 0.05）。家庭对出院准备情况的认知也有显著改善，报告最高评分的家庭比例从85%升至91%（P < 0.05）。计划外72小时再入院情况没有改善（0.7%对1.1%，P = 0.29），30天再入院率略有恶化（4.5%对&6.3%，P = 0.05）。
参与协作的机构与出院相关的护理失误率较低，家庭出院准备情况得到改善。计划外再入院情况没有显著改善。需要更多研究来评估哪些干预措施最有效，并评估在非儿童医院环境中的可行性。
