实践促进与学术推广干预可提高基层医疗安全网诊所的癌症筛查率。

A Practice Facilitation and Academic Detailing Intervention Can Improve Cancer Screening Rates in Primary Care Safety Net Clinics.

作者信息

Mader Emily M, Fox Chester H, Epling John W, Noronha Gary J, Swanger Carlos M, Wisniewski Angela M, Vitale Karen, Norton Amanda L, Morley Christopher P

机构信息

From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).

出版信息

J Am Board Fam Med. 2016 Sep-Oct;29(5):533-42. doi: 10.3122/jabfm.2016.05.160109.

DOI:10.3122/jabfm.2016.05.160109

PMID:27613786

Abstract

BACKGROUND

Despite the current evidence of preventive screening effectiveness, rates of breast, cervical, and colorectal cancer in the United States fall below national targets. We evaluated the efficacy and feasibility of combining practice facilitation and academic detailing quality improvement (QI) strategies to help primary care practices increase breast, cervical, and colorectal cancer screening among patients.

METHODS

Practices received a 1-hour academic detailing session addressing current cancer screening guidelines and best practices, followed by 6 months of practice facilitation to implement evidence-based interventions aimed at increasing patient screening. One-way repeated measures analysis of variance compared screening rates before and after the intervention, provider surveys, and TRANSLATE model scores. Qualitative data were gathered via participant focus groups and interviews.

RESULTS

Twenty-three practices enrolled in the project: 4 federally qualified health centers, 10 practices affiliated with larger health systems, 4 physician-owned practices, 4 university hospital clinics, and 1 nonprofit clinic. Average screening rates for breast cancer increased by 13% (P = .001), and rates for colorectal cancer increased by 5.6% (P = .001). Practices implemented a mix of electronic health record data cleaning workflows, provider audits and feedback, reminder systems streamlining, and patient education and outreach interventions. Practice facilitators assisted practices in tailoring interventions to practice-specific priorities and constraints and in connecting with community resources. Practices with resource constraints benefited from the engagement of all levels of staff in the quality improvement processes and from team-based adaptations to office workflows and policies. Many practices aligned quality improvement interventions in this project with patient-centered medical home and other regulatory reporting targets.

CONCLUSIONS

Combining practice facilitation and academic detailing is 1 method through which primary care practices can achieve systems-level changes to better manage patient population health.

摘要

背景

尽管目前有证据表明预防性筛查有效，但美国乳腺癌、宫颈癌和结直肠癌的筛查率仍低于国家目标。我们评估了结合实践促进和学术细节质量改进（QI）策略以帮助初级保健机构提高患者乳腺癌、宫颈癌和结直肠癌筛查率的有效性和可行性。

方法

各机构参加了一次为时1小时的学术细节讲解课程，内容涉及当前癌症筛查指南和最佳实践，随后进行6个月的实践促进，以实施旨在提高患者筛查率的循证干预措施。采用单向重复测量方差分析比较干预前后的筛查率、提供者调查结果以及TRANSLATE模型得分。通过参与者焦点小组和访谈收集定性数据。

结果

有23家机构参与了该项目：4家联邦合格健康中心、10家隶属于大型医疗系统的机构、4家医生所有的机构、4家大学医院诊所和1家非营利诊所。乳腺癌的平均筛查率提高了13%（P = .001），结直肠癌的筛查率提高了5.6%（P = .001）。各机构实施了一系列电子健康记录数据清理工作流程、提供者审核与反馈、简化提醒系统以及患者教育和外展干预措施。实践促进者协助各机构根据特定实践的优先事项和限制条件调整干预措施，并与社区资源建立联系。资源有限的机构受益于各级工作人员参与质量改进过程以及基于团队的办公室工作流程和政策调整。许多机构将该项目中的质量改进干预措施与以患者为中心的医疗之家及其他监管报告目标相结合。