Sheu Josephine, Chun Stanford, O'Day Emily, Cheung Sara, Cruz Rusvelda, Lightdale Jenifer R, Fishman Douglas S, Bousvaros Athos, Huang Jeannie S
*Department of Pediatrics, University of California San Diego, La Jolla †Division of Pediatric Gastroenterology and Nutrition, University of Massachusetts, Worcester ‡Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX §Division of Pediatric Gastroenterology, Children's Hospital, Boston, MA ||Division of Pediatric Gastroenterology, Rady Children's Hospital, San Diego, CA.
J Pediatr Gastroenterol Nutr. 2017 May;64(5):671-678. doi: 10.1097/MPG.0000000000001488.
Beginning in 2013, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) sponsored and developed subspecialty field-specific quality improvement (QI) activities to provide Part 4 Maintenance of Certification (MOC) credit for ongoing certification of pediatric gastroenterologists by the American Board of Pediatrics. Each activity was a Web-based module that measured clinical practice data repeatedly over at least 3 months as participants implemented rapid cycle change. Here, we examine existing variations in clinical practice among participating pediatric gastroenterologists and determine whether completion of Web-based MOC activities improves patient care processes and outcomes.
We performed a cross-sectional and prospective analysis of physician and parent-reported clinical practice data abstracted from Web-based MOC modules on the topics of upper endoscopy, colonoscopy, and informed consent collected from pediatric gastroenterologists from North America from 2013 to 2016.
Among 134 participating pediatric gastroenterologists, 56% practitioners practiced at an academic institution and most (94%) were NASPGHAN members. Participating physicians reported data from 6300 procedures. At baseline, notable practice variation across measured activities was demonstrated. Much of the rapid cycle changes implemented by participants involved individual behaviors, rather than system/team-based improvement activities. Participants demonstrated significant improvements on most targeted process and quality care outcomes.
Pediatric gastroenterologists and parents reported baseline practice variation, and improvement in care processes and outcomes measured during NASPGHAN-sponsored Web-based MOC QI activities. Subspecialty-oriented Web-based MOC QI activities can reveal targets for reducing unwarranted variation in clinical pediatric practice, and can effectively improve care and patient outcomes.
从2013年开始，北美儿科胃肠病学、肝病学和营养学会（NASPGHAN）发起并开展了特定亚专业领域的质量改进（QI）活动，以便为美国儿科学会对儿科胃肠病学家进行持续认证提供第4部分认证维持（MOC）学分。每项活动都是一个基于网络的模块，在参与者实施快速循环改进期间，至少持续3个月反复测量临床实践数据。在此，我们研究参与活动的儿科胃肠病学家临床实践中现有的差异，并确定完成基于网络的MOC活动是否能改善患者护理流程和结果。
我们对2013年至2016年从北美儿科胃肠病学家收集的关于上消化道内镜检查、结肠镜检查和知情同意等主题的基于网络的MOC模块中提取的医生和家长报告的临床实践数据进行了横断面和前瞻性分析。
在134名参与的儿科胃肠病学家中，56%的从业者在学术机构工作，大多数（94%）是NASPGHAN成员。参与医生报告了6300例手术的数据。在基线时，各测量活动中存在显著的实践差异。参与者实施的快速循环改变大多涉及个人行为，而非基于系统/团队的改进活动。参与者在大多数目标流程和质量护理结果方面有显著改善。
儿科胃肠病学家和家长报告了基线实践差异，以及在NASPGHAN赞助的基于网络的MOC QI活动期间所测量的护理流程和结果的改善。以亚专业为导向的基于网络的MOC QI活动可以揭示减少儿科临床实践中不必要差异的目标，并能有效改善护理和患者结局。
