Heckman George A, Boscart Veronique M, Franco Bryan B, Hillier Loretta, Crutchlow Lauren, Lee Linda, Molnar Frank, Seitz Dallas, Stolee Paul
Schlegel - University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
Schlegel - University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; Conestoga College's School of Health & Life Sciences and Community Services, Schlegel Villages, Kitchener, ON, Canada.
Can Geriatr J. 2016 Dec 23;19(4):164-181. doi: 10.5770/cgj.19.233. eCollection 2016 Dec.
Primary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer's disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs.
We employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. Thirty-eight candidate QIs and 19 potential quality improvement mechanisms were presented to participants in two rounds of electronic Delphi surveys. Written comments were collected and descriptively analyzed.
The response rate for the first and second rounds were 21.3% (n = 179) and 12.8% (n = 88), respectively. The majority of respondents were physicians. Fourteen QIs remained after the consensus process. Ten quality improvement mechanisms were selected with those characterized by specialist integration, such as case discussions and mentorships, being ranked highly. Written comments revealed three major themes related to potential barriers and facilitators to quality assurance: 1) perceived importance, 2) collaboration and role clarity, and 3) implementation process.
We successfully utilized a consultative process among primary and specialty providers to identify core QIs and quality improvement mechanisms for PCMCs. Identified quality improvement mechanisms highlight desire for multi-modal education. System integration and closer integration between PCMCs and specialists were emphasized as essential for the provision of high-quality dementia care in community settings.
在多个辖区已设立了以初级保健为基础的记忆诊所（PCMC），以改善对阿尔茨海默病及相关痴呆症患者的护理。我们试图确定关键质量指标（QI）、质量改进机制以及建立PCMC质量保证框架的潜在障碍和促进因素。
我们采用德尔菲法，就QI和质量改进机制征求PCMC临床医生和专科医生的共识。在两轮电子德尔菲调查中，向参与者提出了38个候选QI和19个潜在的质量改进机制。收集书面意见并进行描述性分析。
第一轮和第二轮的回复率分别为21.3%（n = 179）和12.8%（n = 88）。大多数受访者为医生。经过共识达成过程后，保留了14个QI。选择了10个质量改进机制，其中以专科整合为特征的机制，如病例讨论和指导，排名较高。书面意见揭示了与质量保证的潜在障碍和促进因素相关的三个主要主题：1）感知重要性，2）协作和角色明确性，3）实施过程。
我们成功地在初级和专科医疗服务提供者之间利用了一个协商过程，以确定PCMC的核心QI和质量改进机制。确定的质量改进机制突出了对多模式教育的需求。强调系统整合以及PCMC与专科医生之间更紧密的整合对于在社区环境中提供高质量痴呆症护理至关重要。
