1 Canadian Foundation for Healthcare Improvement, Ottawa, Canada.
2 Department of Family Medicine, Faculty of Health Sciences, School of Health Studies, Schulich School of Medicine and Dentistry; The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Chron Respir Dis. 2018 Feb;15(1):5-18. doi: 10.1177/1479972317712720. Epub 2017 Jun 14.
Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of <$1-million CAD, a pan-Canadian quality improvement collaborative (QIC) supported the spread of INSPIRED to 19 teams in the 10 Canadian provinces contingent upon participation in evaluation. The collaborative evaluation followed a mixed-methods summative approach relying on collated quantitative data, team documents, and surveys sent to core members of the 19 teams. Survey questions included a series of multiple-choice responses, Likert scale ratings, and open-ended questions. The qualitative evaluation entailed key informant interviews and focus groups undertaken between February and April 2016 post-collaborative. Teams reported that the year-long QIC helped bring focus to a needed, though often overlooked area of improvement, facilitating innovation spread. They report examples of new work practices as well as unanticipated cultural change (given the short QIC time frame). Most teams gained new skills in quality improvement (QI) and evidence-based medicine, showing progress in their ability to measure and implement COPD care improvements. Teams felt networking with other teams across the country toward a common solution as well as learning from a team of clinical innovators and evidence-based innovation were critical to their success. Factors affecting sustainability included local leadership support, involvement of frontline clinicians, and sharing milestones to motivate continued QI. The INSPIRED QIC enabled teams across Canada to adapt and implement a new COPD care model for high users of health-care with rapid improvements to work practices, cultural change, and skill sets, and at relatively low cost.
慢性阻塞性肺疾病（COPD）是导致死亡、发病和医疗保健支出的主要原因。位于新斯科舍省哈利法克斯的 INSPIRED COPD 推广计划™ 已被证明对患者和医疗保健系统非常有益。通过直接投资不到 100 万加元，一个全加质量改进合作组织（QIC）支持 INSPIRED 在 10 个加拿大省份的 19 个团队中传播，前提是参与评估。合作评估采用混合方法总结性方法，依赖于整理的定量数据、团队文件以及发送给 19 个团队核心成员的调查。调查问题包括一系列多项选择题、李克特量表评分和开放式问题。定性评估包括关键知情者访谈和焦点小组，于合作结束后的 2016 年 2 月至 4 月进行。团队报告称，为期一年的 QIC 有助于关注一个需要改进的领域，尽管这通常被忽视，促进了创新的传播。他们报告了一些新的工作实践以及意想不到的文化变革（考虑到 QIC 的时间框架很短）的例子。大多数团队在质量改进（QI）和循证医学方面获得了新技能，在衡量和实施 COPD 护理改进方面的能力取得了进展。团队认为，与全国各地的其他团队建立联系以寻求共同解决方案以及向临床创新者和循证创新团队学习对于他们的成功至关重要。影响可持续性的因素包括当地领导层的支持、一线临床医生的参与以及分享里程碑以激励持续的 QI。INSPIRED QIC 使加拿大各地的团队能够适应和实施新的 COPD 护理模式，为高使用率的医疗保健患者提供快速改进的工作实践、文化变革和技能集，而且成本相对较低。
