Rocker Graeme M, Amar Claudia, Laframboise Wendy L, Burns Jane, Verma Jennifer Y
Division of Respirology, Nova Scotia Health Authority/Dalhousie University, Halifax, NS.
Canadian Foundation for Healthcare Improvement.
Int J Chron Obstruct Pulmon Dis. 2017 Jul 26;12:2157-2164. doi: 10.2147/COPD.S140043. eCollection 2017.
A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program?
Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1) patient- and family-centeredness, 2) coordination, 3) efficiency, and 4) appropriateness. Evaluation of a complex intervention followed a mixed-methods approach.
Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3). Twelve teams used the Lung Information Needs Questionnaire (LINQ). Admissions, emergency room visits, and patient-related costs fell substantially for two teams described in detail (combined enrollment 208 patients). Most teams reported gaining deeper knowledge around complexities of COPD care, optimizing patient care through action plans, self-management support, psychosocial support, advance care planning, and coordinating community partnerships.
Quality-of-care gains are achievable in the short term among different teams across diverse geographical and social contexts. A well-designed, adequately funded public-private partnership can deliver widespread beneficial outcomes for the health care system and for those living with advanced COPD.
由加拿大医疗保健改进基金会（CFHI）牵头开展的为期一年的全加拿大质量改进协作项目（QIC），助力将成功的、位于新斯科舍省哈利法克斯市的“激励型慢性阻塞性肺疾病（COPD）外展项目™”推广至加拿大10个省份的19个团队。我们描述了QIC的结果，回答两个主要问题：1）新斯科舍省“激励型”模式的结果能否在加拿大其他地方复制？2）各团队如何实施和评估其版本的“激励型”项目？
协作教员选择了基于证据、收集相对简单且与当地情况相关的指标。选定的过程和结果指标与四个质量领域相关：1）以患者和家庭为中心，2）协调，3）效率，4）适当性。对复杂干预措施的评估采用了混合方法。
大多数参与者是护士长和/或COPD教育工作者。只有8%是医生。15个团队纳入了所有核心“激励型”干预措施。所有团队都进行了评估。13个团队积极让患者和家庭参与定制的直接护理计划，例如要求他们完成评估调查和/或进行访谈。患者一致报告在症状管理方面更有自信，恢复了日常活动，生活质量得到改善。12个团队使用经过验证的三项护理过渡测量指标（CTM - 3）收集护理过渡数据。12个团队使用了肺部信息需求问卷（LINQ）。详细描述的两个团队（合并登记患者208名）的住院、急诊就诊和与患者相关的费用大幅下降。大多数团队报告称，对COPD护理的复杂性有了更深入的了解，通过行动计划、自我管理支持、心理社会支持、预先护理计划以及协调社区伙伴关系优化了患者护理。
在不同地理和社会背景下的不同团队中，短期内可实现护理质量的提升。精心设计、资金充足的公私合作伙伴关系可为医疗保健系统以及晚期COPD患者带来广泛的有益成果。
