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青少年冠军模式:通过有针对性的质量改进使初级保健以青少年为中心。

The Adolescent Champion Model: Primary Care Becomes Adolescent-Centered via Targeted Quality Improvement.

机构信息

Adolescent Health Initiative, University of Michigan Health System, Ann Arbor, MI.

Adolescent Health Initiative, University of Michigan Health System, Ann Arbor, MI.

出版信息

J Pediatr. 2018 Feb;193:229-236.e1. doi: 10.1016/j.jpeds.2017.09.084. Epub 2017 Nov 29.

Abstract

OBJECTIVE

To evaluate the effects of implementing the Adolescent Champion model, a novel quality improvement program targeted at helping primary care sites become more adolescent-centered.

STUDY DESIGN

Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics implemented the Adolescent Champion model. Each site identified a multidisciplinary champion team to undergo training on adolescent-centered care, deliver prepackaged trainings to other staff and providers, make youth-friendly site changes, implement a standardized flow to confidentially screen for risky behaviors, and complete a quality improvement project regarding confidentiality practices. Adolescent patients, staff, and providers were surveyed at baseline, year-end, and 1-year follow-up to assess changes.

RESULTS

Adolescent patients' experiences with both their provider and the site overall significantly improved (P values from <.0001 to .004, N = 474 baseline, 386 year-end). Staff perceived an improvement in clinic practices relating to adolescents and in their ability to make institutional and personal change (P < .0001, N = 121 baseline, 109 year-end). The majority of changes were sustained 1-year postintervention. Frequently noted site improvements included: (1) initiating a method to gather feedback from adolescent patients; (2) adding trainings on confidentiality, cultural humility, and using a nonjudgmental approach; (3) updating immunizations at every visit; and (4) training providers in long acting reversible contraception via implant training.

CONCLUSIONS

Implementing the Adolescent Champion model successfully helped primary care sites become more adolescent-centered. Further studies are needed to evaluate the effects of this model on patient outcomes.

摘要

目的

评估实施青少年冠军模式的效果,这是一种针对帮助初级保健场所更加以青少年为中心的新质量改进计划。

研究设计

来自儿科、家庭医学和医学-儿科的 9 个初级保健场所实施了青少年冠军模式。每个场所确定了一个多学科冠军团队,接受关于以青少年为中心的护理的培训,向其他员工和提供者提供预制培训,进行有利于青年的场所变更,实施标准化流程以对危险行为进行保密筛查,并完成关于保密性实践的质量改进项目。在基线、年终和 1 年随访时对青少年患者、员工和提供者进行调查,以评估变化。

结果

青少年患者对其提供者和整个场所的体验都有显著改善(P 值从<0.0001 到 0.004,N=474 基线,386 年终)。员工认为诊所与青少年相关的实践和他们进行机构和个人变革的能力有所提高(P<0.0001,N=121 基线,109 年终)。大多数变化在干预后 1 年仍持续存在。经常提到的场所改进包括:(1)启动一种从青少年患者收集反馈的方法;(2)增加关于保密性、文化谦逊和使用非评判性方法的培训;(3)每次就诊时更新免疫接种;(4)通过植入培训培训提供者长效可逆避孕。

结论

实施青少年冠军模式成功地帮助初级保健场所更加以青少年为中心。需要进一步研究来评估该模式对患者结果的影响。

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