LEPS EA3412, Sorbonne Paris Cité University, Bobigny, France.
Mines-Nantes School, Nantes, France.
Orphanet J Rare Dis. 2018 Feb 8;13(Suppl 1):12. doi: 10.1186/s13023-017-0745-7.
An agreement, signed in 2007 by the 49 French Cystic Fibrosis Centers, included a commitment to participate, within the next 5 years, in a care quality assessment and improvement program (QIP). The objective was to roll out in the French Cystic Fibrosis (CF) care network a QIP adapted from the US program for Accelerating Improvement in Cystic Fibrosis Care developed by The Dartmouth Institute Microsystem Academy (TDIMA) and customized by the US CF Foundation between 2002 and 2013.
The French national team at the Nantes-Roscoff CF Center of Expertise was trained at TDIMA and visited US CF centers involved in US Learning and Leadership Collaboratives (LLCs). It introduced the PHARE-M QIP in France by transposing the Action Guide and material. A PHARE-M LLC1 including seven centers, underwent two external assessments. Adjustments were made, then a PHARE-M LLC2 was rolled out at seven more centers in two regions. On-site coaching was strengthened. The teams' satisfaction was assessed and further adjustments were made. In 2014, the program sought recognition as a continuing education program for healthcare professionals.
Ninety-six trainees including 14 patients/parents from the 14 CFCs volunteered to participate, test and adapt the program during LLC1 and LLC2 sessions. Comparison of patient outcomes collected in the Registry report by CF center, reflection on potential best practices, selection by each team of an improvement theme, implementation of improvement actions, and exchanges between teams fostered the adhesion of the teams. The program strengthened quality of care, interdisciplinary functioning and collaboration with patients/parents at the centers. The satisfaction expressed by the teams increased over time. A post-PHARE-M cycle maintains the focus on continuous quality improvement (CQI). In 2015, PHARE-M was recognized as a continuing professional development program in healthcare.
The PHARE-M is a complex intervention in multidisciplinary teams working in a variety of hospital settings. A confluence of factors motivated teams to engage in the program. Involving Patient/Parent in quality improvement (QI) work and developing patient therapeutic education for self-management appeared to be complementary approaches to improve care. Incorporating the program into hospital continuing education insures its sustainability. Transparency of Patient Registry indicators per center published in a brief lapse of time is required to effectively support CQI. The impact of the PHARE-M on patient outcomes after 3 years is the subject of a research program funded by the French Ministry of Health whose results will be available in 2017.
2007 年，49 家法国囊性纤维化中心签署了一项协议，承诺在未来 5 年内参与一项护理质量评估和改进计划（QIP）。该计划旨在推广由美国达特茅斯学院微系统学院（TDIMA）开发并由美国囊性纤维化基金会于 2002 年至 2013 年定制的 QIP，以适应法国囊性纤维化（CF）护理网络。
南特-罗什福尔 CF 中心的法国国家团队在 TDIMA 接受培训，并参观了参与美国学习和领导力合作的美国 CF 中心。它通过翻译行动指南和材料，在法国引入了 PHARE-M QIP。一个包括七个中心的 PHARE-M LLC1 经历了两次外部评估。进行了调整，然后在两个地区的另外七个中心推出了 PHARE-M LLC2。现场指导得到了加强。评估了团队的满意度，并进行了进一步的调整。2014 年，该计划寻求被认可为医疗保健专业人员的继续教育项目。
在 LLC1 和 LLC2 期间，共有 96 名学员，包括 14 名来自 14 个 CFC 的患者/家长自愿参与测试和调整该计划。通过 CF 中心的注册报告收集的患者结果比较，对潜在最佳实践的思考，每个团队选择一个改进主题，实施改进措施，以及团队之间的交流，促进了团队的参与。该计划加强了中心的护理质量、跨学科运作和与患者/家长的合作。团队的满意度随着时间的推移而增加。PHARE-M 周期后保持对持续质量改进（CQI）的关注。2015 年，PHARE-M 被认可为医疗保健领域的持续专业发展项目。
PHARE-M 是一个复杂的干预措施，涉及在各种医院环境中工作的多学科团队。一系列因素促使团队参与该计划。让患者/家长参与质量改进（QI）工作并为自我管理开发患者治疗教育似乎是改善护理的互补方法。将该计划纳入医院继续教育可确保其可持续性。每个中心的患者注册指标的透明度按简短的时间间隔公布，这对于有效支持 CQI 是必要的。PHARE-M 对 3 年后患者结局的影响是法国卫生部资助的研究计划的主题，其结果将于 2017 年公布。
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