Fingrut W, Beck L A, Lo D
Faculty of Medicine, University of Toronto, Toronto, ON.
Division of Hematology and Oncology, St. Joseph's Health Centre, Toronto, ON.
Curr Oncol. 2018 Dec;25(6):371-377. doi: 10.3747/co.25.4087. Epub 2018 Dec 1.
Communities of practice (cops) have been shown to be effective models for achieving quality outcomes in health care.
Here, we describe the application of the cop model to the Canadian oncology context.
We established an oncology cop at our urban community hospital and its networks. Goals were to decrease barriers to access, foster collaboration, and improve knowledge of guidelines in cancer care. We hosted 6 in-person multidisciplinary meetings, focusing on screening, diagnosis, and management of common solid tumours. Health care providers affiliated with our hospital were invited to attend and to complete post-meeting surveys. Likert scales assessed whether cop goals were realized.
Meetings attracted a mean of 57 attendees (range: 48-65 attendees), with a mean of 84% completing the surveys and consenting to the analysis. Attendees included family physicians (mean: 41%), specialist physicians (mean: 24%), nurses (mean: 10%), and allied health care providers (mean: 22%). Repeat attendance increased during the series, with 85% of attendees at the final meeting having attended 1 or more prior meetings. Across the series, most participants agreed or strongly agreed that the cop reduced barriers (mean: 76.0% ± 7.9%) and improved access to cancer care services (mean: 82.4% ± 8.1%) and subject matter experts (mean: 91.7% ± 4.2%); fostered teamwork (mean: 84.5% ± 6.8%) and a culture of collaboration (mean: 94.8% ± 4.2%); improved knowledge of cancer care services (mean: 93.3% ± 4.8%), standards of practice (mean: 92.3% ± 3.1%), and quality indicators (mean: 77.5% ± 6.3%); and improved cancer-related practice (mean: 88.8% ± 4.6%) and satisfaction in caring for cancer patients (mean: 82.9% ± 6.8%). Participant feedback carried a potential for bias.
We demonstrated the feasibility of oncology cops and found that participants perceived their value in reducing barriers to access, fostering collaboration, and improving knowledge of guidelines in cancer care.
实践社区已被证明是在医疗保健领域实现优质成果的有效模式。
在此，我们描述实践社区模式在加拿大肿瘤学背景下的应用。
我们在我们的城市社区医院及其网络中建立了一个肿瘤学实践社区。目标是减少就医障碍，促进协作，并提高癌症护理指南的知晓度。我们举办了6次面对面的多学科会议，重点关注常见实体瘤的筛查、诊断和管理。邀请了与我们医院相关的医疗保健提供者参加并完成会后调查。李克特量表评估实践社区的目标是否实现。
会议平均吸引了57名与会者（范围：48 - 65名与会者），平均84%的人完成了调查并同意进行分析。与会者包括家庭医生（平均：41%）、专科医生（平均：24%）、护士（平均：10%）和专职医疗保健提供者（平均：22%）。在系列会议期间，重复参会人数有所增加，最后一次会议的与会者中有85%参加过1次或更多次之前的会议。在整个系列会议中，大多数参与者同意或强烈同意实践社区减少了障碍（平均：76.0% ± 7.9%），改善了癌症护理服务的可及性（平均：82.4% ± 8.1%）以及获取主题专家的机会（平均：91.7% ± 4.2%）；促进了团队合作（平均：84.5% ± 6.8%）和协作文化（平均：94.8% ± 4.2%）；提高了对癌症护理服务的知晓度（平均：93.3% ± 4.8%）、实践标准（平均：92.3% ± 3.1%）和质量指标（平均：77.5% ± 6.3%）；改善了与癌症相关的实践（平均：88.8% ± 4.6%）以及对癌症患者护理的满意度（平均：82.9% ± 6.8%）。参与者的反馈存在偏差的可能性。
我们证明了肿瘤学实践社区的可行性，并发现参与者认识到其在减少就医障碍、促进协作以及提高癌症护理指南知晓度方面的价值。
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