Haines Mary M, Brown Bernadette, D'Este Catherine A, Yano Elizabeth M, Craig Jonathan C, Middleton Sandy, Castaldi Peter A, Pollock Carol A, Needham Kate, Watt William H, Elliott Elizabeth J, Scott Anthony, Dominello Amanda, Klineberg Emily, Atkinson Jo-An, Paul Christine, Redman Sally
Sax Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia,
Sax Institute, Sydney, NSW, Australia.
Public Health Res Pract. 2018 Dec 6;28(4):28011803. doi: 10.17061/phrp28011803.
Networks of clinical experts are being established internationally to help embed evidence based care in health systems. There is emerging evidence that these clinical networks can drive quality improvement programs, but the features that distinguish successful networks are largely unknown. We examined the factors that make clinical networks effective at improving quality of care and facilitating system-wide changes.
We conducted a retrospective cross-sectional study of 19 state-wide clinical networks that reflected a range of medical and surgical specialty care and were in operation from 2006 to 2008 in New South Wales, Australia. We conducted qualitative interviews with network leaders to characterise potential impacts, and conducted internet surveys of network members to evaluate external support and the organisational and program characteristics of their respective networks. The main outcome measures were median ratings of individual network impacts on quality of care and system-wide changes, determined through independent assessment of documented evidence by an expert panel.
We interviewed 19 network managers and 32 network co-chairs; 592 network members completed internet surveys. Three networks were rated as having had high impact on quality of care, and seven as having had high impact on system-wide change. Better-perceived strategic and operational network management was significantly associated with higher ratings of impact on quality of care (coefficient estimate 0.86; 95% confidence interval [CI] 0.02, 1.69). Better-perceived leadership of the network manager (coefficient estimate 0.47; 95% CI 0.10, 0.85) and strategic and operational network management (coefficient estimate 0.23; 95% CI 0.06, 0.41) were associated with higher ratings of impact on system-wide change.
This study represents the largest study of clinical networks undertaken to date. The results suggest that clinical networks that span the health system can improve quality of care and facilitate system-wide change. Network management and leadership, encompassing both strategic and operational elements at the organisational level, appear to be the primary influences on network success. These findings can guide future organisational and system-wide change programs and the development or strengthening of clinical networks to help implement evidence based care to improve service delivery and outcomes.
国际上正在建立临床专家网络，以帮助将循证医疗融入卫生系统。越来越多的证据表明，这些临床网络可以推动质量改进项目，但成功网络的特征在很大程度上尚不清楚。我们研究了使临床网络在提高医疗质量和促进全系统变革方面有效的因素。
我们对19个全州范围的临床网络进行了一项回顾性横断面研究，这些网络涵盖了一系列医疗和外科专科护理，于2006年至2008年在澳大利亚新南威尔士州运营。我们对网络负责人进行了定性访谈，以描述潜在影响，并对网络成员进行了网络调查，以评估外部支持以及各自网络的组织和项目特征。主要结局指标是通过专家小组对书面证据的独立评估确定的各个网络对医疗质量和全系统变革影响的中位数评分。
我们采访了19名网络管理人员和32名网络联合主席；592名网络成员完成了网络调查。三个网络被评为对医疗质量有高影响，七个网络被评为对全系统变革有高影响。更好的战略和运营网络管理与更高的医疗质量影响评分显著相关（系数估计值0.86；95%置信区间[CI]0.02，1.69）。更好的网络管理人员领导力（系数估计值0.47；95%CI 0.10，0.85）以及战略和运营网络管理（系数估计值0.23；95%CI 0.06，0.41）与更高的全系统变革影响评分相关。
本研究是迄今为止对临床网络进行的规模最大的研究。结果表明，跨越卫生系统的临床网络可以提高医疗质量并促进全系统变革。网络管理和领导力，包括组织层面的战略和运营要素，似乎是网络成功的主要影响因素。这些发现可以指导未来的组织和全系统变革项目以及临床网络的发展或加强，以帮助实施循证医疗，改善服务提供和结果。
