Dominello Amanda, Yano Elizabeth, Klineberg Emily, Redman Sally, Craig Jonathan C, Brown Bernadette, Kalucy Deanna, Haines Mary
Sax Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia,
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, CA, US; UCLA Fielding School of Public Health, Los Angeles, CA, US.
Public Health Res Pract. 2018 Dec 6;28(4):2841829. doi: 10.17061/phrp2841829.
Objectives and importance of study: Evaluating impacts of quality improvement activities across diverse clinical focus areas is challenging. However, evaluation is necessary to determine if the activities had an impact on quality of care and resulted in system-wide change. Clinical networks of health providers aim to provide a platform for accelerating quality improvement activities and adopting evidence based practices. However, most networks do not collect primary data that would enable evaluation of impact. We adapted an established expert panel approach to measure the impacts of efforts in 19 clinical networks to improve care and promote health system change, to determine whether these efforts achieved their purpose.
A retrospective cross-sectional study of 19 clinical networks using multiple methods of data collection including the EXpert PANel Decision (EXPAND) method.
Network impacts were identified through interviews with network managers (n = 19) and co-chairs (n = 32), and document review. The EXPAND method brought together five independent experts who provided initial individual ratings of overall network impact. After attendance at an in-person moderated meeting where aggregate scores were discussed, the experts provided a final rating. Median scores of postmeeting ratings were the final measures of network impact.
Among the 19 clinical networks, experts rated 47% (n = 9) as having a limited impact on improving quality of care, 37% (n = 7) as having a moderate impact and 16% (n = 3) as having a high impact. The experts rated 26% (n = 5) of clinical networks as having a limited impact on facilitating system-wide change, 37% (n = 7) as having a moderate impact and 37% (n = 7) as having a high impact.
The EXPAND method enabled appraisal of diverse clinical networks in the absence of primary data that could directly evaluate network impacts. The EXPAND method can be applied to assess the impact of quality improvement initiatives across diverse clinical areas to inform healthcare planning, delivery and performance. Further research is needed to assess its reliability and validity.
研究目的与重要性：评估质量改进活动在不同临床重点领域的影响具有挑战性。然而，评估对于确定这些活动是否对医疗质量产生影响并导致全系统变革是必要的。医疗服务提供者的临床网络旨在提供一个平台，以加速质量改进活动并采用循证实践。然而，大多数网络并未收集能够评估影响的原始数据。我们采用一种既定的专家小组方法来衡量19个临床网络在改善医疗和促进卫生系统变革方面所做努力的影响，以确定这些努力是否达到了目的。
对19个临床网络进行的回顾性横断面研究，采用多种数据收集方法，包括专家小组决策（EXPAND）方法。
通过与网络管理人员（n = 19）和联合主席（n = 32）进行访谈以及文档审查来确定网络影响。EXPAND方法召集了五位独立专家，他们对网络的总体影响提供初步的个人评分。在参加一次面对面的主持会议讨论综合得分后，专家们给出最终评分。会议后评分的中位数是网络影响的最终衡量指标。
在19个临床网络中，专家们将47%（n = 9）评定为对改善医疗质量影响有限，37%（n = 7）评定为有中等影响，16%（n = 3）评定为有高影响。专家们将临床网络的26%（n = 5）评定为对促进全系统变革影响有限，37%（n = 7）评定为有中等影响，37%（n = 7）评定为有高影响。
EXPAND方法能够在缺乏可直接评估网络影响的原始数据的情况下，对不同的临床网络进行评估。EXPAND方法可用于评估不同临床领域质量改进举措的影响，为医疗保健规划、提供和绩效提供参考。需要进一步研究以评估其可靠性和有效性。
