Kezirian Alexis C, McGregor Margaret J, Stead Umilla, Sakaluk Timothy, Spring Beverly, Turgeon Sue, Slater Jay, Murphy Janice M
a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada.
b Family Practice Research Office , Vancouver Coastal Health Research Institute's Centre for Clinical Epidemiology and Evaluation , Vancouver , British Columbia , Canada.
J Soc Work End Life Palliat Care. 2018 Oct-Dec;14(4):328-345. doi: 10.1080/15524256.2018.1547673. Epub 2019 Jan 17.
This study evaluated a practice improvement initiative conducted over a 6 month period in 15 Canadian nursing homes. Goals of the initiative included: (1) use the Plan-Do-Study-Act (PDSA) model to improve advance care planning (ACP) within the sample of nursing homes; (2) investigate whether improved ACP practice resulted in a change in residents' hospital use and ACP preferences for home-based care; (3) engage participating facilities in regular data collection to inform the initiative and provide a basis for reflection about ACP practice and; (4) foster a team-based participatory care culture. The initiative entailed two cycles of learning sessions followed by implementation of ACP practice improvement projects in the facilities using a PDSA approach by participating clinicians (e.g., physicians, social workers, nurses). Clinicians reported significantly increased confidence in many dimensions of ACP activities. Rates of hospital use and resident preference for home-based care did not change significantly. The initiative established routine data collection of outcomes to inform practice change, and successfully engaged physicians and non-physician clinicians to work together to improve ACP practices. Results suggest recurrent PDSA cycles that engage a 'critical mass' of clinicians may be warranted to reinforce the standardization of ACP in practice.
本研究评估了一项在加拿大15家养老院开展的为期6个月的实践改进计划。该计划的目标包括：（1）在养老院样本中使用计划-实施-研究-改进（PDSA）模型来改善临终关怀计划（ACP）；（2）调查ACP实践的改进是否导致居民住院率以及对居家护理的ACP偏好发生变化；（3）让参与的机构定期收集数据，为该计划提供信息，并为反思ACP实践提供依据；（4）培育基于团队的参与式护理文化。该计划包括两个学习周期，随后参与的临床医生（如医生、社会工作者、护士）采用PDSA方法在各机构实施ACP实践改进项目。临床医生报告说，他们在ACP活动的许多方面的信心显著增强。住院率和居民对居家护理的偏好没有显著变化。该计划建立了结果的常规数据收集以指导实践变革，并成功促使医生和非医生临床医生共同努力改善ACP实践。结果表明，可能需要反复进行PDSA循环，让“关键数量”的临床医生参与，以加强实践中ACP的标准化。
