Charnaya Olga, Ahn Sun-Young
Division of Nephrology, Children's National Health System, Washington, DC, United States.
Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, United States.
Front Pediatr. 2019 Mar 29;7:112. doi: 10.3389/fped.2019.00112. eCollection 2019.
Childhood nephrotic syndrome is frequently seen in pediatric nephrology practice and often requires patient hospitalization for management. Numerous complications of this disease can be managed in an outpatient setting if brought to the attention of the medical team in a timely manner. Outpatient management will reduce healthcare cost and improve patient safety. The goal of this quality improvement initiative was to reduce admissions for nephrotic syndrome relapse from 8 to <5 admissions at a single center in a 3-month period. Fish-bone analysis was used to determine barriers to early recognition of relapse and successful outpatient care. Patient education about the disease process was identified as the primary barrier. A standardized approach to patient education as well as educational materials were developed. Champions were identified within each stakeholder group to train and disseminate the new process. Admission counts were compared from 3 years prior to implementation to 2 years post-implementation. Clinic visits for nephrotic syndrome were tallied as a balancing measure. Patients were surveyed in the outpatient clinics about whether they had ever received the education as a process measure. Admission counts were reduced and met goal for the first 3 quarters that were examined; however, the number of admissions went above target in the last quarter. Clinic visit numbers did not change over the study period. Process measure showed that 75-80% of families were provided with nephrotic syndrome education. A standardized approach to patient and family education about idiopathic nephrotic syndrome can reduce admissions for management of relapse. This will reduce healthcare expenditure as well as improve patient safety.
儿童肾病综合征在儿科肾脏病实践中较为常见，通常需要患者住院治疗。如果能及时引起医疗团队的注意，该疾病的许多并发症可以在门诊进行处理。门诊管理将降低医疗成本并提高患者安全性。这项质量改进举措的目标是在一个单一中心，将肾病综合征复发的住院人数在3个月内从8例减少至<5例。鱼骨分析用于确定复发早期识别和成功门诊治疗的障碍。患者对疾病过程的教育被确定为主要障碍。制定了标准化的患者教育方法以及教育材料。在每个利益相关者群体中确定了倡导者来培训和传播新流程。比较了实施前3年与实施后2年的住院人数。将肾病综合征的门诊就诊次数作为一项平衡指标进行统计。在门诊对患者进行调查，询问他们是否接受过作为流程指标的教育。在所检查的前三个季度，住院人数减少并达到了目标；然而，最后一个季度的住院人数超过了目标。在研究期间门诊就诊次数没有变化。流程指标显示，75 - 80%的家庭接受了肾病综合征教育。一种针对特发性肾病综合征患者及家属的标准化教育方法可以减少复发管理的住院人数。这将减少医疗支出并提高患者安全性。
