基于注册数据对来自不同医疗保健领域的两个质量改进合作组织进行深入比较——可能有助于在项目时间之外持续改善结果的因素。

In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data-possible factors contributing to sustained improvement in outcomes beyond the project time.

机构信息

Department of Food and Nutrition, and Sport Science, University of Gothenburg, Faculty of Education, Box 300, 405 30, Gothenburg, Sweden.

School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.

出版信息

Implement Sci. 2019 Jul 23;14(1):74. doi: 10.1186/s13012-019-0926-y.

DOI:10.1186/s13012-019-0926-y

PMID:31337394

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6647054/

Abstract

BACKGROUND

Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

METHODS

Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

RESULTS

The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

CONCLUSIONS

Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.

摘要

背景

质量改进合作（QIC）被广泛用于改善医疗保健，但很少有研究关注长期持续改善的结果，并且关于促成成功的因素也没有一致的证据。本研究的目的是揭开 QIC 的神秘面纱，并比较两个不同 QIC 的特征和活动，以了解它们从基线到接下来 3 年的变化结果。

方法

对两个 QIC 的最终报告进行了分析，一个是心力衰竭护理 QIC，有 5 个团队，另一个是骨关节炎护理 QIC，有 7 个团队，包括每个 QIC 团队的详细改进项目描述，通过 18 个 QIC 特征和 4 个团队特征进行了编码。在 2013 年（基线）、2014 年、2015 年和 2016 年，从每个团队常规收集的瑞典心力衰竭登记处（SwedeHF）和骨关节炎患者管理登记处（BOA）的目标变量进行了单变量分析。

结果

两个 QIC 在设计上存在很大差异。SwedeHF-QIC 涉及 8 名专家，运行时间为 12 个月，而 BOA-QIC 则有 3 名专家参与，运行时间为 6 个月。SwedeHF-QIC 的活动数量大约是 BOA-QIC 的两倍，活动范围从团队协调的标准化到更好的信息和结构化随访。团队内部和 QIC 之间的结果结果存在异质性。两个 QIC 都受到参与者的高度赞赏，并促进了他们的学习，例如改进方法；然而，当 QIC 于 2013 年启动时，一些团队已经达到了目标值。

结论

尽管进行了许多 QI 活动，但很难看到结果的持续改善。应谨慎选择需要改进的具体可衡量的护理方面作为结果。专注于遵守标准护理方案和增加患者随访的活动似乎会带来更持久的改善。尽管早期研究表明，数据跟踪和测量技能以及功能良好的数据仓库有助于持续改进，但目前的登记处功能和当时的 QIC 并没有充分支持这些方面。应该进一步研究 QIC 及其对项目时间之外的改进的影响，特别要研究这些因素的影响。