Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Ste 1600, Seattle, WA, 98101, USA.
Oregon Rural Practice Research Network, Oregon Health Sciences University, Portland, OR, USA.
BMC Fam Pract. 2019 Jul 25;20(1):103. doi: 10.1186/s12875-019-1000-1.
Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation.
To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors.
The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r = 0.16, p = 0.049) and blood pressure control (r = 0.18, p = 0.013). Rural practices and those with 2-5 clinicians had lower QICA scores..
The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.
This trial is registered with www.clinicaltrials.gov Identifier# NCT02839382, retrospectively registered on July 21, 2016.
健康之心西北（H2N）是一项关于外部支持策略的研究，旨在通过关注心血管风险因素（如适当使用阿司匹林、控制血压和筛查/戒烟）来提高基层医疗质量改进（QI）能力。
为了指导实践促进者的支持，实践转化专家确定了七个 QI 能力领域，并将先前经过验证的医疗之家评估工具中的项目映射到这些领域。实践促进者（PF）与每个实践中的临床医生和工作人员会面，讨论质量改进能力评估（QICA）中的每个项目，从而对每个项目做出实践层面的回应。我们检查了 QICA 总分和子量表评分、实践特征、管理实践变革经验的衡量标准以及三个心血管风险因素的临床质量指标（CQM）之间的关联。
QICA 评分与管理变革的经验有关，与三个 CQM 中的两个有中度关联：阿司匹林使用（r=0.16，p=0.049）和血压控制（r=0.18，p=0.013）。农村实践和有 2-5 名临床医生的实践得分较低。
QICA 可用于评估实践中的 QI 能力，并可作为促进者和基层医疗实践在努力建立这种能力和提高临床质量措施方面的指南。
本试验在 www.clinicaltrials.gov 上注册，标识符为# NCT02839382，于 2016 年 7 月 21 日进行了回顾性注册。
