Department of Medicine, Division of General Internal Medicine and Geriatrics.
Center for Primary Care Innovation.
Med Care. 2020 Apr;58(4):344-351. doi: 10.1097/MLR.0000000000001260.
Effective quality improvement (QI) strategies are needed for small practices.
The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care.
Two arm, practice-randomized, comparative effectiveness study.
Small and mid-sized primary care practices.
Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies.
Proportion of eligible patients in a practice meeting "ABCS" measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months.
A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02-0.06), Blood pressure 0.04 (0.02-0.06), Cholesterol 0.05 (0.03-0.07), Smoking 0.05 (0.02-0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (-0.02 to 0.05), Blood pressure -0.01 (-0.04 to 0.03), Cholesterol 0.03 (0.00-0.07), and Smoking 0.02 (-0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09-0.51) but did not significantly differ across arms.
Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
需要有效的质量改进（QI）策略来针对小型实践。
本研究的目的是比较单独实施即时护理（POC）QI 策略的实践促进与促进实施即时护理加人群管理（POC+PM）策略在预防心血管护理方面的效果。
双臂、实践随机、比较有效性研究。
小型和中型初级保健实践。
实践与促进者合作，针对 QI 进行为期 12 个月的工作，以实施 POC 或 POC+PM 策略。
实践中符合“ABCS”措施的合格患者比例：（阿司匹林）阿司匹林/抗血小板治疗缺血性血管疾病，（血压）控制高血压，（胆固醇）他汀类药物用于心血管疾病的预防和治疗，以及（吸烟）烟草使用：筛查和戒烟干预，以及变革过程能力问卷。测量在基线、12 个月和 18 个月进行。
共有 226 个实践被随机分配，179 个实践提供了随访数据。与基线相比，12 个月时每个绩效测量的患者比例更高：阿司匹林 0.04（95%置信区间：0.02-0.06），血压 0.04（0.02-0.06），胆固醇 0.05（0.03-0.07），吸烟 0.05（0.02-0.07）；每个 P<0.001。18 个月时仍能保持改善。在 12 个月时，POC+PM 臂与 POC 相比的比例差异的调整后差异：阿司匹林 0.02（-0.02 至 0.05），血压-0.01（-0.04 至 0.03），胆固醇 0.03（0.00-0.07），吸烟 0.02（-0.02 至 0.06）；所有 P>0.05。变革过程能力问卷略有改善，平均变化 0.30（0.09-0.51），但双臂之间无显著差异。
促进者主导的 QI 促进人群管理方法加上 POC 改进策略并不明显优于单独的 POC 策略。
