Ontario Health, Toronto, Ontario, Canada.
Ontario Health, Toronto, Ontario, Canada.
J Am Med Dir Assoc. 2020 Mar;21(3):420-425. doi: 10.1016/j.jamda.2019.11.017. Epub 2020 Jan 20.
The province of Ontario in Canada is an example of a jurisdiction that is using a specific quality improvement mechanism, known as "audit and feedback," to help clinicians enhance the care they provide to long-term care (LTC) home residents. This program, launched in 2015, is unique in that the reports are provided across an entire jurisdiction. These reports were co-designed with clinicians, including medical directors, scientists, and other stakeholders, and are updated regularly to maintain their relevance to medical practice in LTC. The data for the reports is calculated using record linkage with available administrative data sources. The reports are updated with new data 4 times each year and emailed directly to physicians who have requested their report. The reports are designed to have an overall dashboard summarizing the practice level data with a comparison to all physicians in Ontario. More detailed information on their data such as trend data and resources for quality improvement are found in subsequent pages of the report. These reports are a tool to support physicians in quality improvement efforts in their LTC practice. We believe the role of a medical director is very important in both the uptake and use of these reports as the medical director would act as a trusted advisor who can influence quality of care overall within an LTC home. We are also testing a new format for delivering the reports in an interactive online format that enables more options for viewing practice data. Initial evaluation of these reports shows that there is a statistically significant impact on reducing the prescription of antipsychotic medications in LTC homes. In future, we hope to see a larger effect on the latest topic included in the reports: antibiotic prescribing.
加拿大安大略省是一个使用特定质量改进机制的管辖区的范例，该机制被称为“审计和反馈”，旨在帮助临床医生提高他们为长期护理（LTC）院居民提供的护理水平。该计划于 2015 年启动，其独特之处在于报告是在整个管辖区内提供的。这些报告是与临床医生共同设计的，包括医学主任、科学家和其他利益相关者，并且定期更新以保持其与 LTC 中医疗实践的相关性。报告中的数据是使用与可用管理数据源的记录链接计算得出的。报告每年更新 4 次新数据，并直接通过电子邮件发送给要求报告的医生。报告旨在使用总体仪表板总结实践水平数据，并与安大略省的所有医生进行比较。报告的后续页面上提供了有关其数据的更详细信息，例如趋势数据和质量改进资源。这些报告是支持医生在 LTC 实践中进行质量改进工作的工具。我们认为医学主任在接受和使用这些报告方面的作用非常重要，因为医学主任可以作为可信赖的顾问，影响整个 LTC 院的护理质量。我们还在测试一种新的报告交付格式，以交互式在线格式提供，从而为查看实践数据提供更多选择。对这些报告的初步评估表明，它们对减少 LTC 院中抗精神病药物的处方有统计学上的显著影响。将来，我们希望在报告中包含的最新主题：抗生素处方方面看到更大的影响。
