Ursu Allison, Greenberg Grant, McKee Michael
Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Fam Med Community Health. 2019 Mar 25;7(2):e000085. doi: 10.1136/fmch-2018-000085. eCollection 2019.
This article illustrates quality improvement (QI) methodology using an example intended to improve chlamydia screening in women. QI projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting, yet many academic centres lack training programmes on how to conduct QI projects. The choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and treat. At the University of Michigan, we implemented a multidepartment process to improve the chlamydia screening rates using the plan-do-check-act model. Steps to guide QI projects include the following: (1) assemble a motivated team of stakeholders and leaders; (2) identify the problem that is considered a high priority; (3) prepare for the project including support and resources; (4) set a goal and ways to evaluate outcomes; (5) identify the root cause(s) of the problem and prioritise based on impact and effort to address; (6) develop a countermeasure that addresses the selected root cause effectively; (7) pilot a small-scale project to assess for possible modifications; (8) large-scale roll-out including education on how to implement the project; and (9) assess and modify the process with a feedback mechanism. Using this nine-step process, chlamydia screening rates increased from 29% to 60%. QI projects differ from most clinical research projects by allowing clinicians to directly improve patients' health while contributing to the medical science body. This may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.
本文通过一个旨在改善女性衣原体筛查的例子来说明质量改进（QI）方法。医疗保健领域的QI项目为在实际医疗环境中提高患者质量和安全性提供了巨大机会，但许多学术中心缺乏关于如何开展QI项目的培训计划。选择衣原体筛查是基于尽管有简单的筛查和治疗方法，但衣原体仍带来的重大健康负担。在密歇根大学，我们采用计划-执行-检查-行动模型实施了一个多部门流程来提高衣原体筛查率。指导QI项目的步骤如下：（1）组建一个由利益相关者和领导者组成的积极团队；（2）确定被视为高度优先的问题；（3）为项目做准备，包括支持和资源；（4）设定目标和评估结果的方法；（5）确定问题的根本原因，并根据解决问题的影响和努力程度进行优先级排序；（6）制定一项能有效解决所选根本原因的对策；（7）进行小规模试点项目以评估可能的修改；（8）大规模推广，包括关于如何实施该项目的培训；（9）通过反馈机制评估和修改流程。通过这个九步流程，衣原体筛查率从29%提高到了60%。QI项目与大多数临床研究项目不同，它允许临床医生在为医学科学做出贡献的同时直接改善患者健康。这可能会引起希望开展可通过学术渠道传播的相关研究的临床医生的兴趣。
