Kindratt Tiffany, Day Philip G, Blower Jessica, Yun Olivia, Gimpel Nora
Department of Kinesiology, University of Texas at Arlington, Arlington, TX.
Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
PRiMER. 2021 Jul 27;5:25. doi: 10.22454/PRiMER.2021.888918. eCollection 2021.
The Accreditation Council for Graduate Medical Education (ACGME) requires family medicine residents to complete a quality improvement (QI) project. There is a need for more QI training activities to be shared to meet this requirement. Our objective was to describe an activity for residents to improve women's preventive health services in an underserved clinic. Specific aims were to determine: (1) how women's receipt of preventive services compared to benchmarks, (2) physician and staff knowledge of the process and barriers to receiving services, and (3) whether an intervention to increase awareness among physicians and staff improved preventive services.
Residents (N=30) evaluated charts (N=505) to determine receipt of mammograms, pap tests, colon cancer screenings, and pneumonia vaccines. We compared estimates to existing clinic benchmarks. We presented initial (preintervention) results to physicians and staff at clinic team meetings. We collected perceptions of processes and barriers to preventive services. Preintervention methods were replicated (N=100) and results were compared (postintervention).
Preintervention, mammograms (72%) and Pap tests (65%) were lower than clinic benchmarks. Most (81%) women ages 65 and older received a pneumonia vaccine; however, this was lower than the national Healthy People 2020 goal. Fear, knowledge, and scheduling were identified as top barriers. Post-intervention, there was a statistically significant increase in Pap tests (=.0013).
This activity trained residents how to impact their practice through QI methods and can be used in other programs as a foundation for developing basic QI initiatives. Future efforts should focus on evaluating barriers to preventive services from the patient perspective.
毕业后医学教育认证委员会（ACGME）要求家庭医学住院医师完成一项质量改进（QI）项目。需要分享更多的QI培训活动以满足这一要求。我们的目标是描述一项让住院医师改善服务欠缺诊所中女性预防性健康服务的活动。具体目标是确定：（1）女性接受预防性服务的情况与基准相比如何；（2）医生和工作人员对接受服务的流程及障碍的了解；（3）一项提高医生和工作人员意识的干预措施是否改善了预防性服务。
住院医师（N = 30）评估病历（N = 505），以确定乳房X光检查、巴氏试验、结肠癌筛查和肺炎疫苗的接受情况。我们将评估结果与诊所现有的基准进行比较。我们在诊所团队会议上向医生和工作人员展示了初始（干预前）结果。我们收集了对预防性服务流程和障碍的看法。重复干预前的方法（N = 100）并比较结果（干预后）。
干预前，乳房X光检查（72%）和巴氏试验（65%）低于诊所基准。大多数65岁及以上的女性（81%）接种了肺炎疫苗；然而，这低于《健康人民2020》的全国目标。恐惧、知识和安排被确定为主要障碍。干预后，巴氏试验有统计学上的显著增加（P =.0013）。
这项活动培训住院医师如何通过QI方法影响其实践，可作为其他项目开展基本QI倡议的基础。未来的工作应侧重于从患者角度评估预防性服务的障碍。
