College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
BMJ Open Qual. 2022 Mar;11(1). doi: 10.1136/bmjoq-2021-001774.
Hospital use increases with age. Older people and their families have reported poor experiences of care at the time of discharge home from hospital. As part of a larger project, we established and evaluated a quality improvement collaborative to address hospital to home transitions for older people.
We convened an expert panel of 34 stakeholders to identify modifiable issues in the hospital-home transition period. We established a collaborative involving health professionals across a range of agencies working to common goals. Teams were supported by a network manager, three learning sessions and quality improvement methodology to address their identified area for improvement. We used mixed methods to evaluate whether the establishment of the quality improvement collaborative built networks, built capacity in the health professionals and improved the quality of care for older people. Evaluation methods included interviews, surveys, network mapping and case studies.
Nine teams (n=41 participants) formed the collaborative and attended all meetings. Mapping showed an increase in networks between participants and organisations at the conclusion of the collaborative. Interview data showed that building relationships across services was one of the most important parts of the collaborative. Survey results revealed that most (77%) believed their quality improvement skills had developed through participation. Advice and regular meetings to progress project work were considered important in ensuring teams stayed focused. In terms of improving the quality of care, some participants indicated that they achieved the stated aims of their project better than expected (21%), most (41%) felt they achieved their aim as expected, 26% got close to their aim and the rest did not know the outcome (13%).
Establishing a quality improvement collaborative was a positive activity in terms of building a network across organisations and progressing quality improvement projects which aimed to achieve the same overall goal.
医院的使用随着年龄的增长而增加。老年人及其家属报告说，在从医院出院回家时，他们的护理体验很差。作为一个更大项目的一部分，我们成立并评估了一个质量改进合作组织，以解决老年人从医院到家庭的过渡问题。
我们召集了一个由 34 名利益相关者组成的专家小组，以确定在医院到家庭过渡期间可修改的问题。我们建立了一个合作组织，涉及跨越多个机构的卫生专业人员，共同追求共同的目标。团队由网络经理、三次学习会议和质量改进方法学支持，以解决他们确定的改进领域。我们使用混合方法评估质量改进合作组织的建立是否建立了网络、增强了卫生专业人员的能力以及改善了老年人的护理质量。评估方法包括访谈、调查、网络映射和案例研究。
九个团队（n=41 名参与者）组成了合作组织，并参加了所有会议。映射显示，在合作结束时，参与者和组织之间的网络增加了。访谈数据显示，在服务之间建立关系是合作的最重要部分之一。调查结果显示，大多数（77%）人认为他们的质量改进技能通过参与得到了发展。建议和定期会议以推进项目工作被认为是确保团队保持专注的重要因素。就改善护理质量而言，一些参与者表示，他们比预期更好地实现了项目的既定目标（21%），大多数（41%）人认为他们达到了预期目标，26%的人接近目标，其余的人不知道结果（13%）。
就建立跨越组织的网络和推进旨在实现总体目标的质量改进项目而言，建立质量改进合作组织是一项积极的活动。
