Payton Kurlen S E, Gould Jeffrey B
Cedars-Sinai Medical Center, Department of Pediatrics, Division of Neonatology, Los Angeles, CA 90048, USA.
California Perinatal Quality Care Collaborative, Stanford, CA 94305, USA.
Healthcare (Basel). 2022 Dec 20;11(1):7. doi: 10.3390/healthcare11010007.
Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, some practice variation is due to the individual preference or style of the clinicians. Quality improvement collaboratives are commonly used to disseminate quality care on a wide scale. Practice variation is a notable barrier to any quality improvement effort. A detailed and accurate understanding of practice variation can help optimize the quality improvement efforts. The traditional survey methods do not capture the complex nuances of practice variation. Vignette methods have been shown to accurately measure the actual practice variation and quality of care delivered by clinicians. Vignette methods are cost-effective relative to other methods of measuring quality of care. This review describes our experience and lessons from implementing vignette research methods in quality improvement collaboratives in California neonatal intensive care units. Vignette methodology is an ideal tool to address practice variation in quality improvement collaboratives, actively engage a large number of participants, and support more evidence-based practice to improve outcomes.
医疗机构之间以及机构内部患者治疗结果的差异是医疗保健领域的一个主要问题。这种差异部分归因于实践差异，即不同的治疗方式。由于对特定患者进行适当的个性化护理，出现一些实践差异是可以预期的。然而，有些实践差异是由于临床医生的个人偏好或风格所致。质量改进协作组织通常用于大规模推广优质护理。实践差异是任何质量改进努力的显著障碍。对实践差异进行详细准确的了解有助于优化质量改进工作。传统的调查方法无法捕捉实践差异的复杂细微之处。案例法已被证明能够准确衡量临床医生实际的实践差异和所提供护理的质量。与其他衡量护理质量的方法相比，案例法具有成本效益。本综述描述了我们在加利福尼亚新生儿重症监护病房的质量改进协作组织中实施案例研究方法的经验和教训。案例法是解决质量改进协作组织中实践差异、积极吸引大量参与者并支持更多循证实践以改善治疗结果的理想工具。
