Hausmann Leslie R M, Lamorte Carolyn, Estock Jamie L
Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Health Equity. 2023 May 26;7(1):312-320. doi: 10.1089/heq.2023.0009. eCollection 2023.
Although health care systems aspire to deliver equitable care, practical tools that empower the health care workforce to weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews that informed the development of a user-centered tool to support equity-focused QI.
Semistructured interviews were conducted from February to April of 2019. Participants included 14 medical center administrators, departmental or service line leaders, and clinical staff involved in direct patient care from three Veterans Affairs (VA) Medical Centers within a single region. Interviews covered existing practices for monitoring health care quality (i.e., priorities, tasks, workflow, and resources) and explored how equity data might fit into current processes. Themes extracted through rapid qualitative analysis were used to draft initial functional requirements for a tool to support equity-focused QI.
Although the potential value of examining disparities in health care quality was clearly recognized, the data necessary for examining disparities were lacking for most quality measures. Interviewees also desired guidance on how inequities could be addressed through QI. The ways in which QI initiatives were selected, carried out, and supported also had important design implications for tools to support equity-focused QI.
The themes identified in this work guided the development of a national VA Primary Care Equity Dashboard to support equity-focused QI within VA. Understanding the ways in which QI was carried out across multiple levels of the organization provided a successful foundation upon which to build functional tools to support thoughtful engagement around equity in clinical settings.
尽管医疗保健系统致力于提供公平的医疗服务，但缺乏能让医疗保健人员在质量改进（QI）过程中融入公平理念的实用工具。在本文中，我们报告了使用情境访谈的结果，这些结果为开发以用户为中心的工具以支持聚焦公平的QI提供了依据。
2019年2月至4月进行了半结构化访谈。参与者包括来自同一地区三个退伍军人事务（VA）医疗中心的14名医疗中心管理人员、部门或服务线负责人以及直接参与患者护理的临床工作人员。访谈涵盖了监测医疗质量的现有做法（即优先事项、任务、工作流程和资源），并探讨了公平数据如何融入当前流程。通过快速定性分析提取的主题被用于起草支持聚焦公平的QI工具的初始功能要求。
尽管人们清楚地认识到检查医疗质量差异的潜在价值，但大多数质量指标缺乏检查差异所需的数据。受访者还希望得到关于如何通过QI解决不公平问题的指导。QI计划的选择、实施和支持方式对支持聚焦公平的QI工具也有重要的设计意义。
这项工作中确定的主题指导了国家VA初级保健公平仪表板的开发，以支持VA内部聚焦公平的QI。了解QI在组织多个层面的实施方式为构建功能性工具提供了成功的基础，以支持在临床环境中围绕公平进行深入参与。
