利用患者健康结果反馈来改进矫形物理治疗师的实践：一项质量改进研究。

Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study.

机构信息

Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA

Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands.

出版信息

BMJ Open Qual. 2024 Mar 1;13(1):e002338. doi: 10.1136/bmjoq-2023-002338.

DOI:10.1136/bmjoq-2023-002338

PMID:38429061

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10910658/

Abstract

OBJECTIVE

Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected health outcomes of patients with low-back pain and neck pain.

METHODS

The QI programme was conducted by three teams of 5-6 physical therapists from outpatient settings. Plan-do-study-act cycles were used based on team-selected goals. Monthly feedback reports of process and outcomes of care, including pre-post treatment changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI), guided the QI efforts. Primary outcomes were pre-QI and post-QI changes in knowledge and attitudes towards outcome measures through a survey, and administered and self-reported compliance with using the ODI and NDI. Semistructured interviews and a focus group were conducted to evaluate the perceived value of the programme.

RESULTS

Post-QI, the survey showed improvements in two items related to the role of patients and implementation of outcome measures. Registered pre-QI and post-QI completion rates were high at intake (ODI:91% pre, 88% post; NDI:75% pre, 84% post), while completion rates at discharge improved post-QI (ODI:14% pre, 66% post; NDI: 32% pre, 50% post). Perceived benefits of the QI programme included clinician and institutional accountability to processes and strategies aimed at continuous improvement in patient care. An important facilitator for programme participation was autonomy in project selection and development, while a main barrier was the time required to set up the QI project.

CONCLUSION

A QI programme based on the feedback of routinely collected health outcomes of patients with low back pain and neck pain was feasible and well accepted by three pilot teams of physical therapists.

摘要

目的

衡量健康结果在以患者为中心的医疗保健中起着重要作用。当汇总患者的结果时，这些结果可以为质量改进（QI）提供数据。然而，大多数物理治疗师并不熟悉基于患者结果的 QI 方法。本混合方法研究旨在开发和评估一种基于门诊物理治疗中腰痛和颈痛患者常规收集的健康结果的 QI 计划。

方法

QI 计划由来自门诊环境的三个由 5-6 名物理治疗师组成的团队实施。根据团队选定的目标，使用计划-执行-研究-行动循环。每月的护理过程和结果反馈报告，包括 Oswestry 残疾指数（ODI）和颈部残疾指数（NDI）治疗前后的变化，指导 QI 工作。主要结果是通过问卷调查，了解 QI 前后对结果测量的知识和态度的变化，并管理和自我报告使用 ODI 和 NDI 的依从性。进行半结构式访谈和焦点小组，以评估该计划的价值。

结果

QI 后，调查显示与患者角色和实施结果测量相关的两个项目有所改善。入组时，ODI 和 NDI 的登记预 QI 和后 QI 完成率较高（ODI：91%预，88%后；NDI：75%预，84%后），而 QI 后出院时的完成率有所提高（ODI：14%预，66%后；NDI：32%预，50%后）。QI 计划的好处包括临床医生和机构对旨在不断改进患者护理的过程和策略的责任。计划参与的一个重要促进因素是项目选择和开发的自主权，而主要障碍是为 QI 项目设置所需的时间。