Jomy Jane, Lin Ke Xin, Huang Ryan S, Chen Alisia, Malik Aleena, Hwang Michelle, Bhate Tahara D, Sharfuddin Nazia
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Qual Saf. 2025 Jan 28;34(2):120-129. doi: 10.1136/bmjqs-2023-017022.
Quality improvement (QI) efforts are critical to promoting health equity and mitigating disparities in healthcare outcomes. Equity-focused QI (EF-QI) interventions address the unique needs of equity-deserving groups and the root causes of disparities. This scoping review aims to identify themes from EF-QI interventions that improve the health of equity-deserving groups, to serve as a resource for researchers embarking on QI.
In adherence with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, several healthcare and medical databases were systematically searched from inception to December 2022. Primary studies that report results from EF-QI interventions in healthcare were included. Reviewers conducted screening and data extraction using Covidence. Inductive thematic analysis using NVivo identified key barriers to inform future EF-QI interventions.
Of 5,330 titles and abstracts screened, 36 articles were eligible for inclusion. They reported on EF-QI interventions across eight medical disciplines: primary care, obstetrics, psychiatry, paediatrics, oncology, cardiology, neurology and respirology. The most common focus was racialised communities (15/36; 42%). Barriers to EF-QI interventions included those at the provider level (training and supervision, time constraints) and institution level (funding and partnerships, infrastructure). The last theme critical to EF-QI interventions is sustainability. Only six (17%) interventions actively involved patient partners.
EF-QI interventions can be an effective tool for promoting health equity, but face numerous barriers to success. It is unclear whether the demonstrated barriers are intrinsic to the equity focus of the projects or can be generalised to all QI work. Researchers embarking on EF-QI work should engage patients, in addition to hospital and clinic leadership in the design process to secure funding and institutional support, improving sustainability. To the best of our knowledge, no review has synthesised the results of EF-QI interventions in healthcare. Further studies of EF-QI champions are required to better understand the barriers and how to overcome them.
质量改进（QI）工作对于促进健康公平和减少医疗保健结果的差异至关重要。以公平为重点的QI（EF-QI）干预措施解决了应获公平对待群体的独特需求以及差异的根本原因。本范围综述旨在确定EF-QI干预措施中改善应获公平对待群体健康的主题，为开展QI研究的人员提供资源。
按照系统评价和Meta分析的首选报告项目指南，从数据库建立到2022年12月对多个医疗保健和医学数据库进行了系统检索。纳入报告医疗保健中EF-QI干预措施结果的原始研究。评审人员使用Covidence进行筛选和数据提取。使用NVivo进行归纳主题分析，确定关键障碍，为未来的EF-QI干预措施提供参考。
在筛选的5330篇标题和摘要中，36篇文章符合纳入条件。这些文章报告了八个医学学科的EF-QI干预措施：初级保健、产科、精神病学、儿科、肿瘤学、心脏病学、神经病学和呼吸病学。最常见的关注对象是种族化社区（15/36；42%）。EF-QI干预措施的障碍包括提供者层面的障碍（培训和监督、时间限制）和机构层面的障碍（资金和伙伴关系、基础设施）。对EF-QI干预措施至关重要的最后一个主题是可持续性。只有六项（17%）干预措施积极让患者伙伴参与。
EF-QI干预措施可以成为促进健康公平的有效工具，但面临众多成功障碍。尚不清楚所显示的障碍是项目公平重点所固有的，还是可以推广到所有QI工作。开展EF-QI工作的研究人员除了应让医院和诊所领导参与设计过程以确保资金和机构支持、提高可持续性外，还应让患者参与。据我们所知，尚无综述综合医疗保健中EF-QI干预措施的结果。需要对EF-QI倡导者进行进一步研究，以更好地了解障碍以及如何克服这些障碍。
