Forcino Rachel C, Jobse Bruce C, Ahmad Jabeen, Oliver Brant J
Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA.
Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA.
Perm J. 2024 Sep 16;28(3):278-283. doi: 10.7812/TPP/24.009. Epub 2024 Aug 27.
Coproduction learning health system models clearly define the use of clinical and patient-reported data for system learning and quality improvement, but less is known about how to document formative learning about coproduction value creation over the course of a quality improvement initiative. The authors aimed to 1) assess the feasibility, utility, and acceptability of novel self-assessment tools for coproduction value creation and 2) identify domains of coproduction value creation.
The authors conducted 4 focus groups with quality improvement teams from 4 health systems in the United States and Sweden between June 2021 and September 2023. A single analyst coded transcripts and proposed themes, with investigator triangulation validating results.
Participants found the self-assessment tools acceptable and useful. The improvement passport was seen as more feasible for routine use than the full self-assessment guide. Peer learning within the community of practice, diverse multidisciplinary improvement teams, and leadership support facilitated teams' work. Domains of coproduction value creation included communication, self-efficacy, interconnectedness, direct and indirect costs of health care utilization, health professional experience, and access to the right care.
Peer learning and camaraderie within the community of practice maintained momentum among participating teams during a challenging time of limited resources and mounting responsibilities in health care settings, suggesting enhanced resiliency through approaching difficult tasks in community.
The authors identified themes of coproduction value creation and drivers of engagement. Future research will draw on the measurement domains established in this study to inform the development of measures of coproduction value creation. Those measures could then be incorporated into the data-rich environments of coproduction learning health systems to enhance focus on value from service user and professional perspectives.
共同生产学习型健康系统模型明确规定了临床数据和患者报告数据在系统学习和质量改进中的用途，但对于如何记录在质量改进计划过程中关于共同生产价值创造的形成性学习，人们了解较少。作者旨在：1）评估用于共同生产价值创造的新型自我评估工具的可行性、实用性和可接受性；2）确定共同生产价值创造的领域。
作者在2021年6月至2023年9月期间，与美国和瑞典4个卫生系统的质量改进团队进行了4次焦点小组讨论。由一名分析师对记录进行编码并提出主题，通过研究者三角互证法验证结果。
参与者认为自我评估工具是可接受且有用的。与完整的自我评估指南相比，改进护照被认为更适合常规使用。实践社区内的同行学习、多元化的多学科改进团队以及领导支持促进了团队的工作。共同生产价值创造的领域包括沟通、自我效能感、相互联系、医疗保健利用的直接和间接成本、卫生专业人员的经验以及获得适当护理的机会。
在医疗环境中资源有限且责任不断增加的具有挑战性时期，实践社区内的同行学习和同志情谊在参与团队中保持了动力，这表明通过在社区中处理困难任务可增强复原力。
作者确定了共同生产价值创造的主题和参与的驱动因素。未来的研究将利用本研究中确定的测量领域，为共同生产价值创造的测量方法的开发提供信息。然后，这些测量方法可纳入共同生产学习型健康系统的数据丰富环境中，以从服务使用者和专业人员的角度加强对价值的关注。
