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利用质量改进方法解决教职医生和住院医师在结直肠癌筛查方面的差异

Utilizing Quality Improvement Methodology to Address Disparities in Colorectal Cancer Screening Between Faculty and Resident Physicians.

作者信息

Tang Kevin, Layne Sabrina, Panchal Sarju, Mehta Shivan, Rhodes Corinne, Patel Neha, Bird Amber

机构信息

Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

J Gen Intern Med. 2025 Apr;40(5):1023-1027. doi: 10.1007/s11606-024-09147-1. Epub 2024 Dec 9.

Abstract

Health system data from a large academic medical center revealed a 14% lower rate of colorectal cancer (CRC) screening in resident patient panels compared to faculty patient panels. This resident-led quality improvement (QI) work identified causes for disparities in CRC screening and implemented an innovative panel management intervention to reduce CRC screening disparities. Analysis was conducted across two academic primary care clinics at a single institution. Residents engaged key stakeholders in the CRC screening process to identify causes for disparities and potential solutions in the CRC screening process. A novel interprofessional panel management protocol was implemented to guide residents on how to perform population health strategies to increase CRC screening and to streamline the navigation process. The effectiveness of each intervention in improving CRC screening was analyzed. After four months of protocol implementation, CRC screening for resident patient panels improved from 62 to 68% based on analysis done on a run chart. The difference in CRC screening between faculty and resident patient panels decreased from 14 to 10%, reducing the disparity by 29%. This interprofessional panel management protocol significantly increased the CRC screening rates among patients receiving primary care from resident physicians. This further highlights the importance of multipronged interventions to improve disparities in CRC screening and to improve overall screening rates.

摘要

来自一家大型学术医疗中心的卫生系统数据显示,住院患者组的结直肠癌(CRC)筛查率比教职员工患者组低14%。这项由住院医师主导的质量改进(QI)工作确定了结直肠癌筛查差异的原因,并实施了一项创新的患者组管理干预措施,以减少结直肠癌筛查差异。分析是在同一机构的两家学术初级保健诊所进行的。住院医师让关键利益相关者参与到结直肠癌筛查过程中,以确定筛查差异的原因和结直肠癌筛查过程中的潜在解决方案。实施了一项新颖的跨专业患者组管理方案,以指导住院医师如何执行人群健康策略以增加结直肠癌筛查,并简化转诊流程。分析了每项干预措施在改善结直肠癌筛查方面的有效性。在方案实施四个月后,根据运行图分析,住院患者组的结直肠癌筛查率从62%提高到了68%。教职员工患者组和住院患者组之间的结直肠癌筛查差异从14%降至10%,差异减少了29%。这种跨专业患者组管理方案显著提高了接受住院医师初级保健的患者的结直肠癌筛查率。这进一步凸显了多管齐下的干预措施对于改善结直肠癌筛查差异和提高总体筛查率的重要性。

相似文献

本文引用的文献

1
Colorectal Cancer Screening - Approach, Evidence, and Future Directions.结直肠癌筛查:方法、证据与未来方向。
NEJM Evid. 2022 Jan;1(1):EVIDra2100035. doi: 10.1056/EVIDra2100035. Epub 2022 Jan 10.
6
Optimizing the Quality of Colorectal Cancer Screening Worldwide.优化全球结直肠癌筛查质量。
Gastroenterology. 2020 Jan;158(2):404-417. doi: 10.1053/j.gastro.2019.11.026. Epub 2019 Nov 20.
7
Strategies for Colorectal Cancer Screening.结直肠癌筛查策略。
Gastroenterology. 2020 Jan;158(2):418-432. doi: 10.1053/j.gastro.2019.06.043. Epub 2019 Aug 5.

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