Solberg L I, Isham G, Kottke T E, Magnan S, Nelson A, Reed M, Richards S
Group Health Foundation, Minneapolis, MN 55440-1309, USA.
Jt Comm J Qual Improv. 1995 Nov;21(11):600-10. doi: 10.1016/s1070-3241(16)30188-2.
In July 1993, an unusual collaboration developed between competing managed care plans and with competing primary care clinics as part of a federally funded research grant (IMPROVE from the Agency for Health Care Policy and Research). The goal of this collaboration is to scientifically test the ability of an health maintenance organization (HMO) to improve the delivery of eight adult preventive services by training and facilitating the use of continuous quality improvement and prevention systems by contracted private primary clinics.
In order to conduct this effectiveness study, it was necessary for two HMOs to come to a structural and functional understanding of how to operate jointly. Investigators recruited 44 private clinics for a randomized controlled trial in which 22 are being assisted in improving the process used to deliver these preventive services and 22 are being left alone as comparison clinics. The intervention is a train-the-trainer and consultation approach focused on clinics as collaborating customers. The comparison will be based on repeated surveys of patients and clinic personnel as well as chart audits to measure changes in systems and prevention rates.
Although this project was made possible by a number of unusual favorable factors, it can serve as a model for support of the clinician leadership that is essential to true health care delivery reform.
1993年7月，作为一项联邦资助研究拨款（来自医疗保健政策与研究机构的“改善计划”）的一部分，在相互竞争的管理式医疗计划之间以及与相互竞争的初级保健诊所之间开展了一项不同寻常的合作。这项合作的目标是通过培训并促进签约的私立初级诊所使用持续质量改进和预防系统，科学地测试健康维护组织（HMO）改善八项成人预防服务提供的能力。
为了进行这项有效性研究，两家HMO有必要在结构和功能上了解如何联合运作。研究人员招募了44家私立诊所进行一项随机对照试验，其中22家诊所得到协助以改进提供这些预防服务的流程，另外22家诊所作为对照诊所不做处理。干预措施是一种以培训培训员和咨询为重点的方法，将诊所视为合作客户。比较将基于对患者和诊所工作人员的反复调查以及病历审核，以衡量系统变化和预防率。
尽管这个项目得益于一些不同寻常的有利因素才得以实现，但它可以作为支持临床医生领导力的一个典范，而临床医生领导力对于真正的医疗服务改革至关重要。
