Freedman J A, Cook C A, Robison T, Kinney E D
Research Initiatives and Analysts, Department of Veterans Affairs, Washington
Jt Comm J Qual Improv. 1995 Dec;21(12):701-10. doi: 10.1016/s1070-3241(16)30198-5.
In a statewide demonstration project funded by The Robert Wood Johnson Foundation, the state of Indiana, vendors, clients and Indiana University researchers began working together in 1992 to use quality improvement (QI) techniques to improve the delivery of community-based long term care services. QI STRATEGIES: These collaborators, working with state Area Agencies on Aging (AAAs) case managers, are implementing two strategies--Normative Treatment Planning (NTP), which standardizes the clinical assessment of client needs and the prescription of services by case managers, and the Client Feedback System (CFS), a systematic method for obtaining feedback from long term care clients on the quality of in-home services.
This community-based long term care project has been implemented in AAAs throughout the state of Indiana. In January 1995 the state's 16 AAAs were randomly assigned to four experimental or control groups to assess the project's effectiveness. In the interim, clients are surveyed by telephone every six months to evaluate their satisfaction with services and clinical needs.
The experience suggests several lessons: (1) build on existing and successful activities; (2) involve a wide range of participants, not just innovators; (3) obtain buy-in from trade and professional associations that represent program participants; (4) turn national attention given to the program into an asset; (5) conduct separate data collection to evaluate an intervention's success; (6) visit the field often; (7) pay as much attention to program implementation as to development; and (8) provide ongoing, informal educational opportunities for the field.
This project has resulted in significant movement toward a shared quality improvement vocabulary, information system, and a shared vision of high-quality home care.
在由罗伯特·伍德·约翰逊基金会资助的一项全州范围的示范项目中，印第安纳州、供应商、客户以及印第安纳大学的研究人员于1992年开始合作，运用质量改进（QI）技术来改善社区长期护理服务的提供。
QI策略：这些合作者与州老年事务区域机构（AAA）的个案经理共同实施两项策略——规范性治疗计划（NTP），该计划使个案经理对客户需求的临床评估和服务处方标准化；以及客户反馈系统（CFS），这是一种从长期护理客户那里获取关于居家服务质量反馈的系统方法。
这个基于社区的长期护理项目已在印第安纳州的各个AAA中实施。1995年1月，该州的16个AAA被随机分为四个实验组或对照组，以评估该项目的效果。在此期间，每六个月通过电话对客户进行一次调查，以评估他们对服务和临床需求的满意度。
该经验表明了几点教训：（1）基于现有的成功活动；（2）让广泛的参与者参与，而不仅仅是创新者；（3）获得代表项目参与者的行业和专业协会的认可；（4）将国家对该项目的关注转化为一项资产；（5）进行单独的数据收集以评估一项干预措施的成功；（6）经常实地考察；（7）对项目实施和开发给予同样多的关注；（8）为该领域提供持续的非正式教育机会。
该项目已在朝着共享质量改进词汇、信息系统以及高质量居家护理的共同愿景方面取得了重大进展。
