Solberg L I, Kottke T E, Brekke M L, Calomeni C A, Conn S A, Davidson G
Group Health Foundation, Minneapolis, Minnesota 55440, USA.
Prev Med. 1996 May-Jun;25(3):259-67. doi: 10.1006/pmed.1996.0055.
Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preventive services in medical practice. Although much has been learned about the office systems that seem to be needed for major change in a busy clinical practice, there are still no examples of a model for developing, implementing, and sustaining those office systems in a nonacademic practice.
IMPROVE, the first large randomized controlled trial of CQI (continuous quality improvement) in any industry, is providing a scientific test of the hypothesis that HMO sponsorship of a CQI-based intervention can lead to sustained organizational change, implementation and maintenance of office systems, and improved rates of adult preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receiving training, consultation, networking, and reinforcement for internal multidisciplinary teams as they work through a structured process to understand and improve their clinic's process for providing preventive services. Rates and quality of eight preventive services in these clinics are being compared over time with those in 22 matched comparison clinics.
The 44 clinics needed for the trial have been recruited and randomized, and baseline comparisons show no significant differences between the two groups. Nine months into the trial, 21 of 22 intervention clinics have completed training and are pursuing a systematic improvement process for preventive services.
With external training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use CQI techniques to study and systematically improve their entire process for providing preventive services.
即使是最被广泛接受的预防指南本身也无法促使其在医疗实践中得到实施或实现足够的预防服务使用率。尽管对于繁忙的临床实践中实现重大变革所需的办公系统我们已经有了很多了解，但目前仍没有在非学术性实践中开发、实施和维持这些办公系统的模型实例。
IMPROVE是任何行业中首个大规模的持续质量改进（CQI）随机对照试验，它正在对以下假设进行科学验证：健康维护组织（HMO）对基于CQI的干预措施的支持能够带来持续的组织变革、办公系统的实施与维护，以及提高签约私人初级保健诊所的成人预防服务使用率。被分配到研究干预组的22家诊所，其内部多学科团队在通过结构化流程来理解和改进诊所提供预防服务的过程中，正在接受培训、咨询、建立网络联系和强化支持。随着时间的推移，将这些诊所的八项预防服务的使用率和质量与22家匹配的对照诊所进行比较。
试验所需的44家诊所已招募并随机分组，基线比较显示两组之间无显著差异。试验进行到九个月时，22家干预诊所中有21家已完成培训，并正在对预防服务开展系统改进工作。
通过外部培训和咨询，许多私人初级保健诊所将自愿投入到一项长期的多学科团队工作中，运用CQI技术来研究并系统改进其提供预防服务的整个流程。
