Carlin E, Carlson R, Nordin J
HealthPartners, Minneapolis, MN 55440-1309, USA.
Jt Comm J Qual Improv. 1996 Apr;22(4):277-88. doi: 10.1016/s1070-3241(16)30231-0.
In August 1992 the medical director of the 19 Group Health medical clinics (now part of HealthPartners) in Minnesota chartered a continuous quality improvement (CQI) team to improve the pediatric (two-year-old) immunization rates. THE TEAM'S WORK: The team created a process flow for the current immunization process, collected data on the process, determined the causes of late or missed immunizations, collected data on children not up-to-date with immunization, analyzed the data, acted on recommendations, and obtained buy-in. The chief reasons for the child's not being up-to-date on immunizations included missed opportunities (when the child is in the clinic receiving care, perhaps for an acute illness, and could have safely received the immunization but did not), no previous visits or chart, and parents instructed to have their child return at two years.
Recommendations pertained to missed opportunities, record keeping, and enhanced patient and provider responsibility. For example, providers were given algorithms for catch-up of patients not on schedule or with incomplete immunizations. Another CQI team was launched to address and simplify the myriad locations in a medical record for recording information on immunizations. An automated vaccine administration record is now being piloted at two clinics.
Immunizations have increased from a mean of 53.5% before the team started to meet to a mean of 86.5% for the most recent four quarters for which data are available.
A problem is best addressed by the very people who will have to bring about the necessary changes for the desired improvements.
1992年8月，明尼苏达州19家集团健康医疗诊所（现为HealthPartners的一部分）的医疗主任发起了一个持续质量改进（CQI）团队，以提高儿科（两岁）免疫接种率。
该团队为当前的免疫接种流程创建了一个流程图，收集了该流程的数据，确定了延迟或错过免疫接种的原因，收集了未及时接种疫苗儿童的数据，分析了数据，根据建议采取行动，并获得了各方支持。儿童未及时接种疫苗的主要原因包括错过机会（当儿童在诊所接受治疗时，可能是因为急性疾病，本可以安全地接种疫苗但未接种）、没有之前的就诊记录或病历，以及家长被告知让孩子在两岁时再来。
建议涉及错过的机会、记录保存以及增强患者和提供者的责任。例如，为提供者提供了针对未按时接种或免疫接种不完整患者的补种算法。另一个CQI团队被启动，以处理和简化病历中记录免疫接种信息的众多位置。目前正在两家诊所试点使用自动疫苗接种记录。
免疫接种率已从团队开始开会前的平均53.5%提高到最近四个可获得数据季度的平均86.5%。
解决问题的最佳人选是那些将为实现预期改进而带来必要变革的人。
