Solberg L I, Reger L A, Pearson T L, Cherney L M, O'Connor P J, Freemen S L, Lasch S L, Bishop D B
Group Health Foundation/HealthPartners, Minneapolis, MN, USA.
Jt Comm J Qual Improv. 1997 Nov;23(11):581-92. doi: 10.1016/s1070-3241(16)30341-8.
The care of patients with chronic diseases, especially those with diabetes mellitus, has been less than ideal. However, despite clear national guidelines, various examples of better care models, and multiple attempts to improve care, an effective process for facilitating and replicating diabetes care improvements in typical primary care practices has been elusive.
On the basis of the approach and lessons from developmental work at the Minnesota Diabetes Control Program and a trial of continuous quality improvement for clinical preventive services (IMPROVE), a clinic-based intervention processes (IDEAL) has been developed to improve the system and process of care for patients with diabetes as a model for all chronic diseases. The intervention incorporates facilitation of leadership actions in support of change, training for the leader and facilitator of an intraclinic multidisciplinary continuous quality improvement (CQI) team, and consultative and networking support of the change process. Each element of this intervention emphasizes a seven-step process improvement approach and a system for care of patients with diabetes. This model is being developed and tested in a unique partnership between the Minnesota Department of Health and HealthPartners, a large managed care organization (MCO).
A prepilot demonstration has succeeded in improving glycemic control, three primary care clinics affiliated with HealthPartners have succeeded in a pilot of the intervention, and an additional 13 clinics are participating in a randomized controlled trial of a refined intervention.
The IDEAL model holds promise for substantial improvements in care, not only for diabetes but for all chronic diseases and for other settings.
慢性病患者的护理，尤其是糖尿病患者的护理，一直不尽如人意。然而，尽管有明确的国家指南、多种更好护理模式的实例，以及多次改善护理的尝试，但在典型的初级保健实践中，促进和复制糖尿病护理改善的有效流程却难以捉摸。
基于明尼苏达糖尿病控制项目的发展工作方法和经验教训，以及临床预防服务持续质量改进试验（IMPROVE），开发了一种基于诊所的干预流程（IDEAL），以改善糖尿病患者的护理系统和流程，作为所有慢性病的典范。该干预措施包括促进支持变革的领导行动、对诊所内多学科持续质量改进（CQI）团队的领导者和促进者进行培训，以及为变革过程提供咨询和网络支持。该干预措施的每个要素都强调七步流程改进方法和糖尿病患者护理系统。此模式正在明尼苏达州卫生部与大型管理式医疗组织（MCO）HealthPartners之间的独特合作中进行开发和测试。
预试点示范成功改善了血糖控制，与HealthPartners相关的三家初级保健诊所干预试点成功，另外13家诊所正在参与一项改进后干预措施的随机对照试验。
IDEAL模式有望大幅改善护理，不仅适用于糖尿病，也适用于所有慢性病以及其他环境。
