Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru
Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru
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DOI：
10.1007/s00268-016-3832-3
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发表时间：
2017-04-01
影响因子：
2.6
通讯作者：
Mock, Charles N.
中科院分区：
文献类型：
--
作者：
LaGrone, Lacey N.;Fuhs, Amy K.;Mock, Charles N.
有证据表明，质量改进（QI）计划对发病率、死亡率、患者满意度和成本产生了积极影响。关于低收入和中等收入国家QI计划的现状以及对其实施的障碍和促进因素的深入研究的数据是有限的。这项横断面描述性研究采用了混合方法设计，包括匿名定量调查和与利马10家大型医院参与受伤护理的医疗保健提供者的个人访谈，秘鲁.在发病率和死亡率会议方面查明需要改进的关键领域是病例选择的标准化、将医学文献中的证据纳入病例介绍和讨论、病例记录以及制定明确的病例后续行动计划。QI计划实施的主要障碍是缺乏QI的优先级，缺乏足够的人力和行政资源，缺乏政治支持，缺乏关于QI实践的教育。一个国家计划，使QI成为所有医疗服务提供者的专业培训和责任的必要组成部分，将有效地解决秘鲁的QI计划的大部分已确定的障碍。具体来说，在培训研究生前医生的医院中，应该要求存在基本的QI元素，如M&M会议。或者，如果没有这个国家级组织，通过机构之间的学徒制或将QI整合到继续医学教育中来利用当地例子的努力将有望建立在秘鲁现有的QI计划的促进者的基础上。
Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited.This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru.Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices.A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.