EQUIP: implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series.
EQUIP: implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series.
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DOI：
10.1186/1748-5908-3-9
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发表时间：
2008-02-15
期刊：
影响因子：
--
通讯作者：
Young AS
中科院分区：
文献类型：
--
作者：
Brown AH;Cohen AN;Chinman MJ;Kessler C;Young AS
本文提出了一个案例研究，展示了题为“增强精神病护理质量”(EQUIP) 的项目的演变，该项目大约在美国退伍军人事务部的质量增强研究计划 (QUERI) 和实施科学兴起时开始。 EQUIP 开发了在精神分裂症治疗中实施慢性病护理原则的方法和工具，并使用小规模对照试验评估了这种实施情况。该项目的下一个迭代 EQUIP-2 通过实施科学和 QUERI 工具的使用得到了进一步的启发。本文报告了 EQUIP 的背景、发展、结果和影响，并描述了该项目第二阶段 (EQUIP-2) 正在进行的工作。 EQUIP 干预措施使用实施策略和工具来提高慢性病护理原则的采用和实施。在 EQUIP-2 中，这些策略和工具在概念上基于变革阶段模型，包括临床和交付系统干预以及采用/实施工具。形成性评价与干预一起进行，包括发展性评价、以进展为重点、以实施为重点和解释性评价。 EQUIP 的评估让人们了解质量差距以及如何解决精神分裂症的相关问题。 EQUIP 表明，精神分裂症质量问题的解决方案因治疗领域而异，并且由于缺乏对循证实践的认识而加剧。 EQUIP 还表明，改善护理需要为医生创造资源，帮助他们轻松实施实践变革，再加上强化教育以及帮助医生使用这些资源的产品冠军。组织变革，例如增加护理经理和信息系统，被证明可以帮助医生发现问题、进行转诊和监测随访。在目前正在进行的 EQUIP-2 中，这些初步发现被用来开发更全面的方法来实施和评估慢性病护理模型。在 QUERI，小型项目有助于开发和加强以当前实施科学为基础的实践性、面向行动的服务导向项目。该项目支持这样一个概念：QUERI 工具可用于实施面向循证临床护理改进的复杂护理模型。
This paper presents a case study that demonstrates the evolution of a project entitled "Enhancing QUality-of-care In Psychosis" (EQUIP) that began approximately when the U.S. Department of Veterans Affairs' Quality Enhancement Research Initiative (QUERI), and implementation science were emerging. EQUIP developed methods and tools to implement chronic illness care principles in the treatment of schizophrenia, and evaluated this implementation using a small-scale controlled trial. The next iteration of the project, EQUIP-2, was further informed by implementation science and the use of QUERI tools. This paper reports the background, development, results and implications of EQUIP, and also describes ongoing work in the second phase of the project (EQUIP-2). The EQUIP intervention uses implementation strategies and tools to increase the adoption and implementation of chronic illness care principles. In EQUIP-2, these strategies and tools are conceptually grounded in a stages-of-change model, and include clinical and delivery system interventions and adoption/implementation tools. Formative evaluation occurs in conjunction with the intervention, and includes developmental, progress-focused, implementation-focused, and interpretive evaluation. Evaluation of EQUIP provided an understanding of quality gaps and how to address related problems in schizophrenia. EQUIP showed that solutions to quality problems in schizophrenia differ by treatment domain and are exacerbated by a lack of awareness of evidence-based practices. EQUIP also showed that improving care requires creating resources for physicians to help them easily implement practice changes, plus intensive education as well as product champions who help physicians use these resources. Organizational changes, such as the addition of care managers and informatics systems, were shown to help physicians with identifying problems, making referrals, and monitoring follow-up. In EQUIP-2, which is currently in progress, these initial findings were used to develop a more comprehensive approach to implementing and evaluating the chronic illness care model. In QUERI, small-scale projects contribute to the development and enhancement of hands-on, action-oriented service-directed projects that are grounded in current implementation science. This project supports the concept that QUERI tools can be useful in implementing complex care models oriented toward evidence-based improvement of clinical care.
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