Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units.
Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units.
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DOI：
10.12688/wellcomeopenres.18710.3
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发表时间：
2023
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在低收入和中等收入国家，改善获得医疗保健的机会并不等同于改善健康结果。医疗质量的缺失或不稳定是部分原因。改善重症监护病房（icu）的结果需要多个专业协同工作，提供复杂的干预措施，同时预防与疾病和治疗干预相关的可避免伤害。因此，改进干预措施的成功设计和实施需要了解决定护理交付和实现持续改进的可能性的行为、组织和外部因素。我们的目标是确定导致低收入和中等收入国家icu临床结果不理想的护理过程，并为改善护理过程建立障碍和推动因素。使用快速评估方法，我们将使用四种数据收集方法：1)注册嵌入指标来评估护理过程的质量及其相关结果；2)过程绘图，提供初步框架，以了解当前和期望的护理做法之间的差距；3)对从过程图中识别的相关过程进行结构化观察；4)与利益相关者进行焦点小组讨论，以确定影响当前和期望的护理实践之间差距的障碍和推动因素。我们亦会收集有关质素改善准备程度的自我评估。数据收集和分析将由当地利益攸关方牵头，在肯尼亚、印度、马来西亚、尼泊尔、巴基斯坦、南非、乌干达和越南等8个国家并行进行，并通过迭代过程进行。我们的研究结果将提供必要的信息，说明在哪里以及如何改进护理过程，以促进中低收入国家危重病人的护理质量；从而降低icu的可预防死亡率和发病率。此外，了解将用于本研究的快速评估方法将使其他研究人员和医疗保健专业人员能够在icu和其他医疗服务中开展类似的研究。
Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.