A practice change model for quality improvement in primary care practice
A practice change model for quality improvement in primary care practice
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DOI：
10.1097/00115514-200405000-00005
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发表时间：
2004-05-01
影响因子：
1.8
通讯作者：
Stange, KC
中科院分区：
文献类型：
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作者：
Cohen, D;McDaniel, RR;Stange, KC
面对快速变化的医疗保健环境，初级保健实践通常必须改变其行医方式。然而改变是困难的，并且理解和促进实践改进的过程尚未得到很好的阐明。因此，我们使用来自质量改进干预措施的数据开发了一个实践变革模型，该干预措施成功地实现了可持续的实践改进。一个多学科团队评估了通过理解实践加强预防研究 (STEP-UP) 的数据，这是一项随机临床试验，旨在改善俄亥俄州东北部 79 个诊所提供的循证预防服务。该团队对高改进实践和低改进实践进行了比较案例研究分析，以确定对变革过程至关重要的变量，并创建变革的概念模型。该模型描述了理解和指导实践变革的关键要素，并强调了这些要素不断发展的相互关系的重要性。这些要素是（1）关键利益相关者实现变革目标的动机； (2) 促进变革的工具性、个人性和互动性资源； (3) 实践之外的激励因素，包括更大的医疗环境和社区； and (4) opportunities for change-that is, how key stakeholders understand the change options.变化受到实践内外因素复杂相互作用的影响。基于理解四个关键要素及其相互关系的干预措施可以在初级保健实践中产生可持续的质量改进。
Faced with a rapidly changing healthcare environment, primary care practices often have to change how they practice medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement intervention that was successful in creating a sustainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial conducted to improve the delivery of evidence-based preventive services in 79 northeastern Ohio practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process and to create a conceptual model for the change.The model depicts the critical elements for understanding and guiding practice change and emphasizes the importance of these elements' evolving interrelationships. These elements are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change-that is, how key stakeholders understand the change options. Change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice.