Systematic review of the application of the plan-do-study-act method to improve quality in healthcare.
Systematic review of the application of the plan-do-study-act method to improve quality in healthcare.
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DOI：
10.1136/bmjqs-2013-001862
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发表时间：
2014-04
影响因子：
5.4
通讯作者：
Reed JE
中科院分区：
文献类型：
--
作者：
Taylor MJ;McNicholas C;Nicolay C;Darzi A;Bell D;Reed JE
计划-做-研究-行动(PDSA)循环为改进系统质量的变更迭代测试提供了一种结构。该方法在医疗保健改进中被广泛接受；然而，关于该方法如何应用的总体评估很少。本文提出了一个评估PDSA周期应用质量的理论框架，并探讨了该方法在同行评议文献中应用的一致性。NHS证据和Cochrane数据库由三名独立的审查员搜索。实证研究包括报道的PDSA方法在医疗保健中的应用。根据该方法的主要特点对PDSA周期的应用进行了评估，包括文档特征、迭代周期的使用、基于预测的变更测试、初始小规模测试和随时间推移的数据使用。在确定的409篇单独文章中，有73篇符合纳入标准。在73篇文章中，有47篇记录了充分详细的PDSA周期，以便对整个框架进行全面分析。其中许多研究报道了PDSA方法的应用，但未能符合该方法的主要特征。只有不到20%(14/73)完整记录了一系列迭代周期的应用。此外，显然没有遵守小规模变化的概念，只有15%(7/47)的人报告说，在每月或更频繁的数据间隔中使用量化数据来告知周期进展情况。为了推动改进科学的发展，更好地了解改进方法的使用，包括PDSA，对于就其有效性得出可靠的结论至关重要。这将得到为应用和报告私人部门会计准则制定系统和严格的标准的支持。
Plan–do–study–act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework. NHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time. 73 of 409 individual articles identified met the inclusion criteria. Of the 73 articles, 47 documented PDSA cycles in sufficient detail for full analysis against the whole framework. Many of these studies reported application of the PDSA method that failed to accord with primary features of the method. Less than 20% (14/73) fully documented the application of a sequence of iterative cycles. Furthermore, a lack of adherence to the notion of small-scale change is apparent and only 15% (7/47) reported the use of quantitative data at monthly or more frequent data intervals to inform progression of cycles. To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness. This would be supported by the development of systematic and rigorous standards for the application and reporting of PDSAs.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
--
作者：
Ogrinc, G.;Mooney, S. E.;Watts, B.
通讯作者：
Watts, B.
影响因子：
3.8
作者：
McCormack, B;Kitson, A;Seers, K
通讯作者：
Seers, K
影响因子：
105.7
作者：
Benning, Amirta;Ghaleb, Maisoon;Lilford, Richard
通讯作者：
Lilford, Richard
影响因子：
105.7
作者：
Plsek, PE;Wilson, T
通讯作者：
Wilson, T