Assessment of Chronic Illness Care (ACIC): A practical tool to measure quality improvement
Assessment of Chronic Illness Care (ACIC): A practical tool to measure quality improvement
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DOI：
10.1111/1475-6773.00049
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发表时间：
2002-06-01
影响因子：
3.4
通讯作者：
VonKorff, M
中科院分区：
文献类型：
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作者：
Bonomi, AE;Wagner, EH;VonKorff, M
Objective.描述慢性病护理评估（ACIC）的初步测试，这是一个实用的质量改进工具，可以帮助组织在六个方面评估其提供慢性病护理的优势和劣势：社区联系，自我管理支持，决策支持，交付系统设计，信息系统和护理组织。(1)研究设计：（1）研究前、研究后、研究者自我报告的ACIC数据，来自参加13个月的质量改进协作的组织团队，该协作专注于慢性病护理;（2）独立教师在协作结束时对团队进展的评分。团队在协作开始和结束时使用共识格式完成ACIC，该格式产生了其系统为目标慢性病提供护理的方法的平均评级。获得了所有四个协作团队的平均年龄ACIC子量表得分（范围从0到11，11代表最佳护理），以表明团队在开始改善工作之前如何评价他们对慢性病的护理。配对t检验用于评估ACIC的灵敏度，以检测两个（四个）合作团队的系统改善，重点关注糖尿病和充血性心力衰竭（CHF）的护理。ACIC分量表得分和教师团队绩效评分之间的Pearson相关性也得到了。在合作开始时登记的所有团队的平均基线得分从4.36（信息系统）到6.42（护理组织）不等，表明慢性病的基本护理到良好护理。所有六个ACIC子量表评分均对糖尿病和CHF团队在合作过程中所做的系统改善做出反应。在决策支持、交付系统设计和信息系统方面取得了最大的改进。CHF团队在完成协作时的自我管理支持得分特别高。ACIC各分量表与教师评分的Pearson相关系数在.28 ~.52之间。这些结果和来自团队的反馈表明，ACIC对医疗质量改进工作做出了反应，可能是指导慢性病护理质量改进和跟踪进展的有用工具。
Objective. To describe initial testing of the Assessment of Chronic Illness Care (ACIC), a practical quality-improvement tool to help organizations evaluate the strengths and weaknesses of their delivery of care for chronic illness in six areas: community linkages, self-management support, decision support, delivery system design, information systems, and organization of care.Data Sources. (1) Pre-post, self-report ACIC data from organizational teams enrolled in 13-month quality-improvement collaboratives focused on care for chronic illness; (2) independent faculty ratings of team progress at the end of collaborative.Study design. Teams completed the ACIC at the beginning and end of the collaborative using a consensus format that produced average ratings of their system's approach to delivering care for the targeted chronic condition. Aver-age ACIC subscale scores (ranging from 0 to 11, with 11 representing optimal care) for teams across all four collaboratives were obtained to indicate how teams rated their care for chronic illness before beginning improvement work. Paired t-tests were used to evaluate the sensitivity of the ACIC to detect system improvements for teams in two (of four) collaboratives focused on care for diabetes and congestive heart failure (CHF). Pearson correlations between the ACIC subscale scores and a faculty rating of team performance were also obtained.Results. Average baseline scores across all teams enrolled at the beginning of the collaboratives ranged from 4.36 (information systems) to 6.42 (organization of care), indicating basic to good care for chronic illness. All six ACIC subscale scores were responsive to system improvements diabetes and CHF teams made over the course of the collaboratives. The most substantial improvements were seen in decision support, delivery system design, and information systems. CHF teams had particularly high scores in self-management support at the completion of the collaborative. Pearson correlations between the ACIC subscales and the faculty rating ranged from .28 to .52.Conclusion. These results and feedback from teams suggest that the ACIC is responsive to health care quality-improvement efforts and may be a useful tool to guide quality improvement in chronic illness care and to track progress over time.