Using continuous quality improvement to increase preventive services in clinical practice--going beyond guidelines.
Using continuous quality improvement to increase preventive services in clinical practice--going beyond guidelines.
复制标题
利用持续的质量改进来增加临床实践中的预防服务——超越指南。
作者：
Leif I. Solberg;Thomas E. Kottke;M. Brekke;C. A. Calomeni;Shirley A. Conn;Gestur Davidson
背景
即使是最一致接受的预防准则本身也不能导致在医疗实践中实施或达到适当的预防服务率。虽然已经了解了很多关于办公室系统，似乎需要在一个忙碌的临床实践中的重大变化，仍然没有一个模型的例子，开发，实施和维持这些办公室系统在非学术实践。
方法
IMPROVE是任何行业中第一个CQI（持续质量改进）的大型随机对照试验，它提供了一个科学的假设测试，即HMO赞助基于CQI的干预措施可以导致持续的组织变革，办公系统的实施和维护，以及合同私人初级保健诊所中成人预防服务的提高。被分配到该研究干预部门的22家诊所正在接受内部多学科团队的培训、咨询、网络建设和加强，因为他们通过一个结构化的过程来了解和改善其诊所提供预防服务的过程。这些诊所提供的八项预防服务的比率和质量，正与22个配对诊所的比率和质量进行比较。
结果
试验所需的44个诊所已经招募和随机化，基线比较显示两组之间没有显著差异。试验开展9个月后，22个干预诊所中的21个已完成培训，并正在系统地改进预防服务。
结论
通过外部培训和咨询，许多私人初级保健诊所将自愿参加一个漫长的多学科团队，使用CQI技术来研究和系统地改善其提供预防服务的整个过程。
BACKGROUND
Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preventive services in medical practice. Although much has been learned about the office systems that seem to be needed for major change in a busy clinical practice, there are still no examples of a model for developing, implementing, and sustaining those office systems in a nonacademic practice.
METHODS
IMPROVE, the first large randomized controlled trial of CQI (continuous quality improvement) in any industry, is providing a scientific test of the hypothesis that HMO sponsorship of a CQI-based intervention can lead to sustained organizational change, implementation and maintenance of office systems, and improved rates of adult preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receiving training, consultation, networking, and reinforcement for internal multidisciplinary teams as they work through a structured process to understand and improve their clinic's process for providing preventive services. Rates and quality of eight preventive services in these clinics are being compared over time with those in 22 matched comparison clinics.
RESULTS
The 44 clinics needed for the trial have been recruited and randomized, and baseline comparisons show no significant differences between the two groups. Nine months into the trial, 21 of 22 intervention clinics have completed training and are pursuing a systematic improvement process for preventive services.
CONCLUSIONS
With external training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use CQI techniques to study and systematically improve their entire process for providing preventive services.