Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol)
Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol)
复制标题
DOI：
10.1186/1748-5908-6-45
复制
发表时间：
2011-05-09
影响因子：
7.2
通讯作者：
Grol, Richard
中科院分区：
文献类型：
--
作者：
Boivin, Antoine;Lehoux, Pascale;Grol, Richard
背景：公众对改善的优先考虑往往不同于临床医生和管理人员。公众参与已被提出作为一种方式来弥合专业和公共临床护理优先级之间的差距，但尚未在质量指标选择的背景下进行研究。我们的目标是评估的可行性和影响，公众参与的质量指标的选择和协议与公共priorites.Methods：我们将进行一个集群随机对照试验，比较质量指标的优先级，没有公众参与。在试验准备过程中，我们基于对现有有效指标集的系统性回顾，开发了一个质量指标“菜单”。参与者（公众代表、临床医生和管理人员）将从6个参与研究中心招募。在干预现场，公众代表将通过直接参与（公众代表、临床医生和管理人员将共同商议，就质量指标的选择和使用达成一致）和咨询（将收集个人公众的改进建议并提交给决策者）参与。在对照研究中心，只有临床医生和管理人员将参与优先排序过程。将收集关于质量指标选择和预期用途的数据。我们的主要结果将比较干预组和对照组之间的质量指标选择和协议与公共优先事项。将进行基于直接观察、录像和参与者评估的过程评估，以帮助解释研究结果。讨论：我们确定了801个质量指标，符合我们的纳入标准。一个专家小组商定了最后一套37个项目，其中包括与初级保健慢性病预防和管理有关的经验证的质量指标。我们对27名参与者（11名公众代表和16名临床医生和管理人员）进行了公众参与干预的试点测试，并对另外21名参与者进行了研究工具的测试，这证明了干预的可行性，并产生了重要的见解和适应性，以更有效地吸引公众代表。据我们所知，这项研究是公众参与质量指标优先排序的首次试验，其结果可以促进患者和公众更有效地参与临床实践改进。
Background: Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities.Methods: We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed.Discussion: We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement.