Understanding team-based quality improvement for depression in primary care.
Understanding team-based quality improvement for depression in primary care.
复制标题
了解初级保健中基于团队的抑郁症质量改进。
DOI：
10.1034/j.1600-0560.2002.63.x
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发表时间：
2002
影响因子：
3.4
通讯作者：
Gordon,NancyP
中科院分区：
文献类型：
--
作者：
Rubenstein,LisaV;Parker,LouiseE;Meredith,LisaS;Altschuler,Andrea;dePillis,Emmeline;Hernandez,John;Gordon,NancyP
目的：评估质量改进（QI）团队的特点及其环境对团队成功设计和实施高质量、持久的抑郁症护理改进项目的影响。研究设置/数据来源：两个非营利管理式护理组织赞助了五个QI团队，其任务是在大型PC实践中改善抑郁症护理。研究设计：对中央团队（CT）开发的抑郁症改善项目的质量和实施持续时间进行比较形成性评价，强调专家设计，地方团队（LT）强调参与性当地临床医生设计，以及其他团队和环境因素对每种类型团队的影响。这两种类型的团队都依赖于当地的临床医生来实施。主要发现：CT干预计划的设计比LT更基于证据。专家团队的领导，当地实践管理的支持，以及当地心理健康专家的支持强烈影响了成功的团队计划的发展。CT和LT是同样成功的，当这些条件可以满足，但CT是更成功的比LT在较低的支持性environments.Conclusions. LT的方法QI抑郁症需要高的本地支持和专业知识，从初级保健和心理健康临床医生。当当地实践条件不是最佳时，CT方法比LT方法更有可能成功。
Objective.To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing highquality, enduring depression care improvement programs in primary care (PC) practices.Study Setting/Data Sources.Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews.Study Design.Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors oneach type of team. Both types of teams depended upon local clinicians for implementation.Principal Findings.The CT intervention program designs were more evidence‐based than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments.Conclusions.The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal.