A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.
A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.
复制标题
一项整群随机质量改进研究，旨在改善两项住院患者中风质量指标。
DOI：
10.1136/bmjqs-2015-004188
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发表时间：
2016
影响因子：
5.4
通讯作者：
Damush,TeresaM
中科院分区：
文献类型：
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作者：
Williams,Linda;Daggett,Virginia;Slaven,JamesE;Yu,Zhangsheng;Sager,Danielle;Myers,Jennifer;Plue,Laurie;Woodward-Hagg,Heather;Damush,TeresaM
质量指标的收集和反馈改善了卒中护理。我们试图确定质量改进培训加指标反馈在改善住院卒中指标方面是否比单独指标反馈更有效。方法我们进行了一项整群随机质量改进试验，随机选择医院进行质量改进培训加指标反馈与单独指标反馈以改善深静脉血栓形成（DVT）预防和吞咽困难筛查。干预站点接受了基于协作的质量改进培训、外部促进和指标反馈。对照站点仅收到指示性反馈。我们比较了实施前（pre-I）、积极实施（active- i）和实施后（post-I）时期的指标。我们构建了两个指标的混合效应logistic模型，对医院效应采用随机截距，调整了患者、时间、干预和医院变量。结果干预点（1147例）患者的种族、性别和美国国立卫生研究院卒中量表评分与对照点（1017例）相似。在主动i期，干预点DVT预防改善更多（or比4.90,p<0.001），但在主动i期后没有差异。两组在i活动期间的吞咽困难筛查改善相似，但对照部位在i活动后改善更多（or比0.67,p=0.04）。在logistic模型中，干预与主动i期DVT表现独立正相关，与主动i期后吞咽困难表现负相关。结论：质量改善训练与早期DVT改善相关，但效果不能持续，在吞咽困难筛查中也没有发现。外部质量改进计划可能会迅速提高绩效，但其效果可能因指标而异，也可能无法长期持续。
BackgroundQuality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators.MethodsWe conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables.ResultsPatients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, p<0.001), but did not differ in post-I period. Dysphagia screening improved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period.ConclusionQuality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time.