Contrasting Perspectives of Practice Leaders and Practice Facilitators May Be Common in Quality Improvement Initiatives
Contrasting Perspectives of Practice Leaders and Practice Facilitators May Be Common in Quality Improvement Initiatives
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DOI：
10.1097/jhq.0000000000000223
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发表时间：
2020-05-01
影响因子：
1.3
通讯作者：
Persell, Stephen D.
中科院分区：
文献类型：
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作者：
McHugh, Megan;Brown, Tiffany;Persell, Stephen D.
实践促进是推进质量改进的一种方法，但其成功取决于参与者之间的有效关系和沟通。我们的目标是确定模式的对比实施问题的实践领导者和他们的实践促进者之间的观点，并可能有助于他们的因素。我们与实践领导者和分配给他们的实践促进者进行了个别访谈，作为初级保健实践中预防心脏病学计划的一部分。我们使用总结性内容分析来量化对比观点的发生率，并使用双变量和定性分析来探索对比观点和背景因素之间的关系。在这16对中，对比的观点通常与最容易或最难实施的QI干预措施（16对中的8对）和实践成功实施干预措施（16对中的5对）有关。主持人亲自访问QI的次数与对比观点的总数之间存在不显著的负相关（r =-0.19，p = 0.47）。工作人员的更替率经常以对比的观点成对报告。尽管对比观点的影响值得进一步研究，但使用实践促进的QI计划的规划者应考虑采取措施，通过解决营业额挑战和鼓励分享观点的机会，最大限度地减少对比观点或其潜在的不利后果。
Practice facilitation is an approach for advancing quality improvement (QI), but its success depends on effective relationships and communication among participants. Our goal was to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators, and factors that may contribute to them. We conducted individual interviews with practice leaders and the practice facilitators assigned to them as part of a program focused on preventive cardiology within primary care practices. We used summative content analysis to quantify the incidence of contrasting perspectives, and bivariate and qualitative analyses to explore relationships between contrasting perspectives and contextual factors. Among the 16 dyads, contrasting perspectives commonly related to the easiest or hardest QI interventions to implement (8 of 16 dyads) and the practice's success implementing interventions (5 of 16 dyads). There was a nonsignificant, inverse correlation (r = -0.19, p = .47) between the number of in-person QI visits from the facilitator and the total number of contrasting perspectives. Turnover of staff was frequently reported in dyads with contrasting perspectives. Although the impact of contrasting perspectives warrants additional study, planners of QI initiatives using practice facilitation should consider taking steps to minimize contrasting perspectives, or the potential adverse consequences of them, by addressing turnover challenges and encouraging opportunities to share perspectives.