Using Process Improvement and Systems Redesign to Improve Rheumatology Care Quality in a Safety Net Clinic
Using Process Improvement and Systems Redesign to Improve Rheumatology Care Quality in a Safety Net Clinic
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DOI：
10.3899/jrheum.190472
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发表时间：
2020-11-01
影响因子：
3.9
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
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作者：
Aguirre, Alfredo;Trupin, Laura;Yazdany, Jinoos
客观的。制定和评估干预措施，以提高城市安全网成人风湿病诊所 4 个优先领域的护理质量，为种族/民族和社会经济多样化的患者群体提供服务。方法。医疗保健改进研究所的改进模型被用来重新设计临床流程，以在 2015 年至 2017 年期间在以下领域达到预先设定的基准： 在免疫功能低下的患者中接种 13 价肺炎球菌结合疫苗 (PCV13)；使用临床疾病活动指数（CDAI）对类风湿关节炎患者进行疾病活动监测；对患有 RA 的新生物制剂使用者进行潜伏性结核感染 (LTBI) 筛查；以及为接受潜在致畸药物的妇女提供生殖健康咨询。我们使用标准化指标来衡量每个人的表现，定义为接受推荐护理的合格患者的比例。结果。 2015 年至 2017 年间，诊所接诊了 1205 名患者。就人口统计而言，71% 为女性，88% 为少数种族/族裔，45% 符合至少一项质量衡量标准。 PCV13 和 CDAI 指标的 Shewart 图表显示了随着时间的推移医疗保健服务有所改善的证据。 CDAI 和 LTBI 指标的性能分别为 93% 和 91%。 PCV13 和生殖健康咨询措施的绩效分别为 78% 和 46%，但未达到预先设定的改善目标。结论。通过跨专业的方法，我们能够在很大程度上通过加强工作流程、吸引非医生提供者和管理实践变化来实现关键风湿病质量测量的持久改进。
Objective. To develop and evaluate interventions to improve quality of care in 4 priority areas in an urban safety net adult rheumatology clinic serving a racially/ethnically and socioeconomically diverse patient population.Methods. The Institute for Healthcare Improvement's Model for Improvement was used to redesign clinical processes to achieve prespecified benchmarks in the following areas from 2015 to 2017: 13-valent pneumococcal conjugate vaccine (PCV13) administration among immunocompromised patients; disease activity monitoring with the Clinical Disease Activity Index (CDAI) for patients with rheumatoid arthritis; latent tuberculosis infection (LTBI) screening for new biologic users with RA; and reproductive health counseling among women receiving potentially teratogenic medications. We measured performance for each using standardized metrics, defined as the proportion of eligible patients receiving recommended care.Results. There were 1205 patients seen in the clinic between 2015 and 2017. Regarding demographics, 71% were women, 88% identified as racial/ethnic minorities, and 45% were eligible for at least 1 of the quality measures. Shewart charts for the PCV13 and CDAI measures showed evidence of improved healthcare delivery over time. Benchmarks were achieved for the CDAI and LTBI measures with 93% and 91% performance, respectively. Performance for the PCV13 and reproductive health counseling measures was 78% and 46%, respectively, but did not meet prespecified improvement targets.Conclusion. Through an interprofessional approach, we were able to achieve durable improvements in key rheumatology quality measures largely by enhancing workflow, engaging nonphysician providers, and managing practice variation.