Key findings of the US Cystic Fibrosis Foundation's clinical practice benchmarking project
Key findings of the US Cystic Fibrosis Foundation's clinical practice benchmarking project
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DOI：
10.1136/bmjqs-2013-002369
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发表时间：
2014-04-01
影响因子：
5.4
通讯作者：
Schechter, Michael S.
中科院分区：
文献类型：
--
作者：
Boyle, Michael P.;Sabadosa, Kathryn A.;Schechter, Michael S.
基准测试是使用结果数据来识别高绩效中心并确定与其杰出绩效相关的实践的过程。美国囊性纤维化基金会 (CFF) 患者登记处包含美国所有 CFF 认证的儿科和成人囊性纤维化 (CF) 护理项目的特定中心结果数据。 CFF 基准项目分析了这些登记数据，根据已知影响结果的患者病例组合差异进行调整，并确定了美国在肺部和营养结果方面表现最佳的儿科和成人 CF 护理计划。独立的多学科儿科和成人基准测试团队分别访问了 10 个 CF 护理项目，其中 5 个在肺部结果排名前五分之一，另外 5 个在营养结果排名前五分之一。确定了儿科和成人项目中具有出色临床结果的关键实践模式和方法，并将其概括为系统、态度、实践、患者/家庭赋权和项目。其中包括：(1) 强有力的领导和运作良好的护理团队，采用系统方法提供一致的护理； (2) 提供者和家庭对结果抱有很高期望； (3) 对临床衰退进行早期和积极的管理，避免依赖“救援”； (4) 患者/家属参与疾病管理及其基本原理，并获得授权并充分了解疾病管理及其基本原理。总之，对具有前五分位肺部和营养结果的 CF 护理中心的实践模式进行评估，可以深入了解可能有助于优化患者治疗结果的特征实践。
Benchmarking is the process of using outcome data to identify high-performing centres and determine practices associated with their outstanding performance. The US Cystic Fibrosis Foundation (CFF) Patient Registry contains centre-specific outcomes data for all CFF-certified paediatric and adult cystic fibrosis (CF) care programmes in the USA. The CFF benchmarking project analysed these registry data, adjusting for differences in patient case mix known to influence outcomes, and identified the top-performing US paediatric and adult CF care programmes for pulmonary and nutritional outcomes. Separate multidisciplinary paediatric and adult benchmarking teams each visited 10 CF care programmes, five in the top quintile for pulmonary outcomes and five in the top quintile for nutritional outcomes. Key practice patterns and approaches present in both paediatric and adult programmes with outstanding clinical outcomes were identified and could be summarised as systems, attitudes, practices, patient/family empowerment and projects. These included: (1) the presence of strong leadership and a well-functioning care team working with a systematic approach to providing consistent care; (2) high expectations for outcomes among providers and families; (3) early and aggressive management of clinical declines, avoiding reliance on 'rescues'; and (4) patients/families that were engaged, empowered and well informed on disease management and its rationale. In summary, assessment of practice patterns at CF care centres with top-quintile pulmonary and nutritional outcomes provides insight into characteristic practices that may aid in optimising patient outcomes.