Evaluating the use of a modified CAHPS® survey to support improvements in patient-centred care:: lessons from a quality improvement collaborative
Evaluating the use of a modified CAHPS® survey to support improvements in patient-centred care:: lessons from a quality improvement collaborative
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DOI：
10.1111/j.1369-7625.2007.00483.x
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发表时间：
2008-06-01
影响因子：
3.2
通讯作者：
Cleary, Paul D.
中科院分区：
文献类型：
--
作者：
Davies, Elizabeth;Shaller, Dale;Cleary, Paul D.
目的评估修改后的医疗保健提供者和系统消费者评估(CAHPS(R))调查在以患者为中心的协作护理中支持质量改进的使用情况，评估患者体验的后续变化，并确定促进或阻碍数据使用的因素。背景医疗系统越来越多地使用调查来评估患者的护理体验，但很少建立关于如何将这些数据用于质量改进的信息。质量改进协作的设计过程评估。设置和参与者来自哈佛医学院和临床系统改进研究所的CAHPS团队组织了一次学习协作，其中包括明尼苏达州的八个医疗小组。干预最近访问每个小组的患者样本在之前、之后和持续超过12个月的项目中完成了修改后的CAHPS(注册商标)调查。鼓励团队使用基线数据设定改进目标，并通过双月协作会议、报告每月数据的在线工具、称为CAHPS(R)改进指南的资源手册和电话会议来支持他们进行干预。主要结果衡量患者体验的变化。对团队负责人的访谈评估了协作资源的有用性、经验教训和使用数据的障碍。结果7个团队设定了目标，6个团队进行了干预。在一些组中观察到患者体验的微小改善，但在其他组中，变化是混合的，并不总是与团队行动相关。两个成功的小组似乎拥有强大的质量改进结构，并专注于相对简单的干预措施。团队负责人报告说，频繁的调查报告是改善的强大刺激，但他们需要更多的时间和支持来吸引工作人员和临床医生改变他们的行为。结论通过短期项目，患者体验可能会取得微小的、可衡量的改善。要维持更实质性的变化，可能需要组织战略、积极参与的领导、文化变革、定期衡量和业绩反馈以及解释和使用调查数据的经验。
Objectives To evaluate the use of a modified Consumer Assessment of Healthcare Providers and Systems (CAHPS(R)) survey to support quality improvement in a collaborative focused on patient-centred care, assess subsequent changes in patient experiences, and identify factors that promoted or impeded data use.Background Healthcare systems are increasingly using surveys to assess patients' experiences of care but little is established about how to use these data in quality improvement.Design Process evaluation of a quality improvement collaborative.Setting and participants The CAHPS team from Harvard Medical School and the Institute for Clinical Systems Improvement organized a learning collaborative including eight medical groups in Minnesota.Intervention Samples of patients recently visiting each group completed a modified CAHPS(R) survey before, after and continuously over a 12-month project. Teams were encouraged to set goals for improvement using baseline data and supported as they made interventions with bi-monthly collaborative meetings, an online tool reporting the monthly data, a resource manual called The CAHPS(R) Improvement Guide, and conference calls.Main outcome measures Changes in patient experiences. Interviews with team leaders assessed the usefulness of the collaborative resources, lessons and barriers to using data.Results Seven teams set goals and six made interventions. Small improvements in patient experience were observed in some groups, but in others changes were mixed and not consistently related to the team actions. Two successful groups appeared to have strong quality improvement structures and had focussed on relatively simple interventions. Team leaders reported that frequent survey reports were a powerful stimulus to improvement, but that they needed more time and support to engage staff and clinicians in changing their behaviour.Conclusions Small measurable improvements in patient experience may be achieved over short projects. Sustaining more substantial change is likely to require organizational strategies, engaged leadership, cultural change, regular measurement and performance feedback and experience of interpreting and using survey data.