Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.
Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.
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DOI：
10.7812/tpp/13-010
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发表时间：
2013-01-01
影响因子：
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通讯作者：
Chang, Christine
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文献类型：
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作者：
McDonald, Kathryn M;Schultz, Ellen M;Chang, Christine
背景：卫生保健研究和质量机构的《弥合质量差距》系列总结了八个高度优先的卫生保健主题的证据：残疾研究中使用的结果、捆绑的支付计划、公共报告倡议、卫生保健差异、姑息治疗、以患者为中心的疗养院、预防卫生保健相关感染和药物依从性。目的：从该系列中提取证据，并洞察质量改进(QI)的科学状况。方法：我们为主题开发提供了共同的指导，并从系列主题报告中定性地合成了证据，以确定跨主题的主题、挑战、以及与QI实践和科学相关的证据差距。结果：在检查QI干预有效性的主题中，我们发现一些结果有改善，但另一些没有改善。QI活动的实施背景和潜在危害没有得到广泛的评估或报道，尽管市场因素似乎对基于激励的QI战略很重要。以患者为中心和以系统为中心的策略通常比以临床医生为中心的策略更有效，尽管后者提高了临床医生对感染预防策略的依从性。审计和反馈似乎更适合针对专业人员和组织，而不是患者。主题评价者观察到用于QI评估的结果的异质性、研究设计的弱点和不完整的报告。结论：综合不同主题的证据为从业者和研究人员提供了对QI领域状况的洞察。为了促进未来的证据合成，需要就QI评估中使用的一组较小的结果以及更广泛地描述QI干预的框架和词典达成共识，以与负责提高质量的决策者的需求保持一致。
CONTEXT: The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence.OBJECTIVE: To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI).METHODS: We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science.RESULTS: Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting.CONCLUSIONS: Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.