持续质量改进方法学:一项关于改善衣原体筛查的多学科合作的案例研究

Continuous Quality Improvement Methodology:a Case Study on Multidisciplinary Collaboration to Improve Chlamydia Screening

本文旨在通过一个改善女性衣原体筛查的示例来解读质量改进方法学。医疗保健中的质量改进项目为在现实世界的医疗环境中提高患者照护质量和安全性提供了很好的机遇,但很多学术中心缺乏如何开展质量改进项目的培训计划。选择进行衣原体筛查,是因为尽管有简单的筛查和治疗方法,衣原体仍造成了沉重的健康负担。密歇根大学实施了一个多部门流程,使用计划-执行-检查-处理模型来提高衣原体筛查率。指导质量改进项目的步骤包括以下部分:(1)组建一个具有主动性的利益相关者和领导者团队;(2)确定被认为具有较高优先级的问题;(3)为项目做好支持和资源方面的准备;(4)设定评估结果的目标和方法;(5)根据问题的影响和解决问题的努力,确定产生问题的根本原因和确定优先事项;(6)制定有效解决所选定的根本原因的对策;(7)在小型项目进行试点,以评估可能的修订;(8)大规模推广,包括如何实施项目的教育工作;(9)利用反馈机制评估和修改过程。使用这个九步法,衣原体筛查率从29%增加到了60%。质量改进项目与大多数临床研究项目不同,其允许临床医生在为医学科学本身做出贡献的同时,也直接改善患者的健康状况。这可能会吸引希望进行这种可以通过学术渠道传播的研究的临床医生的兴趣。

This article illustrates quality improvement(QI)methodology using an example intended to improve chlamydia screening in women.QI projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting,yet many academic centres lack training programmes on how to conduct QI projects.The choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and treat.At the University of Michigan,we implemented a multidepartment process to improve the chlamydia screening rates using the plan-docheck-act model.Steps to guide QI projects include the following:(1)assemble a motivated team of stakeholders and leaders;(2)identify the problem that is considered a high priority;(3)prepare for the project including support and resources;(4)set a goal and ways to evaluate outcomes;(5)identify the root cause(s)of the problem and prioritise based on impact and effortto address;(6)develop a countermeasure that addresses the selected root cause effectively;(7)pilot a small-scale project to assess for possible modifications;(8)large-scale roll-out including education on how to implement the project;and(9)assess and modify the process with a feedback mechanism.Using this nine-step process,chlamydia screening rates increased from 29%to 60%.QI projects differ from most clinical research projects by allowing clinicians to directly improve patients’health while contributing to the medical science body.This may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.