使用精益六西格玛的医生驱动的质量改善管理干预措施改善了社区获得肺炎患者的护理
Lea M Monday1,2,3, Omid Yazdanpaneh2, Caleb Sokolowski3
1Department of Internal Medicine, Division of General Internal Medicine, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
Global journal on quality and safety in healthcare
|June 1, 2023
概括
使用DMAIC方法的质量改进计划成功地减少了社区获得性肺炎 (CAP) 患者的抗生素持续时间,增加了对IDSA指南的遵守,而不会影响临床结果.
科学领域:
- 传染性疾病 传染性疾病
- 抗微生物药物管理委员会
- 提高质量 提高科学 提高质量
背景情况:
- 社区获得性肺炎 (CAP) 治疗指南建议至少5天的抗生素治疗.
- 过度持续的抗生素治疗 (DOT) 是一种常见的临床实践.
- 定义,测量,分析,改进和控制 (DMAIC) 方法对抗微生物药物管理的有用性尚未得到充分证实.
研究的目的:
- 评估医生驱动的管理干预对减少住院CAP患者过量抗生素DOT的影响.
- 评估干预对临床结果的影响.
- 为了确定处方抗生素DOT超出推的最低的原因.
主要方法:
- 进行了一项单一中心,准实验性的质量改进研究.
- 干预使用了DMAIC的方法,包括教育,同行审计/反,以及每天跟踪DOT.
- 该研究比较了基线追溯对照组 (2018年10月至2019年2月) 与干预组 (2020年10月至2019年2月).
主要成果:
- 在干预组中,中位数的抗生素DOT从8天减少到5天 (p < 0.001).
- 在IDSA最低持续时间内接受治疗的患者比例显著增加 (5.3%至56%;p < 0.001).
- 在死亡率,再接收,停留时间或Clostridioides difficile感染率方面没有发现显著差异.
结论:
- 一个由医生领导的基于DMAIC的质量改善计划有效地减少了CAP的抗生素DOT.
- 干预改善了对CAP的IDSA治疗指南的遵守.
- 管理干预实现了DOT的降低,但对患者的临床结果没有不利影响.
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