审计和反以减少规模上的不合理的临床变化:对实施战略机制的现实研究
Mitchell Sarkies1,2, Emilie Francis-Auton3, Janet Long3
1Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. mitchell.sarkies@sydney.edu.au.
Implementation science : IS
|December 12, 2023
概括
审计和反可以减少不必要的临床变化,当临床医生参与,信息是有意义的. 成功取决于临床医生的支持,明确的沟通和问责制,避免被认为是不公平或失去自主权.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善临床质量 改善临床质量
- 实施科学 实施科学
背景情况:
- 不合理的临床变异,包括使用不足,过度使用或滥用服务,是医院护理中的一个重要问题.
- 审计和反是解决这种变化的常见策略,但其有效性取决于环境.
研究的目的:
- 确定影响审计和反对不合理临床变异的影响的实施策略,机制和上下文因素.
主要方法:
- 澳大利亚新南威尔士州 (2017-2021) 全州基于价值的医疗保健计划的现实研究.
- 利用多个数据源进行初始理论开发,随后对56名参与者进行半结构面试.
- 使用上下文-机制-结果框架进行数据分析,并通过三个专家小组验证发现.
主要成果:
- 审计和反策略涉及八个机制过程.
- 通过临床医生的所有权,可理解的信息,社会影响力和问责制来提高有效性.
- 限制因素包括合理化当前做法,感知不公平,数据完整性问题,未被考虑的改进计划和侵犯专业自主权.
结论:
- 当临床医生参与,有意义的指标,明确的计划和尊重专业知识时,审计和反可以减少不合理的变化.
- 提出了一种规模实施审计和反的模型.
- 建议限制指标,让临床医生参与反,并允许反思.
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