对一个资源有限的儿科病房进行实践质量改进的变化
Phoebe H Yager1, Kevin Mary Callans1, Aubrey Samost-Williams2
1Massachusetts General Hospital, Boston, MA, United States.
Frontiers in public health
|June 27, 2024
概括
通过优化护理和实施最佳实践,儿科重症监护病房的质量改善计划显著降低了儿童死亡率. 当地团队推动了进一步的改进,建议采取多因素的方法来减少低资源环境中的死亡率.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 儿科重症监护室的重症监护人员.
- 全球卫生倡议全球卫生倡议
背景情况:
- 在低收入和中等收入国家 (LMICs) 的儿科重症监护室 (PICU) 中优化多学科护理和临床最佳实践至关重要.
- 了解影响儿童死亡率下降的因素在质量改善倡议 (QII) 实施后是必不可少的.
研究的目的:
- 评估QII对LMIC PICU中儿科患者死亡率的可持续性和影响.
- 探索有助于观察到儿童死亡率减少的因素.
主要方法:
- 使用直管儿科患者死亡率作为主要结局的QII的纵向评估.
- 统计分析包括t测试和干预后36个月的线性回归.
- 用影响路径和驱动图模型来分析干预采用和改善路径.
主要成果:
- 死亡率显著下降,从22.4%降至9.5% (p=0.002).
- 每100天出意外的输出,机械通风最初显著下降,但平稳.
- 实施了15个新的,本地驱动的质量实践,表明了多因素的改进.
结论:
- 观察到持续改善的护理为直管儿科患者.
- 质量II有助于改善结果,但由于地方倡议,变化可能是多因素的.
- 影响路径模型显示了理解LMIC PICU中复杂改进动态的潜力.
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