建立社区卫生中心团队:评估团队培训的影响
Young-Jin Sohn1, Hannah L Schmitt1, Amie A Pollack2
1Center for Primary Care, Harvard Medical School, Boston, MA, USA.
进步团队计划 (ATP) 通过提高质量改善和实践转型的技能,改善了服务不足的社区卫生中心的初级保健团队. 这种以团队为基础的培训导致了更好的以患者为中心的护理和诊所运作.
科学领域:
- 主要护理是指初级护理.
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 高绩效的团队通过提高质量和实践转型来提高初级保健,从而带来更好的患者结果.
- 在医疗服务不足的社区 (MUCs) 中,以团队为基础的护理尤其重要.
研究的目的:
- 评估以团队为基础的培训计划的影响,重点是质量改善和实践转型.
- 该计划的目标是社区卫生中心 (CHCs),为马萨诸塞州资源不足的人口提供服务.
主要方法:
- 进步团队计划 (ATP) 在47个跨学科团队中实施了6年 (2016-2022年) 来自服务于MUC的CHC.
- 混合方法设计包括前后调查 (Qualis Health以患者为中心的医疗家庭评估 - PCMH-A) 和改进项目的定性分析.
- 参与者包括327名行政人员,临床医生和实习生.
主要成果:
- 医疗健康中心为高比例的医疗补助和无保险患者提供服务 (>65%).
- 在PCMH-A评分中观察到的显著改善 (p<0.05) 是领导参与,基于团队的护理,基于证据的实践,以患者为中心的互动,访问和护理协调.
- 以患者为中心的相互作用显示了最大的改善 (+1.04,p=0.001),ATP与增强的患者决策和自我管理支持有关. 提高领导层参与度预测了更好的临床功能 (β=0.68,p<0.001).
- 定性分析显示,在行为健康,糖尿病,药物滥用和健康的社会决定因素的护理方面取得了成功的改善.
结论:
- 进步团队计划 (ATP) 显示出在资源不足的社区卫生中心发展初级保健团队的前景.
- 进一步的研究应侧重于评估团队质量,并采用可靠的方法来衡量改进项目的成果.
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