PDF(Pubmed)
Abstract：
OBJECTIVE: To describe the application and examine the influence of a continuous quality improvement intervention, which had a goal of standardizing care to reduce the proportion of patients who do not have a meaningful improvement in patient-reported outcomes following total knee arthroplasty (TKA). DESIGN: Continuous quality improvement. METHODS: A physical therapy (PT) care guideline was initiated in 2013 for patients following TKA. The Knee Outcome Survey - Activities of Daily Living (KOS-ADL) was measured at every visit, and scores were extracted from a clinical outcomes database to calculate the proportion of patients who did not achieve a minimal clinically important difference. Based on logistic regression analysis, we compared the proportion of patients who did not progress on the KOS-ADL in a non-care guideline group (2008-2012) to a care guideline (CG) group (2014-2019). RESULTS: This study included 12 355 patients (aged 18-92 years) following TKA incurring at least 3 PT visits from 2008 to 2019. The percentage of patients who did not progress in the non-care guideline group was 25.8% and in the care guideline group 14.3% (P<0.001). The relationship between care guideline adherence and lack of progression on the KOS-ADL was statistically significant, X2 (df = 1) = 148.7, P<.001. CONCLUSION: The percentage of patients who did not achieve meaningful progress on the KOS-ADL declined significantly in the 6 years after implementing a TKA care guideline without an increase in the number of clinical visits. The standardized care guideline was associated with meaningful improvements for patients following TKA when applied in conjunction with PT access to outcome data, feedback through audits, performance goals, and financial incentives. J Orthop Sports Phys Ther 2023;53(3):143-150. Epub: 12 December 2022. doi:10.2519/jospt.2022.11369.
摘要：
目的：描述持续质量改进（CQI）干预的应用并检查其影响，其目标是标准化护理，以减少全膝关节置换术（TKA）后患者报告的结局没有有意义改善的患者比例。设计：持续质量改进方法：2013年针对以下患者（TKA）启动了物理治疗（PT）护理指南。每次就诊时测量膝关节结果调查（KOS-ADL），并从临床结果数据库中提取得分，以计算未达到最小临床重要差异的患者比例。基于Logistic回归分析，我们比较了非护理指南(NCG)组(2008-2012)和护理指南(CG)组(2014-2019)中KOS-ADL无进展的患者比例.结果：纳入了2008-2019年TKA后发生至少3次PT就诊的12,355例患者（年龄18-92岁）。NCG组未进展的患者比例为25.8%,CG组为14.3%(p<0.001)。护理指南依从性与KOS-ADL缺乏进展之间的关系具有统计学意义，X2(df=1)=148.7,p<0.001。结论：在实施TKA护理指南后的六年中，KOS-ADL未取得有意义进展的患者百分比显着下降，而临床就诊次数没有增加。当与PT对结果数据的访问一起应用时，标准化护理指南与TKA后患者的有意义的改善相关。通过审计反馈，绩效目标，和财政激励。
