PDF(Pubmed)
Abstract：
OBJECTIVE: This study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.
METHODS: Semistructured interviews and qualitative proforma surveys were conducted with skin cancer experts from a range of healthcare settings. Framework analysis was employed to identify key groups of quality measures within the domains of the Donabedian model of healthcare quality (structure, process, outcome). Interview and survey data were triangulated to identify common groups of quality measures, barriers and facilitators.
METHODS: We purposively recruited skin cancer experts from Australia and internationally with knowledge and experience in skin cancer management. The final sample consisted of 15 participants who had clinical or academic backgrounds.
RESULTS: Participants unequivocally expressed the need for quality measures to guide skin cancer care. Ten groups of quality measures were identified: three groups related to the structural elements of care (eg, diagnostic tools), four related to the processes of care (eg, diagnostic process) and three related to outcomes of care (eg, treatment outcomes). Implementation barriers included clinician resistance, system inadequacies and external factors (eg, patient risk). Facilitators included incentives, education, agreed and feasible indicators and support and guidance.
CONCLUSIONS: To service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement.
METHODS: Semistructured interviews and qualitative proforma surveys were conducted with skin cancer experts from a range of healthcare settings. Framework analysis was employed to identify key groups of quality measures within the domains of the Donabedian model of healthcare quality (structure, process, outcome). Interview and survey data were triangulated to identify common groups of quality measures, barriers and facilitators.
METHODS: We purposively recruited skin cancer experts from Australia and internationally with knowledge and experience in skin cancer management. The final sample consisted of 15 participants who had clinical or academic backgrounds.
RESULTS: Participants unequivocally expressed the need for quality measures to guide skin cancer care. Ten groups of quality measures were identified: three groups related to the structural elements of care (eg, diagnostic tools), four related to the processes of care (eg, diagnostic process) and three related to outcomes of care (eg, treatment outcomes). Implementation barriers included clinician resistance, system inadequacies and external factors (eg, patient risk). Facilitators included incentives, education, agreed and feasible indicators and support and guidance.
CONCLUSIONS: To service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement.
摘要：
目的：本研究探索了改善初级保健机构皮肤癌管理的潜在质量措施，以及与实施相关的障碍和促进者。
方法：与来自一系列医疗机构的皮肤癌专家进行了半结构化访谈和定性形式调查。框架分析被用来识别医疗质量的Donabedian模型领域内的质量测量的关键组(结构，process,结果)。访谈和调查数据进行了三角测量，以确定常见的质量措施组，障碍和促进者。
方法：我们有目的地招募了来自澳大利亚和国际的皮肤癌专家，这些专家具有皮肤癌管理方面的知识和经验。最终样本由15名具有临床或学术背景的参与者组成。
结果：参与者明确表示需要采取质量措施来指导皮肤癌护理。确定了十组质量指标：与护理结构要素相关的三组（例如，诊断工具)，四个与护理过程有关(例如，诊断过程)和三个与护理结果相关(例如，治疗结果)。实施障碍包括临床医生的抵抗，系统不足和外部因素(例如，患者风险)。促进者包括激励措施，教育,商定的、可行的指标以及支持和指导。
结论：为了服务澳大利亚不断增长的皮肤癌患者，初级保健的作用需要更明确，及其护理提供者支持并更多地参与质量改进过程。结构,过程和结果质量度量，源自初级保健设置的详细指南，可用于跟踪从业者的表现并促进持续改进。
方法：与来自一系列医疗机构的皮肤癌专家进行了半结构化访谈和定性形式调查。框架分析被用来识别医疗质量的Donabedian模型领域内的质量测量的关键组(结构，process,结果)。访谈和调查数据进行了三角测量，以确定常见的质量措施组，障碍和促进者。
方法：我们有目的地招募了来自澳大利亚和国际的皮肤癌专家，这些专家具有皮肤癌管理方面的知识和经验。最终样本由15名具有临床或学术背景的参与者组成。
结果：参与者明确表示需要采取质量措施来指导皮肤癌护理。确定了十组质量指标：与护理结构要素相关的三组（例如，诊断工具)，四个与护理过程有关(例如，诊断过程)和三个与护理结果相关(例如，治疗结果)。实施障碍包括临床医生的抵抗，系统不足和外部因素(例如，患者风险)。促进者包括激励措施，教育,商定的、可行的指标以及支持和指导。
结论：为了服务澳大利亚不断增长的皮肤癌患者，初级保健的作用需要更明确，及其护理提供者支持并更多地参与质量改进过程。结构,过程和结果质量度量，源自初级保健设置的详细指南，可用于跟踪从业者的表现并促进持续改进。
