背景:医疗保健中持续质量改进(CQI)计划的日益采用已经引起了研究兴趣的激增,以获得对CQI的更深入了解。然而,关于CQI在医疗保健中的不同方面的综合证据有限.我们的审查试图全面掌握CQI的概念和原则,探索现有的模型和工具,分析障碍和促进者,并调查其总体影响。
方法:使用Arksey和O\'Malley的方法框架进行了定性范围审查。我们在PubMed上搜索了文章,WebofScience,Scopus,EMBASE数据库。此外,我们访问了GoogleScholar的文章。我们使用了混合方法分析,包括定性内容分析和定量描述性的定量结果,以总结结果和PRISMA扩展范围审查(PRISMA-ScR)框架,以报告整体工作。
结果:共87篇,涵盖了14个CQI模型,包括在审查中。虽然有19种工具用于CQI模型和计划,Plan-Do-Study/Check-Act循环是理解CQI实施过程的常用模型。使用CQI的主要报告目的,作为其积极影响,是为了改善卫生系统的结构(例如,领导力,卫生劳动力,卫生技术的使用,用品,和成本),加强医疗保健交付流程和产出(例如,护理协调和联系,满意,可访问性,护理的连续性,安全,和效率),改善治疗结果(降低发病率和死亡率)。CQI的实现并非没有挑战。有文化(即,抵制/不愿意以质量为中心的文化,害怕责备或惩罚),技术,结构(与组织结构有关,进程,和系统),以及在实施CQI过程中通常报告的与战略(规划不足和目标不当)相关的障碍。
结论:实施CQI计划需要彻底理解关键原则,如团队合作和时间表。为了有效应对挑战,识别障碍并积极实施最佳干预措施至关重要。医疗保健专业人员和领导者需要具备心理素质,并认识到CQI计划在实现护理质量方面发挥的重要作用。
BACKGROUND: The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our
review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.
METHODS: This qualitative scoping
review was conducted using Arksey and O\'Malley\'s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.
RESULTS: A total of 87 articles, which covered 14 CQI models, were included in the
review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.
CONCLUSIONS: Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it\'s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.