澳大利亚土著初级卫生保健(PHC)服务机构广泛采用了持续质量改进(CQI)计划,并且已经有国家政策承诺对此予以支持。然而,国际证据表明,实施CQI具有挑战性,影响是可变的,对阻碍或提高有效性的因素知之甚少。进行了范围审查,以探索土著PHC的吸收和实施,包括在常规实践中嵌入CQI的障碍和促成因素。我们就如何加强研究和评估以支持实施提供指导。
搜索是在MEDLINE中进行的,CINAHL和Cochrane系统评价数据库。对关键网站和出版物进行了手工搜索。包括在土著PHC中进行的研究,这些研究展示了CQI特征的某些组合并评估了实施的某些方面。进行了两阶段分析。第一阶段确定了文学的广度和重点。第二阶段调查了障碍和推动者。PHC绩效评估框架(2008年)用于构建分析框架。数据提取了研究类型,方法,时间范围,CQI策略,障碍和推动者。
第1阶段包括60篇文章,第2阶段包括21篇文章。实施CQI过程的障碍主要涉及专业和组织过程,并在多个层面(个人,团队,服务,卫生系统),而改善护理的障碍更直接地与促进适当护理的最佳实践和团队流程的知识有关。很少有研究描述了实施时间框架,实施的CQI周期或改进策略的数量,只有两个应用了变化理论。
调查修改CQI的实施和影响的障碍和推动者提出了概念和方法上的挑战。更完整的CQI过程描述,实施战略,障碍和推动者可以增强跨环境进行比较的能力,并有助于更好地理解关键成功因素。
Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping
review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation.
Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature. Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers.
Sixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or improvement strategies implemented and only two applied a change theory.
Investigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.