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背景不断扩展的知识体系对改善卫生保健组织和服务起到了指导作用,大多数知识在医院得以实践。但是,如何将此类知识体系运用于初级医疗还存在不确定性。目的对全科诊所实施大型慢性阻塞性肺疾病(COPD)人群改善服务方案的促进和限制因素进行探究。设计和场所此定性研究在社会经济类型、种族混合的英国伦敦东部市区进行,纳入189家全科诊所。方法方案实施前,对方案组织者进行12次半结构面谈,并对方案参与者进行17次深度面谈。参试者包含地方卫生系统的主管、临床医生和诊所管理员。改善方案的理论框架源于有证据的指南。带有社会和技术元素的复合干预包含培训和辅导、引导、分析工具和数据反馈。结果诊所医务人员愿意参试并学习设计优良的协同改善项目。不过,限制表现在工作人员实施系统改善的能力、获取数据和数据质量问题以及基于叙述的初级医疗临床医生的通才定位与定量单病种定位之间的矛盾。如今,许多质量改善活动都具有定量单病种定位特征。结论很大程度上衍生于医院研究的改善指南,多半可在初级医疗单位进行应用,尽管全科诊所做出大的改变会面临着一些挑战。但需要更好理解和应对这些挑战,才能使改善措施有所收效。
Background The expanding body of knowledge has guided the improvement of health care organizations and services, and most of the knowledge is practiced in hospitals. However, there is still uncertainty about how to apply such knowledge system to primary care. Objective To explore the promotion and limitation factors of service improvement programs in large-scale chronic obstructive pulmonary disease (COPD) patients in general practice clinics. Design and Locations This qualitative study was conducted in 189 societies of socioeconomic type, racially mixed urban areas of eastern London, England. Before implementation of the methodological plan, the program organizers conducted 12 semi-structured interviews and conducted 17 in-depth interviews with program participants. The participants included supervisors of local health systems, clinicians and clinic administrators. The theoretical framework for improving programs stems from evidence-based guidelines. Compound interventions with social and technical elements include training and mentoring, mentoring, analytical tools and data feedback. Results Clinic medical staff are willing to attend and learn to design good collaborative improvement projects. However, the limitations are reflected in the staff’s ability to implement systematic improvements, access to data and data quality issues, and the contradiction between narrative-based primary care clinicians’ generalization and single-disease positioning. Today, many quality improvement activities have the capacity to quantify the location of single disease loci. Conclusions Much of the guidance for improvement derived from hospital research is likely to be used in primary care units, although major changes in GPs face some challenges. However, improvements need to be better understood and addressed.