Results of a healthcare transition learning collaborative for emerging adults with sickle cell disease: the ST3P-UP study transition quality improvement collaborative.

IF 5.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

BMJ Quality & Safety Pub Date : 2024-11-21 DOI:10.1136/bmjqs-2024-017725

Ifeyinwa Osunkwo, Jennifer S Cornette, Laura Noonan, Cheryl Courtlandt, Sarah Mabus, Patience H White, Margaret McManus, Myra M Robinson, Michelle L Wallander, James R Eckman, Elna Saah, Ofelia A Alvarez, Mark Goodwin, Leila Jerome Clay, Payal Desai, Raymona H Lawrence

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引用次数: 0

Abstract

Background: Individuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.

Methods: A central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition's process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.

Results: Of a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).

Conclusions: The ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.

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针对新发镰状细胞病成人患者的医疗保健过渡学习合作成果：ST3P-UP 研究过渡质量改进合作。

背景：镰状细胞病（SCD）患者在从儿科护理向成人护理过渡时，临床疗效不佳。需要为 SCD 过渡期制定标准。我们成立了一个质量改进（QI）合作组织，旨在通过建立标准化的 SCD 过渡流程，提高所有年轻成人 SCD 患者的护理质量。本研究评估了医疗过渡六大核心要素（6CE）的实施情况，这也是镰状细胞特雷弗-汤普森过渡项目（ST3P-UP）研究的基本组成部分：方法：一个中央 QI 小组对 14 个 ST3P-UP 研究机构进行了 QI 方法、6CE 和 Got Transition 流程测量工具 (PMT) 方面的培训。各研究点的 QI 小组成员包括一名过渡协调员、诊所医生/员工、SCD 患者/家长以及社区代表。在 54 个月的时间里，各医疗点每 6 个月完成一次 PMT，并每月对随机抽取的 10 份病历进行审核，以核实准备/自我护理评估和紧急护理计划：在可能的 100 分中，儿科诊所的 PMT 总平均分（±SD）在基线时为 23.9（±13.8）分，在 24 个月时为 95.9（±6.0）分，在 54 个月时为 98.9（±2.1）分。成人诊所的 PMT 总平均值基线为 15.0 (±13.5)，24 个月时为 88.4 (±11.8)，54 个月时为 95.8 (±6.8)。QI 协作项目 PMT 总分提高了 402%。基线时，38% 的儿科患者和 20% 的成人患者的准备/自我护理评估是最新的；20% 的儿科患者和 3% 的成人患者的紧急护理计划是最新的。儿科诊所有一次中位准备评估转变（76%）和四次中位紧急护理计划转变（65%、77%、79%、84%）。成人诊所经历了三次自我护理评估轮班的中位数（58%、63%、70%）和两次紧急护理计划轮班的中位数（57%、70%）：ST3P-UP QI 合作项目成功地将 "医疗保健过渡 6CE "嵌入到常规护理中，并增加了对处于过渡年龄段的 SCD 患者的评估和紧急护理计划的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-

CiteScore

9.80

自引率

7.40%

发文量

104

审稿时长

4-8 weeks

期刊介绍： BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.