A Practical Guide to Assessing and Addressing Context in Quality Improvement.

Q1 Nursing
Amy Tyler, Michael Perry, Ashleigh Slemmer, Kathryn Westphal, Laura Chavez
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引用次数: 0

Abstract

This article highlights the often underestimated influence of context in improving the quality of inpatient pediatric care. Context includes environmental, social, cultural, and systemic factors that surround and influence health care service delivery and intervention outcomes. Underappreciation for context can be responsible for the lack of intervention success in improving patient outcomes and can lead to differences in outcomes when initiatives are replicated or spread across health care settings. We draw from the field of implementation science (IS) to highlight essential concepts for measuring context, emphasizing the need for a comprehensive, multifaceted approach to address context effectively. Quality improvement (QI) and IS are complementary disciplines that share a common goal of improving health outcomes. They often engage the same stakeholders in similar environments, addressing overlapping challenges. Whereas QI is usually an "inside job" with practitioners deeply embedded in the context they seek to improve, IS seeks to understand how to implement evidence-based practices across varied contexts unfamiliar to those leading the implementation. This lack of familiarity with the context makes measuring and adapting to context a primary focus in IS. Recognizing that context influences how well interventions work, implementation scientists use frameworks to conceptualize, measure, and adapt to diverse contexts effectively. These frameworks help ensure interventions are appropriately tailored to the specific environments to achieve the desired outcomes. In this article, we introduce one such framework, the Practical Robust Implementation and Sustainability Model (PRISM). Organized by PRISM domain, we outline a multifaceted approach for improvers to address context comprehensively, which, at a minimum, includes clinical and community partner engagement, diverse QI team composition, and iterative data-driven adaptations to dynamic contextual factors. Addressing context should improve QI success, patient outcomes, and the replication of initiatives.

质量改进中评估和处理环境的实用指南。
这篇文章强调了经常被低估的环境在提高儿科住院护理质量方面的影响。环境包括围绕和影响卫生保健服务提供和干预结果的环境、社会、文化和系统因素。对环境的认识不足可能导致干预措施在改善患者预后方面缺乏成功,并可能导致在整个卫生保健环境中复制或推广举措时结果的差异。我们借鉴实施科学(IS)领域,强调衡量情境的基本概念,强调需要一种全面、多方面的方法来有效解决情境问题。质量改进(QI)和信息系统是互补的学科,具有改善健康结果的共同目标。他们经常在相似的环境中让相同的涉众参与进来,解决重叠的挑战。QI通常是一项“内部工作”,实践者深深嵌入到他们寻求改进的环境中,而is则试图理解如何在领导实施的人不熟悉的各种环境中实施基于证据的实践。缺乏对上下文的熟悉使得测量和适应上下文成为IS的主要关注点。认识到环境影响干预措施的效果,实施科学家使用框架来概念化、衡量和有效地适应不同的环境。这些框架有助于确保干预措施适合具体环境,以实现预期结果。在本文中,我们将介绍一个这样的框架,即实用稳健实施和可持续性模型(PRISM)。通过PRISM领域的组织,我们概述了一种多方面的改进方法,以全面解决环境问题,其中至少包括临床和社区合作伙伴的参与,多样化的QI团队组成,以及对动态环境因素的迭代数据驱动的适应。解决环境问题可以提高QI的成功程度、患者的治疗效果和计划的可重复性。
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
Hospital pediatrics
Hospital pediatrics Nursing-Pediatrics
CiteScore
3.70
自引率
0.00%
发文量
204
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