大规模改进方案的质量和报告:2010-2023年英国国民保健制度产妇倡议审查。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
James McGowan, Bothaina Attal, Isla Kuhn, Lisa Hinton, Tim Draycott, Graham P Martin, Mary Dixon-Woods
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引用次数: 0

摘要

背景:大规模改进规划是对全球卫生系统质量和安全问题的常见回应,但其影响好坏参半。目前尚不清楚它们在多大程度上符合方案质量标准,特别是在报告和评价的透明度方面。目的:确定2010-2023年期间英国国家卫生服务产科服务实施的以分娩时护理为重点的大规模改进方案,并进行结构化质量评估。方法:我们借鉴了系统评价的首选报告项目和范围评价的元分析扩展指南,为我们研究的设计和报告提供信息。我们使用灰色文献、研究数据库和其他来源的多种搜索策略确定相关程序。符合预先规定的改进方案定义的方案、侧重于分娩时护理的方案和具有可检索的评价报告的方案都要利用方案质量的选定特征进行有组织的评价。结果:通过数据库和其他来源鉴定出1434条记录。由于缺乏可检索的评估报告,无法对英国产妇服务的14项主要举措进行质量评估。对符合我们评估标准的15个改进计划进行的质量评估发现,质量和报告变化很大。节目规格变化无常,而且大多质量低下。只有8家报告了其干预措施的证据基础。对实现支持的描述很差,没有人报告针对有问题的服务进行了定制。没有一个报告将减少不平等作为明确目标。只有7个使用了明确的病人和公众参与实践,只有6个明确使用了已发表的理论/模型/框架来指导实施。方案在报告评价的规划、范围和设计方面各不相同,设计明显薄弱。结论:缺乏透明度的报告和薄弱或缺失的评估通过限制学习和问责制破坏了大规模的改进计划。这项审查指出了提高大型方案质量的重要目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010-2023.

Background: Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear.

Aim: To identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010-2023, and to conduct a structured quality assessment.

Methods: We drew on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance to inform the design and reporting of our study. We identified relevant programmes using multiple search strategies of grey literature, research databases and other sources. Programmes that met a prespecified definition of improvement programme, that focused on intrapartum care and that had a retrievable evaluation report were subject to structured assessment using selected features of programme quality.

Results: We identified 1434 records via databases and other sources. 14 major initiatives in English maternity services could not be quality assessed due to lack of a retrievable evaluation report. Quality assessment of the 15 improvement programmes meeting our criteria for assessment found highly variable quality and reporting. Programme specification was variable and mostly low quality. Only eight reported the evidence base for their interventions. Description of implementation support was poor and none reported customisation for challenged services. None reported reduction of inequalities as an explicit goal. Only seven made use of explicit patient and public involvement practices, and only six explicitly used published theories/models/frameworks to guide implementation. Programmes varied in their reporting of the planning, scope and design of evaluation, with weak designs evident.

Conclusions: Poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.

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来源期刊
BMJ Quality & Safety
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.
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