确保安全和公平出院:针对妊娠高血压疾病患者的质量改进倡议

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Kathleen M. Zacherl, Emily Carper Sterrett, Brenna L. Hughes, Karley M Whelan, James Tyler-Walker, Samuel T Bauer, Heather C Talley, Laura J Havrilesky
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引用次数: 0

摘要

目的 改善妊娠期高血压疾病(HDP)患者产后血压(BP)监测的及时性和公平性。方法 美国一家大型学术医疗中心针对产后 HDP 患者实施了一项质量改进计划。主要目标是在 6 个月内将 HDP 患者出院后 7 天内完成血压检查的比例从 40% 提高到 70%。次要目标包括提高预约就诊率、严重 HDP 患者 3 天内完成就诊率和无人就诊率。再入院率是平衡衡量标准。使用了统计过程控制图,并按种族和民族对数据进行了分层。通过电话访谈获得了分娩者的直接反馈,在发现无人看护就诊存在种族差异后,重点关注了黑人分娩者。结果 所有指标均有明显改善。出院后 7 天内完成探视和计划探视的比例分别从 40% 提高到 76%,61% 提高到 90%。严重 HDP 患者 3 天内完成探视的比例从 9% 提高到 49%。基线时的无人看护就诊率为 26%,其中非西班牙裔黑人的无人看护就诊率是非西班牙裔白人的 2.3 倍。随着差异的消除,无人就诊率总体下降到 15%。通过患者的反馈,发现需要在出院时配备血压计,并加强对黑人的教育。结论 对产后 HDP 患者进行及时随访具有挑战性,需要对我们的护理服务进行调整。利用分娩个体和前线反馈的医院级质量改进措施可改善以人为本的公平护理。如有合理要求,可提供相关数据。可应要求提供所有图、表和补充材料的去标识化数据分析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy
Objective To improve timely and equitable access to postpartum blood pressure (BP) monitoring in individuals with hypertensive disorders of pregnancy (HDP). Methods A quality improvement initiative was implemented at a large academic medical centre in the USA for postpartum individuals with HDP. The primary aim was to increase completed BP checks within 7 days of hospital discharge from 40% to 70% in people with HDP in 6 months. Secondary aims included improving rates of scheduled visits, completed visits within 3 days for severe HDP and unattended visits. The balancing measure was readmission rate. Statistical process control charts were used, and data were stratified by race and ethnicity. Direct feedback from birthing individuals was obtained through phone interviews with a focus on black birthing people after a racial disparity was noted in unattended visits. Results Statistically significant improvements were noted across all measures. Completed and scheduled visits within 7 days of discharge improved from 40% to 76% and 61% to 90%, respectively. Completed visits within 3 days for individuals with severe HDP improved from 9% to 49%. The unattended visit rate was 26% at baseline with non-Hispanic black individuals 2.3 times more likely to experience an unattended visit than non-Hispanic white counterparts. The unattended visit rate decreased to 15% overall with an elimination of disparity. A need for BP devices at discharge and enhanced education for black individuals was identified through patient feedback. Conclusion Timely follow-up of postpartum individuals with HDP is challenging and requires modification to our care delivery. A hospital-level quality improvement initiative using birthing individual and frontline feedback is illustrated to improve equitable, person-centred care. Data are available upon reasonable request. Deidentified data analysis is available upon request for all figures, tables and supplementary material.
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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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