缩小需要公平的群体在医疗质量方面的差距:对以公平为重点的医疗质量改进干预措施的范围界定综述。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Jane Jomy, Ke Xin Lin, Ryan S Huang, Alisia Chen, Aleena Malik, Michelle Hwang, Tahara D Bhate, Nazia Sharfuddin
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引用次数: 0

摘要

导言:质量改进(QI)工作对于促进健康公平和减少医疗结果差异至关重要。以公平为重点的 QI(EF-QI)干预措施可满足需要公平的群体的独特需求,并解决造成差异的根本原因。本范围综述旨在从 EF-QI 干预措施中找出可改善应享公平群体健康的主题,为开展 QI 的研究人员提供资源:方法:根据《系统综述和元分析首选报告项目》指南,系统检索了从开始到 2022 年 12 月的多个医疗保健和医学数据库。纳入了报告医疗保健领域 EF-QI 干预结果的主要研究。审稿人使用 Covidence 进行筛选和数据提取。使用 NVivo 进行归纳式专题分析,找出关键障碍,为未来的 EF-QI 干预措施提供参考:在筛选出的 5330 篇标题和摘要中,有 36 篇符合纳入条件。这些文章报道了八个医学学科的 EF-QI 干预措施:初级保健、产科、精神病学、儿科、肿瘤学、心脏病学、神经病学和呼吸病学。最常见的重点是种族化社区(15/36;42%)。EF-QI 干预的障碍包括提供者层面(培训和监督、时间限制)和机构层面(资金和伙伴关系、基础设施)的障碍。最后一个对环境-品质-创新干预至关重要的主题是可持续性。只有六项(17%)干预措施有患者合作伙伴的积极参与:讨论:EF-QI 干预可以成为促进健康公平的有效工具,但要取得成功却面临诸多障碍。目前还不清楚这些障碍是这些项目关注公平的固有因素,还是可以推广到所有质量改进工作中。研究人员在开展 EF-QI 工作时,除了让医院和诊所领导参与设计过程外,还应让患者参与进来,以确保资金和机构支持,提高可持续性。据我们所知,目前还没有综述对医疗保健领域的 EF-QI 干预结果。需要对 EF-QI 倡导者进行进一步研究,以更好地了解障碍以及如何克服这些障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Closing the gap on healthcare quality for equity-deserving groups: a scoping review of equity-focused quality improvement interventions in medicine.

Introduction: Quality improvement (QI) efforts are critical to promoting health equity and mitigating disparities in healthcare outcomes. Equity-focused QI (EF-QI) interventions address the unique needs of equity-deserving groups and the root causes of disparities. This scoping review aims to identify themes from EF-QI interventions that improve the health of equity-deserving groups, to serve as a resource for researchers embarking on QI.

Methods: In adherence with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, several healthcare and medical databases were systematically searched from inception to December 2022. Primary studies that report results from EF-QI interventions in healthcare were included. Reviewers conducted screening and data extraction using Covidence. Inductive thematic analysis using NVivo identified key barriers to inform future EF-QI interventions.

Results: Of 5,330 titles and abstracts screened, 36 articles were eligible for inclusion. They reported on EF-QI interventions across eight medical disciplines: primary care, obstetrics, psychiatry, paediatrics, oncology, cardiology, neurology and respirology. The most common focus was racialised communities (15/36; 42%). Barriers to EF-QI interventions included those at the provider level (training and supervision, time constraints) and institution level (funding and partnerships, infrastructure). The last theme critical to EF-QI interventions is sustainability. Only six (17%) interventions actively involved patient partners.

Discussion: EF-QI interventions can be an effective tool for promoting health equity, but face numerous barriers to success. It is unclear whether the demonstrated barriers are intrinsic to the equity focus of the projects or can be generalised to all QI work. Researchers embarking on EF-QI work should engage patients, in addition to hospital and clinic leadership in the design process to secure funding and institutional support, improving sustainability. To the best of our knowledge, no review has synthesised the results of EF-QI interventions in healthcare. Further studies of EF-QI champions are required to better understand the barriers and how to overcome them.

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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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