持续质量改进方法学: 一项关于改善衣原体筛查的多学科合作的案例研究

This article illustrates quality improvement(QI)methodology using an example intended to improve chlamydia screening in women.QI projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting, yet many academic centres lack training programmes on how to conduct QI projects.The choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and treat.At the University of Michigan, we implemented a multidepartment process to improve the chlamydia screening rates using the plan-docheck-act model.Steps to guide QI projects include the following: (1)assemble a motivated team of stakeholders and leaders;(2) identify the problem that is considered a high priority;(3)prepare for the project including support and resources;(4)set a goal and ways to evaluate outcomes;(5)identify the root cause(s)of the problem and prioritise based on impact and effort to address;(6)develop a countermeasure that addresses the selected root cause effectively;(7)pilot a small-scale project to assess for possible modifications;(8)large-scale roll-out including education on how to implement the project;and(9) assess and modify the process with a feedback mechanism.Using this nine-step process, chlamydia screening rates increased from 29% to 60%.QI projects differ from most clinical research projects by allowing clinicians to directly improve patients' health while contributing to the medical science body.This may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.