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首页> 外文期刊>BMJ Open Quality >Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease
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Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease

机译：改善慢性阻塞性肺疾病患者的专业间和副产品护理结果

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In the U.S., suboptimal care quality for patients with chronic obstructive pulmonary disease (COPD) is reflected by high rates of emergency department visits and hospital readmissions, as well as excessive costs. Moreover, a substantial proportion of COPD patients do not receive guideline-directed therapies. In quality improvement (QI) programs, these types of health care problems are commonly addressed through interventions that primarily or exclusively support physicians in aligning their practices with guidelines and clinical quality measures. However, the root causes of many deficits in health care quality are not necessarily “physician centric.” Instead, they often involve suboptimal collaboration among members of interprofessional health care teams and gaps in coproductive relationships among patients and providers.We conducted a QI project to identify interprofessional and coproductive correlates of COPD care quality in the context of a continuing education program designed to advance knowledge and skill among patients, providers, and the interprofessional COPD team regarding coproductive COPD care. Participants in the program included providers in 30 primary care practices across the U.S. who, along with their own COPD patients and a separate cohort of patients from COPD advocacy groups, completed a patient-provider survey study designed to identify alignments and mismatches in coproductive perceptions and behaviors, a private survey feedback session for each practice9s team, and online/mobile educational activities on COPD. In addition, more than 1,000 additional providers and 200 patients participated in just the online/mobile education.From the patient perspective, baseline measures indicated a high rate of dissatisfaction with COPD treatment plans and suboptimal coproductive interaction with members of the interprofessional health care team. Across providers, there were gaps and variation in provision of patient education, attitudes and practices regarding shared decision-making, and care coordination with pulmonary specialists. In addition, relatively low proportions of providers reported high levels of skill in various coproductive processes.The project outcomes indicated mismatches between COPD patients and providers in perceived ability to recognize COPD exacerbations, shared treatment goals, barriers to medication adherence, perceived impact of COPD on quality of life, and other aspects of COPD care. Providers demonstrated improvements in knowledge and attitudes regarding coproductive and coordinated COPD care.
机译：在美国，慢性阻塞性肺疾病（COPD）患者的护理质量欠佳反映在急诊就诊率和住院再住院率高以及费用过高的情况下。而且，很大一部分COPD患者未接受指南指导的治疗。在质量改进（QI）计划中，通常会通过干预措施来解决这些类型的医疗保健问题，这些干预措施主要或完全支持医师将其实践与指南和临床质量措施相结合。但是，许多医疗保健质量不足的根本原因不一定是“以医生为中心”。取而代之的是，它们经常涉及跨专业医疗团队成员之间的最佳合作以及患者和提供者之间的共生关系方面的差距。患者，提供者和专业间COPD团队之间关于协同生产COPD护理的知识和技能。该计划的参与者包括全美30种初级保健实践的提供者，他们与他们自己的COPD患者以及COPD倡导组的另一组患者一起，完成了一项患者-供应商调查研究，旨在确定协同生产观念和方法的错位和不匹配。行为，针对每个业务团队的私人调查反馈会议以及关于COPD的在线/移动教育活动。此外，还有1000多名医疗服务提供者和200名患者参加了在线/移动教育。从患者的角度来看，基线测量结果表明，对COPD治疗计划的不满意率很高，并且与跨专业医疗团队成员的合作产生的效果不佳。在提供者之间，在提供患者教育，关于共同决策的态度和做法以及与肺科专家进行护理协调方面存在差距和差异。此外，相对较低的医疗服务提供者在各种辅助生产过程中报告了较高的技能水平。该项目的结果表明，COPD患者和医疗服务提供者在认识到COPD恶化的能力，共同的治疗目标，药物依从性障碍，COPD对患者的影响方面存在不匹配生活质量以及COPD护理的其他方面。提供者表现出在协同生产和协调的COPD护理方面的知识和态度得到了改善。

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