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首页> 外文期刊>The Journal of Graduate Medical Education >First Steps: Exploring Use of a Prospective, Office-Based Registry as the Foundation for Quality Improvement in Cardiology Training
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First Steps: Exploring Use of a Prospective, Office-Based Registry as the Foundation for Quality Improvement in Cardiology Training

机译：第一步：探索使用基于Office的前瞻性注册表作为改善心脏病学培训质量的基础

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Introduction In the past decade, assessment in graduate medical education has focused on 6 competencies that define the attributes of the ideal physician: medical knowledge, patient care (clinical skills), professionalism, interpersonal and communication skills, practice-based learning and improvement (PBLI), and systems-based practice (SBP).1 Developing effective curricula for, and measurements of, PBLI and SBP pose particular challenges for teaching programs.2–4 The PINNACLE (Practice INNovation and CLinical Excellence, National Cardiovascular Data Registry, American College of Cardiology, Washington, DC) Registry was initiated in 2008 as the first prospective, office-based, cardiac quality improvement (QI) registry in the United States.5 Data are collected to assess compliance with the American College of Cardiology, the American Heart Association, and the American Medical Association-Physician Consortium for Performance Improvement performance measures for coronary artery disease, hypertension, heart failure, and nonvalvular atrial fibrillation.6–8 Cardiology fellows at St John Hospital & Medical Center in 2009 became the first trainees nationally to participate in PINNACLE. We hypothesized that this tool would serve as an effective foundation for studying ambulatory care, identifying gaps in care, and planning interventions to advance competence in PBLI and SBP. We present our initial findings.;Results Study Population Fellows recorded 2400 patients through March 2012, which was approximately 0.8% of 3 million visits tallied nationally in the PINNACLE Registry. The fellows' patients were predominately male (56%; 1344 of 2400), older than 65?years old (52%; 1248 of 2400), and non-Hispanic White (75%; 1800 of 2400). Compared with the national data set, cardiology fellows at St John Hospital & Medical Center saw more African Americans (24% [576 of 2400] versus 7% [25?055 of 357?935]) and more patients with hypertension (93% [2232 of 2400] versus 83% [297?085 of 357?935]). The remaining cardiovascular risk factors were all slightly more frequent in the national practices than in the fellows' practice.;Discussion Our results show that PINNACLE offers a foundation of data on which QI projects can be planned and studied. Most of our fellows found participation to be feasible and acceptable. We can evaluate our adherence to performance measures of ambulatory care, recognize gaps, and benchmark against national data sets. Our efforts to date have not resulted in substantial practice-based or systems-based improvements. Lurie et al4 argued that current tools cannot measure individual competencies. Jones et al9 noted that competencies become tangible only when connected to patient care. ten Cate10 proposed entrustable, professional activity as a measure to link competencies to clinical practice. An ambulatory registry, such as PINNACLE, is a structure that also links competencies to clinical practice. To fully test the hypothesis in our program, we must follow through with substantive QI projects that complete the cycle of plan-do-study-act.11,12 Limitations of our study include that it was a single-center study of an ambulatory practice with 12 cardiology fellows, and the findings may not be applicable to other settings.;Conclusion An ambulatory registry can provide a foundation for studying ambulatory care, identifying gaps in care, and planning QI interventions in a cardiology training program. Future studies are needed to assess the effects of this approach on enhancing performance in PBLI and SBP.
机译：简介在过去的十年中，研究生医学教育的评估重点关注6种能力，这些能力定义了理想医师的属性：医学知识，患者护理（临床技能），敬业精神，人际交往和沟通能力，基于实践的学习与改善（PBLI） ）和基于系统的实践（SBP）。1为PBLI和SBP开发有效的课程并对其进行测量对教学计划提出了特殊的挑战。2–4 PINNACLE（实践创新和临床卓越，美国国家心血管数据注册中心，美国大学华盛顿特区心脏病学注册中心）于2008年启动，是美国首个基于办公室的前瞻性心脏质量改善（QI）注册中心。5收集数据以评估对美国心脏病学会（American Heart）的依从性协会，以及美国医学会-医师协会，旨在改善冠心病的性能，高血压，心力衰竭和非瓣膜性心房颤动。2009年，圣约翰医院和医学中心的6-8名心脏病学研究员成为全国首位参加PINNACLE的学员。我们假设该工具将成为研究门诊护理，发现护理差距以及规划干预措施以提高PBLI和SBP能力的有效基础。我们展示了我们的初步发现。;结果研究截至2012年3月，人口研究员记录了2400名患者，占PINNACLE登记册中全国300万人次访视的0.8％。研究员的患者主要是男性（56％，占2400的1344），年龄大于65岁（52％，占2400的1248），以及非西班牙裔白人（75％，占2400的1800）。与国家数据集相比，圣约翰医院和医学中心的心脏病专家看到了更多的非洲裔美国人（24％[2400的576]比7％[25？055的357？935]）和更多的高血压患者（93 ％[2400之2232]与83 ％[357？935之297-085]）。在国家实践中，其余的心血管危险因素均比在同伴实践中更为频繁。;讨论我们的结果表明，PINNACLE为可计划和研究QI项目提供了数据基础。我们的大多数研究员都认为参与是可行且可以接受的。我们可以评估我们对门诊护理绩效衡量指标的遵守情况，发现差距并根据国家数据集进行基准测试。迄今为止，我们的努力尚未带来基于实践或系统的实质性改进。 Lurie等[4]认为，当前的工具无法衡量个人能力。琼斯等人[9]指出，只有与患者护理相关联的能力才是有形的。 10 Cate10提出了可委托的专业活动，以将能力与临床实践联系起来。动态注册中心（例如PINNACLE）是一种将能力与临床实践联系起来的结构。为了在我们的程序中充分检验假设，我们必须执行实质性的QI项目，以完成计划-研究-学习-行动的周期。11,12我们研究的局限性在于它是非卧床练习的单中心研究结论：门诊登记可以为研究门诊护理，识别护理差距以及规划心脏病学培训计划中的QI干预提供基础。该研究由12名心脏病学研究人员组成，其研究结果可能不适用于其他场合。需要进一步的研究来评估这种方法对增强PBLI和SBP的性能的影响。

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