医学
心理干预
质量管理
多学科方法
德尔菲法
指南
心肌梗塞
急诊医学
经皮冠状动脉介入治疗
重症监护医学
医疗急救
护理部
运营管理
内科学
管理制度
社会科学
统计
数学
病理
社会学
经济
作者
Daan Aeyels,Deborah Seys,Peter Sinnaeve,Marc J. Claeys,Sofie Gevaert,Danny Schoors,Walter Sermeus,Massimiliano Panella,Luk Bruyneel,Kris Vanhaecht
标识
DOI:10.1177/1474515118759065
摘要
Background: A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. Aims: The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Methods: Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal–Wallis test. A performance heat-map allowed for hospital-specific priority setting. Results: Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Conclusions: Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.
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