MAJIC, MAKING ADVANCES AGAINST JAUNDICE IN INFANT CARE

MAJIC，在婴儿护理领域对抗黄疸取得进展

基本信息

批准号：
6185425
负责人：
R H PALMER
金额：
$ 55.34万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
1998
资助国家：
美国
起止时间：
1998-05-01 至 2003-04-30
项目状态：
已结题

项目摘要

This project will develop and evaluate a model for a Collaborative Quality Improvement Program in loosely structured managed care organizations (MCOs). Most quality improvement initiatives for hospitals or MCOs have occurred in tightly managed systems. This model addresses how MCOs can fulfill their responsibility for quality improvement among professionals and organizations with whom they have contractual leverage but not direct control. The model will be tested by application to the American Academy of Pediatrics clinical practice guideline for the care of the healthy term newborn with jaundice. Two large managed care organizations will partner with the core research team, enlisting specific patient care units - organizations and professionals responsible for the continuum of care for a baby during the first month of life - to participate. The MCOs will conduct and evaluate two rounds of collaborative QI, each focusing on a distinct perspective on quality. In the first, the MCO will focus on improving clinical performance from the professional perspective. In the second, the focus will be improving the parents experience of receiving care for their newborn. The relationship between clinical and consumer perspectives will be explored to test whether clinically excellent providers are more or less successful in providing a high quality patient experience. Clinical performance will be assessed by measuring conformance with selected guideline recommendations for infants with an elevated serum bilirubin level. Data for clinical performance measurement will be obtained from administrative sources (claims, encounter and laboratory databases), the infant's inpatient medical record and if necessary the infant's ambulatory medical record. The parental experience of care will be assessed by a telephone survey of parents, with questions adapted from the AHCPR's Consumer Assessment of Health Plans Survey (CAHPS) to apply to the baby's first month of life and care for jaundice. Approximately 2,200 study-eligible infants are anticipated across the two participating MCOs. Parental experience and clinical performance data will be fed back to the MCOs on a quarterly basis to stimulate and guide QI efforts. Each MCO will collaborate with the other on exchange of performance data, of best practices for patient care, and of quality improvement ideas. They will also be aided in implementing additional, MCO-specific QI interventions. An overall summative evaluation of the effect of the five-year Collaborative QI Program will be conducted. In addition, clinical and parent experience data relating to the same baby will be paired for analyses of the convergence and divergence between the performance of patient care units. Finally, descriptions of the performance measures based on clinical performance and parent experie nce data, together with sample results, will be used to elicit an evaluation by independent panels of purchasers, consumers and physicians of the usefulness of these two types of measures.

该项目将开发和评估协作模型结构松散的管理式医疗质量改进计划组织 (MCO)。大多数质量改进举措医院或 MCO 发生在严格管理的系统中。这个型号阐述 MCO 如何履行质量责任与他们合作的专业人员和组织的改进合同杠杆但不直接控制。该模型将被测试通过向美国儿科学会临床实践申请健康足月新生儿黄疸护理指南。两家大型管理式医疗组织将与核心研究合作团队，招募特定的患者护理单位 - 组织和负责婴儿期间持续护理的专业人员生命的第一个月——参与。 MCO 将进行并评估两轮协作 QI，每轮都侧重于不同的对质量的看法。首先，MCO将重点改善从专业角度看临床表现。在第二个中，重点将是改善父母接受护理的体验为了他们的新生儿。临床与消费者的关系将探索不同的观点来测试临床是否优秀提供商或多或少成功地提供了高质量的服务患者体验。临床表现将通过测量符合性来评估针对血清升高婴儿的精选指南建议胆红素水平。临床表现测量的数据将是从行政来源获得（索赔、遭遇和实验室数据库）、婴儿的住院病历以及必要时的婴儿的动态医疗记录。父母的照顾经历将通过对家长的电话调查进行评估，并提出问题改编自 AHCPR 的消费者健康计划评估调查 (CAHPS) 适用于婴儿出生后第一个月的护理黄疸。预计约有 2,200 名符合研究资格的婴儿跨越两个参与的 MCO。家长的经验和临床表现数据将反馈给每季度进行一次 MCO，以刺激和指导 QI 工作。每个 MCO 将与对方合作交换性能数据，患者护理的最佳实践以及质量改进理念。他们还将获得帮助实施额外的 MCO 特定 QI 干预措施。对五年行动成效的总体总结性评价将开展协作 QI 计划。此外，临床和与同一婴儿相关的家长体验数据将被配对分析绩效之间的趋同性和差异性病人护理单位。最后，对绩效指标的描述基于临床表现和家长经验数据，以及样本结果将用于引发独立评估由购买者、消费者和医生组成的小组讨论这两类措施。