An Evaluation of the WISE QI Program

WISE QI 计划的评估

• 批准号: 7008341
• 负责人: PAUL ARTHUR JAMES
• 金额: $ 22.13万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7008341
• 关键词: chronic disease /disorder; clinical research; community health services; health care cost /financing; health care model; health care quality; health care service availability; health care service evaluation; health services research tag; human subject; interview; noninsulin dependent diabetes mellitus; patient care management; patient oriented research; rural health

DESCRIPTION (provided by applicant): Despite scientific evidence supporting the care of patients with common chronic diseases, patients continue not to receive evidenced-based care, especially in rural practices. Problems preventing practice implementation include lack of financial incentives and a lack of understanding of the nature of primary care. Evidence suggests that multifaceted interventions are needed to improve utilization of research findings; however investigations have not attempted to apply these in rural practices. The primary objective of this study is to test the effectiveness of a multifaceted intervention program to improve the quality of care for high-risk diabetic patients in rural settings. The program to be tested is the Wellmark Incentive-Support to Encourage Quality Improvement (WISE Ql) a program based on the chronic care model. It applies aspects from each of the 6 components of the model, including 1) delivery system redesign, 2) health care organization, 3) clinic information systems, 4) decision support, 5) self-management support, and 6) community resources. This study is a prospective study to evaluate the impact of the WISE Ql program on health care quality. The study will enroll 200 patients at four rural primary care practices. Patients in the 2 intervention practices will receive the WISE Ql program to enhance health care quality, while patients in the 2 control practices will receive usual care. Both process and outcome measures will be evaluated. In addition, this study will identify contextual factors that enhance program effectiveness for further study based on qualitative analysis of interviews with physician, nurses, and patients. There is a high probability that this intervention can impact the quality of patient care in rural community-based primary care and has excellent potential for sustainability following the completion of the study. The specific aims include the following: Specific Aim 1: To test the effectiveness of the WISE Ql program to improve health care quality of high-risk rural patients with diabetes mellitus type 2. Specific Aim 2: To assess the impact of the WISE Ql program on the costs of care. Specific Aim 3: To identify the contextual factors (facilitators and barriers) that modify individual and program outcomes.

描述（由申请人提供）：尽管有科学证据支持常见慢性病患者的护理，但患者仍然没有得到循证护理，尤其是在农村地区。阻碍实践实施的问题包括缺乏经济激励和缺乏对初级保健性质的了解。有证据表明，需要采取多方面的干预措施来提高研究成果的利用率；然而，调查并未尝试将这些应用到农村实践中。本研究的主要目的是测试多方面干预计划的有效性，以提高农村地区高危糖尿病患者的护理质量。待测试的计划是 Wellmark 鼓励质量改进激励支持 (WISE Ql) 计划，这是一个基于慢性病护理模式的计划。它应用了该模型的 6 个组成部分中的每一个组成部分，包括 1) 交付系统重新设计、2) 医疗保健组织、3) 诊所信息系统、4) 决策支持、5) 自我管理支持和 6) 社区资源。本研究是一项前瞻性研究，旨在评估 WISE Ql 计划对医疗保健质量的影响。该研究将招募 4 个农村初级保健机构的 200 名患者。 2 个干预实践中的患者将接受 WISE Ql 计划以提高医疗保健质量，而 2 个对照实践中的患者将接受常规护理。过程和结果测量都将被评估。此外，本研究将基于对医生、护士和患者访谈的定性分析，确定提高项目有效性的背景因素，以供进一步研究。这种干预措施很可能会影响农村社区初级保健中的患者护理质量，并且在研究完成后具有可持续性的巨大潜力。具体目标包括以下内容： 具体目标 1：测试 WISE Ql 计划提高农村 2 型糖尿病高危患者医疗保健质量的有效性。 具体目标 2：评估 WISE Ql 计划的影响关于护理费用。具体目标 3：确定改变个人和项目成果的背景因素（促进因素和障碍）。