【JAMA2011】在ICU网络中质量改进的多层面的干预

蓝鱼o_0

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units
作者：
Damon C. Scales, MD, PhD
Katie Dainty, MSc, PhD
Brigette Hales, MSc
Ruxandra Pinto, PhD
Robert A. Fowler, MDCM, MS
Neill K. J. Adhikari, MDCM, MSc
Merrick Zwarenstein, MBBCh, PhD

Context Evidence-based practices improve intensive care unit (ICU) outcomes, but
eligible patients may not receive them. Community hospitals treat most critically ill patients
but may have few resources dedicated to quality improvement.
Objective To determine the effectiveness of a multicenter quality improvement program
to increase delivery of 6 evidence-based ICU practices.
Design, Setting, and Participants Pragmatic cluster-randomized trial among 15
community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred
during the trial (November 2005 to October 2006) and 7141 admissions during a decaymonitoring
period (December 2006 to August 2007).
Intervention We implemented a videoconference-based forum including audit and
feedback, expert-led educational sessions, and dissemination of algorithms to sequentially
improve delivery of 6 practices. We randomized ICUs into 2 groups. Each group
received this intervention, targeting a new practice every 4 months, while acting as
control for the other group, in which a different practice was targeted in the same
period.
Main Measure Outcomes The primary outcome was the summary ratio of odds
ratios (ORs) for improvement in adoption (determined by daily data collection) of all
6 practices during the trial in intervention vs control ICUs.
Results Overall, adoption of the targeted practices was greater in intervention ICUs
than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-
7.74). Improved delivery in intervention ICUs was greatest for semirecumbent positioning
to prevent ventilator-associated pneumonia (90.0% of patient-days in last month
vs 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent
catheter-related bloodstream infection (70.0% of patients receiving central lines vs
10.6%; OR, 30.06; 95% CI, 11.00-82.17). Adoption of other practices, many with
high baseline adherence, changed little.
Conclusion In a collaborative network of community ICUs, a multifaceted quality
improvement intervention improved adoption of care practices.
Trial Registration clinicaltrials.gov Identifier: NCT00332982

JAMA. 2011;305(4):363-372

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太遗憾！英语水平太差。楼主能否翻译成中文,