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【质量改善】剖析权威指南——教你怎样写出卓越的质量改善研究报告!(上)

 

编者按:在临床实践中,众多质量改善措施常在当地被交流、共享,但在同行评议期刊上发表的文章较少。尽管这些改善工作具有实际作用,但研究设计的准确性、完整性和透明度却存在较大差异。

 

基于此,卓越质量改善报告标准(SQUIRE)指南在 2008 年诞生,在 2015 年更新至 2.0 版本,并已在全球范围内被广泛使用。SQUIRE 指南有助于质量改善研究撰写、报告及审查的准确性、完整性和透明度的提高。无论质量改善措施是大规模或小规模,简单或是复杂,SQUIRE 指南都为其提供了准确、详细的框架。
 

本文通过罗列 SQUIRE 指南中对标题、摘要及前言的写作要求,同时辅以具体的实例,希望能加深大家对质量改善研究的认识,并在方案设计、文章撰写等方面起到一定的参考作用。


l  标题:需要展示质量改善的具体措施

 

由于标题是读者获取到的第一条信息,因此我们首先需要在描述上吸引读者。需要重点体现出对医疗保健的改善(广义的质量改善包括对医疗保健质量、安全性、有效性、时效性、成本、效率和公平性等任一方面的改善)。标题中应使用与质量改善相关的词汇,以便审稿人或读者能清晰辨别。

 

质量改善的主题词有: Health Care Quality Access and Evaluation; Quality Assurance; Quality Improvement; Outcome and Process Assessment (Healthcare); Quality Indicators, Health Care; Total QualityManagement; Safety Management 

 

标题中可以参考词汇有:Quality, Safety, Evidence, Efficacy, Effectiveness, Theory,  Interventions, Improvement, Outcomes, Processes, and Value

 

示范如下:

 

Example1: Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic.
Example2: Large scale organizational intervention to improve patient safety in four UK hospitals: mixed method evaluation.

 

l  摘要:提供足够信息并对关键信息进行概括

 

摘要的目的有两个:首先是为检索和索引提供足够的信息;其次是基于预投稿的杂志要求或采用结构化的写作方式对关键信息进行概括与呈现,包括:文章背景、需解决的问题、方法、干预、结果和结论。摘要需同时具有描述性,即表明此研究的目的、方法、及研究的范围;也要包含丰富的信息,即研究的结果、结论及推荐等。以便审稿人或读者可以通过阅读摘要快速地判断这篇文章对自己是否有益。

 

示范如下:

 

a.    背景:简单的描述研究的目的、参与者及开展环境。

 

Background: Pain assessment documentation was inadequate because of the use of a subjective pain assessment strategy in a tertiary level IV neonatal intensive care unit [NICU]. The aim of this study was to improve consistency of pain assessment document-ation through implementation of a multidimensional neonatal pain and sedation assessment tool. The study was set in a 60-bed level IV NICU within an urban children’s hospital. Participants included NICU staff, including registered nurses, neonatal nurse practitioners, clinical nurse specialists…

 

b.    方法:表明研究的设计及干预措施。

 

Methods: The Plan Do Study Act method of quality improvement was used for this project. Baseline assessment included review of patient medical records 6 months before the intervention. Documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and document-ation of pain assessment were reviewed. Literature review and listserv query were conducted to identify neonatal pain tools.

 

Intervention: Survey of staff was conducted to evaluate know-ledge of neonatal pain and also to determine current healthcare providers』practice as related to identification and treatment of neonatal pain. A multidimensional neonatal pain tool, the Neonatal Pain, Agitation, and Sedation Scale [N-PASS], was chosen by the staff for implementation.

 

c.     结果:写明数据以及数据的变化带来的影响。

 

Results: Six months and 2 years following education on the use of the N-PASS and implementation in the NICU, a chart review of all hospitalized patients was conducted to evaluate documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and documentation of pain assessment in the medical progress note. Documentation of pain scores improved from 60% to 100% at 6 months and remained at 99% 2 years following implementation of the N-PASS. Pain score documentation with ongoing nursing assessment improved from 55% to greater than 90% at 6 months and 2 years following the intervention. Pain assessment documentation following intervent-ion of an elevated pain score was 0% before implementation of the N-PASS and improved slightly to 30% 6 months and 47% 2 years following implementation.

 

d.    结论:做一个简短的总结,表明成功的原因以及学习到的启示。

 

Conclusions: Identification and implementation of a multidi-mensional neonatal pain assessment tool, the N-PASS, improved documentation of pain in our unit. Al-though improvement in all quality improvement moni-tors was noted, additional work is needed in several key areas, specifically documentation of reassessment of pain following an intervention for an elevated pain score.

 

l  前言:需要表明为什么要开展此研究

 

在一篇质量改善报告中,标题、摘要及前言都有着各自重要的意义。标题决定了读者对质量改善报告的最初印象;摘要能够使读者快速判断此研究与自己工作的关系并决定是否需要查阅全文;前言则通过对问题、背景信息、理论依据和研究目的 4 部分的详细描述,向读者清晰的表明进行此研究的理由。

 

至此,关于质量改善的标题、摘要、前言部分已经介绍完啦!下期内容,我们会进一步解读研究方法、研究结果和讨论部分的写作要点。

 

【参考文献】

 

Goodman D, Ogrinc G, Davies L, et al. BMJ Qual Saf 2016,25(12):e7

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