目的 探索提升早产儿出院后随访率的措施，并应用质量改进方法学评价改进措施的效果。 方法 以2017年3—5月出院的早产儿出院后随访现状为质量改进前基线，并提出随访率提升具体目标。应用帕累托图分析随访失败原因，根据提高随访率涉及的各个环节构建关键驱动图，结合失访原因确定质量改进关键环节和干预措施，通过控制图监测每周随访率变化直至达到质量改进目标。 结果 早产儿出院随访率在质量改进前基线为57.92%（117/202），设定质量改进目标为12个月内将早产儿出院随访率从基线提升至80%以上。帕累托分析显示随访失败的主要原因有：随访档案管理缺陷，随访时间点设定不规范（33.70%，31/92）；随访宣教不到位，沟通联系不畅（25.00%，23/92）；随访诊疗项目不能满足家长多样性需求（18.48%，17/92）。根据质量改进关键环节及主要失访原因，采取干预措施：（1）加强随访宣传教育；（2）随访队伍建设；（3）随访平台和随访制度建设。控制图显示每周随访率随着系列干预措施的实施于2017年7月升至74.09%（306/413），2017年12月后升至83.09%（511/615），最终达到预定质量改进目标。新型冠状病毒感染疫情期间随访率因疫情波动于23.54%（460/1 954）至70.97%（1 931/2 721），疫情后2023年2月开始随访率恢复至疫情前水平。 结论 通过质量改进方法学验证了采取根据随访失败的主要原因制定的干预措施，可以显著提升早产儿出院后随访率。该质量改进方法切实可行，具有临床推广价值。
Abstract
Objective To explore the measures to improve the follow-up rate of preterm infants after discharge, and to evaluate the effectiveness of these measures using quality improvement methodology. Methods The follow-up status of preterm infants discharged from March to May 2017 was used as the baseline before quality improvement, and a specific quality improvement goal for the follow-up rate was proposed. The Pareto chart was used to analyze the causes of follow-up failure, and a key driver diagram was constructed based on the links involved in improving follow-up rate. The causes of failure were analyzed to determine the key links and intervention measures for quality improvement, and the follow-up rate was monitored weekly using a control chart until the quality improvement goal was achieved. Results The follow-up rate of preterm infants after discharge was 57.92% (117/202) at baseline before quality improvement, and the quality improvement goal was set to increase the follow-up rate of preterm infants from baseline to more than 80% within 12 months. The Pareto chart analysis showed that the main causes of follow-up failure were deficiencies in follow-up file management and irregular follow-up times (33.70%, 31/92), insufficient follow-up education and poor communication (25.00%, 23/92), and the inability to meet the diverse needs of parents (18.48%, 17/92). Based on the key links for quality improvement and the main causes of follow-up failure, the following intervention measures were adopted: (1) strengthen follow-up publicity and education; (2) build a follow-up team; and (3) establish a follow-up platform and system. The control chart indicated that with the implementation of the above intervention measures, the weekly follow-up rate increased to 74.09% (306/413) in July 2017 and 83.09% (511/615) in December 2017, finally achieving the quality improvement goal. During the COVID-19 pandemic, the follow-up rate of preterm infants fluctuated between 23.54% (460/1 954) and 70.97% (1 931/2 721), and subsequently, it returned to pre-pandemic levels starting in February 2023. Conclusions The application of quality improvement methodology can help to formulate intervention measures based on the main causes of follow-up failure, thereby improving the follow-up rate of preterm infants after discharge. This quality improvement method is feasible and practical and thus holds promise for clinical application.
关键词
随访率 /
出院 /
质量改进 /
早产儿
Key words
Follow-up rate /
Discharge /
Quality improvement /
Preterm infant
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基金
中央高水平医院临床科研专项（2022-PUMCH-B-077）。
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