提高成人长期护理服务的质量:LOCOMOTION 质量改进合作组织的研究结果。

IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-23 DOI:10.1016/j.clinme.2024.100237
Julie Darbyshire, Trisha Greenhalgh, Nawar D Bakerly, Kumaran Balasundaram, Sareeta Baley, Megan Ball, Emily Bullock, Rowena Cooper, Helen Davies, Johannes H De Kock, Carlos Echevarria, Sarah Elkin, Rachael Evans, Zacc Falope, Cliodhna Flynn, Emily Fraser, Stephen Halpin, Samantha Jones, Rachel Lardner, Cassie Lee, Ashliegh Lovett, Victoria Masey, Harsha Master, Ghazala Mir, Adam Mosley, Jordan Mullard, Rory J O'Connor, Amy Parkin, Anton Pick, Janet Scott, Nikki Smith, Emma Tucker, Paul Williams, Darren Winch, Conor Wood, Manoj Sivan
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引用次数: 0

摘要

被称为 "长COVID "的COVID-19长期型于2020年首次被描述。其症状、病程和预后差异很大;一些患者会出现多系统、致残和长期患病的情况。2021 年,为在英格兰建立 90 个长焦病毒诊所提供了专项资金;苏格兰和威尔士也建立了一些诊所。由 NIHR 资助的 "LOCOMOTION "项目在全英范围内开展了一项质量改进合作项目,其中有 10 家诊所参与其中,该项目从 2021 年持续到 2023 年。在大约每 8 周举行一次的定期在线会议上,与会者确定主题的优先次序,讨论研究证据和指南,并展示示范病例和诊所审计。患者咨询小组还进行了优先事项设定工作,参加了质量会议,并进行了服务评估审核。接连不断的质量改进周期旨在改变实践,使之与证据保持一致,但这一目标有时很难实现,因为在这一新病症方面尚不存在确切的证据;许多患者有合并症;诊所受到各种实际限制。尽管如此,我们还是取得了很大进展,并编写了一系列 "最佳实践 "指南,内容涉及一般评估和管理、呼吸困难、正性心动过速和其他自主神经症状、疲劳和认知障碍以及职业康复。本文以一线临床医生为中心,总结了主要研究成果。
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Improving quality in adult long covid services: Findings from the LOCOMOTION quality improvement collaborative.

The protracted form of COVID-19 known as 'long covid' was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The NIHR-funded LOCOMOTION project implemented a UK-wide quality improvement collaborative involving ten of these clinics, which ran from 2021 to 2023. At regular online meetings held approximately 8-weekly, participants prioritised topics, discussed research evidence and guidelines, and presented exemplar case histories and clinic audits. A patient advisory group also held a priority-setting exercise, participated in quality meetings and undertook a service evaluation audit. The goal of successive quality improvement cycles aimed at changing practice to align with evidence was sometimes hard to achieve because definitive evidence did not yet exist in this new condition; many patients had comorbidities; and clinics were practically constrained in various ways. Nevertheless, much progress was made and a series of 'best practice' guides was produced, covering general assessment and management; breathing difficulties; orthostatic tachycardia and other autonomic symptoms; fatigue and cognitive impairment; and vocational rehabilitation. This paper summarises key findings with the frontline clinician in mind.

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来源期刊
Clinical Medicine
Clinical Medicine 医学-医学:内科
CiteScore
7.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector. Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired. ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year
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