Are quality improvement messages registering?
Are quality improvement messages registering?
复制标题
质量改进消息是否已注册？
DOI：
10.1111/j.1475-6773.2005.00357.x
复制
发表时间：
2005
影响因子：
3.4
通讯作者：
Siu,AlbertL
中科院分区：
文献类型：
--
作者：
Halm,EthanA;Siu,AlbertL
More often than not, commentaries highlight the findings of studies with important new positive findings. Instead, we highlight three papers that we believe are important and have largely negative or null findings. We are all familiar with efforts, particularly in the last decade or so that have been undertaken to improve the quality and efficiency of medical care. Changing the behavior of physicians and other health care workers is at the crux of many of these efforts. Some progress has been made in improving quality, but three papers in this issue deal with various aspects of these efforts, and they highlight the difficulty of communicating and bringing about some of the changes and improvements that many would agree need to occur. The papers report on three commonly used approaches for changing clinical practice. Clinical pathways and computerized decision support have been advocated to improve adherence with practice guidelines, and Quality Improvement Organizations (QIOs) have been charged with assisting providers in quality improvement (QI) activities. Tierney et al.(2005) report on a randomized trial of just-in-time, tailored guideline-based suggestions via an electronic medical record for clinicians for improving outpatient management of asthma or chronic obstructive pulmonary disease. They found that the intervention had no effect on adherence with recommendations, medication compliance, quality of life, satisfaction, or emergency room/hospital visits. Clinical pathways, structured care plans that note the essential elements of care by hospital day, have been widely used by hospitals in efforts to improve the quality and efficiency of care. In a second paper, Dy et al.(2005) report that only seven of 26 pathways used at a large academic medical center had the desired impact. They report on a qualitative analysis to describe characteristics that differentiate effective from ineffective pathways. They found that many of these care plans were unused. Even among the few that did appear to have an impact, their effectiveness may not have been related to their actual use.
