The unintended consequences of quality improvement.
The unintended consequences of quality improvement.
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DOI：
10.1097/mop.0b013e3283329937
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发表时间：
2009-12
影响因子：
3.6
通讯作者：
Cabana MD
中科院分区：
文献类型：
--
作者：
Bardach NS;Cabana MD
对质量改进的关注导致了儿科护理中的几种类型的举措;然而，这些计划可能会导致潜在的意外后果。对已描述的质量改进计划的意外后果进行审查。对资源利用的意外影响包括对成本的影响，以及无法在不同人群中实施计划和影响护理差异。对提供者行为的意外影响包括测量固定行为以及“挤出”行为，其中一个领域的质量增益可能只是以牺牲另一个领域的护理质量为代价。患者的偏好可能并不总是与特定的质量改进措施相匹配。对患者的非预期影响可能包括患者满意度下降，对其提供者的信任或信心下降。认识和预测准则实施可能产生的意外后果是在实践中利用质量改进的所有好处的关键一步。
The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences. Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care. Unintended effects on provider behavior include measurement fixation behavior, as well as ‘crowding out’ behavior, in which gains in quality in one area may simply occur at the expense of quality of care in another area. Patient preferences may not always match specific quality improvement measures. Unintended effects for patients may include decreased patient satisfaction, trust or confidence in their provider. Recognition and anticipation of the possible unintended consequences of guideline implementation is a critical step to harnessing all the benefits of quality improvement in practice.