Quality of care: measuring a neglected driver of improved health
Quality of care: measuring a neglected driver of improved health
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DOI：
10.2471/blt.16.180190
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发表时间：
2017-06-01
影响因子：
11.1
通讯作者：
Kruk, Margaret E.
中科院分区：
文献类型：
--
作者：
Akachi, Yoko;Kruk, Margaret E.
卫生系统提供的护理质量有助于努力实现关于健康和福祉的可持续发展目标3。越来越多的证据表明，在低收入国家，保健质量差削弱了保健干预措施的影响。医疗质量对于全民健康覆盖举措的成功也至关重要;对所覆盖服务的质量和范围不满意的公民不太可能支持公共医疗融资。此外，还存在着一种道德动力，以确保所有人，包括最贫穷的人，获得有效改善健康的最低质量标准的护理。然而，目前中低收入国家的质量衡量不足以完成这项任务。保健信息系统提供的数据不完整，而且往往不可靠，设施调查收集了太多效用不确定的指标，侧重于有限的几项服务，而且很快就过时了。现有的措施很难捕捉护理过程和患者体验。很少收集对医疗保健做法敏感的患者结果，这是高收入国家质量评估的主要内容。我们提出了六项政策建议，以改善护理质量衡量并扩大其政策影响：㈠加倍努力改善民事登记和生命统计系统并使其制度化; ㈡改革设施调查并加强常规信息系统; ㈢为资源匮乏的情况创新新的质量衡量标准; ㈣从病人的角度看待质量问题; ㈤投资于国家质量数据;以及（vi）将质量证据转化为政策影响。
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.