Disclosing clinical performance: the case of cardiac surgery.
Disclosing clinical performance: the case of cardiac surgery.
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披露临床表现：心脏手术病例。
DOI：
10.1108/14777261011088665
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发表时间：
2010
影响因子：
1.4
通讯作者：
Exworthy M
中科院分区：
文献类型：
--
作者：
Exworthy M
目的：近年来，披露了英国冠名心脏外科医生的临床表现。本文旨在探讨临床绩效披露的性质及其影响。设计/方法/方法-本文借鉴了来自社会科学的文献，以评估信息披露作为一种透明度形式对提高临床表现的影响。具体来说，它采用了披露的“程序理论”。发现——披露的“程序理论”包括识别、命名、公众认可和接受者反应。通过披露已确定的个别（顾问）外科医生，但这掩盖了包括初级外科医生在内的临床团队的贡献。死亡率是主要的绩效衡量标准，但鉴于低死亡率，对这一衡量标准的解释存在问题。外科医生的名字是通过网站上的披露来实现的，这是由卫生保健监管机构和外科专业本身共同开发的。然而，参与仍然是自愿的。披露的目的是让利益相关方（尤其是患者）避开表现不佳的外科医生。但是，这些当事方行使这一制裁的意愿和能力似乎有限。外科医生的反应是紧急的，但目前约有四分之一的外科医生没有参与。人们担心外科医生会避开高风险患者，但这种担心似乎没有实现。虽然信息披露可能对个人声誉影响不大，但整个外科行业已经接受了信息披露。原创性/价值——虽然披露的目的是建立一个透明的医疗系统，提高临床绩效，但披露可能会产生相反的效果，掩盖一些绩效问题，并可能加强专业自主权。因此，信息披露代表着卫生保健领域更大的透明度，但尚不确定它是否会以政策所希望的方式改善绩效。
Purpose–In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.Design/methodology/approach–The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.Findings–The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.Originality/value–While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.
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DOI：
10.1002/9780470755679.ch3
发表时间：
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期刊：
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影响因子：
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