The urgent need to improve health care quality - Institute of medicine National Roundtable on Health Care Quality
The urgent need to improve health care quality - Institute of medicine National Roundtable on Health Care Quality
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DOI：
10.1001/jama.280.11.1000
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发表时间：
1998-09-16
影响因子：
120.7
通讯作者：
Galvin, RW
中科院分区：
文献类型：
--
作者：
Chassin, MR;Galvin, RW
客观。-确定与美国医疗保健质量相关的问题，包括其测量，评估和改进，需要医疗保健专业人员或公共或私营部门的其他选区采取行动。国家医疗保健质量圆桌会议由美国国家科学院下属的医学研究所召集，由20名来自私营和公共部门的代表组成，他们从事医学和护理工作，代表学术界、商业界、消费者权益倡导者和健康媒体，还包括联邦健康计划的负责人。圆桌会议在1996年2月至1998年1月期间举行了6次会议。它探讨了医疗保健的持续快速变化以及这些变化对美国健康和医疗保健质量的影响。圆桌会议成员与各种各样的专家进行了讨论，召开了会议，委托撰写论文，并借鉴了他们的个人专业经验。在审议结束时，圆桌会议成员通过委员会会议上的一系列讨论和对连续文件草案的审查，就本文所述的结论达成了共识，其中第一个草案是由列出的作者和医学研究所项目主任创建的。在这些讨论之后对草案进行了修订，并根据国家科学院国家研究理事会的正式报告审查程序批准了最后文件。卫生保健的质量可以被精确地定义和测量，其科学准确度可与临床医学中使用的大多数测量方法相媲美。在美国的医学界，普遍存在着严重的质量问题。这些问题可分为使用不足、过度使用或滥用，在全国各地的小型和大型社区都有发生，在管理式护理和收费服务护理系统中发生的频率大致相同。大量的美国人因此而受到伤害。护理质量是问题所在，而不是管理式护理。除非我们做出重大的、系统的努力，彻底改革我们提供医疗保健服务的方式，教育和培训临床医生，评估和提高质量，否则目前的努力将不会成功。
Objective.-To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors.Participants.-The National Roundtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 representatives of the private and public sectors, practicing medicine and nursing, representing academia, business, consumer advocacy, and the health media, and including the heads of federal health programs. The roundtable met 6 times between February 1996 and January 1998. It explored ongoing, rapid changes in health care and the implications of these changes for the quality of health and health care in the United States.Evidence.-Roundtable members held discussions with a wide variety of experts, convened conferences, commissioned papers, and drew on their individual professional experience.Consensus Process.-At the end of its deliberations, roundtable members reached consensus on the conclusions described in this article by a series of discussions at committee meetings and reviews of successive draft documents, the first of which was created by the listed authors and the Institute of Medicine project director. The drafts were revised following these discussions, and the final document was approved according to the formal report review procedures of the National Research Council of the National Academy of Sciences.Conclusions.-The quality of health care can be precisely defined and measured with a degree of scientific accuracy comparable with that of most measures used in clinical medicine. Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care. Current efforts to improve will not succeed unless we undertake a major, systematic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality.