CRITICAL PATHWAYS AS A STRATEGY FOR IMPROVING CARE - PROBLEMS AND POTENTIAL
CRITICAL PATHWAYS AS A STRATEGY FOR IMPROVING CARE - PROBLEMS AND POTENTIAL
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DOI：
10.7326/0003-4819-123-12-199512150-00008
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发表时间：
1995-12-15
影响因子：
39.2
通讯作者：
LEE, TH
中科院分区：
文献类型：
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作者：
PEARSON, SD;GOULARTFISHER, D;LEE, TH
在医疗保健竞争日益激烈的时代，关键路径指南已成为最受欢迎的新举措之一，旨在降低成本，同时保持甚至提高护理质量。关键路径主要是为高容量的医院诊断而开发的，它为患者显示目标，并提供相应的理想顺序和员工行动的时间，以实现这些目标，以最佳的效率。尽管关键路径计划在美国各地的医院迅速传播，但其发展，实施和评估仍存在许多不确定性。此外，他们对病人的结果和满意度的护理，医生的自主权，医疗事故的风险，以及许多医院的教学和研究任务的影响提出了严重的关注。这些担忧的基础是缺乏来自对照试验的数据来评估关键途径的影响，医生应该了解与关键途径相关的潜在益处和问题，因为越来越多的医生被要求为途径项目提供领导。医生和其他卫生服务调查人员也应该制定方法来研究不断发展的卫生保健环境中的途径。虽然降低成本和提高质量的承诺是诱人的，但我们对关键途径的知识差距是广泛的;因此，像任何新的医疗保健技术一样，应该对途径计划进行全面评估，以了解实现承诺的条件。
In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency.Despite the rapid dissemination of critical pathway programs in hospitals throughout the United States, many uncertainties remain about their development, implementation, and evaluation. In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpractice risks, and the teaching and research missions of many hospitals. Underlying these concerns is the absence of data from controlled trials to evaluate the effects of critical pathways.Physicians should understand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide leadership for pathway programs. Physicians and other health service investigators should also develop methods to study pathways in evolving health care settings. Although the promise of reduced costs and improved quality is enticing, the gaps in our knowledge about critical pathways are extensive; therefore, like any new health care technology, pathway programs should be fully evaluated in order to understand the conditions under which that promise may be fulfilled.