Health care quality and how to achieve it
Health care quality and how to achieve it
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DOI：
10.1097/00001888-200201000-00021
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发表时间：
2002-01-01
影响因子：
7.4
通讯作者：
Shine, KI
中科院分区：
文献类型：
--
作者：
Shine, KI
医学研究所进行的研究表明，美国医疗保健系统提供的服务与其全部潜力之间存在严重差距。这是由于大量的过度使用、使用不足和滥用卫生保健造成的。医学研究所（IOM）的一份关注医疗差错的出版物--《犯错是人类的：建立一个更安全的医疗保健系统》--激励了公共和私营部门以及专业人员努力建立一个更安全的医疗保健系统。在其报告《跨越质量鸿沟：21世纪的新卫生系统》中，国际移民组织委员会设想了一系列卫生保健系统的目标和规则，这些目标和规则将成功地推动卫生保健系统进入21世纪。多学科专业团队应该为越来越多的患有一种或多种慢性病的人口（现在约为40%）提供护理。由于20种疾病占美国医疗保健费用的80%，作者建议特别关注其中15种疾病，以便在未来五年内系统地提高医疗质量。信息技术提供了重要的机会，以改善病人的安全，并有助于更好地和不断提高质量，消除书面临床笔记到2010年是一个可以实现的目标。这些发展要求医学教育工作者和健康从20世纪的医生范式中走出来，他们独自执业，将自主权作为核心价值，以不断学习和获得新知识为荣，并在面对患者和同事时声称万无一失。21世纪的范例是那些理解团队合作和护理系统的医生，他们称之为提供领导力。虚拟和真实的团体实践将允许信息系统的支持，收集有关护理的证据，并努力持续改进质量。不可靠应该被多学科解决问题的方法所取代，知识的获取必须与对变革需求的承诺和理解相联系。
Studies conducted by the Institute of Medicine have demonstrated a serious gap between what the American health care system provides and its full potential. This results from a substantial amount of overuse, underuse, and misuse of health care. An Institute of Medicine (IOM) publication focusing attention on medical errors -To Err is Human: Building a Safer Healthcare System-galvanized the public and private sector as welt as the professions to strive for building a safer health care system. In its report, Crossing the Quality Chasm: A New Health System fur the 21st Century, the IOM's committee visualized a series of aims and rules for the health care system that would propel it successfully into the 21st century. Multidisciplinary professional teams should provide care for an increasing portion of the population (now about 40%) who have one or more chronic illnesses. Since 20 conditions account for 80% of America's health care costs, the author recommends that a special focus be placed upon 15 of these conditions to systematically improve the quality of care over the next five years. Information technology offers important opportunities to improve patient safety and contribute to better and continuous improvement of quality, The elimination of written clinical notes by the year 2010 is an achievable objective. These developments require medical educators and health to move from a 20th-century paradigm of the physician who was in solo practice, held autonomy as a central value, prided himself or herself upon continuous learning and the acquisition of new knowledge, and laid claim to infallibility when confronting patients and colleagues. The 21st-century paradigm is that of physicians who understand teamwork and systems of care in which they call provide leadership. Group practice, both virtual and real, will allow the support of information systems, the collection of evidence about care, and efforts for continuous quality improvement. Fallibility should be replaced by an approach to multidisciplinary problem solving, and the acquisition of knowledge must be associated With the commitment and understanding of the need for change.