James B C
IHC Institute for Health Care Delivery Research, Intermountain Health Care, Salt Lake City, UT.
Front Health Serv Manage. 1993 Fall;10(1):3-37; discussion 54-6.
The American health care delivery environment is changing. As provider-at-risk payment strategies become increasingly dominant, they will force health care providers to replace old strategies that measured and managed revenues with new strategies that measure and manage costs. Quality improvement (QI) theory provides a set of tools to do exactly that--to understand, measure, and manage health care delivery processes and their associated costs. As a methodology for process management, QI theory merges case management, practice guidelines, and outcomes research into a single coordinated effort. It appropriately redirects management focus to care delivery processes, rather than to physicians. It also defines and illustrates a set of principles by which health care administrators can constructively team with physicians to find and document the best patient care outcomes at the lowest necessary cost, using QI-based practice guidelines as a decision support and measurement tool.
美国的医疗保健服务环境正在发生变化。随着提供者承担风险的支付策略日益占据主导地位，它们将迫使医疗保健提供者用衡量和管理成本的新策略取代那些衡量和管理收入的旧策略。质量改进（QI）理论提供了一套工具来做到这一点——理解、衡量和管理医疗保健服务流程及其相关成本。作为一种流程管理方法，QI理论将病例管理、实践指南和结果研究整合为一项协调一致的工作。它将管理重点适当地重新导向护理服务流程，而不是医生。它还定义并阐述了一套原则，医疗保健管理人员可以据此与医生建设性地合作，以最低的必要成本找到并记录最佳的患者护理结果，将基于QI的实践指南用作决策支持和衡量工具。
