Epstein A M
Brigham and Women's Hospital, USA.
Baxter Health Policy Rev. 1996;2:207-34.
Quality measurement is not a new idea. However, in recent years, several new trends have gained prominence: greater interest in publicly reported information on quality of care, access to care, and patient satisfaction; an increased focus on health plans and integrated systems of care rather than on institutional providers and practitioners as the unit of observation; wide adoption of the techniques of continuous quality improvement within the health care sector; increased use of clinical practice guidelines to improve care for a broad range of medical conditions; incorporation of computer technology into the clinical setting; and greater appreciation for health outcomes as a measure of quality of care. This chapter first reviews the changes in the medical landscape that have seeded these trends and the distinction between quality assurance and quality improvement. It then focuses on public policy concerns, in particular on the emergence of publicly disseminated information about quality of care, now often called "quality report cards." The major prototypes of these reports developed to date, the responses to quality reporting by different members of the delivery system, and the major criticisms of this approach are reviewed. The chapter concludes by predicting probable developments and the strategies most likely to move health care forward in a productive direction.
质量衡量并非一个新观念。然而，近年来出现了几个显著的新趋势：对公开报告的医疗质量、医疗可及性和患者满意度信息的兴趣大增；越来越关注健康计划和综合医疗体系，而非以机构提供者和从业者作为观察单位；医疗保健部门广泛采用持续质量改进技术；更多地利用临床实践指南来改善对各种医疗状况的护理；将计算机技术融入临床环境；以及更加重视健康结果作为医疗质量的衡量标准。本章首先回顾引发这些趋势的医疗领域变化以及质量保证与质量改进之间的区别。然后重点关注公共政策问题，特别是公开传播的医疗质量信息（现在常称为“质量报告卡”）的出现。回顾了迄今为止这些报告的主要原型、医疗服务系统不同成员对质量报告的反应以及对这种方法的主要批评。本章最后预测了可能的发展以及最有可能推动医疗保健朝着富有成效的方向前进的策略。
