Nelson E C, Splaine M E, Godfrey M M, Kahn V, Hess A, Batalden P, Plume S K
Dartmouth Medical School, USA.
Jt Comm J Qual Improv. 2000 Dec;26(12):667-85. doi: 10.1016/s1070-3241(00)26057-4.
The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not Mandatory)" and "Create the Guiding Coalition. (A Small, Devoted Group of People Can Change the World)."
Over the long term, we must transform thousands of local practice cultures so that useful data are used every day in countless ways to assist clinicians, support staff, patients, families, and communities.
本文旨在帮助临床医生扩大数据的使用范围，以提高医疗实践绩效并开展改进研究。临床实践可被视为为特定患者群体提供服务的小型复杂组织（微观系统）。通过将测量融入实践中的日常工作流程，这些服务可得到极大改善。
为何要这样做？在日常医疗实践中建立测量的四个充分理由是：（1）诊断实践绩效的优势和劣势；（2）利用改进研究改进并创新护理和服务的提供；（3）管理患者及实践；（4）评估随时间推移结果的变化。拥有一个医疗实践的“生理”模型有助于分析实践、管理实践并改进实践。一种模型将临床实践视为旨在为特定患者子集产生期望健康结果并有效利用资源的微观系统。本文提供案例研究示例，以展示一个基于办公室的实践如果大部分时间使用一线测量来改善护理和服务，并且有时进行临床改进研究，会是什么样子。
使用数据改善护理过程和结果的原则是什么？案例研究示例中体现的原则——例如“保持测量简单。从大处着眼，从小处着手”以及“数据多不一定就更好。在测量中追求有用性，而非完美性”——可能有助于指导用于研究和改进实践的数据的开发。
一个实践如何开始使用数据来改善护理并开展改进研究？开始使用数据以加强护理和改进研究涉及实际挑战。为提高成功几率，明智的做法是使用变革管理策略来启动启动计划。其他建议包括“营造紧迫感。（生存并非必需）”以及“创建指导联盟。（一小群专注的人可以改变世界）”。
从长远来看，我们必须转变数以千计的地方实践文化，以便每天以无数方式使用有用数据来协助临床医生、支持人员、患者、家庭和社区。
