Eisenberg J M
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 2101 East Jefferson Ave., Rockville, MD 20852, USA.
J Contin Educ Health Prof. 2000 Fall;20(4):197-207. doi: 10.1002/chp.1340200403.
Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has high-lighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of-care delivery.
自1999年11月医学研究所发布关于医疗差错和患者安全的报告以来,几个国家的卫生政策制定者和医疗保健领导者一直在寻求能够提高医疗保健安全性的解决方案。对患者安全的这种关注凸显了采用学习方法和系统方法进行质量衡量与改进的重要性。在需要公开披露绩效的同时,带有反馈的保密报告是美国、加拿大、英国和澳大利亚等国家应对这一挑战的主要方式之一。在美国,质量跨部门协调特别工作组召集了参与医疗保健质量改进的联邦机构开展一项协调行动。如果要将对患者安全的关注转化为学习型医疗保健系统中强化的继续教育和质量改进,基于对医疗保健质量衡量与改进的强大研究基础进行投资,继续教育有八个关键经验教训。这些经验教训的主题分别是:(1)信息学用于获取信息,(2)将指南作为学习工具,(3)向意见领袖学习,(4)向患者学习,(5)决策支持系统,(6)团队共同学习,(7)学习型组织,以及(8)即时和床边交付。