Evans D B, Edejer T T, Lauer J, Frenk J, Murray C J
Evidence and Information for Policy, World Health Organization, Geneva, Switzerland.
Int J Qual Health Care. 2001 Dec;13(6):439-46. doi: 10.1093/intqhc/13.6.439.
The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.
关于质量的文献常常聚焦于过程指标。在本文中，我们概述了一个框架，用于从一系列期望的结果方面来描述和衡量卫生系统的质量。我们举例说明如何使用从世界卫生组织（WHO）近期开展的卫生系统绩效评估中收集的数据来进行衡量。然后，我们探讨该框架可用于衡量系统所有组成部分（例如地区、行政区、医院和提供者）质量的程度。从结果而非过程指标的角度来定义质量有其优缺点。优点在于它使政策制定者关注系统是否正在实现期望的目标。事实上，如果没有衡量结果的能力，就无法确定过程变化是否真的能提高社会期望目标的达成情况。缺点是在系统的所有层面衡量结果会带来一些问题，特别是与衡量结果所需的样本量有关。WHO正在对此进行探索，最初是针对医院。本文讨论了两个主要挑战。第一个是归因问题，即确定结果的哪一部分归因于所讨论的系统组成部分。第二个是时间问题，包括当前卫生行动现在和未来的所有影响。
