McLoughlin V, Leatherman S, Fletcher M, Owen J W
Priorities and Quality Branch, Commonwealth Department of Health and Aged Care, Canberra, Australia.
Int J Qual Health Care. 2001 Dec;13(6):455-62. doi: 10.1093/intqhc/13.6.455.
This article describes recent national performance improvement initiatives in the United States, United Kingdom, and Australia. This comparison is of particular interest because each of these three countries faces similar challenges in delivering health care and improving health. Each has elevated a focus on safety and quality improvement to a national level. Marked differences in the organization and financing of health care across these three countries provide a unique opportunity to compare and contrast approaches. Drawing on the experience of the authors in each of the three countries and publicly available data sources about specific national initiatives, we describe the national context for improvement and outline recent performance improvement initiatives and emerging issues and challenges. Similarities and differences in the current evolution of national performance initiatives are described and conclusions are drawn about challenges that all three countries face, particularly in terms of developing meaningful sets of national indicators of health system performance. The challenges for future work include the importance of information infrastructure, the paucity of accurate and accessible clinical data, the need for effective performance measurement processes at a local level to capture useful data, and the tensions of balancing accountability and improvement agendas for measurement.
本文介绍了美国、英国和澳大利亚近期的全国性绩效改进举措。这种比较尤为引人关注，因为这三个国家在提供医疗保健和改善健康状况方面都面临着类似的挑战。每个国家都将对安全和质量改进的关注提升到了国家层面。这三个国家在医疗保健的组织和融资方面存在显著差异，这为比较和对比方法提供了独特的机会。借鉴这三个国家作者的经验以及关于特定国家举措的公开可用数据源，我们描述了改进的国家背景，概述了近期的绩效改进举措以及新出现的问题和挑战。描述了国家绩效举措当前演变过程中的异同，并就所有三个国家面临的挑战得出结论，特别是在制定有意义的卫生系统绩效国家指标方面。未来工作面临的挑战包括信息基础设施的重要性、准确且可获取的临床数据的匮乏、在地方层面需要有效的绩效衡量流程以获取有用数据，以及在衡量方面平衡问责制和改进议程的紧张关系。
