Øvretveit J, Gustafson D
Nordic School of Public Health, Karolinska Institute, Sweden.
Qual Saf Health Care. 2002 Sep;11(3):270-5. doi: 10.1136/qhc.11.3.270.
In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement.
针对对质量日益增长的担忧，许多国家正在开展大规模项目，其中包括国家质量战略、医院项目以及质量认证、评估和审查流程。越来越多的资源被投入到这些干预措施中，但它们是否能确保或提高医疗质量呢？关于这些措施的有效性或实现最大有效性的条件，几乎没有研究证据。缺乏评估研究的原因包括衡量结果以及将因果关系归因于这些针对组织或卫生系统的复杂、不断变化的长期社会干预措施所面临的方法学挑战，而这些组织和卫生系统本身也是复杂且不断变化的。然而，有一些方法可用于评估这些项目，并能为决策者提供基于研究的指导，告知他们如何规划和实施这些项目。本文描述了研究挑战、可使用的方法，并给出了未来研究的示例和指导。它强调了此类研究对提高这些项目的有效性以及发展质量改进科学所能做出的重要贡献。
