Martin Douglas K, Walton Nancy, Singer Peter A
Department of Health Policy, Management, and Evaluation, University of Toronto, 88 College Street, Toronto, Ontario M5G 1L4, Canada.
World J Surg. 2003 Aug;27(8):962-6. doi: 10.1007/s00268-003-7100-y. Epub 2003 Jun 6.
Surgeons and surgical programs encounter priority-setting challenges every day, such as in regard to purchasing new technologies or managing waiting lists for elective surgery. The purpose of this paper was to explore priority setting in surgery. Traditionally in surgery, priority-setting decisions for new technologies have been based on evidence of effectiveness and cost-effectiveness; and decisions about managing waiting lists for elective surgery have been based on urgency rating scores. The fairness of priority-setting processes in surgical programs should be enhanced to permit all relevant information and values to be considered. The quality of these decisions can be improved by using an approach that captures and shares lessons from each priority-setting experience. The approach we propose in this paper- describe, evaluate, and improve using a leading conceptual framework for priority setting, called "accountability for reasonableness"-can be used by any surgical program to improve its priority setting, share lessons with others, and develop an evidence base for how these important health policy decisions should be made.
外科医生和外科项目每天都会面临确定优先事项的挑战，比如在购买新技术或管理择期手术等候名单方面。本文的目的是探讨外科手术中的优先事项确定。传统上，在外科领域，关于新技术的优先事项确定决策是基于有效性和成本效益的证据；而关于管理择期手术等候名单的决策则是基于紧急程度评分。外科项目中优先事项确定过程的公平性应得到加强，以便能够考虑所有相关信息和价值观。通过采用一种能够从每次优先事项确定经验中汲取并分享经验教训的方法，可以提高这些决策的质量。我们在本文中提出的方法——使用一种名为“合理问责制”的领先的优先事项确定概念框架进行描述、评估和改进——可供任何外科项目用于改进其优先事项确定、与其他项目分享经验教训，并为如何做出这些重要的卫生政策决策建立证据基础。
