Burns L R, Denton M, Goldfein S, Warrick L, Morenz B, Sales B
Department of Management and Policy, University of Arizona, Tucson.
QRB Qual Rev Bull. 1992 Dec;18(12):434-9. doi: 10.1016/s0097-5990(16)30569-3.
The federal government is currently supporting the development and dissemination of clinical practice guidelines. Physicians fear that payers who promote guidelines are more interested in reducing variation to control their behavior and contain health care spending than in improving quality of care. There is also apprehension that guidelines will shift the responsibility for quality to parties external to the physician-patient relationship and the local professional community. Continuous quality improvement (CQI) methods provide an avenue for physician responsibility and participation in guideline development which can alleviate these concerns. This article describes the efforts of one health maintenance organization (HMO) to use CQI techniques to mobilize plan physicians to develop, disseminate, and implement practice guidelines in a manner that satisfies the needs of physicians, patients, and the HMO.
联邦政府目前正在支持临床实践指南的制定与传播。医生们担心，推行指南的支付方更感兴趣的是减少差异以控制他们的行为并遏制医疗保健支出，而非提高医疗质量。还有人担心，指南会将质量责任转移到医患关系和当地专业团体之外的各方。持续质量改进（CQI）方法为医生承担责任并参与指南制定提供了一条途径，这可以缓解这些担忧。本文描述了一个健康维护组织（HMO）为运用CQI技术动员计划内医生以满足医生、患者和HMO需求的方式制定、传播和实施实践指南所做的努力。
