Arah O A, Klazinga N S, Delnoij D M J, ten Asbroek A H A, Custers T
Netherlands Institute for Health Sciences, Erasmus MC, Rotterdam, The Netherlands.
Int J Qual Health Care. 2003 Oct;15(5):377-98. doi: 10.1093/intqhc/mzg049.
Countries and international organizations have recently renewed their interest in how health systems perform. This has led to the development of performance indicators for monitoring, assessing, and managing health systems to achieve effectiveness, equity, efficiency, and quality. Although the indicators populate conceptual frameworks, it is often not very clear just what the underlying concepts might be or how effectiveness is conceptualized and measured. Furthermore, there is a gap in the knowledge of how the resultant performance data are used to stimulate improvement and to ensure health care quality.
This paper therefore explores, individually, the conceptual bases, effectiveness and its indicators, as well as the quality improvement dynamics of the performance frameworks of the UK, Canada, Australia, US, World Health Organization, and Organisation for Economic Co-operation and Development.
We see that they all conceive health and health system performance in one or more supportive frameworks, but differ in concepts and operations. Effectiveness often implies, nationally, the achievement of high quality outcomes of care, or internationally, the efficient achievement of system objectives, or both. Its indicators are therefore mainly outcome and, less so, process measures. The frameworks are linked to a combination of tools and initiatives to stimulate and manage performance and quality improvement.
These dynamics may ensure the proper environment for these conceptual frameworks where, alongside objectives such as equity and efficiency, effectiveness (therefore, quality) becomes the core of health systems performance.
各国和国际组织最近重新关注卫生系统的绩效表现。这促使人们开发绩效指标，用于监测、评估和管理卫生系统，以实现有效性、公平性、效率和质量。尽管这些指标构成了概念框架，但往往不太清楚其潜在概念是什么，或者有效性是如何被概念化和衡量的。此外，在如何利用所得绩效数据来促进改进和确保医疗质量方面，存在知识差距。
因此，本文分别探讨了英国、加拿大、澳大利亚、美国、世界卫生组织和经济合作与发展组织绩效框架的概念基础、有效性及其指标，以及质量改进动态。
我们发现，它们都在一个或多个支持性框架中构想健康和卫生系统绩效，但在概念和操作上存在差异。在国家层面，有效性通常意味着实现高质量的护理结果；在国际层面，则意味着高效实现系统目标，或者两者兼而有之。因此，其指标主要是结果指标，过程指标相对较少。这些框架与一系列工具和举措相结合，以促进和管理绩效及质量改进。
这些动态变化可能为这些概念框架营造适宜的环境，在这个环境中，除了公平和效率等目标外，有效性（进而质量）成为卫生系统绩效的核心。
