Neil Nancy, Nerenz David
Virginia Mason Medical Center, Seattle, USA.
Jt Comm J Qual Saf. 2003 Oct;29(10):523-30. doi: 10.1016/s1549-3741(03)29062-6.
The success of performance improvement efforts depends on effective measurement and feedback regarding clinical processes and outcomes. Yet most health care organizations have fragmented rather than integrated data systems. Methods and practical guidance are provided for leveraging available information sources to obtain and create valid performance improvement-related information for use by clinicians and administrators.
At Virginia Mason Health System (VMHS; Seattle), a vertically integrated hospital and multispecialty group practice, patient records are paper based and are supplemented with electronic reporting for laboratory and radiology services. Despite growth in the resources and interest devoted to organization-wide performance measurement, quality improvement, and evidence-based tools, VMHS's information systems consist of largely stand-alone, legacy systems organized around the ability to retrieve information on patients, one at a time. By 2002, without any investment in technology, VMHS had developed standardized, clinic-wide key indicators of performance updated and reported regularly at the patient, provider, site, and organizational levels.
On the basis of VHMS's experience, principles can be suggested to guide other organizations to explore solutions using their own information systems: for example, start simply, but start; identify information needs; tap multiple data streams; and improve incrementally.
绩效改进工作的成功取决于对临床过程和结果进行有效的衡量与反馈。然而，大多数医疗保健组织的数据系统是分散的，而非整合的。本文提供了方法和实用指南，以利用现有信息源获取并创建与绩效改进相关的有效信息，供临床医生和管理人员使用。
病例 vignette：在弗吉尼亚梅森医疗系统（VMHS；西雅图），这是一家垂直整合的医院和多专科集团诊所，患者记录以纸质形式保存，并辅以实验室和放射科服务的电子报告。尽管在全组织范围内的绩效衡量、质量改进和循证工具方面投入的资源和关注度有所增加，但 VMHS 的信息系统主要由围绕逐个检索患者信息能力构建的独立遗留系统组成。到 2002 年，在未对技术进行任何投资的情况下，VMHS 已制定了标准化的、全诊所范围的关键绩效指标，并在患者、提供者、科室和组织层面定期更新和报告。
基于 VHMS 的经验，可以提出一些原则来指导其他组织利用自身信息系统探索解决方案：例如，从简单处着手，但要开始；确定信息需求；利用多个数据流；逐步改进。
